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PubMedDate not supplied

Advances in the topical treatment of acne and rosacea.

Acne and rosacea are common skin diseases which may present similarly and both involve inflammation. Both can result in significant cosmetic impairment and lead to quality of life decrements if not optimally treated. The conventional approach for both diseases involves the use of topical therapy to treat inflammatory lesions in combination, when needed, with a systemic or topical antibiotic. An important issue in the management of both diseases at present is the need to reduce antibiotic usage due to the increasing problem of bacterial resistance. One of the emerging treatment paradigms that is becoming increasingly useful as an antibiotic-sparing strategy is the use of procedural therapies in combination with medical management. Such procedural modalities include lasers, intense pulsed light (IPL), and photodynamic therapies (PDT). Topical regimens are used pre-treatment and following physical modalities for maintenance of remission.

Acne Vulgaris↗
PubMed1979

[Metronidazole therapy in rosacea (author's transl)].

Metronidazole was administered (500 mg daily the first month, 250 mg daily the second month and, in some cases, 250 mg every other day the following months) to 62 patients suffering from rosacea or perioral dermatitis. 90 p. 100 of them improved within 2 months and Metronidazole was particularly effective against papulo-pustules. Relapses after interruption of treatment seemed to be less frequent than with Tetracycline therapy. Side-effects (gastro-intestinal disturbances) occurred in few patients but long-term tolerance remains uncertain. So, the length of treatment was less than 6 months and the drug was not given to pregnant women.

Adult↗
PubMed2005

Combination sodium sulfacetamide 10% and sulfur 5% cream with sunscreens versus metronidazole 0.75% cream for rosacea.

Topical metronidazole and combination sodium sulfacetamide and sulfur commonly are used to treat rosacea. Recently, the relative efficacy and safety of sodium sulfacetamide 10% and sulfur 5% cream with sunscreens (Rosac Cream) (n = 75) and metronidazole 0.75% cream (Metrocream) (n = 77) were compared in an investigator-blinded, randomized, parallel-group study at 6 sites. After 12 weeks of treatment with sodium sulfacetamide 10% and sulfur 5% cream with sunscreens, there was a significantly greater percentage reduction (80%) in inflammatory lesions compared with metronidazole 0.75% cream (72%)(P = .04), as well as a significantly greater percentage of subjects with improved erythema (69% vs 45%, respectively; P = .0007). In addition, the sodium sulfacetamide 10% and sulfur 5% cream with sunscreens group had a significantly greater proportion of subjects with success in global improvement at week 12 compared with the metronidazole 0.75% cream group (79% vs 59%, respectively; P = .01). There was no significant difference between treatment groups in the percentage of subjects with improvement in investigator global severity. Overall tolerance was good or excellent in 85% of subjects in the sodium sulfacetamide 10% and sulfur 5% cream with sunscreens group and in 97% of subjects in the metronidazole 0.75% cream group. Seven subjects had poor tolerance to the sodium sulfacetamide 10% and sulfur 5% cream with sunscreens, possibly caused by a sulfa drug allergy.

Analysis of Variance↗
PubMed2006

Photodynamic therapy for the treatment of erythema, papules, pustules, and severe flushing consistent with rosacea.

We report a case of a 45-year-old woman who presented with facial erythema, papules, pustules, and severe flushing consistent with rosacea. The patient had failed standard pharmacologic treatments. The patient's flushing was so severe that she had undergone an elective sympathectomy. She received 6 sessions of photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA as Levulan Kerastick, Dusa Pharmaceuticals) given at 2-week intervals. Improvement was evident after the second treatment and was considered "excellent" after the sixth treatment. Improvement continued and no flares were observed 1 month after the final treatment.

Aminolevulinic Acid↗
PubMed2006

Metronidazole in the treatment of rosacea: do formulation, dosing, and concentration matter?

BACKGROUND: Topical metronidazole is commonly used in the management of rosacea. No consensus on the optimal formulation, concentration, or dosing regimen exists. PURPOSE: To assess the relative efficacy of metronidazole cream, gel, and lotion at concentrations of 0.75% and 1%, in dosing regimens of once and twice daily. METHODS: A meta-analysis of published metronidazole efficacy rates was performed. RESULTS: In non-weighted analysis, the mean efficacy was 28.2% (95% confidence interval [CI], 22.0%-34.4%) for the cream, 38.4% (95% CI, 18.4%-58.4%) for the gel, and 35% for the lotion. Confidence intervals for QD versus BID dosing and 0.75% versus 1% concentrations also overlapped. In weighted analysis, the mean reduction was 31.3% for the cream, 22.1% for the gel, and 35% for the lotion. CONCLUSIONS: Metronidazole cream, gel, and lotion vehicles have similar efficacies. There were no substantial differences between concentrations of 0.75% and 1%, or between once daily and twice daily regimens.

Administration, Cutaneous↗
PubMed1990

Perioral dermatitis with histopathologic features of granulomatous rosacea: successful treatment with isotretinoin.

A young woman with a persistent eruption of small granulomas about the mouth and chin was studied and granulomatous perioral dermatitis was diagnosed. Some authorities consider that perioral dermatitis is a circumscribed variant of rosacea; the findings in this case tend to show a relationship between the two conditions. Once conventional therapies failed to result in a response, the eruption cleared, leaving pitted, atrophic scarring after a twenty week course of isotretinoin treatment.

Administration, Oral↗
PubMed1989

[Granulomatous rosacea associated with ulcerative colitis: 2 case reports].

Inflammatory gastrointestinal disorders (ulcerative colitis and Crohn's disease) are often associated with cutaneous disorders, which occasionally may even precede the internal symptoms. Aside from the specific skin diseases, such as erythema nodosum or pyoderma gangraenosum, a number of unspecific skin eruptions may be found in both disorders. Here we report on 2 cases of ulcerative colitis associated with granulomatous rosacea.

