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PubMed2003

The role of free oxygen radicals in the aetiopathogenesis of rosacea.

A possible link between superoxide dismutase activity and malondialdehyde level with the clinical manifestations of rosacea was investigated. We found differences in superoxide dismutase activities between mild rosacea (stages I and II) and severe involvement (stage III) groups, as well as between disease and control groups that were statistically significant (P < 0.05). In the mild involvement group (stages I and II), the superoxide dismutase activity was higher than in the control group (P < 0.05), while the malondialdehyde levels did not differ from the control. In the severe involvement group (stage III), the superoxide dismutase activity was lower than in the control group (P < 0.05), and this was coupled to a raised level of malondialdehyde (P < 0.05). These findings clearly show that in the mild involvement phase of rosacea patients, superoxide dismutase activity was stimulated to protect the skin against reactive oxygen species so that the malondialdehyde levels were maintained. In contrast, in more severe disease, due to a decrease in the capacity of the antioxidant defence system, the malondialdehyde levels were increased. These findings support the 'antioxidant system defect hypothesis' in rosacea patients.

Adult↗
PubMed1998

Capillaropathy and capillaroneogenesis in the pathogenesis of rosacea.

BACKGROUND: Dilatation of vascular vessels in rosacea has generally been attributed to yielding to deranged connective tissue. In contrast, in a previous study a degrading effect of insufficient vascular vessels in connective tissue has been demonstrated in connection with diabetic microangiopathy. In yet another paper, it was demonstrated that the fusing of damaged capillaries, which had lost part of their adjacent walls due to functional inadequacy, led to the formation of dilated vessels. These pathogenetic patterns are the main subjects of this study of rosacea. METHODS: Punch biopsies from rosacea lesions were examined by light microscopy and immunochemistry in order to identify structural changes leading to the formation of telangiectasias. RESULTS: Deranged connective tissue is secondary to damaged capillaries. The primary damage may be evoked mostly by environmental influences, mainly the sun. CONCLUSIONS: Infections, infestations, and granulomatous formations are not primary in the development of rosacea.

Adult↗
PubMed2003

Objective and quantitative improvement of rosacea-associated erythema after intense pulsed light treatment.

BACKGROUND: Despite the widespread and quite successful use of various lasers and light sources to treat facial erythema, the literature contains little, if any, objective and quantitative improvement. In addition, very few studies specifically address rosacea-associated erythema. OBJECTIVE: To assess quantitatively the degree of improvement in patients with rosacea after intense pulsed light treatment. The three main parameters that were objectively measured were blood flow, telangiectasia, and erythema. METHODS: Four patients with rosacea-associated erythema and telangiectasia were treated five times at 3-week intervals with the Photoderm VL (Lumenis, Needham, MA). The 515-nm filter, a single pulse duration of 3 ms, and various fluences were used. Blood flow was measured by the scanning laser Doppler. Close-up photography ensured reproducibility and enabled quantification of telangiectasia and erythema by subsequent computer image analysis. Measurements were taken at baseline and at 1 month after the last treatment. RESULTS: The scanning laser Doppler demonstrated a 30% decrease in blood flow (P<0.05). A 29% decrease in actual area of the cheek occupied by telangiectasia was noted (P<0.05). A 21% decrease in the intensity of erythema was noted (P<0.05). CONCLUSION: As demonstrated by truly objective and quantitative means, intense pulsed light is effective for reducing rosacea-associated blood flow, telangiectasia, and erythema.

Adult↗
PubMed2003

Efficacy and safety of azelaic acid (15%) gel as a new treatment for papulopustular rosacea: results from two vehicle-controlled, randomized phase III studies.

BACKGROUND: Rosacea is a common, chronic dermatosis for which safe and effective new treatment options are needed. OBJECTIVE: The objective of these studies was to evaluate the efficacy, tolerability, and safety of a new formulation of 15% azelaic acid (15%) gel (AzA gel), for the topical treatment of moderate, papulopustular rosacea. METHODS: Two multicenter, double-blind, randomized, parallel-group, vehicle-controlled studies were conducted using identical study designs, patient-selection criteria, and efficacy end points. Overall, 329 patients were enrolled in study 1 and 335 patients in study 2. RESULTS: Both studies consistently demonstrated the superiority of AzA gel over vehicle in the topical treatment of moderate, papulopustular rosacea. AzA gel yielded statistically significantly higher reductions in mean inflammatory lesion count than vehicle: 58% versus 40%, study 1 (P =.0001); 51% versus 39%, study 2 (P =.0208). Significantly higher proportions of patients treated with AzA gel experienced improvement in erythema compared with vehicle gel: 44% versus 29%, study 1 (P =.0017); 46% versus 28%, study 2 (P =.0005). Using the investigator's global assessment, therapeutic success in terms of a clear, minimal, or mild final result was achieved in 61% and 62% of patients treated with AzA gel in studies 1 and 2, respectively, which was significantly superior to the result achieved with vehicle (40% and 48%, respectively) (P <.0001, study 1; P =.0127, study 2). No serious, treatment-related adverse events were reported. CONCLUSION: The results of these 2 controlled studies demonstrate that AzA gel, used twice daily, is an efficacious, safe, and well-tolerated topical treatment for moderate, papulopustular rosacea.

