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PubMed1998

Demodex mites in acne rosacea.

The hair follicle mites Demodex folliculorum and Demodex brevis and their role in the pathogenesis of rosacea have been the subject of much debate in the past. We studied the prevalence of Demodex mites in facial skin biopsies obtained from 80 patients with rosacea, 40 with facial eczematous eruption and 40 with lupus erythematosus discoides. The mite prevalence in the rosacea group (51%) was significantly higher than in the rest of the study population (eczema 28% and lupus discoides 31%). Demodex mites were found on all facial sites. The most infested areas in the whole study group were the forehead (49%) and the cheeks (44%). Males were more frequently infested (59%) than females (30%). We did not find any significant difference in mite counts of infested follicles between rosacea and the control group. A lympho-histiocytic cell infiltration was seen around the infested hair follicles. Our results suggest that Demodex mites may play a role in the inflammatory reaction in acne rosacea.

Adolescent↗
PubMed1982

Pancreatic exocrine function in rosacea.

As some rosacea patients complain of gastrointestinal troubles and the administration of pancreatic extracts ameliorates both dyspepsia and skin lesions, the pancreatic exocrine function in 21 subjects affected with rosacea has been investigated by means of the secretin-cerulein infusion test. 21 healthy controls have been studied for comparison. No difference was found between rosacea and control subjects for flow rate, bicarbonate and chymotrypsin concentration and output, while lipase concentration and output was significantly lower in rosacea patients, with a decrease ranging from 18.5 to 66% of normal values. Therefore, a deficient lipase secretion could be responsible, at least partly, for the clinical manifestations of rosacea.

Adult↗
PubMedDate not supplied

Comparison of tear function tests and impression cytology with the ocular findings in acne rosacea.

PURPOSE: The aim of this study was to determine the correlation between tear function tests and impression cytology results and the clinical findings in ocular rosacea. METHODS: Patients with a histopathologic and clinical diagnosis of acne rosacea were studied. Ocular examination consisted of best-corrected visual acuity measurement, slitlamp examination, tear break-up time (BUT), basal Schirmer test, and rose Bengal staining. Impression cytology was done two days later. Ocular findings and symptoms were checked and scored. Age-matched controls were assessed using the same parameters. RESULTS: The most frequent symptoms were itching (80%), redness (68%), burning (64%), and photophobia (60%). The most frequent clinical findings were meibomitis (92%), telangiectasis (88%), blepharitis (84%), superficial punctate keratopathy (72%), and hyperemia (60%). Mean tear BUT was 9.6+/-3.1 (SD) seconds (range 5-17 seconds). Mean Schirmer test measured 11.4+/-1.6 mm (SD) (range 8-15 mm). Mean rose Bengal staining scored 1.8+/-0.1. Mean tear BUT, Schirmer test and rose Bengal staining scores were lower in the rosacea group than the control group (p<0.003, p=0.04, p< or =0.038, respectively). Staining was pathologic in 18 patients (36%) and the highest staining score was 4. No significant difference was found between the stages of the nasal and temporal conjunctival impression cytologies in each eye, and there was no relationship between impression cytology stages and rose Bengal scores (p>0.05). A significant relation was observed between the stages of impression cytology and the severity of meibomitis (Fisher's test, chi2=9.625, p=0.001). The Schirmer test gave lower results in patients with severe blepharitis (Mann-Whitney U Test, U=180.5, p=0.034). CONCLUSIONS: Early diagnosis prevents serious ocular complications and chronic dry eye in rosacea. We suggest that in addition to tear function tests, rose Bengal staining and impression cytology can be successfully used in the early diagnosis of dry eye and in monitoring medical treatment in ocular rosacea. Meibomian glands play an important role in the pathogenesis of the ocular disease.

Adult↗
PubMed2003

Impression cytology and ocular characteristics in ocular rosacea.

PURPOSE: To examine clinical findings and histologic changes on the conjunctival surface in ocular rosacea. METHODS: Thirty-five patients with ocular rosacea and 30 normal subjects underwent dermatologic and ocular examinations. Tear film break-up time, Schirmer tests with and without topical anesthesia, and conjunctival impression cytology were done. Patients were divided into the following groups according to quantity of ocular signs: mild (Group 1), moderate (Group 2), and severe (Group 3). Impression cytology was performed on both upper-bulbar and intrapalpebral inferonasal-bulbar conjunctiva. RESULTS: Patients had significant cell alteration on the conjunctival surface compared with normal eyes. The most frequent ocular signs and symptoms were feelings of dryness and blepharitis. Average tear break-up times for patients with ocular rosacea were 8.2 seconds in Group 1, 5.69 seconds in Group 2, and 5 seconds in Group 3 (17.2 seconds in normal subjects). Schirmer test results with anesthesia were 11.5 mm, 7.6 mm, and 5.0 mm, and without anesthesia were 14.8 mm, 13.6 mm, and 7.0 mm, in Groups 1, 2, and 3, respectively. These results were 18.7 mm with anesthesia and 24.7 mm without anesthesia in normal controls. Schirmer tests and tear film break-up time were significantly lower in patients with ocular rosacea than in normal controls (p < 0.05). Impression cytology showed that both upper bulbar and inferonasal interpalpebral bulbar ocular surface had significant cell alterations compared with those obtained from normal subjects. CONCLUSIONS: Patients with ocular rosacea not only had decreased tear production but also tear instability. Ocular surface epithelium had significant degeneration in patients compared with normal subjects.

