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PubMed1975

A follow-up of tetracycline-treated rosacea. With special reference to rosacea keratitis.

Seventy patients with rosacea were treated with systemic tetracycline for 6 months. Sixty-eight of them cleared with treatment. After withdrawal of the drug seventeen relapsed immediately and the overall relapse rate over 4 years was 69%. The serum tetracycline levels were not significantly different in two patients who failed to respond. Six patients had rosacea keratitis and responded dramatically within 1 month. Symptoms recurred as the drug was withdrawn. It is suggested that rosacea patients with keratitis should receive early and prolonged tetracycline medication.

Clinical Trials as Topic↗

PubMed1992

The possible role of skin surface lipid in rosacea with epitheloid granulomas.

The examination was carried out in 50 rosacea patients (30 females and 20 males) in order to establish the connexion between skin surface lipids, infestation with Demodex folliculorum and previous local corticosteroid treatment with the appearance of epitheloid granulomas. Our analysis showed three types of histological conditions: 1) chronic dermatitis of the rosacea type was noted in 15 patients (30%); 2) granulomas composed of epitheloid cells was found in 16 patients (32%). In three female patients of this group presence of caseous necrosis associated with epitheloid granuloma was noted, too; 3) prevalence of perifollicular absceses was found in 19 patients (38%). Demodex folliculorum was detected in 43 rosacea patients (86%), considerably more then in the control group. The normal value of the skin surface lipids was found in 9 female rosacea patients (30%) and in 9 female controls (43%), in 8 male rosacea patients (40%) and in 5 males controls (33%). Lower amounts of skin surface lipids were found in 19 female rosacea patients (63%) and in 9 female controls (43%), in 4 male rosacea patients (20%) and in 1 male control (7%). Higher amounts of skin surface lipids were found in 2 female rosacea patients (7%) and in 3 female controls (14%), in 8 male rosacea patients (40%) and in 9 male controls (60%). Lower quantities of lipids determined a higher incidence of Demodex folliculorum in rosacea patients. Demodex folliculorum were also more frequently detected in patients who had previously been treated with topical corticosteroids (even in 91.9%), what was often followed by epitheloid granulomas. The treatment with tetracycline yielded good or excellent results in 90% of all the patients.

Adult↗

PubMed1992

Schirmer testing for dry eyes in patients with rosacea.

BACKGROUND: Dry eyes have been reported in a significantly greater number of patients with ocular rosacea than in control subjects. OBJECTIVE: Our purpose was to assess the incidence of dry eyes in patients with cutaneous rosacea and to compare this with a control population. METHODS: With the use of the Schirmer test without anesthesia, the amount of aqueous tear secretion of 32 consecutive patients (16 women, 16 men) with rosacea was compared with that of 32 psoriasis patients (16 women, 16 men) without rosacea who served as age- and sex-matched controls. Two criteria, 5 mm and 8 mm of strip wetting, were used to indicate the lower limit of normal aqueous tear secretion. RESULTS: Of rosacea patients, 56.3% had less than 8 mm of strip wetting compared with 25% of control patients (p less than 0.02). Of rosacea patients, 40.6% had less than 5 mm of strip wetting compared with 18.75% of controls (p less than 0.10). CONCLUSION: The results of this study suggest that dry eyes occur frequently in rosacea. It is important that dermatologists and ophthalmologists be aware of the frequency of dry eyes in rosacea, so that patients are investigated and appropriate therapy can be provided.

Adult↗

PubMed2026

Systemic Proteomic Alterations and Predictive Biomarkers of Paroxetine Response in Refractory Rosacea: A Secondary Analysis of a Randomized Clinical Trial.

