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Rosacea is a chronic inflammatory skin disease whose late manifestations have not yet been clearly reported in animal models. The objective of this study is to describe the skin lesions and major histopathological changes in a rosacea-like phenotype in mice induced by prolonged LL-37 administration and furthermore, to assess the potential of long-term LL-37 administration in inducing irreversible rosacea-like skin lesion models. Balb/c mice were continuously injected intradermally with LL-37 every 12 h to induce a rosacea-like phenotype. After LL-37 injections were administered for 20 consecutive days, the area of rosacea-like lesions gradually expanded in the first 13 days, then entered a stable phase. Haematoxylin and eosin (H&E) and Van Gieson’s staining showed a high degree of inflammatory cell aggregation, thickening of the epidermis and dermis, and collagen deposition in large quantities. The results of immunofluorescence staining and Western blotting showed that the expression of α-SMA, TNF-α, vimentin, and COL1 in the skin of mice was significantly upregulated. Short-term LL-37 administration induced rosacea-like lesions that only featured the aggregation of inflammatory factors and thickening of the epidermis, whereas no collagen hyperplasia was observed, and a full recovery was noticed. However, rosacea-like skin lesions induced by long-term LL-37 administration did not completely recover. Our study compares rosacea-like lesions induced by short-term versus long-term LL-37 administration, and the results suggest that irreversible rosacea-like lesions can be induced by long-term LL-37 administration.

Objective: Rosacea-Specific Quality of Life Scale (RosaQoL) developed specifically for rosacea. The aim of the study was to adapt the RosaQoL Scale that is specific to Rosacea used in evaluating the quality of life of patients with Rosacea into Turkish, and evaluate its validity and reliability. Methods: The RosaQoL Scale is a 21-item index that is specific to Rosacea, and was developed originally in English. The Turkish Scale, which was created after the clinical examinations of the patients, was applied to the patients. A total of 285 people, 240 females (84.2%) and 45 males (15.8%), who were diagnosed with Rosacea, admitting to the dermatology clinic between May 2019 and August 2019 were included in the study. Results: The mean age of the patients was found to be 44.8 ± 12.5 years in the study. The internal consistency of the scale (Cronbach’s Alpha Coefficient) was found to be 0.952. The correlation coefficient was calculated as r=0.988 in the test-retest reliability. The total RosaQoL score was 62.4 ± 11.5 (Mean ± SD), and the total DLQI score was 7.85 ± 5.04 (Mean ± SD). For validity analysis, the correlation coefficient between RosaQoL and DLQI was calculated as r=0.411 (p

To compare the effectiveness of long-pulsed alexandrite laser (LPAL) with that of pulsed-dye laser (PDL) for rosacea.This was a single-blind randomized controlled trial on 27 patients who were clinically diagnosed with rosacea. Randomly assigned split face in each patient received four times monthly treatment of LPAL plus low-fluence Nd:YAG with the contralateral side serving as the control treated with PDL. At every visit, the erythema index (EI) was measured with skin analysis systems, and two independent dermatologists evaluated digital photographs for five-point global aesthetic improvement scale (GAIS).The EI significantly decreased on both treated sides (LPAL 366.5 ± 101.0 vs. 295.8 ± 90.2, p 0.001, PDL 369.0 ± 124.3 vs. 302.7 ± 92.1, p 0.001) 1 month after fourth treatment (visit 5). Also 3 months after the fourth treatment (visit 6), the reduction in the EI was well maintained on both sides (LPAL 360.3 ± 96.8 vs. 282.0 ± 89.2, p 0.001, PDL 364.3 ± 121.6 vs. 281.6 ± 97.8, p 0.001). When comparing the improvement in the EI between the two groups, the percentage reduction in the EI on the LPAL-treated side was not inferior to the PDL-treated side (visit 5: LPAL 18.7 ± 15.7% vs. PDL 16.4 ± 12.9%, p = 0.501 and visit 6: LPAL 21.7 ± 13.9% vs. PDL 21.9 ± 15.2%, p = 0.943). The GAIS and patient satisfaction were comparable between the LPAL and PDL sides and did not show any significant difference. No serious adverse events occurred on either of the treated sides.This study showed that the decrease in EI in the treatment of rosacea was comparable between PDL and LPAL. Therefore, LPAL could be a promising alternative treatment option with good merits for rosacea, considering no consumables are required for device maintenance.

Rosacea is a chronic inflammatory skin disease of unknown pathogenesis. TWEAK and TRAIL are two cytokines thought to have a role in the pathogenesis of some inflammatory and autoimmune diseases.The purpose of this study was to examine TWEAK and TRAIL serum levels and oxidative stress markers in patients with rosacea.Forty rosacea patients and 40 sex- and age-matched healthy controls were involved in the study. Serum TWEAK and TRAIL levels were evaluated with ELISA kits. Serum total antioxidant status, total oxidant status, total thiol, native thiol, disulfide levels were evaluated, and oxidative stress index was computed.Serum levels of TWEAK, TRAIL, and oxidative stress markers did not differ statistically in the patients and controls. Both TWEAK and TRAIL levels in the patients were detected to be statistically higher in male than in female.TWEAK and TRAIL may not have a systemic effect in rosacea, unlike other inflammatory diseases. More studies are needed to investigate the role of TWEAK and TRAIL in rosacea.

Histoplasmosis is a dimorphic fungal infection, which is rare outside endemic pockets in North, Central, and South America, Asia, and Africa. Herein, we describe a woman in her 80s living in the Scottish Borders region of the United Kingdom with a recent diagnosis of granulomatous rosacea, who on receiving escalating immunosuppression for suspected sarcoidosis, and long-standing rheumatoid arthritis developed a striking eruption involving her eyelids along with painful ulceration of the oral and nasal mucosa. Histopathologic examination of the skin and mucosal lesions demonstrated granulomatous inflammation with numerous yeast forms of fungal organisms with morphological characteristics of Histoplasma species. This was confirmed to be H. capsulatum on fungal culture and direct panfungal polymerase chain reaction assay. Although the patient had not left the United Kingdom for more than 20 years, she gave a travel history involving multiple trips to countries where histoplasmosis is known to occur, before that. This case exemplifies the challenges involved in making a diagnosis of histoplasmosis in nonendemic regions for both clinicians and pathologists alike. In this particular patient, the diagnostic difficulties were compounded by the clinicopathological overlap with other cutaneous and systemic granulomatous disorders like granulomatous rosacea and suspected sarcoidosis and also the exceptionally long latency period between the purported historical primary infection and recent recrudescence. We highlight this unusual case to increase an awareness of histoplasmosis, which is very rare in nonendemic regions like the United Kingdom and involves cases acquired during residence in or travel to endemic areas, to ensure its prompt recognition and treatment.