Adult↗
PubMed1999

Stinging and rosacea.

A total of 32 rosacea patients (25 with the papulopustular type of rosacea and 7 with the erythematotelangiectatic type) and 32 healthy persons were single-blind tested with a solution of 5% lactic acid and pure water applied to their cheeks. Twenty-four patients and 6 controls reacted positively as "stingers" (p<0.001) in this objective test of sensitive skin. All 7 of the patients with erythematotelangiectatic rosacea, but only 17/25 with the papulopustular type, were stingers (n.s.). The reason why some patients react with subjective symptoms, such as itching, burning, stinging, prickling or tingling, is unclear. The findings in this study are not surprising, but do support the theory that impairment due to different stimuli, most likely because of vascular sensitivity, is a central mechanism in the aetiology of rosacea. The correlation between sensitive vessels and sensitive skin has, however, not yet been determined.

Adult↗
PubMed1992

Oral spironolactone therapy in male patients with rosacea.

Spironolactone at 50 mg/day was orally administered for four weeks to 13 male patients with rosacea in order to observe its clinical effectiveness. Serum estradiol (E2), 17OH-progesterone (17OH-P4), testosterone (T), androstenedione (delta 4 A), dihydrotestosterone (DHT), dehydro-epiandrosterone sulfate (DHEA-S) were measured prior to and after treatment. Although there were no significant changes in T, delta 4A, DHT, or DHEA-S, the serum levels of 17OH-P4 increased significantly. E2 tended to increase, although the change was not significant. Two of the 13 patients discontinued spironolactone treatment because of general malaise, but seven of the remaining eleven patients exhibited an improvement in their rosacea. These findings demonstrate that a low dose of spironolactone is effective in the treatment of rosacea in some male patients and suggest that it is possible that changes in the metabolism of sex steroid hormones such as cytochrome p-450 isozymes have some bearing on the etiology of rosacea.

Administration, Oral↗
PubMed1975

The sebum excretion rate in rosacea.

The sebum excretion rate (SER) was measured in fifty-five patients with rosacea and 126 control subjects. The mean SER in the patients with rosacea was not increased, nor was there any correlation between SER and severity of rosacea. Our data suggest that seborrhoea plays no part in the pathogenesis of rosacea.

Adult↗
PubMed2004

Remission of rosacea induced by reduction of gut transit time.

Rosacea is a chronic disorder characterized by hypersensitivity of the facial vasculature, presenting with intense flushing eventually leading to chronic erythema and telangiectasia. Although the precise aetiology of rosacea is not known, numerous associations with inflammatory gastrointestinal tract disorders have been reported. Furthermore, substance P-immunoreactive neurones occur in considerably greater numbers in tissue surrounding affected blood vessels suggesting involvement of neurogenic inflammation and moreover plasma kallikrein-kinin activation is consistently found in patients. In this report, a patient without digestive tract disease is described, who experienced complete remission of rosacea symptoms following ingestion of a material intended to sweep through the digestive tract and reduce transit time below 30 h. It is possible that intestinal bacteria are capable of plasma kallikrein-kinin activation and that flushing symptoms and the development of other characteristic features of rosacea result from frequent episodes of neurogenic inflammation caused by bradykinin-induced hypersensitization of facial afferent neurones. The possible relevance of this hypothesis to other conditions featuring afferent hypersensitivity, such as fibromyalgia, is considered.

Adult↗
PubMed2005

Topical application of 1-methylnicotinamide in the treatment of rosacea: a pilot study.

Rosacea is a chronic facial dermatosis with a progressive course, which is characterized by the presence of erythema, papules, pustules, telangiectasias and sebaceous gland hyperplasia. However, the aetiology is still unknown; genetic predisposition, gastrointestinal disorders (Helicobacter pylori), infestations with Demodex folliculorum and environmental stimuli are considered to be involved in the inflammatory process. A metabolite of nicotinamide, 1-methylnicotinamide (MNA(+)), has anti-inflammatory properties, and this is the first study to test the effectiveness of this agent in treating rosacea. In total, 34 patients with rosacea were treated with a gel containing 0.25% MNA(+) as a chloride salt, twice daily for 4 weeks, after which improvement was observed in 26/34 cases. The improvement was good in 9/34 and moderate in 17/34, but no clinical effect was noted in seven subjects. In only one case was skin irritation given as the reason for treatment withdrawal. These results indicate that MNA(+) might be a useful agent for treating rosacea.

