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[Demodicidosis in humans as a current problem in dermatology].

Demodex mites are common parasites in the hair follicles and in the pilosebaceous glands. Demodex folliculorum and D. brevis have been identified in humans and play a role in three facial conditions: Pityriasis folliculorum, rosacea-like demodicidosis and Demodicidosis gravis. The highly infected sites by this mites are: forehead, area around the orbit, area around the nose, chin and area around the mouth. Infection of the skin by D. folliculorum is more frequent among females and in the elderly people. The presence of mites can be determined by microscopic inspection of secretion from sebum glands and skin surface biopsy. The aim of our study was to report a 25-year-old woman suffering from skin diseases with high D. folliculorum density.

Administration, Cutaneous↗

[Flavonoids--main constituents of the leaves of Holodiscus discolor (Pursh) Maxim].

The paper deals with the isolation and identification of constituents of the leaves of Holodiscus discolor (Pursh) Maxim. (Rosaceae). Three flavonoid glycosides of flavonol type were isolated from the methanolic extract: kaempferol-3-O-rhamnoside, quercetin-3-O-glucoside (isoquercitrin) and quercetin-3-O-rhamnoside (quercitrin). Isolates were identified by physical-chemical data, by comparison with authentic samples and literature data. The above-mentioned compounds were isolated from Holodiscus discolor (Pursh) Maxim. for the first time.

Flavonoids↗

[Iridoscopy in the diagnosis of internal pathology in dermatoses].

Iridoscopy was carried out in 40 patients with rosacea and seborrheic dermatitis in order to detect visceral abnormalities. Various gastrointestinal diseases were revealed in 32, vascular and neuropsychic disorders in 16, and renal or pancreatic shifts in 5 patients.

Adolescent↗

[Therapy of rhinophyma].

The formation of rhinophyma is due to hyperplasia and hypertrophia of the sebaceous glands of the nose and represents the final stage of rosacea. The associated fibrosis can only be reduced by surgical procedures. Thus the therapy of choise is surgical excision completed by dermabrasion. From 1977 to 1985, 23 patients with rhinophyma were treated in this way at our clinic.

Adult↗

Rhinophyma.

Rhinophyma, a florid overgrowth of the tip of the nose with hypervascularity and nodularity, is an unusual progression of acne rosacea of unknown cause. In this article, its history, etiology, stages of progression, and current concepts of medical and surgical treatment are reviewed. Successful treatment depends on a clear understanding of the disease and its early medical management as well as corrective surgery of the established tumor with meticulous attention to surgical details.

Adult↗

Is the skin affected by work at visual display terminals?

According to some reports, mainly from Norway and Sweden, visual display terminal work is suspected of causing skin rashes. In three different studies, we have tried to elucidate the question, and the results indicate that there might be a relation between VDT work and aggravation of some common skin diseases such as rosacea, seborrheic and atopic dermatitis, and acne. Whether this depends on physical, chemical, or psychological factors is still unknown.

Adolescent↗

Topical antibiotics in dermatology.

Topical antibiotics are safe and effective in certain conditions, primarily acne, rosacea, and nasal carriage of Staphylococcus aureus. They are useful in impetigo only when it is of limited extent. Their efficacy in other pyodermas is unclear, although mupirocin is probably effective in many cases. In "infected eczema" that does not require systemic therapy they seem to add little to what topical corticosteroids alone achieve. They are ineffective in reducing the incidence of significant infection with indwelling intravenous catheters. They are safe preparations, but extensive use, especially in closed populations, may encourage the emergence of resistant bacteria.

Acne Vulgaris↗

Tetracyclines in ophthalmology.

Tetracycline and its congeners demonstrate antimicrobial activity against bacteria, Chlamydiae and Toxoplasma gondii. Ophthalmologists can use these drugs to treat bacterial and chlamydial infections, and also for ocular rosacea and similar disorders. Side effects associated with systemic tetracycline use are most commonly related to the gastrointestinal tract and to signs of yeast superinfection. Minocycline use may be limited by its vestibular toxicity. Temporary growth retardation and staining of erupting teeth may occur with oral use of tetracycline in children under 8 years; these drugs should not be given in pregnancy or to young children. Topical tetracycline application yields good tear and aqueous humor concentrations.

Absorption↗

Metronidazole and Demodex folliculorum.

In vitro survival of Demodex folliculorum was tested in the presence of various concentrations of metronidazole (Flagyl). Demodex was found to survive in concentrations of as much as 1 mg/ml. Thus, it seems unlikely that the effect of metronidazole on rosacea is attributable to its direct activity on the mite.

Hair↗

Photo-onycholysis due to tetracycline-hydrochloride.

A case of monosymptomatic photo-onycholysis due to tetracycline-hydrochloride is reported. A 40-year-old woman with rosacea had been treated with tetracycline-hydrochloride (Achromycin) 250 mg daily for 3 years. In the summer period after one month of intensive sun exposure she developed painful bullae under the nails.

Adult↗

Postrhinoplasty "red nose": differential diagnosis and treatment by laser.

Prior to anticipated nasal surgery, the nasal and facial skin should be examined for any vascular lesions. The skin type should be ascertained. A history of any prior nasal surgery, particularly on the nasal dorsum, should be noted. If rosacea is a clinical possibility, a trial of 1.5 to 2.0 gm q.d. of tetracycline for 6 to 8 weeks is warranted. If, after rhinoplasty, a diffuse "redness" on the nasal dorsum results and one can exclude other diagnoses, then argon laser therapy should be considered. A 3-mm punch biopsy should be obtained to see whether superficial ectatic vessels are present, a finding that would be indicative of a good result from laser therapy.

