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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.

Background The treatment of facial erythema and subjective symptoms of rosacea patients remains challenging in clinical practice. Cosmeceuticals, care components containing active ingredients such as phytochemicals, play a growing role in treatment plans. However, well-designed studies on their efficacy and limitations are widely missing. Objective A foam and a cream for rosacea patients were assessed based on objective and subjective methodology. The tolerability of skin and eyes was evaluated. Methods A randomized, double-blinded, split-face, and vehicle-controlled trial was conducted. At baseline and after four weeks of product use, dermatological and ophthalmological investigations were performed, employing image analysis of facial erythema, clinical assessments, and questionnaires. Results The patient cohort comprised 33 females with persistent facial erythema due to rosacea. No significant differences were found between the vehicle and the verum. According to the analysis of facial erythema, a "less pronounced" or "much less pronounced" appearance was seen in two thirds of patients comparing V1 to V0. Especially, the dryness of the skin improved by the use of the vehicle and the verum. Adverse subjective skin sensations decreased by 61.3% for the verum side and by 58.6% for the vehicle side. Subjective and objective analysis of ocular manifestation differed, with subjective manifestations reported more frequently, thus highlighting underdiagnosis of ocular rosacea. Conclusions As no clear differences between the verum and the vehicle were found, an optimal skin care regime itself seems to have a superior effect in the relief of facial erythema and foremost of subjective symptoms, rather than certain active ingredients.

Immune-related adverse events (irAEs) is a term used to describe the various toxicities associated with immune checkpoint inhibitor (ICI) use. As this class of cancer immunotherapy grows, the diversity of documented irAEs also continues to expand. Ocular toxicities secondary to ICI use are relatively rare, with dry eye and uveitis as the most frequently reported ocular side effects. This article specifically investigates the relationship between ocular surface disease and ICI therapy through a review of the existing literature. Dry eye disease (DED), conjunctivitis, and keratitis were the most commonly reported irAEs affecting the ocular surface across the 29 studies reviewed. Keratoplasty graft rejection was also described in two case reports. Our review of eight clinical trials found the incidence of DED, the most common ocular surface irAE, to range from 1 to 4%. Nearly all cases of ocular surface irAEs were graded as mild or moderate in severity and were often self-limited or controlled with conservative treatment. Duration of checkpoint inhibitor use prior to onset of ocular surface side effects varied widely, ranging from days to months. Ocular surface toxicities associated with checkpoint immunotherapy appear to be under-reported and under-investigated. Further work remains to be done to investigate the full breadth of ocular surface pathologies and the molecular mechanisms by which these toxicities occur.

Die okulare Rosazea im Kindesalter ist eine seltene, aber oft unterdiagnostizierte Erkrankung. Chronische Blepharokonjunktivitis, Chalazien, Hornhauttrubungen und -neovaskularisationen sind typische Befunde. Die empfohlene Therapie besteht aus topischen (Lidhygiene, Steroide, Ciclosporin, Benetzungsmittel) und systemischen (Antibiotika, z. B. Erythromycin) Masnahmen. Unsere Fallserie von 8 Kindern belegt die Wirksamkeit der lokalen 1,5 % Azithromycin-Therapie kombiniert mit Lidhygiene bei kindlicher okularer Rosazea. Ein weiterer Vorteil dieser topischen Therapie ist, dass sie nur 2‑mal taglich uber 3 Tage mit anschliesender Pause von 7 Tagen angewendet werden muss. Dies verbessert auch die Therapietreue.

Among the temporary skin ecto-parasites, Demodex folliculorum is a worm-like mite that infests hairfollicles in various mammals including man. Rosacea is a common skin disorder that may occur inadults of all ethnic backgrounds, but is most commonly diagnosed in individuals with fair skin. Ocularrosacea may present independently or in association with cutaneous subtypes of rosacea. This studyclarified the correlation between ocular rosacea and demodicosis folliculorum in family patients; twofemales of them were superimposed with secondary bacterial infection. The patients acquired in zoonoticinfestation from their pet dog. The pet dog was sent to the Governmental Veterinary Hospital atAbbassia and was treated with Ivermectin®.Specific ocular infections often required etiological diagnosis of combined consultant ophthalmologyand microbiology

La rosácea es una alteración cutánea crónica que se ha asociado con factores etiológicos inespecíficos y diversas manifestaciones sistémicas. La rosácea cutánea suele evolucionar a rosácea ocular del 6 al 72 % de los pacientes. Al no existir criterios específicos que la caractericen, la rosácea ocular implica un reto diagnóstico. Para fortalecer la sospecha diagnóstica temprana, se presentan tres casos de pacientes con evolución clínica distinta, pero que tuvieron en común el retraso diagnóstico, lo que se tradujo en manifestaciones graves y daño ocular extenso.

