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PubMed2004

Noxious sensory perceptions in patients with mild to moderate rosacea treated with azelaic acid 15% gel.

Patients with rosacea form a unique subset of the sensitive skin population because of the barrier defects inherent in this condition and the increased propensity for burning/stinging from topical products. This propensity for burning/ stinging when medications, skin care products, or cosmetics are applied to the facial skin has been frequently documented but never quantified. The objective of this 2-week study was to determine the prevalence of heightened neurosensory perceptions of burning/stinging in a random population of 40 women with mild to moderate rosacea defined as 15 or fewer inflammatory papules or pustules. Also evaluated was the effect of azelaic acid 15% gel on barrier function and facial stinging utilizing transepidermal water loss (TEWL), corneometry, and lactic acid facial sting tests as noninvasive measurement criteria. At baseline, the incidence of lactic acid stinging among these rosacea subjects was 62.5%, which is substantially higher than observed in the general population. Two weeks after application of azelaic acid 15% gel, no evidence of barrier damage was noted on TEWL or corneometry tests. Moreover, there was no statistical relationship between lactic acid stinging and a stinging response that is occasionally reported with exposure to azelaic acid 15% gel.

Administration, Cutaneous↗
PubMed2004

A farmer's occupational airborne contact dermatitis masqueraded by coexisting rosacea: delayed diagnosis and legal acknowledgement.

A rare case of coexistence of occupational airborne dermatitis with rosacea is presented in a 41-year-old female farmer. Her first dermatitis symptoms appeared at the age of 10 when she started helping her parents on the farm. Uncovered skin areas of the face, neck, décolleté, forearms and the hands gradually became involved. The dermatitis symptoms were provoked by agricultural dusts (especially of flax and dried herbs). For the subsequent 30 years, the work-related disease remained undiagnosed due to the lack of pre-employment and periodical health check in agriculture. She also suffered from protein contact dermatitis of the hands from cow epithelium. About 20 years after the onset of airborne dermatitis, rosacea developed, possibly secondary to the prolonged treatment. Diagnostic tests carried out at our department confirmed hypersensitivity to occupational allergens: type I allergy to storage mites, moulds, and cow epithelium. A cutaneous late-phase reaction on prick tests and serum precipitins to the bacterium Pantoea agglomerans (Erwinia herbicola) also were found. Among non-occupational hypersensitivities, type I allergy to house dust mites and contact allergy to methylchloroisothiazolinone/methylisothiazolinone (Kathon CG) was found. In connection with these results, the significance of agricultural dusts in farmers' airborne dermatitis is discussed. Also presented are the problems with obtaining acceptance from the State Sanitary Authority for qualification of this case as an occupational disease, which was due to the coexistence of the non-occupational rosacea. Discussed is also the problem of pre-employment exposure to occupational allergens among farmers' children, and the difficulties with delivering occupational health services to self-employed farmers.

Adult↗
PubMed1979

Steroid rosacea in children.

Steroid rosacea is a facial dermatitis clinically resembling acne rosacea. Fluorinated topical steroids have been implicated as the cause or precipitating factor in previous case reports mainly involving an adult population. Four cases of pediatric acne rosacea associated with the use of topical fluorinated glucocorticosteroids are described. The process worsened during the two weeks following steroid cessation. We recommend that fluorinated glucocorticosteroids should not be used on the face of infants and children.

Child↗
PubMed2005

Present and future rosacea therapy.

Despite its prevalence, rosacea has not received the same attention of researchers as other dermatologic disorders. Nevertheless, new pharmacologic and nonpharmacologic therapies for the condition continue to be developed. The future of rosacea treatment will probably involve a combination of drugs and devices. Certain core therapies (i.e., topical metronidazole, topical azelaic acid, oral tetracyclines, and topical sulfur/sodium sulfacetamide) are validated by the greatest amount of high-order clinical evidence and will undoubtedly remain first-line therapeutic choices. However, more research is necessary to validate the efficacy and safety of newer pharmacologic agents and light-based therapy. Because rosacea is a chronic condition, pharmacologic maintenance therapy is necessary to maintain remission.

Anti-Infective Agents↗
PubMed2005

The rigor of trials evaluating Rosacea treatments.