Adult↗
PubMed1999

Needs survey of Canadian rosacea patients.

BACKGROUND: In 1995, a Rosacea Awareness Program (RAP) was initiated in Canada to make available educational resources for physicians and rosacea patients. Material is in French or English, and is accessible though physician offices and by toll-free telephone. Information was communicated to the public via noncommercial, editorial media. The RAP created a database of rosacea patients in Canada. OBJECTIVE: We investigated if individuals in the database had a confirmed diagnosis of rosacea, how they perceived their treatment by the medical system, and identified their needs. METHODS: A two-page questionnaire was mailed to 7874 individuals registered with the RAP. Thirty percent of these individuals responded. Where comparisons were made a chi-squared statistic was used. RESULTS: Over 70% learned of the RAP via public media. It took patients an average of 5 years to have a diagnosis made after the first symptoms appeared. In the majority of patients (53%) the diagnosis was ultimately made by a specialist. Fifty-eight individuals said they had not discussed their condition with their doctor. Patients were likely to continue on medication that was prescribed (60%) and topical metronidazole was the most common medication used, mostly the gel formulation. Most patients used these twice daily. Patients were very satisfied with treatments and almost 90% had reduced symptoms. Despite receiving explanations and written material, patients expressed a strong interest in more information being available on skin care, make-up, and psychological aspects of rosacea. CONCLUSIONS: The RAP provides a needed educational service and is a useful database. Patients are very knowledgeable about their disease, but despite this and excellent therapeutic responses, the patients demand more information.

Administration, Cutaneous↗
PubMed2003

Identifying rosacea: what all dentists should know.

BACKGROUND: Dentists frequently encounter adult patients who have facial rosacea. This common dermatologic condition can undermine a patient's appearance. Although rosacea can be progressive, the condition responds well to treatment, especially when started early. RESULTS: This article will help dentists recognize rosacea and differentiate it from other dermatologic disorders. Clinicians then will be able to refer patients suspected of having rosacea to the appropriate medical specialist for confirmation of the diagnosis and treatment. CONCLUSION: Dentists can provide a service to patients to improve their overall health and appearance by early recognition of this condition. CLINICAL IMPLICATIONS: Recognizing rosacea in dental patients and properly referring them for diagnosis and treatment constitutes a medical service that is relatively easy for dentists to perform. This service, in addition to others, such as measuring blood pressure, will make the dental examination more comprehensive.

Administration, Topical↗
PubMed2005

[Cost-benefit analysis of ocular examination of patients with rosacea].

PURPOSE: To observe the main ocular manifestations of patients with rosacea and to evaluate the cost-benefit of supplementary diagnostic examinations. METHODS: Twenty patients with acne rosacea from the Dermatology Service of the São Paulo Federal University (UNIFESP) were interviewed through a questionnaire, submitted to ophthalmologic examination and tested with Schirmer I, fluorescein and rose Bengal staining, impression cytology and conjunctival scrub. The costs of these examinations were abstracted from the Public Health System's values (SUS), Brazilian Medical Association values (AMB) and values charged by a private service. RESULTS: Twenty patients were enrolled initially in the study, but only 16 completed it. Eleven patients were female (55%), 19 were white (95%) and the average age was 56 years. All patients had at least one complaint related to rosacea. The most common symptoms were itching (40%), tearing (35%), foreign body sensation (30%). The most common signs were telangiectasis of lid margins (70%), hyperemia of lid margins (70%), meibomitis (65%) and blepharitis (50%). Most subsidiary examination showed normal results. There was difference of costs between the different paying sources. CONCLUSIONS: The main ocular manifestations in rosacea were related with meibomian gland disease. Considering the subsidiary examination costs and their results, the ophthalmologic check-up presents the best cost-benefit for the patient with rosacea.

Adult↗
PubMedDate not supplied

Topical metronidazole. A review of its use in rosacea.