Administration, Topical↗
PubMed2004

Therapeutic potential of azithromycin in rosacea.

BACKGROUND: Systemic antibiotics currently used in the treatment of rosacea are sometimes associated with uncomfortable side-effects. Therefore, a need for an effective agent with few side-effects and good patient compliance exists. Azithromycin, a macrolide antibiotic with prolonged mode of action, has recently been found to be an effective alternative in the treatment of inflammatory acne. We planned a study to evaluate the efficacy and safety of azithromycin in rosacea. METHODS: An open-labeled study was performed in a population of 18 patients, with Plewig-Kligman stage 2 rosacea. Patients were given oral azithromycin for 12 weeks in decreasing doses. RESULTS: Fourteen subjects completed the trial. The treatment produced therapeutic benefits with regard to total scores as well as inflammatory lesion scores. At the end of 12 weeks, there was a 75% decrease in total scores (P < 0.001) and an 89% decrease in inflammatory lesion scores compared with basal values. Improvement continued during the 4 weeks after treatment. Adverse effects were minimal and well tolerated in most patients. CONCLUSION: Azithromycin is a promising agent in the treatment of rosacea with its few side-effects and good patient compliance.

Administration, Oral↗
PubMed2005

Adapalene vs. metronidazole gel for the treatment of rosacea.

BACKGROUND: Rosacea is a common, chronic dermatosis that requires long-term therapy. Oral isotretinoin and topical and/or oral antibiotics are effective, but their usage may be limited due to side-effects. OBJECTIVE: The goal of the study was to compare the efficacy of topical adapalene gel (0.1%) and topical metronidazole gel (0.75%) in the treatment of patients with papulopustular rosacea. METHODS: This study included 55 patients with papulopustular rosacea. Diagnostic efforts were focused on clinical and histological features. Patients were randomly assigned to the adapalene (n = 30) and metronidazole (n = 25) groups. Sunlight protection factor 20 cream was used to protect all patients from sunlight. The characteristics and numbers of inflammatory papules, pustules, erythema and telangiectasia were scored at baseline and after 2, 4, 8 and 12 weeks. Side-effects were recorded at each visit. RESULTS: Fifty patients, 27 in the adapalene group and 25 in the metronidzaole group, completed the study. Significant reductions in the total number of inflammatory lesions were found in the adapalene group compared with the metronidazole group. There was no significant difference in the scores of erythema and telangiectasia in the adapalene group. However, a significant reduction in erythema was seen in the metronidazole group. CONCLUSIONS: Adapalene gel is well tolerated and can be used as an alternative for topical treatment of papulopustular rosacea.

Adapalene↗
PubMed1992

Childhood rosacea.

Rosacea usually occurs in adults and rarely has been noted in children. We recently observed three children with rosacea, all of whom responded dramatically to systemic and topical antibiotics. Rosacea in childhood must be distinguished from other erythematous facial disorders, most commonly acne, granulomatous perioral dermatitis, and sarcoidosis. The distribution of facial lesions; the presence of telangiectasias, flushing, and pustules; and the appearance of lesional biopsy sections and the ocular lesions, if present, allow differentiation of rosacea from other facial eruptions.

Anti-Bacterial Agents↗
PubMed2005

Group IIA phospholipase A(2) concentration of tears in patients with ocular rosacea.

PURPOSE: To determine the concentration of group IIA phospholipase A(2) (GIIAPLA(2)) in tears of patients with ocular rosacea, and to compare it with GIIAPLA(2) concentration in tears of age-matched healthy controls. METHODS: The GIIAPLA(2) concentration in tears was measured with a time-resolved fluoroimmunoassay in 21 patients with ocular rosacea (mean age 55.6+/-9.2 years) and in 21 normal subjects (mean age 53.4+/-8.2 years). Conjunctival brush cytology was carried out and eosinophils, neutrophils, lymphocytes, squamous epithelial cells, columnar epithelial cells, metaplastic changes and goblet cells were calculated separately. RESULTS: The GIIAPLA (2) concentration in tears was statistically significantly lower in patients with ocular rosacea (31.0+/-18.4 microg/ml, p=0.0099) and, more specifically, in patients who had dry eye (25.8+/-15.1 microg/ml, p=0.0034), compared to that in normal controls. There was no correlation between the GIIAPLA (2) content of tears and the conjunctival cells collected by the brush cytology. CONCLUSION: The tears of patients with dry eye symptoms due to ocular rosacea have decreased GIIAPLA (2) content. The pathogenic importance of this finding is discussed.