The Cochrane Collaboration is an international nonprofit organization that conducts systematic reviews of healthcare interventions. The organization has recently reviewed all studies meeting designated criteria on interventions for rosacea. To be included in the review, trials had to be randomized controlled trials (RCTs) that met the methodological criteria of the reviewers and that were conducted in an adult patient population with moderate to severe rosacea. The electronic databases searched included The Cochrane Skin Group Specialised Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, BIOSIS, and Science Citation Index. The reviewers tried to obtain details of unpublished and ongoing RCTs through correspondence with authors and pharmaceutical companies. After evaluating the included studies, the reviewers concluded there is evidence that topical metronidazole in 1% cream and 0.75% gel formulations and azelaic acid in 20% cream formulation are effective and safe. Furthermore, there is some evidence that oral metronidazole and tetracycline are effective. The reviewers also made suggestions about future rosacea research.

Anti-Infective Agents↗
PubMed2005

[Perolen cream for therapy of rosacea].

Acne rosacea belongs to the most common inflammatory dermatoses of the face. Current treatments for this disease remain unsatisfactory, that's why searching for new methods and remedy are very important. For the topical therapy we have used a new cream perolen ("New Pharma", Georgia). The main component of the creme is the water extract of gastric mucous membrane of cow, which is the source of proteolytic ferments. Another main component is a Perilla oil which contains unsaturated fatty acids--linolenic and linol, presented in the highest amounts. The cream is characterized by bactericidal, bacteriostatical, anti-inflammatory and anti-oxidant effects, it also assists to tissue regeneration, make blood vessels more elastic and decreases penetration. We have observed 40 patients with papulo-pustular subtype of rosacea (25 females and 15 males). Patients were divided into two groups. For oral therapy in both groups we used Tetracycline and Trichopol. For topical treatment in the first group of patients was used rosamet cream and in the second group--perolen cream. Both of these creams were applied once daily during 2 months. Reduction of comedones, inflammations, papules, pustules and small nodules occurred after one month. Erythema, oedema, desquamation improved significantly during the treatment, but the positive effects were more prominent in the second group of patients. In conclusion, the study shows that topically used cream perelon represents a new approach in the management of acne rosacea.

Adult↗
PubMed2005

Subantimicrobial dose doxycycline: a unique treatment for rosacea.

Rosacea affects many individuals and is commonly treated with long-term antibiotics, which are associated with the emergence of antibiotic-resistant organisms. Recently, subantimicrobial dose doxycycline 20 mg twice a day (SDD) has been used to treat rosacea because of its anti-inflammatory properties. Results of clinical studies support the benefits of SDD, its efficacy in rosacea and acne vulgaris, and even its potential use to prevent atherosclerosis.

Anti-Bacterial Agents↗
PubMed2005

Diagnosing and managing the patient with rosacea.

Rosacea is a common, chronic facial dermatosis that may present in varying manners. Subtypes of rosacea include erythematotelangiectatic, papulopustular, phymatous, and ocular. In this article, we discuss the diagnosis of these rosacea subtypes and focus on the therapeutics specific to each. Treatments include topical agents, oral antibiotics, laser therapies, surgical treatments, and the role of cosmetics and skin care.

Administration, Oral↗
PubMed2005

Autosomal dominant familial chronic mucocutaneous candidiasis associated with acne rosacea.

INTRODUCTION: Autosomal dominant chronic mucocutaneous candidiasis (CMC) without endocrinopathy (OMIM 114580) is a well-described entity. The associations recorded with this disorder to date are intercellular adhesion molecule-1 (ICAM-1) deficiency and hyper-immunoglobulin E syndrome. CLINICAL PICTURE: We report a new association in a family (mother and nonidentical twin sons) where acne rosacea is a prominent feature together with CMC. In addition, antibodies to thyroid microsomal and antiparietal cell were also isolated. The autoantibodies might be associated with a current "latent" endocrinopathy in particular autoimmune thyroiditis. TREATMENT: The patient was treated with intermittent pulses of itraconazole for the candidiasis and doxycycline initially before being substituted with isotretinoin 6 months later for the rosacea. OUTCOME: The patient's candidiasis responded well and has been in remission for 3 months while his rosacea continues to improve.

Adult↗
PubMed2006

Laser and light therapies for acne rosacea.