The genital skin may be affected by a variety of dermatoses, be it inflammatory, infectious, malignant, idiopathic, or others. The red scrotum syndrome is characterized by persistent erythema of the scrotum associated with a burning sensation, hyperalgesia, and itching. Its cause is unknown, but proposed mechanisms include rebound vasodilation after prolonged topical corticosteroid use and localized erythromelalgia. The condition is chronic, and treatment is often difficult. Here we review the etiology, the physical and histopathologic findings, and the management of this condition. We also describe related conditions such as red scalp syndrome, red ear syndrome, and red vulva syndrome. Finally, we summarize the different cases reported in the literature and discuss the features that help in the differentiation of red scrotum syndrome from its mimickers.

This case report describes a boy who presented to the hospital with worsening facial rash and fevers. He had previously been prescribed mometasone cream for rosacea, which his mother applied daily for about 45 days. After a biopsy was performed, he was diagnosed with acneiform dermatitis likely secondary to topical corticosteroid use complicated by demodex folliculitis and a superimposed bacterial infection.

Frontal fibrosing alopecia (FFA) is a progressive frontotemporal hairline recession with eyebrow loss. Facial papules are present in up to 14% of FFA cases and can start with facial flushes. Nevertheless, these flushes are commonly associated with rosacea, a much more prevalent disease. In this case, a woman with FFA had, at first, clinical and histopathological findings of rosacea and was treated with ivermectin 1% cream with no improvement. She returned reporting new papules in the frontal region, reaching the frontotemporal hairline. Trichoscopy of the scalp showed mild perifollicular erythema and follicular scale. The new skin biopsy was compatible with FFA, and oral finasteride (5 mg/day) and hydroxychloroquine were introduced to stabilise the disease.

Die vorliegende aktualisierte und auf S2k-Niveau angehobene Leitlinie befasst sich mit der Diagnostik und der Therapie der Rosazea, bei welcher es sich um eine häufige, chronisch-entzündliche Hauterkrankung handelt, die meist das Gesicht betrifft. Der Verlauf der Rosazea ist initial durch rezidivierende Erytheme, Teleangiektasien sowie Flushing gekennzeichnet. Später überwiegt die entzündliche Komponente, wobei es zu persistierenden Erythemen mit follikulären Papeln, Papulopusteln und Pusteln kommt. Die Bildung von Phymen, die meist an den Akren auftreten, stellt dabei die schwerste Ausprägung der Erkrankung dar. Zur Behandlung empfiehlt die interdisziplinäre Leitlinienkommission, die aus Vertretern der Deutschen Dermatologischen Gesellschaft (DDG), des Berufsverbandes der Deutschen Dermatologen (BVDD), der Deutschen Ophthalmologischen Gesellschaft (DOG), der Gesellschaft für Dermopharmazie (GD), der Schweizerischen Gesellschaft für Dermatologie und Venerologie (SGDV) und der Deutschen Rosazea Hilfe e. V. besteht, neben der Meidung von Triggerfaktoren, die topische Anwendung der Wirkstoffe Metronidazol, Azelainsäure oder Ivermectin. Zur symptomatischen Behandlung persistierender zentrofazialer Erytheme können zudem die Vasokonstriktoren Brimonidin oder Oxymetazolin topisch angewandt werden. Bei therapieresistenten sowie bei schweren Formen der Rosacea papulopustulosa wird eine systemische Therapie empfohlen. Hierfür ist niedrigdosiertes Doxycyclin das Präparat der 1. Wahl. Alternativ kann niedrigdosiertes Isotretinoin empfohlen werden. Für die okulären Rosazea kann neben einer Lidrandhygiene die topische Behandlung mit Ciclosporin-haltigen Augentropfen, Azithromycin, Ivermectin oder Metronidazol empfohlen werden.

Rosacea is a chronic inflammatory skin condition of varying severity that can significantly impact patient quality of life. Intense pulsed light (IPL) is an established treatment for rosacea-associated telangiectasia, inflammation, and erythema. This study assessed whether application of a phyto-corrective mask, gel, and resveratrol antioxidant serum after IPL treatment can improve outcomes and reduce procedure-related adverse effects.In a prospective, open-label, split-face, 3-month study, 10 subjects with moderate-to-severe facial rosacea underwent IPL treatment on both sides of the face. The following were applied to the right side of the face only: phyto-corrective mask once weekly starting immediately after IPL; phyto-corrective gel twice daily; and resveratrol antioxidant treatment at night. Both sides of the face were treated with sunscreen. Subjects were assessed on Day 1, 1 and 3 months after IPL by three, independent evaluators using the 5-point Global Aesthetic Improvement Scale (GAIS). All subjects rated skin redness, hydration, and overall improvement on Day 1 and completed a patient satisfaction questionnaire at the 1- and 3-month visits.Ten women were enrolled, aged 44-72 years old, with moderate (n = 6) to severe (n = 4) rosacea. IPL was effective at reducing symptoms with rosacea classified as absent in five women and mild in five at the final 3-month visit. GAIS scores also revealed improvements on both sides of the face, but the skincare treated side showed continuous improvement over 3 months with all patients remaining at least "Improved", whereas there appeared to be a waning effect after 1 month with IPL alone. On Day 1 after IPL, all women reported less redness, improved hydration, and improved skin appearance on the right side of the face. Patient satisfaction was consistently rated higher on the right side of the face.Application of a phyto-corrective mask, gel, and resveratrol antioxidant serum may complement IPL treatment for rosacea by enhancing treatment outcomes and reducing procedure-related symptoms.

Objectives/Aims Rosacea is not only a skin condition but a systemic inflammatory disease that includes chronic inflammation, vascular alterations, and autoimmunity in pathogenesis. We aimed to evaluate the presence of a sensorineural hearing loss in the patients with rosacea in comparison with the healthy control group and, also to compare the audiometric results according to the severity of disease among the patient group. Methods Fifty-three patients with erythematelangiectatic or papulopustular type of rosacea and 105 age- and sex-matched healthy controls were included. Each participant had audiometric measurements after a complete ear-nose-throat examination by the same otorhinolaryngologist. Results The results of air and bone conduction thresholds showed statistically significant differences in particularly high frequencies between the groups in both the right and left ear (for all p < 0.05), but there was no correlation between audiometric measurements and the severity or the type of rosacea (p > 0.05). Conclusions Regardless of disease severity or type, rosacea patients are likely to have sensorineural hearing loss, and it is important to refer these patients in the early period.

Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea.Retrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019.A total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7years). At least 1 positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mix II (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mix II, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mix I in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications-notably corticosteroids and antifungal agents.We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications.

Antibiotic resistance is a growing health concern that has attracted increasing attention from clinicians and scientists in recent years. Although resistance is an inevitable consequence of bacterial evolution and natural selection, misuse and overuse of antibiotics play a significant role in its acceleration. Antibiotics are the mainstay of therapy for common dermatoses, including acne and rosacea, as well as for skin and soft tissue infections. Therefore, it is critical for dermatologists and physicians across all disciplines to identify, appropriately manage, and prevent cases of antibiotic resistance. This review explores dermatologic conditions in which the development of antibiotic resistance is a risk and discusses mechanisms underlying the development of resistance. We discuss disease-specific strategies for overcoming resistant strains and improving antimicrobial stewardship along with recent advances in the development of novel approaches to counter antibiotic resistance.