Introduction: Rosacea is a chronic cutaneous disorder with non specific and variable ocular manifestations. Ocular rosacea is often underdiagnosed, despite the potential for serious sight threatening sequelae. Aim: The study was designed to determine the incidence of ocular disease among the population of rosacea patients along with evaluating the presence of eye dryness in both the patients and controls using Schirmer 1 test. It correlated the severity of ocular disease with the severity of cutaneous rosacea. Materials and Methods: A total of 72 patients with facial rosacea were enrolled and evaluated with thorough history, physical and ophthalmological examination for ocular rosacea. Schirmer’s test was performed on all patients with ocular rosacea and controls. Results: Out of 72 patients with facial rosacea, 30 (41.62%) were diagnosed with ocular rosacea. On the Schirmer test, ocular rosacea patients had statistically significant lower value than the control group. There was also a statistically significant difference between mean Schirmer test values of male patients and controls and female patients and controls. Conclusion: Symptoms of ocular rosacea are not always specific hence underdiagnosed. Ocular features of rosacea in patients presenting with mere cutaneous findings should not be overlooked. Keywords: Ocular, Rosacea, Schirmer’s test.

Background Rosacea is a common chronic inflammatory cutaneous disorder affecting nearly 5.5 % of the adult population. Our aim was to evaluate the prevalence and epidemiology of rosacea and perioral dermatitis (POD) in an ambulatory care setting. Methods We retrospectively analyzed medical data of patients with a confirmed diagnosis of rosacea or perioral dermatitis (POD) presenting at our university hospital outpatient clinic during a 3‐year period. Results Out of 1032 patients, 81.5 % were diagnosed with rosacea and 18.5 % with POD. Overall prevalence was 1.4 % for rosacea and 0.3 % for POD. 69.3 % of the analyzed patients were female. Overall mean age was 49.3 ± 7.7 (1–92) years; the women’s average age was less than the men’s. Patients with POD were younger and predominantly female, whereas patients with phymatous rosacea were older and predominantly male. The most common phenotypes were papulopustular rosacea (68.4 %), erythematotelangiectatic rosacea (22.5 %), and phymatous rosacea (8.0 %). Special forms of rosacea were diagnosed in 15.8 % of the patients; the most frequent were ocular rosacea (6.9 %) and steroid‐induced rosacea (5.4 %). Conclusions The large patient cohort analyzed in our study provides a good estimate of the frequency of the rosacea subtypes, special forms and of perioral dermatitis in a hospital‐based outpatient care setting.

Purpose: To investigate the efficacy of once-daily topical treatment of ocular and cutaneous rosacea with ivermectin 1% cream (Soolantra®, Galderma).Methods: Ten patients with rosacea were evaluate...

Purpose To report a successful treatment of chronic rosacea associated ocular demodicosis with lid scrub containing terpinen-4-ol (T4O). Observations A 72-year old woman presented with recurrent and refractory ocular erythema, irritation, dryness, and photophobia despite conventional medical treatment (artificial tears, hypochlorous acid lid hygiene, doxycycline, and erythromycin) for 5 years. Examination revealed facial erythema, telangiectasias on cheeks, nose and lids, and cylindrical dandruff (CD) on bilateral upper and lower lashes. Epilation sampling confirmed demodicosis. After treatment with lid wipe containing T4O (Cliradex, Biotissue, Miami, FL) over face and lids, ocular discomfort, CD, facial and eyelid erythema, telangiectatic vessels were significantly reduced. Complete eradication of demodex mites and resolution of symptoms and signs lasted 8 months of follow-up. Conclusions This case suggests that T4O is effective in treating chronic rosacea associated ocular demodex blepharitis.

Purpose: To report a case of ocular rosacea with corneal infiltrates and vascularisation. Here we report a case of a 34-year-old male presenting with ocular rosacea with corneal infiltrates and vascularisation in the left eye with posterior blepharitis of both eyes. The clinical diagnosis was based on the facial findings of erythematous papulomacular lesions and telangiectasia. The patient was treated with systemic doxycycline and for ocular lesions treated with antibiotic steroids and lubricants. Ocular rosacea, if not treated on time, can worsen to the stage of corneal infiltrates and vascularisation.