Adult↗
PubMed1985

Does visual display terminal work provoke rosacea?

According to some reports, mainly from Norway, visual display terminal (VDT) work has been thought to cause rashes. In conjunction with an epidemiological study of office employees and VDT work, a dermatological examination was made. No case demonstrated the clinical picture described from Norway among VDT operators, but subjects with rosacea, seborrhoeic dermatitis and acne were over-represented in the VDT-exposed group. The object of the present study was to see whether patients with rosacea experienced aggravation of their symptoms as a result of VDT work and whether they showed a particular clinical picture. All subjects fit for work among the patients diagnosed as rosacea or perioral dermatitis during 1982 were selected for the study. The methods included a questionnaire on VDT work and suspected impairment of the skin disease, clinical examination and telephone interviews. 179 subjects were selected; 42 of them worked daily with VDT and 8 of them suspected impairment due to VDT work. The results imply that a relationship may exist between rosacea and VDT work. To what factor in the work this may be ascribed is still unclear. Those subjects whose symptoms were aggravated did not show any particular clinical picture.

Adolescent↗
PubMed2003

Incidental control of rosacea by somatostatin.

BACKGROUND: The precise pathomechanism of rosacea remains elusive. The disease commonly requires long-term treatments using topical or oral therapies. OBJECTIVE: This report presents incidental findings about the possible modulatory role of somatostatin in the outcome of rosacea. METHOD: Four patients presenting long-standing recalcitrant facial rosacea were treated with octreotide for diabetic retinopathy. RESULTS: Rosacea improved rapidly and even cleared without any recurrence in 3 of the patients. CONCLUSION: The beneficial effect might be attributed to inhibitory actions on the sebaceous gland, the neovascularization and/or on the inflammatory process.

Diabetes Mellitus, Type 1↗
PubMed2006

Rosacea fulminans in pregnancy: case report and review of the literature.

Rosacea fulminans is a rare disease of unknown cause which occurs exclusively in women years after adolescence. Although the etiology is unknown, immunologic, hormonal, and vascular factors have been suggested. When rosacea fulminans occurs during pregnancy and in women taking oral contraceptive pills, hormonal factors may be a trigger. Rosacea fulminans is localized specifically to the face, with the chin, cheeks, and forehead bearing the brunt of the attack. A dull red, cyanotic erythema of all involved facial areas, extending beyond the inflammatory nodules, is typical. We present the case of a 31-year-old pregnant woman who had rosacea fulminans during the first trimester of her second pregnancy. She had multiple erythematous papules, pustules, nodules, and purulent discharging cysts on the face. Conventional therapeutic approaches with systemic corticosteroids were associated with clear improvement within 2 months, and subsequently only 0.75% metronidazole topical cream was used during the second trimester.

Administration, Oral↗
PubMed2000

Treatment of rosacea with doxycycline monohydrate.

Rosacea is one of the most commonly occurring inflammatory dermatoses treated by dermatologists today. Estimates suggest that at least 13 million Americans have recognized rosacea, and the clinical experience of most practitioners would add considerably more to that number. Rosacea is an inflammatory condition of the skin, classically presenting with a history of flushing and/or blushing along with the clinical findings of erythema, edema, telangiectasia, papules, pustules, and nodules of the face. Severity and distribution vary considerably. A patient may have only a few scattered papules and pustules of the central third of the face or there may be numerous inflammatory, painful, tender, large nodules. In some cases, only the face may be affected. In other cases, there may be lesions of the scalp, neck, and/or torso. Although the exact etiology is unknown, rosacea is thought by most experts to be an inflammatory process incited by vascular instability with subsequent leakage of fluid and inflammatory mediators into the dermis.

Anti-Bacterial Agents↗
PubMed2001

The pathogenesis of Demodex folliculorum (hair follicular mites) in females with and without rosacea.

In rosacea patients (ages 11-50 years old) 44% were infested with D. folliculorum as compared to normal controls (23.0%). The difference was significant. The mean +/-SD of mite density ranged between 13.2+/-0.9 to 18.2+/-1.2 as compared to normal controls with mite density ranged between 1.4+/-0.25 to 2.4+/-0.3. Demodex infestation in rosacea patients was 66.1% in squamous, 66.7% in erythemato-telangiectate and 83.3% in papulo-pustular rosacea. The highly infested site was check (27.3%) with mean mite density of 25.3+/-1.3, followed by the area around the orbit (23.4%) with a density of 19.0+/-1.2, the area around the nose (19.5%) with mite density of 7.1+/-1.5, then chin (15.6%) with a density of 8.2+/-1.4 and lastly the area around the mouth (14.1%) with a mite density of 14.2+/-1.3. Undoubtedly, infestation with D. folliculorum particularly in large number causes rosacea.

Adolescent↗