Rosacea and demodicosis are common facial conditions in dermatology practice. While demodicosis is clearly the result of Demodex mite infestation, the pathogenicity of rosacea is still not sufficiently explained, so that it is defined by its symptoms, and not by its cause. It is usually considered as a disease of the immune system associated with neurogenic inflammation triggered by various factors (ultraviolet light, heat, spicy food, alcohol, stress and microorganisms). Its links with demodicosis remain controversial, although there is increasing evidence that Demodex mites may play a key role in the inflammatory process. Indeed, high Demodex densities are observed in nearly all cases of rosacea with papulopustules (PPR) and the papulopustules of rosacea can be effectively treated with topical acaricidal agents. Recent studies suggest that Demodex induces two opposite actions on host immunity: a defensive immune response aimed at eliminating the mite and an immunosuppressive action aimed at favouring its own proliferation. Moreover, the initial defensive immune response is likely diverted towards benefit for the mite, via T-cell exhaustion induced by the immunosuppressive properties of vascular endothelial growth factor, which may also explain the favourable influence that the altered vascular background of rosacea seems to exert on Demodex proliferation. In this review, the evidence for and against a causal role of Demodex in rosacea is discussed, applying three systems traditionally used to attribute causality to a disease (modified Koch criteria, Hill criteria for causality and Rothman model). The findings suggest that PPR can reasonably be attributed to Demodex proliferation, which appears to be a necessary factor in the centre of a causal network in which multiple co-factors interact and influence the occurrence and severity of inflammatory symptoms, from limited (pityriasis folliculorum) to more marked (PPR). PPR could, therefore, be considered as a chronic infection by Demodex mites with associated T-cell exhaustion.

Botulin toxin (BTX) is a potent neurotoxin produced by the bacterium Clostridium botulinum, since its approval by FDA in 2002 for cosmetic purpose has been widely used. Recent studies indicate that it exerts its activity on various type of skin cells and can be used in some dermatological disease.The aim of the study was to demonstrate how to use a peculiar dilution of botulinum toxin type A in the treatment of some dermatological disease like mild-to-moderate acne vulgaris and erythematotelangiectatic rosacea.50 patients were enrolled, 35 with mild-to-moderate acne and 15 with erythematotelangiectatic rosacea. Both group of patients were treated with a specific dilution of Onabotulinum toxin A called Microbotox. Patient images were taken before and 4 weeks after the treatment.The authors and patients were extremely satisfied with their treatments. There were no immediate or delayed complication in none of both group of patients.Botulinum toxin shows a great promise either in dermatological disease like mild-to-moderate acne vulgaris and erythematotelangiectatic rosacea. Microbotox appears to be a valid, long-lasting, and a standardized approach to treat these kind of two disease.

Ocular rosacea is a chronic potentially sight-threatening inflammatory condition, which can occur in approximately 20% of patients without skin involvement. However, an accurate diagnosis of ocular rosacea has not been defined yet due to its rather nonspecific symptoms and clinical findings. Therefore, this article updates the current recommendations for diagnosis and treatment of ocular rosacea and the previously published consensus recommendations from the ROSCO expert panel on the management of rosacea.

As the global multiracial population grows, this case series highlights the current underdiagnosis and misdiagnosis of ocular and oculocutaneous rosacea and the importance of properly identifying the condition in a darkly pigmented pediatric population.This series aims to report the clinical presentation of ocular and oculocutaneous rosacea and adverse sequelae of misdiagnosis in two pediatric African American patients.One 11-year-old boy and one 10-year-old girl, both darkly pigmented African American patients, presented with a history of chronic ocular irritation. The male patient was seen by an eye care provider eight times over the past 7 years for recurrent anterior ocular inflammation. The female patient presented to the clinic with chronic anterior segment ocular inflammation for 1 year. Both patients were previously treated for their acute signs and symptoms. The male patient was diagnosed with ocular rosacea, and the female patient was diagnosed with oculocutaneous rosacea. Both patients were subsequently treated for their underlying inflammatory condition, yielding an improvement in their ocular health.These two cases bring attention to the underdiagnosis and misdiagnosis of ocular and oculocutaneous rosacea in pediatric patients with darkly pigmented skin. Timely and accurate diagnosis is critical to minimize the risk of significant visual and dermatological sequelae.

Rosacea is associated with several comorbidities, but its relationship with psychiatric disorders remains controversial. We aimed to investigate the association of rosacea with depression and anxiety.A systematic review was performed of relevant observational studies in the PubMed, Web of Science, Embase, and Wanfang databases from inception to June 8, 2021. The inclusion criteria for eligible studies were observational studies comparing the incidence or prevalence of depression or anxiety between patients with rosacea and individuals without rosacea. We conducted meta-analyses with a random-effects model. The main outcome was pooled analysis of prevalence or incidence of depression and anxiety in patients with rosacea.We included nine studies with 101,114,209 patients with rosacea. A pooled analysis from cross-sectional and case-control studies revealed that patients with rosacea were significantly more likely to have depression (crude odds ratio [OR], 2.855; 95% confidence interval [CI], 1.258-6.481) and anxiety (crude OR, 2.373; 95% CI, 1.448-3.888) than matched controls; however, adjusted ORs showed no significant association. Furthermore, the meta-analysis from cohort studies indicated that patients with rosacea have significantly higher risks of developing depression (adjusted incidence rate ratio [IRR], 2.443; 95% CI, 1.603-3.723) and anxiety (adjusted IRR, 2.181; 95% CI, 1.660-2.864).Data for a subgroup analysis based on different demographic factors were insufficient.Current findings provide more evidence that rosacea is significantly associated with depression and anxiety, and rosacea may predispose patients to develop depression and anxiety. Clinicians should be aware of the psychological aspects of rosacea.

Mining activities are a current environmental issue due to heavy metal release and subsequent metal uptake by organisms. In this study, we quantified the concentrations of essential (Cu, Zn) and toxic (Cd, Pb) elements in the muscle of 248 leopard groupers, Mycteroperca rosacea, captured by spearfishing and free diving close to a mining district in the Gulf of California during 2014-2015. We analysed metals using high-resolution inductively coupled plasma source mass spectrometry (HR-ICP-MS). We analysed metal concentrations by fish size, sex, maturity, season, year and risk factor for human consumption. The results indicated common levels of essential elements (Cu: 11 ± 34.3 μg/g, Zn: 377 ± 1390 μg/g) in comparison with toxic elements (Cd: 0.06 ± 0.1 μg/g, Pb: 0.98 ± 1.5 μg/g). Cadmium was within the permissible limit of Mexican standards (0.5 μg/g), but lead content bordered its limit (1.0 μg/g). Heavy metal concentrations were comparable between males and females. Metal variations were not significantly correlated with sex, maturity, season or year (p 0.05). The evaluation of benefits (daily mineral intake) and risks (target hazard quotients) to health indicated that these fish did not represent a risk of adverse effects to consumers within worldwide limits, while the nutritional benefits were high.