Background: Rosacea is a common chronic facial dermatosis. Classification of rosacea has evolved from subtyping to phenotyping. Objectives: To update our systematic review on interventions for rosacea. Methods: We searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index and ongoing trials registers (March 2018) for randomized controlled trials. Study selection, data extraction, risk-of-bias assessment and analyses were carried out independently by two authors. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess certainty of evidence. Results: We included 152 studies (46 were new), comprising 20 944 participants. Topical interventions included brimonidine, oxymetazoline, metronidazole, azelaic acid, ivermectin and other topical treatments. Systemic interventions included oral antibiotics, combinations with topical treatments or other systemic treatments. Several studies evaluated laser or light-based treatment. We present the most current evidence for rosacea management based on a phenotype-led approach. Conclusions: For reducing temporarily persistent erythema there was high-certainty evidence for topical brimonidine and moderate certainty for topical oxymetazoline; for erythema and mainly telangiectasia there was low-to-moderate-certainty evidence for laser and intense pulsed light therapy. For reducing papules/pustules there was high-certainty evidence for topical azelaic acid and topical ivermectin; moderate-to-high-certainty evidence for doxycycline 40 mg modified release (MR) and isotretinoin; and moderate-certainty evidence for topical metronidazole, and topical minocycline and oral minocycline being equally effective as doxycycline 40 mg MR. There was low-certainty evidence for tetracycline and low-dose minocycline. For ocular rosacea, there was moderate-certainty evidence that oral omega-3 fatty acids were effective and low-certainty evidence for ciclosporin ophthalmic emulsion and doxycycline.

Background Rosacea is a highly prevalent, chronic inflammatory disease. The treatment of rosacea remains a challenge to dermatologists. Therapies include skin care, medications, lasers, and various combinations of these modalities. The appropriate treatment depends on clinical types and patient's various clinical symptoms. Purpose The purpose of this study was to review and compare current therapies for rosacea of all severities from four different guidelines. Methodology We searched PubMed using the keywords "rosacea," "treatment" AND ["erythema rosacea" OR "papulopustular rosacea" OR "ocular rosacea" OR "phymatous rosacea"]. We selected randomized controlled trials, observational studies, controlled clinical trials, and clinical trials. We indentified further studies (including the guidelines) by hand-searching relevant publications and included those that met the inclusion criteria. Results The total number of records identified was 421. We limited our search to the specific abovementioned study types. Twenty-five of these studies met with our inclusion criteria. An additional five manuscripts were selected using the abovementioned method, and four guidelines were included in this review. Conclusion Diagnosing and choosing the appropriate treatment options of rosacea according to guidelines is the basis of scientific criteria. More large-scale randomized controlled clinical trials on new treatment methods, new drugs, or new dosage forms provide a new guideline for future rosacea treatment. Although there are some differences in the treatment of rosacea, it is generally based on anti-demodex, anti-inflammatory, and anti-angiogenesis.

Background: Current knowledge about ocular rosacea in dark skin individuals is lacking. The prevalence of ocular rosacea varies considerably among studies and is probably higher than previously presumed. Objective: To estimate the prevalence and pattern of ocular rosacea among dark skinned female patients, compare it with fair skinned, and to correlate the severity of cutaneous disease with ocular findings. Method: Female patients diagnosed with rosacea between 2011 and 2013 were studied prospectively. They were referred to ophthalmology for clinical observations and slit lamp examination. In all patients Schirmer and Tear break up time tests to diagnose dry eye were performed. Result: Fifty six consecutive female patients, joined the study with different skin types ranging from skin type 4 to 6. A total of 43 patients (76.8%) were positive for ophthalmologic findings. The most frequent symptoms were itching, burning sensation and redness, while the most frequent signs were meibomian gland dysfunction, dry eyes, eyelid telangiectasia and irregular margin. Significant correlation was noted between meibomian gland dysfunction and irregular lid margin (P = 0.003). Dry eye and Schirmer test significantly correlated with eye lid telangiectasia (p = 0.004; 0.015) respectively. No significant correlation was found between the severity of cutaneous disease and ocular findings. Conclusion: Ocular rosacea in dark skinned females is a common presentation and is comparable to that reported for fair skin, with eyelid telangiectasia and meibomian gland dysfunction being early phenomena. Earlier onset and more benign course were seen compared to other studies. Ocular and cutaneous rosacea are independent of each other. Keywords: Dark skin, Ocular rosacea, Dry eye