UNLABELLED: Topical application of the antibacterial agent metronidazole is effective in the treatment of moderate to severe rosacea, although its mechanism of action has yet to be clearly established. Metronidazole preparations (0.75 and 1% cream, 0.75% gel and 0.75% lotion) were significantly more effective than placebo in patients with moderate to severe rosacea when administered to the affected area once or twice daily for 7 to 12 weeks. The mean number of papules and pustules decreased by between 48 and 65.1% during the treatment period. Reductions were fairly consistent regardless of formulation, strength or application frequency and were significant compared with placebo (p < 0.05). In 1 study, most of the overall effects of metronidazole were observed within the first 3 weeks. Although data are limited, topical metronidazole appears to improve inflammatory lesions and erythema as effectively as oral tetracyclines. Like tetracyclines, however, metronidazole has no effect on telangiectasia. Metronidazole 0.75% gel seems to be effective in maintaining remission of rosacea symptoms in patients successfully treated with both oral tetracycline and topical metronidazole. In the only study, 77% of patients treated with metronidazole gel compared with 58% of placebo recipients (p < 0.05) remained in remission 6 months after the tetracycline was stopped. The effects of topical metronidazole preparations on rosacea symptoms are palliative, not curative, but preliminary data suggest that relapse rates after cessation of therapy are no worse than those after cessation of oral oxytetracycline. Topical metronidazole formulations are generally well tolerated locally, with stinging, dryness, burning and itching reported in < or = 2% of patients. Because minimal concentrations of metronidazole are absorbed after topical administration, systemic adverse events and drug interactions seen with oral or intravenous metronidazole are unlikely. CONCLUSIONS: Topical metronidazole formulations are significantly more effective than placebo when used in the initial treatment of patients with moderate to severe rosacea. Furthermore, limited evidence suggests that the use of topical metronidazole alone may be as effective as oral tetracyclines against the disorder's inflammatory component. Therefore, for those patients with a preference for topical rather than oral therapy, the use of a topical metronidazole formulation must be a consideration.

Administration, Topical↗
PubMed2004

The subtypes of rosacea: implications for treatment.

Lack of standardized rosacea nosology was the rationale for the National Rosacea Society to convene a committee of dermatology thought leaders to develop a standard classification system. Standardization of rosacea classification should be followed by standardization of treatment. Many pharmacologic and nonpharmacologic interventions for rosacea are being used based on clinical observation alone. Many oral and topical pharmacologic agents, however, are validated by randomized controlled trials (RCTs). Topical therapies (eg, metronidazole or an alternative agent such as azelaic acid) and oral antibiotics (eg, the tetracycline family) should remain as foundation therapies for subtypes 1 and 2 rosacea, based on the strength of the evidence.

Diagnosis, Differential↗
PubMed2004

The treatment of rosacea.

The roundtable discussion encompassed many topics-from seminal research by Ronald Marks to the latest National Rosacea Society-funded studies on the pathophysiology of rosacea. All participants commented on the value of the new National Rosacea Society classification system for subtypes of rosacea, designed to direct future research and help physicians better diagnose and manage these subtypes. A lively discussion centered on treatment options for the various subtypes of rosacea ensued.

Anti-Infective Agents↗
PubMedDate not supplied

Rosacea: where are we now?

Advances continue to be made in the classification and treatment of rosacea, a chronic dermatologic syndrome. A new empiric classification system identifies 4 rosacea subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) that may aid in more precise diagnosis. Several new therapies have recently been approved for treatment of rosacea. Azelaic acid 15% gel is a new first-tier topical agent proven effective in reducing inflammatory lesions and erythema. New formulations of metronidazole and sulfacetamide 10%/sulfur 5% that offer cosmetic or tolerability advantages are now available. Intense pulsed light therapy has demonstrated effectiveness in reducing flushing, erythema, and telangiectases, with greater tolerability than existing laser systems. Other treatments under investigation include low-dose doxycycline hyclate (which may provide greater safety than existing oral antibiotics), benzoyl peroxide/clindamycin gel, and tacrolimus ointment (for steroid-induced rosacea). With this expanded armamentarium of medical and light-based therapies, clinicians can now implement a multifaceted approach to treatment, crafting new treatment combinations to address the unique and evolving features of rosacea in each individual patient.

Administration, Cutaneous↗
PubMed2004

Rosacea in the pediatric population.

Rosacea is a condition of vasomotor instability characterized by facial erythema most notable in the central convex areas of the face, including the forehead, cheek, nose, and perioral and periocular skin. Rosacea tends to begin in childhood as common facial flushing, often in response to stress. A diagnosis beyond this initial stage of rosacea is unusual in the pediatric population. If a child is identified with the intermediate stage of rosacea, consisting of papules and pustules, an eye examination should be performed to rule out ocular manifestations. It may be beneficial to recognize children in the early stage of rosacea; however, it is uncertain if prophylactic treatment is necessary.

Child↗
PubMed2004

The nosology of rosacea.