Timolol, a non-selective β-adrenergic receptor blocker, is well-tolerated and is becoming increasingly popular in dermatology especially after its use in the management of infantile hemangiomas. Its effects are mainly due to vasoconstriction, inhibition of angiogenesis and keratinocyte migration promotion for re-epithelialization and wound healing. We review the evidence behind the use of timolol in several dermatological conditions including infantile hemangiomas, pyogenic granulomas, Kaposi's sarcoma, chronic wound healing, post-surgical wounds, acne vulgaris, rosacea, eczema and red scrotum syndrome.

Demodex mites have been implicated in several cutaneous disorders compelling the research efforts for effective anti-Demodex therapy.Compare the survival time (ST) of Demodex folliculorum exposed to six different concentrations of tea tree oil (TTO) versus a positive control (permethrin 5%) and a negative control (immersion oil) group.The wastes of rosacea patients' standardized superficial skin biopsy samples were recruited for the trial. The primary outcome measure of this study was the survival time, defined as the period between the exposure of study agents to the complete cessation of Demodex movements.All differences between the mean survival times of 2.5% (54.0 ± 6.1), 5% (39.0 ± 3.9), 10% (22.0 ± 2.5), 25% (13.0 ± 2.5), 50% (7.8 ± 0.6), and 100% TTO (3.3 ± 1.3) were significant (p 0.05). The ST of the negative control group was 196.0 ± 23.6 min. The ST of permethrin 5% was 12.5 ± 1.9 that did not show a statistically significant difference from the ST of TTO 25% (p = 0.628).The survival times of the six different TTO groups confirmed a dose-related pattern, all of which had survival times shorter than the negative control (immersion oil). TTO 25% had comparable efficacy to the positive control agent (permethrin 5%).

Background: The symptoms of ocular rosacea are often non-specific and there is no dependable diagnostic test for the disease, which may cause difficulties in diagnostics. The aim of this study was to examine the association between clinical findings of rosacea and self-reported ocular symptoms in a general population of middle-aged subjects. Methods: A clinical whole-body examination by a dermatologist was performed for 1,932 subjects belonging to the Northern Finland Birth Cohort 1966 Study. The presence of ocular symptoms was self-reported. The difference between rosacea and ocular symptoms was tested. Logistic regression analysis was used to identify associations between rosacea and ocular symptoms. Results: The prevalence of rosacea was 15.1% (n = 292); in the subjects with rosacea, erythematoteleangiectatic rosacea was found in 83.2% (n = 242), papulopustular in 15.4% (n = 45), ocular in 0.03% (n = 1), and phymatic in 0.1% (n = 3). Ocular symptoms in rosacea subjects were common, with dryness (32.3%), tearing (29.4%), foreign-body sensation (21.8%), and photophobia (20.5%) being the most common ones. Foreign-body sensation was reported significantly more often in those with rosacea compared to those without (p < 0.04). In logistic regression analyses, after adjusting, the subjects with rosacea had a 1.5-fold increased risk for decreased visual acuity in the dark (OR 1.48, 95% CI 1.01–2.14) compared to those without rosacea. Conclusion: Eye symptoms are common in subjects with rosacea. All patients with rosacea should be asked about ocular symptoms and both skin and eyelids should be examined even if the cutaneous findings are mild.

Introduction: Rosacea is a chronic inflammatory skin disease with symptoms like flushing, telangiectasia, papules, pustules, and persistent erythema. Treatment options include self-care, skin care, and endorsed medicines or light and laser therapy. This study investigates the efficacy of intradermal injection of botulinum toxin in treating facial erythema in rosacea patients. Methods: This randomized single-blinded controlled trial investigated the effectiveness of intradermal botulinum toxin injections in treating facial erythema in 23 rosacea patients aged 18-55 from Damascus Hospital of Dermatology. The right cheek received 10 Units of Botulinum toxin (BTX), while the left cheek received normal saline (NS). Patients were evaluated using the Clinician Erythema Assessment (CEA), Global Aesthetic Improvement Scale (GIAS) and Patient Satisfaction Scale (PSS) for 12 weeks. Statistical analysis was performed using different suitable statistical methods. Results: The study involved 23 patients with type 1 rosacea, mostly females and married, with a median age of 40.43. Improvement in CEA and GAIS was observed in both cheeks during subsequent visits, with no significant difference between the two cheeks. Patients reported positive effects throughout the study, which increased from 59.26% in the first visit to 70.37% in the last visit. Patient satisfaction increased from 56.5% to 73.9% between the first and last visits. Side effects were observed in some patients during the study, but there were no serious adverse events. Conclusion: Rosacea is a challenging condition to treat, and current options can be limited and costly. This study found that BTX and normal saline had a similar effect on facial erythema, and aesthetic benefits suggesting micro-needling may have greater impact on rosacea patients. Furthermore, micro-needling treatment, which has been effective in treating various dermatological conditions, can also be utilized as a treatment option for rosacea patients. Micro-needling may be a low-cost alternative to BTX.

OBJECTIVE: Skincare is a part of rosacea treatment; patients benefit from complementary dermo-cosmetic care as well as medical treatments. Some skincare habits are known to trigger and exacerbate rosacea, but there are very few epidemiological studies on this matter. METHODS: A total of 200 people, including 100 patients with rosacea and 100 controls, were included in the study. We questioned the methods used by the participants in daily facial cleansing. Sun and heat exposure, makeup habits, the history of the use of topical steroids, and outdoor working status were noted. A dermoscopic examination, a non-invasive and valuable method to evaluate the presence and severity of Demodex, was performed. RESULTS: We evaluated 30% of our rosacea patients as erythematotelangiectatic rosacea and 13% as papulopustular rosacea and 57% of our patients had mixed type which could not be distinguished from one of these subtypes. In the case group, the proportion of people who used daily facial cleansers and daily soaps was lower than in the control group, while the proportion of those who cleaned their face with only water and those who used facial cleansers less frequently was higher. (p, AMAÇ: Cilt bakımı, rosacea tedavisinin bir parçasıdır; hastalar medikal tedavilerin yanı sıra tamamlayıcı dermo-kozmetik bakımlardan da yararlanmaktadır. Bazı cilt bakımı alışkanlıklarının rosacea'yı tetiklediği ve şiddetlendirdiği bilinmektedir ancak bu konuda çok az sayıda epidemiyolojik çalışma bulunmaktadır. YÖNTEMLER: Çalışmaya 100 rosacealı hasta ve 100 kontrol olmak üzere toplam 200 kişi dahil edildi. Katılımcıların günlük yüz temizliğinde kullandıkları yöntemleri sorguladık. Güneşe ve sıcağa maruz kalma, makyaj alışkanlıkları, topikal steroid kullanım öyküsü ve açık havada çalışma durumu not edildi. Demodex'in varlığını ve ciddiyetini değerlendirmek için non-invaziv ve geçerli bir yöntem olan dermoskopik inceleme yapıldı. SONUÇLAR: Rosacea hastalarımızın %30'unu eritematelenjiektatik tip rozasea, %13'ünü papülopüstüler rozasea olarak değerlendirdik ve hastalarımızın %57'sinde bu alt tiplerin birbirinden ayırt edilemediği miks tip vardı. Vaka grubunda günlük yüz temizleyici ve günlük sabun kullananların oranı kontrol grubuna göre daha düşükken, yüzünü sadece su ile temizleyenlerin ve yüz temizleyicileri daha az kullananların oranı daha yüksekti. (p