Objective: to evaluate the clinical efficiency of eyelid cryotherapy with an autonomous titanium nicke lide cryoapplicator in patients with ocular rosacea regarding the dynamics of pro- and anti-inflammatory cytokines contents at local levels. Materials and methods. 65 patients with ocular rosacea were observed. Depending on the therapy received, the patients were divided into two groups: in the main group, eyelid cryotherapy was applied for 2 weeks with an autonomous cryoapplicator made of porous-permeable titanium nickelide, and in the reference group, the patients received a traditional treatment for a month. The contents of cytokines (IL-1, IL-8, IFN-, IL-2, IL-10) in lachrymal fluid was evaluated by ELISA on Days 3, 7 and 30 after treatment. Results. The opposite nature of cytokine balance changes and the ratio of its pro- and anti-inflammatory link during the follow-up period were revealed. A reliable dynamic increase of examined IFN- and IL2 content in the lacrimal fluid after cryostimulation can evidence for an adequate activation of cellular immunity link, as well as for enhancement of regeneration mechanisms. Conclusion. The analysis of obtained data evidences for a high efficiency of clinical and immunological effect of lid cryotherapy using titanium nickelide cryoprobe for ocular rosacea treatment.

Ocular rosacea is a chronic inflammatory condition that can occur in the absence of cutaneous features. The most common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring and, rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. It can also be associated with systemic disorders such as cardiovascular disease. Management ranges from local therapy to systemic treatment, depending on the severity of the disease. In this review, we describe the epidemiology, pathophysiology, clinical features and treatment of rosacea and ocular rosacea.

Rosacea is a chronic inflammatory condition that affects the skin and the eyes. The pathogenesis of rosacea is complex and includes the interaction between genetic and environmental factors, dysregulation of the innate immune system, neurovascular modifications and the interaction with skin commensals. Clinical manifestations in children include the telangiectatic form, papulopustular rosacea, ocular rosacea, periorificial dermatitis, granulomatous rosacea and idiopathic facial aseptic granuloma. Management is aimed at identifying and avoiding triggers. Topical therapy is used for mild cases with topical antibiotics and anti-inflammatory agents. Oral agents are indicated, in combination with topical therapy, for moderate to severe cases. Prolonged therapy may be required.

Purpose: Rosacea is one of the most common conditions affecting the ocular surface. The purpose of this review is to provide an update on the pathogenesis and treatment of rosacea based on the dermatology and ophthalmology literatures. Methods: Literature searches were conducted for rosacea and ocular rosacea. Preference was given to systematic reviews, meta-analysis, case-controlled studies, and documented case reports while excluding poorly documented case studies and commentaries. The data were examined and independently analyzed by more than two of the authors. Results: Rosacea is a complex inflammatory condition involving the pilosebaceous unit. Its underlying mechanism involves an interplay of the microbiome, innate immunity, adaptive immunity, environmental triggers, and neurovascular sensitivity. The latest classification of rosacea includes three dermatologic subgroups and a fourth subgroup, ocular rosacea. Ocular rosacea clinically displays many features that are analogous to the cutaneous disease, such as lid margin telangiectasia and phlyctenulosis. The role of environmental triggers in the exacerbation of ocular rosacea appears to be understudied. While lid hygiene and systemic treatment with tetracycline drugs remain the mainstay of treatment for ocular rosacea, newer dermatologic targets and therapies may have potential application for the eye disease. Conclusions: Ocular rosacea appears to embody many of the manifestation of the dermatologic disease. Hence, the basic pathophysiologic mechanisms of the ocular and cutaneous disease are likely to be shared. Better understanding of the ocular surface microbiome and the immunologic mechanisms, may lead to novel approaches in the management of ocular rosacea.