IMPORTANCE: Rosacea is a chronic inflammatory cutaneous disorder characterized by persistent erythema and vascular dysregulation. While paroxetine has shown clinical efficacy in reducing these symptoms, the systemic molecular mechanisms underlying its therapeutic response remain poorly characterized. OBJECTIVE: To investigate systemic proteomic alterations and identify potential predictive biomarkers in patients with refractory erythematous rosacea following paroxetine treatment. DESIGN, SETTING, AND PARTICIPANTS: This prospective plasma proteomic analysis was nested within a multicenter, randomized, double-blind, placebo-controlled clinical trial (Prospective Rosacea Refractory Erythema Randomized Clinical Trial [PRRERCT]). Participants included patients aged 18 to 65 years with refractory rosacea (Clinician's Erythema Assessment [CEA] score ≥3). Plasma samples were collected at baseline and after 12 weeks of treatment. The data for this study were analyzed between September 2025 and November 2025. INTERVENTIONS: Participants received oral paroxetine, 25 mg per day, for a 12-week treatment period. MAIN OUTCOMES AND MEASURES: Systemic protein expression profiles were analyzed using data-independent acquisition liquid chromatography-tandem mass spectrometry. Clinical response was evaluated using CEA and the Flushing Assessment Tool. Correlations between proteomic changes and clinical improvements were assessed, and predictive biomarkers were identified using receiver operating characteristic curve analysis. RESULTS: Among 24 participants (mean [SD] age, 35 [11] years; 24 [100%] female), paroxetine treatment significantly reduced mean (SD) CEA scores from 3.1 (0.3) to 2.3 (0.7) and Flushing Assessment Tool scores from 3.1 (0.6) to 2.0 (0.9) (P < .001). Exploratory proteomic analysis revealed 497 candidate differentially expressed proteins after treatment. Downregulated proteins showed preliminary enrichment in pathways related to immune response activation, insulin receptor signaling, and neuronal remodeling. A subset of 98 reversed-response proteins was observed, primarily linked to synaptic vesicle cycles and vascular smooth muscle contraction. Proteomic alterations were associated with clinical improvement (65 proteins for erythema; 73 for flushing). Candidate biomarkers, notably OLFML3 (area under the receiver operating characteristic curve [AUC], 0.87 [95% CI, 0.70-1.00]) and IGFBP2 (AUC, 0.80 [95% CI 0.55-1.00]), demonstrated high predictive value for clinical response. CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial, paroxetine treatment was associated with modulation of systemic neuro-vascular-immune networks in patients with rosacea. These exploratory findings provide preliminary mechanistic clues regarding the possible disease-modifying potential of paroxetine and point to circulating protein signatures that may facilitate personalized therapeutic strategies for rosacea management. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2000031479.

Humans↗

PubMed1992

Rosacea: a study of clinical patterns, blood flow, and the role of Demodex folliculorum.

BACKGROUND: Rosacea is a common facial eruption that has various clinical presentations. OBJECTIVE: We studied blood flow in lesional skin and explored the role of Demodex folliculorum in patients with rosacea. METHODS: A survey of clinical presentations was made in 108 patients with rosacea. Facial blood flow was studied by laser-Doppler flowmetry. The presence of Demodex was determined by microscopy of skin samples. RESULTS: The sex incidence was equal. The incidence peaked in the fourth and seventh decades of life. Lymphedema was common and was seen in 26 patients. Rhinophyma was present in 15 patients, mostly men. Eleven patients were black, an unexpectedly high number. Laser-Doppler flowmetry showed that lesional blood flow was three to four times that of control subjects. Demodex folliculorum was found in 20 of 25 rosacea patients examined but in only 2 of 20 control subjects. CONCLUSION: The findings indicate that the papillary dermal vasculature is dilated in rosacea. Demodex may be present. These findings give no definitive clue as to the origin of the disease.

Adult↗

PubMed2024

Construction of a molecular diagnostic system for neurogenic rosacea by combining transcriptome sequencing and machine learning.

Patients with neurogenic rosacea (NR) frequently demonstrate pronounced neurological manifestations, often unresponsive to conventional therapeutic approaches. A molecular-level understanding and diagnosis of this patient cohort could significantly guide clinical interventions. In this study, we amalgamated our sequencing data (n = 46) with a publicly accessible database (n = 38) to perform an unsupervised cluster analysis of the integrated dataset. The eighty-four rosacea patients were partitioned into two distinct clusters. Neurovascular biomarkers were found to be elevated in cluster 1 compared to cluster 2. Pathways in cluster 1 were predominantly involved in neurotransmitter synthesis, transmission, and functionality, whereas cluster 2 pathways were centered on inflammation-related processes. Differential gene expression analysis and WGCNA were employed to delineate the characteristic gene sets of the two clusters. Subsequently, a diagnostic model was constructed from the identified gene sets using linear regression methodologies. The model's C index, comprising genes PNPLA3, CUX2, PLIN2, and HMGCR, achieved a remarkable value of 0.9683, with an area under the curve (AUC) for the training cohort's nomogram of 0.9376. Clinical characteristics from our dataset (n = 46) were assessed by three seasoned dermatologists, forming the NR validation cohort (NR, n = 18; non-neurogenic rosacea, n = 28). Upon application of our model to NR diagnosis, the model's AUC value reached 0.9023. Finally, potential therapeutic candidates for both patient groups were predicted via the Connectivity Map. In summation, this study unveiled two clusters with unique molecular phenotypes within rosacea, leading to the development of a precise diagnostic model instrumental in NR diagnosis.

Humans↗

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↗

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↗

PubMed1975

Rosacea of common male baldness.

Four patients are described in whom rosacea occurred on the face, and on the scalp in patches of baldness. Histopathological examination of the specimens taken from the scalp showed changes of rosacea and basophilic degeneration of collagen. In two patients direct immunofluorescence studies were performed; in one of these the presence of IgG deposits at the dermo-epidermal junction was demonstrated. These observations confirm the influence of external factors in the pathogenesis of rosacea.