ObjectiveTo evaluate tear functions and Meibomian glands’status in patients with cutaneous rosacea.Material and MethodsRight eyes of 38 patients with cutaneous rosacea(study group) and 30 healthy volunteers (controlgroup) were evaluated. After Ocular Surface DiseaseIndex (OSDI) score was calculated, tear osmolarityand tear break-up time (T-BUT) were measured, andthe Schirmer test was applied respectively. Meibomianglands in the lower and upper eyelids were evaluatedby meibography using the Sirius anterior segmentanalysis system.ResultsNo statistically significant difference was detectedbetween the groups in respect of age and gender(p>0.05). No statistically significant difference wasdetermined between the groups in respect of theOSDI score, tear osmolarity, and Schirmer test values(p>0.05 for all). The T-BUT values of the study groupwere detected to be significantly shorter than thoseof the control group (p, AmaçCilt rozaseası olan hastalarda gözyaşı fonksiyonlarınıve Meibomian bezlerin durumunu değerlendirmek.Gereç ve YöntemCilt rozaseası olan 38 hasta (çalışma grubu) ile 30sağlıklı gönüllü bireyin (kontrol grubu) sağ gözlerideğerlendirildi. Oküler yüzey hastalık indeksi (OSDI)skoru hesaplandıktan sonra sırasıyla gözyaşı ozmolaritelerive gözyaşı kırılma zamanları (T-BUT) ölçülüpve Schirmer testi yapıldı. Alt ve üst kapaktaki meibomianbezler Sirius ön segment analiz sistemi ile meibografiyapılarak değerlendirildi.BulgularGruplar arasında yaş ve cinsiyet açısından istatistikselolarak anlamlı fark saptanmadı (p>0.05). OSDIskoru, gözyaşı ozmolaritesi ve Schirmer değerleriaçısından gruplar arasında istatistiksel olarak anlamlıfark saptanmadı (tümü için p>0.05). Çalışma grubununT-BUT değerlerinin kontrol grubuna göre anlamlıolarak daha kısa olduğu tespit edildi (p

A 43-year-old female zoologist has an occupational dermatomycosis of the face, neck and upper part of chest caused by T. mentagrophytes. It was mistakenly diagnosed and treated as "Rosacea, papulopustular subtype, ocular rosacea" for 1.5 years. Symmetrical, atypical clinical manifestations with recurrent blepharoconjunctivitis developed as a result of self-treatment using a topical steroid. The detection of cicatrizing folliculitis in the eyebrow area and an arcual peripheral edge in fresh foci on the chest helped to suspect dermatomycosis. The definitive diagnosis was made after the detection of abundant coarse septate mycelium during microscopic investigation of skin scales from foci on the face and chest with 30% KOH and an abundant growth of Trichophyton mentagrophytes during a cultural research study of skin scales, eyebrow hair and eyelashes from lesions. The use of terbinafine for 4 weeks led to the recovery of the patient.

The plethora of pharmacologic treatments used for periorificial dermatitis (POD) makes clinical decision-making challenging. The objectives of this review were to assess the efficacy and safety of pharmacological interventions for POD in children and adults. The search was performed on 2 February 2021 and included seven databases and trial registries, with no date or language restrictions Study selection, data extraction and risk of bias assessments were performed independently and in duplicate by two authors, in accordance with a prespecified protocol. Meta-analyses were performed and reported in accordance with PRISMA guidelines. Where meta-analysis was not possible, a narrative synthesis was performed and reported in accordance with SWiM guidelines. The certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. Eleven studies representing 733 participants were included. Oral tetracycline may improve physician-reported severity of POD from day 20 onwards (low certainty evidence). Adverse effects may include abdominal discomfort, facial dryness and pruritus. Pimecrolimus cream may improve physician-reported severity slightly after 4 weeks of treatment (MD -0.49, 95% CI -1.02 to 0.04, n = 164, low certainty evidence). Adverse effects may include erythema, herpes simplex virus infection, burning and pruritus. Azelaic acid gel may result in no change in either physician- or patient-reported severity after 6 weeks of treatment. The evidence is very uncertain about the effect of praziquantel ointment on physician-reported severity and skin-related quality of life after 4 weeks of treatment. The evidence is also very uncertain about the effect of topical clindamycin/benzoyl peroxide on physician-reported severity. The body of evidence to inform treatment of POD currently consists of low and very low certainty evidence for important outcomes. Well-designed trials are needed to further investigate treatment options. Data are required for children and from low-middle income countries to improve external validity. Future trials should also include adequate post-treatment follow-up and standardized outcome measures.

Topical metronidazole is not currently approved in Japan as a treatment for the indication of rosacea, although 0.75% metronidazole gel was authorized in 2014 for the management of cancerous skin ulcers. We conducted a randomized, double-blind, vehicle-controlled study to evaluate the efficacy and safety of 0.75% metronidazole gel in Japanese patients with inflammatory lesions (papules/pustules) and erythema associated with moderate to severe rosacea. Overall, 130 patients were randomly assigned to receive 0.75% metronidazole gel (n = 65) or vehicle (n = 65), and 120 patients completed 12 weeks of treatment. The primary efficacy outcome was the proportion of patients who achieved both of the following at week 12: an improvement of >50% in the number of inflammatory lesions (papules/pustules) and a positive change of at least one degree in erythema severity. This composite outcome was achieved by 72.3% of metronidazole-treated patients versus 36.9% of vehicle-treated patients, with the between-group difference demonstrating significant improvement with 0.75% metronidazole gel (p

Objectives: To report the most frequent signs in ocular rosacea and evaluate their association with skin findings. Materials and Methods: Fifty-one patients diagnosed with rosacea by a trained dermatologist were evaluated by an ocular surface specialist. A complete ophthalmological examination was performed. Results: In our study, the prevalence of ocular signs in patients with rosacea was 74.5%. The average age at presentation was 50 years and women were more affected than men. The most common findings were lid margin erythema, meibomian gland dysfunction, and blepharitis. Fifteen patients had decreased visual acuity due to complications related to rosacea such as leukoma and corneal neovascularization. Interestingly, patients that had the lowest visual acuity presented with dermatological signs of papules and pustules (p=0.001) and rhinophyma (p=0.023). Two patients who showed subepithelial fibrosis and fornix foreshortening were diagnosed as having ocular cicatricial pemphigoid (OCP) by immunohistopathological analysis of conjunctival specimens. Conclusion: Ocular compromise is common in rosacea. Our study shows that there might be a relationship between the severity of ocular involvement and certain subtypes of cutaneous disease. Rosacea and OCP may coexist. In cases that present with conjunctival fibrotic changes, a diagnostic biopsy is mandatory.