Acne rosacea is a multifactorial, somewhat mercurial disorder that can be a challenge to control with standard pharmacologic agents. Laser and light sources have been increasingly utilized, particularly for control of the generalized erythema, flushing, and telangiectasia of rosacea. This paper will review the clinical studies presented in the literature specifically treating patients with rosacea. Long-pulsed dye lasers and intense pulsed light devices can offer patients effective treatment without the purpura of short-pulsed dye lasers. Long-term efficacy has not been studied but maintenance therapy may be necessary to control the vascular manifestations of this disease.

Humans↗
PubMed1989

[The effect of local administration of corticosteroids on the course and therapy of rosacea].

The results of the analysis of 446 patients (305 women and 141 men) with rosacea treated in the Medical cosmetologic section (Department of Dermatology, University Hospital Centre Zagreb) between 1985 and 1986 have been presented. The disease was more common among women than in men. (2.16:1). The duration, localization and clinical picture were typical. The histopathologic analysis was done in 9 patients. Among the 446 rosacea patients, 250 (56.1%) had prolonged therapy with powerful topical corticosteroids. The recommended treatment depended on the severity of the clinical picture consisting of usual local therapy and oral tetracyclines. In the group previously treated with topical corticosteroids, because of more severe clinical picture, tetracyclines were given more frequently (in the 35.6% of cases) than in the other group where the tetracyclines were given in 20.9%. The authors followed-up the duration and treatment success in 275 regularly controlled patients (in 164 with prolonged topical corticosteroid treatment and in 111 without previous corticosteroid treatment). In average, the patients without previous corticosteroid therapy were treated shorter and with better success in contrasts to patients with prolonged topical corticosteroid treatment. The results of the investigation indicate that rosacea patients should not be treated with topical corticosteroids.

Administration, Topical↗
PubMed1989

[Rosacea. Clinical features and treatment].

The paper describes clinical features, concepts in the pathogenesis, and therapeutical aspects of rosacea. Particular attention is paid to recent experiences on topical therapy with metronidazole. A Norwegian double-blind, multi-centre clinical trial compares metronidazole 1% cream applied twice daily with placebo cream in the treatment of 97 patients with rosacea. After eight weeks of treatment there was a statistically significant difference between the two regimens in favour of metronidazole cream. No important side effects were registered. It is concluded that 1% metronidazole cream is an effective and well-tolerated alternative to tetracycline in patients with papulopustular rosacea.

Clinical Trials as Topic↗
PubMed1987

Topical metronidazole therapy for rosacea.

Forty patients with rosacea were treated topically with 0.75% metronidazole gel in a randomized split-face double-blind paired-comparison trial. With twice-daily applications, 36.7, 48.5, and 65.1 mean percent reductions in total papules and pustules were noted over baseline at 3, 6, and 9 weeks, respectively, on the side of the face receiving metronidazole therapy. Therapy with vehicle alone produced a maximum mean percent reduction of 14.9 at nine weeks. Erythema also responded but was less improved by the end of nine weeks of therapy. A mild increase in telangiectasia was noted on both actively treated and placebo-treated sides. The gel was locally well tolerated. Only two of 40 patients failed to complete the trial, both because of flares of rosacea (one at two days, and one at five weeks). No systemic symptoms were noted, and no consistent abnormalities were found in the results of laboratory studies (hematology, chemistry, and urinalysis). Topical metronidazole gel therapy appears to be a safe and efficacious therapy in the treatment of moderate to severe rosacea.

Adult↗
PubMed1988

[Rosacea: histopathologic study of 75 cases].

Few histological studies have been devoted to rosacea, a common but ill-defined disease. We have examined histological sections obtained from 75 patients (41 men aged from 23 to 72 years and 34 women aged from 32 to 68 years), thereby confirming the diagnosis of rosacea. On average, 4 sections from each patient were examined. Blocks from cases with granuloma were serially sectioned in search of remains of hair follicles, degenerated collagen fibres and Demodex folliculorum. Elastotic degeneration, vasodilatation and the number of hair follicles were evaluated; the nature and disposition of inflammatory infiltrates were determined, and the presence of D. folliculorum was looked for. Elastotic degeneration, varying degrees of vasodilatation and inflammatory infiltrates were found in all patients. The infiltrates were predominantly lympho-histiocytic in 62 cases, neutrophilic around skin appendages in 6 cases, tuberculoid unrelated to appendages in 4 cases and tuberculoid surrounding follicle-related necrosis in 3 cases. The number and appearance of hair follicles seemed to be those normally observed in the regions where our specimens were taken. On the basis of histological, immunological and therapeutic arguments, it has been postulated that D. folliculorum was involved in the pathogenesis of rosacea, notably in its granulomatous form. In particular, several cases of granuloma containing the acarid in its core have been reported. However, the significance of such findings remains uncertain. D. folliculorum might induce the formation of a granuloma, but it is also possible that granulomas are consecutive to the destruction and resorption of hair follicles, the mite being "digested" more slowly than the epithelial structures.(ABSTRACT TRUNCATED AT 250 WORDS)

Acari↗
PubMed1981

[Demodex folliculorum: aetiopathogenesis and therapy of rosacea and perioral dermatitis (author's transl)].