Adult↗
PubMed1986

[Anxiety structure and catecholamine parameters in patients with rosacea, alopecia areata and lichen ruber planus].

90 patients suffering from selected dermatoses (rosacea, alopecia areata, lichen planus) underwent psychological tests of examination with special regard to verification of their anxiety structures. Urinalysis of catechol amine levels was simultaneously carried out in these patients. The test results proved a marked correlation between psychological factors and the activity of the adrenergic system. High level of activity, emotional unstableness, as well as tendencies to neurotic activities are connected with increased secretion of adrenaline and decreased secretion of noradrenaline++ and dopamine. The lability of catechol amine secretion (statistically significant variation above or below the physiological standard) is the cause of functional disorders.

Adult↗
PubMed1986

[Isotretinoin in local treatment of acne and rosacea and animal experiment studies on isotretinoin and arotinoid].

Fifteen patients with acne and 4 with rosacea were treated topically with 0.2% isotretinoin cream twice a day for 16 weeks. Inflammatory lesions responded better (30 +/- 22 versus 15 +/- 12) than non-inflammatory lesions (23 +/- 44 versus 17 +/- 24). Neither the "causal level" (123 +/- 85 versus 130 +/- 66 micrograms/cm2 nor the "replacement sum" (70 +/- 29 versus 77 +/- 30 micrograms/cm2) were changed (lipometer assay). In 150 adult male Syrian hamsters 1-2 drops of isotretinoin in concentrations varying from 0.3% to 0.001% and arotinoid ranging in concentration from 0.3% to 0.00001% in acetone were applied to the left ventral ear or the left flank organ twice a day (5/7 days) for 21 days. In higher concentrations there was a significant reduction in sebaceous gland size. Arotinoid, however, is extremely toxic. Even in concentrations as low as 0.00001% the animals showed severe side-effects within the 1st week.

Acne Vulgaris↗
PubMed1986

Topical metronidazole in the treatment of rosacea.

One percent metronidazole in an emollient cream base was compared with 250 mg oral tetracycline taken twice daily for the treatment of seventy-five patients with rosacea. After eight weeks of treatment there was no statistically significant difference between the results of the two treatments. Tetracycline did have a more rapid onset of effect on papules and pustules. Both treatments were well tolerated.

Administration, Topical↗
PubMed1986

Sarcoidal reaction to lymphoma presenting as granulomatous rosacea.

A patient with poorly differentiated lymphocytic lymphoma had rosacealike facial lesions noted at the time of diagnosis of the lymphoma. The skin lesions followed the course of exacerbations and remissions of the systemic lymphoma. A biopsy specimen showed a sarcoidal granulomatous inflammation in the skin, and later in subcutaneous nodules that developed on the face. This case is consistent with a sarcoidal tissue reaction to lymphoma, and is unique in its clinical presentation as granulomatous rosacea.

Humans↗
PubMed1987

[Treatment of acne rosacea with 13-cis retinoic acid].

Thirteen patients of both sexes, affected by a severe form of a papular rosacea, were treated with 13-cis retinoic acid (1 mg/kg/day) for two months. One patient interrupted the treatment after 15 days because of severe blepharitis. The size and number of papules were progressively reduced from the 2nd week, reaching complete regression at the 6th week. Three patients complained of mild blepharitis, nine developed dry cheilitis.

Adult↗
PubMed1987

[Treatment of rosacea with isotretinoin. Results of a multicenter trial follow-up].

A follow up investigation was done on forty-seven patients of the German multicenter study with severe and long standing rosacea who had been treated with isotretinoin (0.5 mg/kg bw/day) over twelve or twenty weeks. During the post-treatment follow up which lasted an average of fifty-seven weeks, seven relapses were registered whereas forty patients remained in remission. After drug withdrawal, both the percentage of patients without inflammatory lesions (pustules, papules or nodules) as well as the mean values of inflammatory lesions remained almost constant over the whole observation period.

Clinical Trials as Topic↗
PubMed1987

[Treatment of acne rosacea with 13-cis-retinoic acid].

13 patients of both sexes, affected by a severe form of papular rosacea, were treated with 13-cis retinoic acid (1 mg/kg/day) for 2 months. One patient interrupted the treatment after 15 days because of severe blepharitis. The size and number of papules were progressively reduced from the 2nd week, reaching complete regression at the 6th week. Three patients complained of mild blepharitis, 9 patients developed dry cheilitis.

Adult↗
PubMed1988

[Lupoid form of rosacea-like dermatitis].

In a 9-year-old girl, a lupoid variant of rosacea-like dermatitis was observed following the topical application of potent glucocorticosteroids. In addition to the micro- and macro-papulopustular forms, this is a third clinical variant of the disease, which has to date only been described in children.

Administration, Topical↗
PubMed1988

[Rosacea].

Rosacea should no longer be considered a follicular skin disease. It is a vascular disease of the face characterized by a significant evolution towards local complications such as telangiectasias, papular and aseptic pustular lesions, lupoid granulomas, chronic facial oedema and seboglandular hyperplasia. The basic abnormality seems to be a microcirculatory disturbance of the function of the facial angular veins directly involved in the brain-cooling vascular mechanism. The first clinic hallmark of this dysfunction is the occurrence of flushing, which may be spontaneous or induced by alcohol, intake of hot food, emotional stress and sudden variations in temperature. Tetracycline, metronidazole and isotretinoin are very useful for therapy but they only influence the cutaneous and ocular complications and do not act upon the basic vascular trouble. Current therapeutic research is directed towards drugs having an alpha-sympathomimetic activity and inhibiting the endogenous opioid mediators of flushing such as naloxone or clonidine.

Body Temperature↗