Rosacea is difficult to treat. Therefore, new alternative modalities are necessary to demonstrate. The present study was conducted to assess the efficacy and safety of the combined therapy of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and intense pulsed light (IPL) for rosacea to provide a new treatment option for rosacea. The study was conducted from November 2017 to April 2019 at the Department of Dermatology, The First Hospital of China Medical University. Patients aged 18-65 years and diagnosed clinically as erythematotelangiectatic (ET) or papulopustular (PP) rosacea were enrolled. Three times of ALA-PDT at 10 days interval followed by 3 times of IPL at 3-4 weeks interval were defined as 1 session and applied to the whole face of each patient. ALA-PDT: 5% ALA, red light (fluency dose 60-100 mW/cm

Background Ocular rosacea is common and is often managed with long-term antibiotic treatment. Doxycycline is the most commonly selected antibiotic for the treatment of rosacea. As there is no established standard of care treatment dose for rosacea, prescribed doses of doxycycline vary widely. The FDA classifies 40 mg daily dose of doxycycline for ocular rosacea as sub-microbial in comparison to an antibiotic dose of 200 mg daily. However, this “sub-microbial” dose has never been evaluated in patients with ocular rosacea, and even the sub-microbial dose has potential to alter systemic mucosa flora. Here, we present a randomized controlled trial using RNA sequencing to fully characterize the impact of sub-microbial antibiotic dosing of doxycycline on antimicrobial resistance and bacterial composition of the ocular and gut flora. Methods In a triple-masked parallel randomized control trial, patients with ocular rosacea will be randomized to three arms: a 40-mg dose of doxycycline, a 200-mg antibiotic dose of doxycycline, or placebo. Collected rectal and lower eyelid samples will be compared for frequency of antimicrobial resistance genetic determinants and microbiome diversity. A subjective ocular surface disease index survey and objective tear breakup time measurement will be determined. Discussion These results will enhance our understanding of the overall systemic impact of long-term systemic sub-microbial antibiotic dosing for the treatment of chronic recurrent ocular inflammatory diseases. Trial registration This trial was registered on ClinicalTrials.org (NCT05296837) on March 22, 2022.

Demodex spp. mites are external obligate parasites; they are transmitted between hosts through direct contact, and may induce several dermatological symptoms when found in large numbers. However, these symptoms may be similar to other commonly known diseases; this often leads dermatologists to neglect the pathogenic role of these mites. Therefore, a better diagnosis is recommended in order to avoid mistreatment. The aim of this study was to investigate the correlation between Demodex mites and dermatological diseases. Infestation rates in patients suffering from acne, rosacea, folliculitis, and psoriasis were compared with asymptomatic patients, along with the mites’ relation to gender, age, personal hygiene, time of year, and residency. These mites were mainly found in patients with rosacea (66.67%) followed by acne (64.41%), while they were only observed in 48.15% of asymptomatic patients, 40.00% in folliculitis, and 0.00% in psoriasis. The statistical analysis showed a significant relationship between infestation and the previously mentioned dermatological diseases (P

Rosacea is a ubiquitous chronic inflammatory dermatosis that affects approximately 10% of the population worldwide. Skin manifestations can appear in diverse amalgamations and several degrees of intensity, with frequent spells of aggravation and regression. According to the National Rosacea Society (NRS), about 16 million Americans were affected by rosacea in 2021. Rosacea has been linked to immune system dysregulation and alterations in the neurological and vascular systems. The primary treatment paradigm for rosacea encompasses local and systemic therapies, as well as lasers. However, no exclusive treatment for rosacea is entirely remedial. Innumerable therapies have been considered till date, all of which provide wavering alleviation of the clinical condition. Recent advancements in combination treatments have resulted in therapeutics that has more robust inceptive outcomes and protracted sustenance than those previously available. Severity evaluation, exact subtype identification, and personalized therapy to meet the patient’s needs are the primary keys to successful rosacea treatment. In this review, compendious discussion is made on rosacea, and the currently available as well as emerging treatments for the management of rosacea.

Azelaic acid (AZA) is a white crystalline dicarboxylic acid naturally found in grains, rye, and barley. AZA has substantial biological and therapeutic abilities (viz a viz) its anti-inflammatory, anti-oxidant, anti-keratinizing, anti-microbial properties, etc., which contribute to its applicability in the management of mild to harsh dermatological complications (acne, rosacea, dermatitis, hyper-pigmentation, carcinomas, etc.). AZA has shown its effectiveness against varied non-inflammatory and inflammatory lesions by normalizing hyper-keratinization state and attenuating the increased levels of microbial content. Topically AZA, either alone or in conjunction with other active moieties, has proved to effectively prevent acne and several other hyper-pigmentary conditions. Chronic applicability of AZA has been evidenced with the effects like itching, burning, stinging, redness, etc. To deal with the former issues, research is being conducted to substitute the conventional formulations with novel preparations (liposome’s, niosomes, micro sponges, lipid nanocarriers, etc.), which could enhance the overall pharmaceutical and pharmacological profile of the drug. This article is an attempt to highlight the basic physiochemical properties of AZA, its physiological role (especially in dermatology), various commercial preparations and recent novel approaches that are in research with an aim to augment the therapeutic and safety profile of AZA.

Background The aim of this study was to describe an ultra-rush (UR) protocol of Raw Golden Apple (RGA) in 28 patients with Oral Allergy Syndrome (OAS) which resulted in avoidance of raw rosaceaes fruits, in order to demonstrate the safety of the protocol and follow-up of patients at 2 months and 1 year. Methods The UR protocol was administered with RGA in a daycare hospital starting with 1 gram (g) of RGA, then by regularly doubling the dose until 128 g, to reach a 255 g cumulative dose in a 3-hours’ period. During the post-hospitalization period, patients had to eat half of a RGA a day during one month, then 1 RGA a day during one month. An assessment consultation was performed at two months follow-up and a telephone interview at one year. Results Duration of OAS to raw rosacea ranged from 6 months to 20 years. All 28 patients received the 255 g cumulative dose. Tolerance was very good in 25 of the 28 patients. No major allergic incident was recorded. After two months, all the patients were eating a RGA. After one year, 21 patients continued eating all types of raw rosacea fruits. Conclusion This study shows that resumption of RGA intake by patients with OAS to raw rosacea fruits, part of a cross-allergy with birch pollen is possible within 3 hours’ after use of an UR protocol. This protocol is simple, safe and easy to administer. Follow-up at 2 months and at one year was positive.