In 16 out of 18 patients with rosacea, mites of the species, Demodex folliculorum were isolated in mostly great numbers from lesions of the facial skin. In patients with perioral dermatitis, the mite was demonstrated in 17 out of 29 patients. All patients, however, including those where no mites were found, could be completely cured by nightly application of hexachlorocyclohexane 0.25% (Jacutin). The average treatment time was 7 weeks for rosacea and 5 weeks for perioral dermatitis. 2 patients with rosacea and 4 patients with perioral dermatitis relapsed, but cleared again after treatment was repeated. The initial flare-up of the dermatitis, which is observed regularly after starting the Jacutin-therapy, is described. Quantitative aspects of Demodex infestation and its histopathological alterations are discussed in relation to present-day knowledge.

Adult↗
PubMed1983

[Oral 13-cis-retinoic acid therapy in adenoma sebaceum symmetricum and the most severe forms of acne and rosacea].

Twenty-one patients with severe acne (acne papulopustulosa, acne conglobata, acne cystica), six patients with severe rosacea (rosacea paulopustulosa, rosacea conglobata, rhinophyma), and three patients with tuberous sclerosis were treated with 13-cis-retinoic acid for 6-48 weeks. Most patients had been previously treated with dermabrasion, antibiotics or metronidazole. Dependent on the severeness of the pathological symptoms 13-cis-retinoic acid was administered at a dose of 0.2 to 0.5 mg/kg body weight and was then reduced every 4 weeks. We confirm the sebostatic and antiinflammatory effect of the 13-cis-retinoic acid and long-lasting remissions. Side effects had not been serious.

Acne Vulgaris↗
PubMed1983

[Anxiety as a state and anxiety as a personality trait in patients with alopecia areata, rosacea and lichen ruber planus].

Our study comprised the examination of 120 persons by psychological methods. Every 30 of them were patients with alopecia areata, rosacea, lichen ruber planus, and healthy skin. The results revealed that patients suffering from skin diseases may be characterized by different anxiety conditions. Patients with rosacea turned out to possess a high level of anxiety trait: accordingly, their reactions towards the disease showed a higher level of anxiety state than could be observed in alopecia areata or lichen ruber planus patients. With regard to rosacea etiopathogenesis, psychogenic factors seem to play a special part if compared to the other diseases. In most of the cases, traumatogenic situations preceded the appearance of dermatoses and aggravated their signs and symptoms.

Adult↗
PubMed1981

[Oral treatment of rosacea with 13-cis-retinoic acid].

Thirteen patients with severe rosacea (rosacea papulopustolosa, rosacea conglobata, and rhinophyma) were treated orally with 0.05, 0.5, or 1.0 mg/kg body weight 13-cis-retinoic acid (isotretinoin, Ro 4-3780) for 12-28 weeks. All patients had been treated previously with high doses of tetracyclines, metronidazole, or dermabrasion, etc., with no or only limited success. The therapeutic effect following 13-cis-retinoic acid was excellent. Inflammatory lesions regressed by 50% within 2 weeks, and by over 95% within 8 weeks. 13-cis-retinoic acid acts as a potent anti-inflammatory and sebum-suppressive agent. Besides papulopustules, nodules, and hemorrhagic abscesses, the inflammatory plaques and facial edema, but to a lesser extent teleangiectasias and the chronic conjunctivitis disappeared. The severe seborrhea disappeared. Long-lasting remission, similar to patients with severe acne being treated with 13-cis-retinoic acid, can be expected, as the first patients are in full remission for over 12 months at the time of writing. Exfoliative cheilitis occurred in every patient. Serum lipids increased only slightly. For female patients a reliable contraception is mandatory as teratogenicity cannot be excluded in this drug (similar to all retinoids).

Adult↗