Rosacea is a chronic inflammatory cutaneous disorder affecting the facial convexities including the cheeks, chin, forehead, and nose. While most commonly associated with facial rash and flushing, the majority of patients with rosacea have ocular involvement, which may even precede other facial symptoms. Ocular rosacea can result in foreign body sensation, dryness, tearing, and light sensitivity arising from eyelid inflammation, including meibomian gland dysfunction, and ocular surface inflammation. Given the current lack of definitive therapy, treatment of ocular rosacea focuses on symptom management and limiting complications. The mainstay of therapy involves aggressive lubrication with artificial tears and ointment with regular use of warm compresses to improve meibomian gland dysfunction. Lifestyle modification and dietary supplementation with omega-3 fatty acids may also play a role. For those patients with persistent symptoms, topical cyclosporine serves as an effective immunomodulator and mitigates the inflammatory response as do topical antibiotics (e.g., macrolides). Oral antibiotics, such as tetracyclines, serve to limit inflammation by targeting matrix metallopeptidases and improve signs and symptoms of the disease. Other common treatments for meibomian gland dysfunction including oral azithromycin have also been shown to be effective in the treatment of ocular rosacea. While the majority of these therapies are well-tolerated, adverse effects can range from relatively benign discomfort during instillation of eyedrops to significant complications in pregnancy. With continued research revealing the interdependence between genetic predisposition, the immune response, and autonomic and vascular dysregulation, multiple new targets for therapy have been identified, which bring with them the potential for more effective and specific therapies.

Rosacea is a syndrome and not a pathogenically defined disease. Currently, there is no well-established basic mechanism of disease established for rosacea. The classification of rosacea began with the distinction from acne, and by the last half of the twentieth century, the classifications of experts in different countries had become aligned around the notion of rosacea having four or more phenotypic subtypes with some versions allowing for possible, but not obligatory, progression of these phenotypic subtypes as “stages.” While these classifications from different authors consistently recognized similar phenotypic subtypes, there were differences in their precise definitions. In 2002 a consensus committee of the National Rosacea Society (NRS) sought to develop definitions which would provide for a more standardized classification system. These four classic phenotypic subtypes of rosacea have important utilities, including the increased awareness that use of products demonstrated to improve only papulopustular rosacea may lead to disappointment in physicians and their patients with only erythematotelangiectatic rosacea.

Background Metronidazole with well-soluble silver nitrate forms a complex with potent activity (synergism) against bacterial strains and fungi with simultaneous lower side effect than in the case of the two agents administered separately. This study aimed to establish effectiveness in the treatment of ocular rosacea with new formulation of drops and ointment with silver(I) complex of metronidazole. Methods Three patients suffering from serious ophthalmic complications of acne rosacea were treated with drops and ointments applied 3 times a day for 3 months. The uncorrected visual acuity testing (UCVA), pachymetry as well as subjective and objective tear film assessment were evaluated. Results In all patients, we have improved UCVA as well as objective and subjective evaluation of the tear film parameters. No significant differences in corneal thickness were observed. Conclusion Well soluble silver(I) complex of metronidazole might be an alternative method in ophthalmic complications of acne rosacea treatment.

Background Many articles in rosacea have been published. Bibliometric analysis is helpful to determine the most influential studies in a specific field. Objective To identify the top 100 most cited articles in rosacea using the bibliometric analysis method. Methods We searched in the Web of Science database on 20 November 2019. Articles were listed in descending order by their total citations. The top 100 most cited articles in rosacea were identified and analysed. Results The top 100 most cited articles were published between 1971 and 2015. The largest number of articles was published in a single interval in 2011-2015. The average annual citations were constantly ascending, and the total citations were positively correlated with annual citations. The 100 articles were classified into different research focuses: treatment (35%), pathogenesis (27%), clinical features and diagnosis (14%), pathophysiology (6%), associated diseases (4%), epidemiology (3%) and others (11%). A total of 19 articles were randomized controlled trials (RCT), 14 focused on the association between rosacea and Demodex, and five focused on the association between rosacea and Helicobacter pylori. Twenty-five publications focused on a specific subtype of rosacea, mainly papulopustular and ocular rosacea. The 100 articles were published in 32 journals. A total of 79 different first corresponding authors were from 20 different countries, mostly in North America and Europe. Steinhoff. M from University of California published the most articles as the corresponding author. Conclusions This study identified the top 100 most cited articles in rosacea and analysed their bibliometric characteristics, which may pave the way for further research.

Demodex folliculorum and Demodex brevis are two mites which infest the human eye and which may, in excess, lead to a wide range of anterior segment findings. Demodex mites have been implicated in anterior and posterior blepharitis, blepharoconjunctivitis, blepharokeratitis, and beyond. Due to significant overlap with other anterior segment conditions, Demodex infestation remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash sampling, and the most common mode of treatment is with tea tree oil in varying concentrations. This article summarizes elements of pathogenesis, diagnosis, and management critical to clinical care of this common condition.