Natalia Kirsten, Nicole Mohr, Matthias Augustin Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, GermanyCorrespondence: Natalia KirstenInstitute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, 20246, GermanyTel +49-40-7410-55428Fax +49-40-7410-5348Email n.kirsten@uke.dePurpose: Although acne vulgaris (AV) is a common disease and can persist into adulthood, there are few large-scale epidemiological studies on the prevalence of acne vulgaris in adults. The aim of our study was to characterise the epidemiology and comorbidity of acne vulgaris in working adults in Germany.Patients and Methods: Within the framework of a cross-sectional study, a total of 161,269 employees underwent dermatological whole-body examinations in more than 500 German companies between 2001 and 2016. Point prevalence rates for acne vulgaris and further skin diseases and their 95% confidence intervals were calculated and differences between participants with and without acne vulgaris were tested with chi-squared tests.Results: Mean age was 43.2 years ± 10.9, 55.5% were male. In total, n = 5311 people (3.3%) with acne vulgaris were identified. Prevalence decreased by age. Controlling for age and gender, acne was significantly associated with folliculitis (OR = 1.91; CI: 1.76– 2.07), contact dermatitis (OR = 1.74; CI: 1.08– 2.81), rosacea (OR = 1.74; CI: 1.40– 2.15), pyoderma (OR = 1.58; 1.22– 2.06), seborrheic dermatitis (OR = 1.47; CI: 1.27– 1.71), hand eczema (OR = 1.34; CI: 1.00– 1.76), verruca vulgaris plantaris (OR = 1.29; CI: 1.09– 1.51), tinea pedis (OR = 1.27; CI: 1.10– 1.47), spider veins (OR = 1.26; CI: 1.16– 1.38) and telangiectasia (OR = 1.15; CI: 1.02– 1.30).Conclusion: These data underline the importance of acne vulgaris in the adult population. Further studies to better understand the pathophysiology of AV and its comorbidity in different phases of adulthood would be desirable to develop appropriate guidelines and therapy concepts.Keywords: acne vulgaris, comorbidities, epidemiology, inflammation

Rosacea is a common skin disorder that predominately affects fair skin people. More then10 million cases per year are found in the India. It usually presents with erythema, telangiectasia, and papulo-pustular lesions on the cheeks chin and central forehead and usually triggered by sun exposure. It is generally affects facial skin and less commonly may involve the neck and chest, it may also happen at non-facial sites. It has characterized in its early on phases by erythema (flushing and redness) on the central face and across the cheeks, nose or forehead. Rosacea is not mentioned specifically in any Ayurveda text. According to description of sign & symptoms of rosacea in modern science, it is resemble as a type of Pitta Dusht Raktaj Vyadhi according to Ayurveda science. Based on these signs and symptoms, according to Ayurveda Acharya this disease is caused by Pitta Dushta Rakta. Ayurveda also implements broad line of management of skin disorders like medicinal and para-surgical approach. Acharya Sushruta clearly mentioned that if all conservative management fails then the disease should consider as blood vitiated disease and Raktamokshana is to consider as choice of treatment. Keywords: Rosacea, Pitta Dusht Rakta, Vyadhi, Raktamokshana, para-surgical, erythema, Panchanimba Churna.

Background Rosacea is a chronic inflammatory skin disease that affects people's life quality. It has been found to be related to many detrimental factors including ultraviolet exposure. However, the association between alcohol consumption and rosacea has long been debated. Aims To elucidate this association, we conducted a systematic review and meta-analysis. Methods We performed a systematic search of the literature published before February 16, 2021 on PubMed, Embase, and the Cochrane database and used a meta-analytic approach to calculate the pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). Results Finally, 14 eligible studies were identified, and alcohol consumption was not found to be a risk factor for rosacea. However, in subgroup analysis, alcohol consumption increased the risk of phymatous rosacea (PhR) and the pooled OR was 4.17 (95% CI = 1.76-9.91). Conclusion Overall, our study showed that alcohol consumption was a risk factor in phymatous rosacea (PhR). More studies of rosacea investigating sex distribution, alcohol intake levels, and types of alcoholic beverages consumed are needed in the future.

Rosacea is a chronic inflammatory cutaneous disease that can be associated with cardiometabolic disorders. Oxidative stress is included in the pathogenesis of rosacea, and thiol-disulfide homeostasis (TDH) acts as antioxidants.To evaluate the TDH and metabolic parameters in patients with rosacea.A total of 42 rosacea patients and 50 controls participated in this prospective study. Demographic data, clinical entities, anthropometric measurements, and laboratory findings were recorded. Additionally, TDH was measured by an automated spectrophotometric method.Rosacea patients had greater body mass index values (27.9 ± 5.2 kg/m² vs. 23 ± 1.4 kg/m², p 0.001), waist-hip ratios (0.87 ± 0.1 vs. 0.77 ± 0.8, p 0.001), and insulin resistance (3.0 ± 2.0 vs. 1.3 ± 0.5, p 0.001) compared with controls. Disulfide levels, the disulfide/native thiol ratio (DNTR), and the disulfide/total thiol ratio (DTTR) were increased (p 0.05) in rosacea patients. Native thiol and total thiol levels and the native/total thiol ratio (NTTR) were decreased in rosacea patients (p 0.05). Different rosacea subtypes had no effect on oxidative stress markers. The duration of illness and insulin resistance values significantly correlated with DNTR and DTTR in the rosacea group (p 0.05).Rosacea has a metabolic milieu with increased oxidative stress and insulin resistance.

KlasJakub, Kluz Natalia, Piwowar Klaudia. Xylometazoline and oxymetazoline - unusual effects of everyday drugs (literature review).Journal of Education, Health and Sport. 2021;11(9):272-281. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.09.033 https://apcz.umk.pl/JEHS/article/view/JEHS.2021.11.09.033 https://zenodo.org/record/5515163 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.09.2021. Revised: 12.09.2021. Accepted: 18.09.2021. Xylometazoline and oxymetazoline - unusual effects of everyday drugs (literature review) Jakub Klas1, Natalia Kluz1, Klaudia Piwowar1 1Medical University of Lublin ORCID ID and E-mail: Jakub Klashttps://orcid.org/0000-0002-4795-1909jakubklas99@gmail.com Natalia Kluzhttps://orcid.org/0000-0002-5801-5913nataliakluz99@gmail.com Klaudia Piwowarhttps://orcid.org/0000-0001-8232-003Xklaudiaklaudia66@gmail.com Abstract The aim of the study is to systematize the knowledge about xylometazoline and oxymetazoline - commonly used nasal sprays with sympathicomimetic effect, mainly directly on α-adrenergic receptors [1]. A review of recent reports on possible side effects and new therapeutic options will be presented. Results: Over several years, reports have been published regarding descriptions of unusual cases of side effects, such as angina attack [4], a case of respiratory failure in a newborn [5], ischemic stroke [6], or anaphylactic reaction during routine surgery. In experiments using rats, on the other hand, it has been shown that these substances can also cause increased inflammation of the lower respiratory tract [7], as well as numerous ophthalmic problems [8]. Recent reports also suggest new uses for xylometazoline and oxymetazoline. In combination with lidocaine, an intranasal solution of xylometazoline has shown efficacy in the anesthesia of maxillary teeth in patients with minor carious lesions [9], and a beneficial therapeutic combination of oxymetazoline and dye laser (PDL) has also been reported for the treatment of rosacea, among others [10]. Conclusions: Although imidazoline derivatives were admitted to the drug list decades ago, still their pharmacological potential has not been fully exploited. Finding applications of these drugs in dermatology and dentistry may not only improve the efficacy and comfort of treatment, but also significantly reduce the costs of the whole therapy. The aforementioned reports on the side effects of xylometazoline and oxymetazoline should not be forgotten. It is possible that the presented examples will increase awareness to use these drugs with more respect, according to the recommendations on the leaflet. Key words : xylometazoline, oxymetazoline, rosacea, anesthesia dental