Aged↗

PubMed2025

Subgenomic divergence and functional innovation following whole-genome duplication in Maleae species of Rosaceae.

Whole-genome duplication (WGD) drives plant evolution by inducing karyotype rearrangements and gene loss through subgenome fractionation. In this study, we investigate post-WGD evolutionary dynamics in Rosaceae, focusing on Maleae species, which uniquely experienced an additional WGD. Using phylogenetic and synteny analyses, we reveal that chromosomal breakpoints act as hotspots for localized fractionation, contributing to blurred homoeologous origins and influencing gene retention patterns. Here, we reconstruct karyotype evolution across Rosaceae subfamilies, highlighting chromosome reductions and lineage-specific rearrangements in Dryadoideae, Rosoideae, and Amygdaloideae. We also identify a bias for retaining transcription factors and hormone-related genes from older WGDs in subsequent polyploidy events. Transcriptome analysis classifies WGD-derived genes in Maleae species, such as apple and loquat, into three expression groups, with hormone-enriched genes playing roles in lignification and fruit-related innovations. These findings demonstrate the interplay between chromosomal breakpoints, biased retention, and functional divergence, revealing their contributions to genomic and phenotypic evolution in Maleae and their adaptive success within Rosaceae.

Genome, Plant↗

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↗

PubMed1992

Pyoderma faciale. A review and report of 20 additional cases: is it rosacea?

BACKGROUND AND DESIGN: Pyoderma faciale was originally described by O'Leary and Kierland in 1940. It is characterized by the sudden onset of monstrous coalescent nodules and confluent draining sinuses confined to the face of young women in their early 20s. This report summarizes our results in 20 cases. The women were 15 to 46 years old (mean, 25 years). RESULTS: All women were flushers and blushers. Histopathologic examination revealed a dense perivascular and periadnexial infiltrate, including granulocytes, eosinophils with epithelioid granulomas, and septal and lobular panniculitis. No consistent laboratory abnormalities were found. After much therapeutic experimentation, we developed an effective treatment plan, based on a combination of oral isotretinoin and corticosteroids. CONCLUSION: We regard it as an extreme form of rosacea and suggest it be renamed rosacea fulminans in analogy with its counterpart, acne fulminans.

Adolescent↗

PubMed1979

Chalazia and rosacea.

Fifty-seven percent of patients scheduled for excision of chalazia over 19 years of age and 64% of patients over the age of 29 were found to have rosacea. This compares to an incidence in our control group of 12% and 13%, respectively. Rosacea was almost twice as common in patients with recurrent chalazia as in those with only one occurrence.

Adult↗

PubMed1976

Treatment of rosacea by metronidazole.

A double-blind trial in twenty-nine patients with rosacea showed that, after 6 weeks' treatment, metronidazole was therapeutically superior to a placebo (P less than 0-02). It was particularly effective against papules and pustules. The mode of action of metronidazole and other antibiotics in rosacea is not known.

Administration, Oral↗

PubMed1992

Development of an orphan drug by a start-up company. MetroGel for rosacea.

The Orphan Drug Act of 1983, along with the discovery of a new use for a known drug and an investor willing to assume the necessary risk, brought about the formation of a start-up pharmaceutical company. The primary incentive of the Orphan Drug Act of seven years of marketing exclusivity provided the protection from competition necessary for recovery of the significant research and development and marketing costs. The orphan product, MetroGel, for the treatment of rosacea, required approximately five years of development before it was approved for marketing by the Food and Drug Administration. MetroGel has become the number one drug in the United States for the treatment of rosacea. It currently is marketed in other countries through a licensing agreement with a major pharmaceutical company.

Administration, Topical↗

PubMed1976

Skin surface lipid composition in rosacea.

Skin surface lipid composition was measured in thirty-one patients with rosacea and their age-matched controls. Patients with rosacea had normal lipid composition, and there was no correlation between the lipid composition and the severity of the disease. Tetracycline therapy produced no measurable change in lipid composition.

Adult↗

PubMed1976

Comparative study of triamcinolone acetonide and hydrocortisone 17-butyrate in rosacea with special regard to the rebound phenomenon.

The clinical efficacy and the rebound phenomenon were studied in a left-right double-blind trial comparing triamcinolone acetonide (TA) and hydrocortisone 17-butyrate (HC 17-B, Locoid). The trial comprised 19 patients with rosacea-like dermatitis of whom 7 did not receive treatment and 12 were pretreated with betamethasone valerate (BMV). Tetracyclince was given all the time as additional treatment. Clinically there was no significant difference between TA and HC 17-B. No rebound phenomenon was observed. If corticosteroids are to be used at all in rosacea or resoacea-like dermatitis, preference is given to HC 17-B.

Administration, Topical↗