The National Rosacea Society (NRS) convened a committee of dermatology thought leaders to develop a standard classification system for rosacea. Based on the primary and secondary characteristics of this disorder, the NRS Expert Committee identified 4 types of rosacea: erythematotelangiectatic, papulopustular, phymatous, and ocular; one variant, granulomatous, also was recognized. The NRS Expert Committee also developed a grading system for rosacea signs and symptoms that will complement this classification system. The classification system and forthcoming grading system will help practitioners refine their diagnosis and treatment of rosacea to ensure better outcomes for patients.

Humans↗
PubMed2005

Lasers and light sources for rosacea.

Pharmacologic agents remain the mainstay for initial and maintenance treatment of rosacea. However, monochromatic (i.e., laser) and polychromatic light-based therapies are increasingly being used for the treatment of certain signs of rosacea. Despite the increased use of lasers and other light-based therapies, few well-controlled studies have been conducted on their use for the treatment of rosacea. The studies that do exist suggest that these modalities have value in treating erythematotelangiectatic rosacea, including persistent erythema and phymatous rosacea. Light-based therapies should be strongly considered in cases of serious erythema, flushing, and telangiectasia because these signs are not optimally addressed by pharmacologic interventions.

Humans↗
PubMedDate not supplied

Assessment of skin barrier function in rosacea patients with a novel 1% metronidazole gel.

The skin of patients with rosacea is extremely sensitive and hyper-reactive to dietary, environmental, and topical factors. Accordingly, the management of rosacea involves not only choosing appropriate medication and treatment for daily skin care, but also avoiding known trigger factors. Recently, 1% metronidazole, a mainstay of topical rosacea therapy, was reformulated in a gel vehicle that contains hydrosolubilizing agents (HSA) niacinamide, beta cyclodextrin, and a low concentration of propylene glycol. It is designed to solubilize greater concentrations of metronidazole than is possible in water alone while reducing the potential for irritation and barrier disruption. A 2-week study was undertaken by the author to evaluate the effect of the new 1% metronidazole gel on the skin barrier in 25 women with mild to moderate rosacea. Statistically significant improvement in disease severity, erythema, desquamation, and skin irritation was noted by the investigator by the end of week 1, which continued throughout the study. After 2 weeks, subjects noted improvements in skin condition and rosacea. Results of noninvasive assessments showed no disruption of the skin barrier. Furthermore, there was an increasing trend in skin hydration that approached statistical significance.

Administration, Topical↗
PubMed2005

Therapeutic response of rosacea to dobesilate.

Despite an incomplete understanding of the pathogenesis of rosacea, therapeutic modalities continue to expand. The principal subtype of rosacea includes erythematotelangiestatic rosacea, which is characterized by uncontrolled angiogenesis. Angiogenic growth factors such as fibroblast growth factors (FGF) and vascular endothelial growth factor (VEGF) are currently targets of intense effort to inhibit deregulated blood vessel formation in diseases such as cancer. Here we report a 33-years-old woman with erythematotelangestatic rosacea who responds to a daily treatment of topically applied dobesilate, an inhibitor of FGF, with an improvement in erythema and telangectasia after two weeks. Thus, dobesilate might be useful in the treatment of rosacea and other diseases that depend on pathologic angiogenesis.

Administration, Topical↗
PubMed1989

[The effectiveness of tetracycline in the treatment of rosacea associated with epithelioid granulomas].

The results of the oxytetracycline therapy given orally to 26 patients with severe papulopustular rosacea are presented. The biopsies were taken at the most typical sites. In 19 out of 26 patients the pathological changes characteristic of papulopustular rosacea were found. In 7 out of 26 patients epitheloid granulomas without central caseation were histologically observed. In these 7 patients tuberculosis was excluded (the absence of other tuberculous stigmata, normal laboratory data). Tetracycline (oxytetracycline) was given orally to 26 patients. One month later, a remarkable clinical improvement could be seen, i.e. the papules and pustules disappeared in all 26 patients and the recurrence of the disease could not be noticed in any patient during a 2.5-year-observation period. As no signs of tuberculosis could be detected in these patients, the authors believe that rosaceiform changes with epitheloid granulomas should be systematized in rosacea as "rosacea-like eruptions". A good therapeutic response of "rosacea-like eruptions" to tetracyclines could possibly confirm the authors' hypothesis.

Adult↗
PubMed1989

[Vasoactive polypeptides in rosacea].

Plasma kininogenesis components were studied in 110 patients with rosacea and in 3 groups of subjects at risk of developing this condition because of chronic gastrointestinal diseases, nervous system stress, or endocrine dysfunctions, conducive to rosacea. Changes in kininogenesis parameters similar to those detected in all rosacea patients were detected in all the 3 risk groups. Vasoactive polypeptide hyperproduction is a common component of rosacea pathogenesis. Vasoactive trend of the kinin action in kinin hyperproduction in rosacea induces vascular changes in the face and general vascular disorders, characteristic of this condition.

Female↗