Diagnosis, Differential↗

Common dermatoses in the elderly.

Common dermatoses in the elderly include xerosis, pruritus, contact dermatitis, acne rosacea, stasis dermatitis, bullous pemphigoid and herpes zoster. Physicians must be able to recognize these pathologic changes superimposed on the intrinsic and extrinsic effects of aging. Diagnosis is dependent on clinical appearance and supportive laboratory studies. Management is based on correct diagnosis.

Aged↗

Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports.

Azelaic acid cream (20 percent) is a new topical treatment for acne with an additional therapeutic potential in rosacea and hyperpigmentation disorders. Azelaic acid (AzA; HOOC-(CH2)7-COOH) is a naturally occurring compound that interferes with acne pathogenesis by virtue of its antikeratinizing, antibacterial, and anti-inflammatory properties. Vehicle-controlled studies have verified that AzA exercises a significant and clinically relevant effect on both non-inflammatory and inflammatory acne lesions. Comparisons with clinically proven therapies have shown that 20 percent AzA cream is an effective monotherapy in mild to moderate forms of acne, with an overall efficacy comparable to that of tretinoin (0.05 percent), benzoyl peroxide (5 percent), and topical erythromycin (2 percent). In the treatment of moderate to severe acne, 20 percent AzA cream may be favorably combined with minocycline (90 percent good and excellent results), and may contribute towards reducing recurrences following discontinuation of systemic therapy (maintenance therapy with AzA cream). Particular advantages of AzA therapy include its favorable safety and side effect profile. It is non-teratogenic, is not associated with systemic adverse events or photodynamic reactions, exhibits excellent local tolerability, and does not induce resistance in Propionibacterium acnes.

Acne Vulgaris↗

Rosaceous lymphedema: a rare variant of a common disorder.

Rosaceous lymphedema is considered to be a rare and disfiguring variant of acne rosacea. Cases remain difficult to treat and can challenge afflicted patients both cosmetically and psychologically. We describe an unusual presentation of rosaceous lymphedema and review the differential diagnosis of persistent facial edema.

Biopsy, Needle↗

Unilateral demodicidosis.

A 45-year-old man presented with a unilateral, papulopustular, rosacealike, chronic dermatitis which involved the left portion of the forehead and the eyelids unilaterally. Many Demodex mites were found in the follicles of the affected area. Topical crotamiton cleared the lesions after an unsuccessful trial with oral metronidazole. This observation provides further evidence that demodicidosis is a condition distinct from common rosacea.

Diagnosis, Differential↗

Hypnosis in dermatology.

BACKGROUND: Hypnosis is an alternative or complementary therapy that has been used since ancient times to treat medical and dermatologic problems. OBJECTIVE: To describe the various uses for hypnosis as an alternative or complementary therapy in dermatologic practice. METHODS: A MEDLINE search was conducted from January 1966 through December 1998 on key words related to hypnosis and skin disorders. RESULTS: A wide spectrum of dermatologic disorders may be improved or cured using hypnosis as an alternative or complementary therapy, including acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. CONCLUSION: Appropriately trained clinicians may successfully use hypnosis in selected patients as alternative or complementary therapy for many dermatologic disorders.

Complementary Therapies↗

Correlation of the Schirmer 1 and fluorescein clearance tests with the severity of corneal epithelial and eyelid disease.

OBJECTIVE: To evaluate the correlations of the fluorescein clearance test (FCT) and the Schirmer 1 test with the severity of corneal epithelial and eyelid disease in normal patients and patients with tear film disorders due to meibomian gland disease (MGD) and/or aqueous tear deficiency (ATD). METHODS: Nineteen normal control subjects, 16 patients with MGD associated with rosacea, 21 patients with noninflammatory atrophic MGD, and 43 patients with ATD were enrolled. There was a similar age and sex distribution in each group. Each patient completed a symptom severity questionnaire that consisted of 11 questions and then underwent a panel of diagnostic tests in the following order: assessment of corneal and conjunctiva sensation with the Cochet-Bonnet esthesiometer, FCT, assessment of corneal fluorescein staining, Schirmer 1 test (5 minutes without anesthesia), and biomicroscopic examination of the eyelid margins and meibomian glands. The FCT was performed with a fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus. By studying the best area under the receiver operating characteristic curves, we developed a formula that combined the FCT and Schirmer test results, which we termed the FCT corrected by Schirmer test. RESULTS: The FCT showed stronger correlation with ocular irritation symptoms (r = 0. 35, P <.001), corneal fluorescein staining (r = 0.54, P<.001), and meibomian gland and eyelid pathologic signs than the Schirmer 1 test. A correction factor that was based on the best area under the receiver operating characteristic curves, added to the FCT score, improved its correlation with ocular irritation symptoms, eyelid margin and meibomian gland pathologic signs, and ocular surface sensitivity scores. CONCLUSIONS: Corneal epithelial disease is correlated with decreased aqueous tear production and delayed tear clearance, whereas eyelid and MGD are correlated with delayed tear clearance. The FCT corrected by Schirmer 1 test improves the correlations of the FCT with ocular irritation symptoms, corneal epithelial and eyelid pathologic signs, and corneal and conjunctival sensitivity for patients with MGD and ATD.

Aged↗