Background: To investigate the microbiome composition in individuals with and without rosacea and correlate findings to individual factors that may affect facial cutaneous and enteric microbiome composition. Methods: Participants with and without rosacea (as determined by a board-certified dermatologist) were surveyed regarding factors that may affect the facial cutaneous/enteric microbiome. Microbiome samples were collected, analyzed for 16S sequences, and mapped to an optimized version of existing databases. R was used to perform Mann-Whitney/Kruskal-Wallis test for categorical comparisons. Correlation between two continuous variables was determined with linear regression models. Primary Component Analysis (PCoA) plots employed Monte Carlo permutation test to estimate p-values. All p-values are adjusted for multiple comparisons with the false discovery rate (FDR algorithm) using Benjamini-Hochberg. Results: 84 individuals with rosacea and 44 controls were evaluated. Individuals with rosacea were more likely to currently own pets (p = 0.029) and consume more alcohol (p = 0.006). Absolute bacteria abundance were similar in facial cutaneous (p = 0.36) and enteral microbiome (p = 0.29). Facial cutaneous microbiome showed significantly decreased richness and evenness (OTU: p = 0.019; Shannon: p = 0.049) and a three to four-fold decrease in abundance of 8 distinct cutaneous bacterial genera in rosacea. Enteral microbiome analysis showed significant reduction in abundance of Ruminococcaceae (FDR = 0.002) and Blautia (FDR < 0.001) and increase in Prevotellaceae (FDR = 0.024) in rosacea. Conclusion: Environmental factors may alter relative abundances of specific microbial genera and lead to microbiome diversity. Further studies with increased sample sizes and higher severity cases may further elucidate the role of dysbiosis in rosacea.

Background: The prevalence and impact of pruritus, pain, and other sensory symptoms in skin diseases are poorly known. Objective: To assess the frequency of these symptoms with dermatoses and their association with depression using data from the “Objectifs Peau” survey. Methods: A representative sample of 20,012 French individuals was created using the usual quota method. Results: When patients suffered from both pruritus and skin pain, they had a higher relative risk of psychological suffering (2.9) than those who suffered only from pruritus (1.4) or skin pain (1.2). Pruritus was reported in 48.55% of patients with acne, 43.24% with mycoses, 44.35% with warts, and 36.51% with rosacea. For skin pain, the results were 11.22%, 27.59%, and 16.13% for atopic dermatitis, acne, and warts, respectively. Other unpleasant sensations, such as tingling or burning, were also frequently reported. Conclusion: Pruritus, pain, or other sensory symptoms were found to be common not only in classic pruritic skin diseases but also in acne, rosacea, or warts. The association of pruritus and pain dramatically increased psychological suffering. These symptoms must be systematically searched for in patients, especially since new therapeutic possibilities are emerging for the symptomatic treatment of pruritus.

BACKGROUND The dermoscopic findings of papulopustular rosacea include tiny papules and pustules, follicular plugs and follicular dilatation. Demodex tails and Demodex follicular openings are dermoscopic indicators that are mainly found in primary demodicosis and, less frequently, in rosacea. AIM To describe the dermoscopic features of papulopustular rosacea and to investigate the differential dermoscopic features between patients with and without concomitant Demodex infestation. METHODS We conducted a prospective study of patients with almost-clear, mild or moderate papulopustular rosacea. For each patient, dermoscopic images were taken and a standardized skin surface biopsy was performed. RESULTS In this group of 60 patients, the most frequent dermoscopic findings were yellow dots, vascular polygons and follicular scales. Patients with moderate rosacea had more Demodex follicular openings compared with patients with mild rosacea (P = 0.02), while patients with mild rosacea had a higher frequency of follicular scales than did patients with almost-clear rosacea (P = 0.01). Patients with moderate rosacea had higher rates of Demodex follicular openings (P = 0.02), follicular scales (P

Background: The frequency of autoimmune diseases and thyroid cancer has been increasingly reported in association with rosacea. However, studies investigating thyroid diseases in rosacea are scarce with conflicting results. Objective: To investigate the relationship between thyroid disorders and rosacea. Methods: A large case-control study on ageand gender-matched 2091 rosacea patients and 9572 controls was conducted. Rosacea patients using the rosacea-specific ICD codes were compiled from the hospital records. Additionally, all participants were evaluated in terms of the presence of hypothyroidism and hyperthyroidism. Conditional logistic regression analysis was used to compute case-control odds ratios (OR) with 95% confidence intervals. Results: The analysis comprehended 2091 rosacea patients (1546 female, 545 male; mean 48.73 ± 14.53 years) and 9572 controls (7009 female, 2563 male; mean 48.73 ± 15.1 years). Whereas the rate of hypothyroidism was significantly higher in rosacea patients (OR = 1.3, 95% CI 1.13-1.49, p < 0.001), there was no significant difference in the rate of hyperthyroidism between the groups (OR = 1.12, 95% CI 0.81-1.53, p = 0.497). Stratification for gender revealed a significant association between hypothyroidism and rosacea in females (OR = 1.27, 95% CI 1.1-1.47, p = 0.002) and males (OR = 1.58, 95% CI 1.04-2.4, p = 0.032). The frequency of hypothyroidism in rosacea patients increased towards the age range of 40-49 and then decreased, parallel with the hypothyroidism frequency of the study population. Study limitations: Different subtypes and severities of rosacea were not distinguished. Conclusions: Hypothyroidism may be a comorbidity of rosacea and investigation for hypothyroidism may be appropriate when evaluating rosacea patients.

This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.

The microbiome plays a significant role in human health, homeostasis, immune system, and disease pathogenesis. Disrupted communication between the microbiome and host has been extensively studied in gastrointestinal diseases. To a lesser extent, there is emerging research on the skin microbiome and its connection with the gut, referred to as the gut-skin axis and its effects on dermatologic conditions. A basic overview will be provided of the gut and skin microbiome with a focus on the impact of this connection on cutaneous diseases, such as psoriasis, atopic dermatitis, rosacea, acne vulgaris, photoaging, and cutaneous wounds. In addition, we shall discuss nutrition-based approaches mediated through the gut-skin axis and topical treatments that could serve as potential adjunctive management by manipulation of the microbiome. In particular, there is a growing body of research on oral probiotics, prebiotics, and dietary modifications that may help improve symptoms for a variety of dermatologic conditions in select demographic groups.