The lack of validated rosacea assessment tools is a hurdle in assessing rosacea severity. This article discusses a valid and reliable rosacea severity self-assessment tool (RSAT) to measure rosacea severity. To determine test-retest validity, participants completed the self-assessment twice. A blinded physician graded the participant's disease severity with the Investigator Global Severity (IGS) score. Pearson correlations were used to assess the relationship between the self-assessment measure and the IGS. Test-retest RSAT measurements were correlated. The RSAT represents a valid and reliable tool. This tool may facilitate determination of rosacea severity in survey research studies.

Childhood rosacea presents a diagnostic difficulty due to the lack of diagnostic criteria and potential mimics. Ocular involvement is a frequent complication of rosacea in children and may appear before cutaneous findings. It is important for clinicians to be aware of these and to screen patients appropriately in order for timely treatment to be instituted.

SummaryBackground Rosacea is currently treated according to subtypes. As this does not adequately address the spectrum of clinical presentation (phenotypes), it has implications for patient management. The ROSacea COnsensus panel was established to address this issue. Objectives To incorporate current best treatment evidence with clinical experience from an international expert panel and establish consensus to improve outcomes for patients with rosacea. Methods Seventeen dermatologists and three ophthalmologists reached consensus on critical aspects of rosacea treatment and management using a modified Delphi approach. The panel voted on statements using the responses ‘strongly disagree’, ‘disagree’, ‘agree’ or ‘strongly agree’. Consensus was defined as ≥ 75% ‘agree’ or ‘strongly agree’. All voting was electronic and blinded. Results The panel agreed on phenotype-based treatments for signs and symptoms presenting in individuals with rosacea. First-line treatments were identified for individual major features of transient and persistent erythema, inflammatory papules/pustules, telangiectasia and phyma, underpinned by general skincare measures. Multiple features in an individual patient can be simultaneously treated with multiple agents. If treatment is inadequate given appropriate duration, another first-line option or the addition of another first-line agent should be considered. Maintenance treatment depends on treatment modality and patient preferences. Ophthalmological referral for all but the mildest ocular features should be considered. Lid hygiene and artificial tears in addition to medications are used to treat ocular rosacea. Conclusions Rosacea diagnosis and treatment should be based on clinical presentation. Consensus was achieved to support this approach for rosacea treatment strategies.

Rosacea is a chronic skin disease characterized by erythema, telangiectasia, papules and pustules in the central facial region. It most often affects adults and is rare in children. Rosacea can also present ocular involvement. Symptoms can precede cutaneous findings, appear simultaneously or after them, with a higher risk of ocular complications in children. Because of low prevalence of rosacea in childhood, the diagnosis is frequently delayed. We report a 1-year-old boy with ocular and cutaneous rosacea who developed corneal opacities and visual impairment. Early diagnosis and treatment is considerable to avoid sequels.

Although the number of dermatologic conditions with ocular manifestations is relatively limited, these entities have a high prevalence and represent a large proportion of clinic visits to both dermatologic and ophthalmic practices. This contribution will review oculocutaneous diseases that are not part of the allergic or autoantibody-mediated spectrum.

Rosacea is a common chronic inflammatory disease, especially in patients with fair skin and positive family history. Typical locations are forehead, nose, cheeks and chin; the periorbital region is usually not involved. Clinical features can be very heterogeneous. Besides different subtypes (erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea), which often overlap, various special forms of rosacea exist. Up to 60% of patients with cutaneous rosacea suffer from ocular rosacea. In Germany, brimonidine, metronidazol, azelaic acid, and ivermectin are approved for topical therapy of rosacea; for systemic therapy, doxycycline at a subantimicrobial dose (40 mg/day) is the only approved substance. In case of resistance to this therapy, contraindications or side effects, various alternative therapies are available, however off-label.

Systemic antibiotics are often used to treat rosacea and tetracyclines are the most common antibiotic prescribed; however, there is ambiguity among clinical guideline suggestions. Importantly, there is an increasing call to all clinicians to curtail antibiotic use.To investigate the utilization and cost of long-term oral antibiotic use for the treatment of rosacea, including ocular rosacea.This was a retrospective cohort study of MarketScanThe sample included 72,411 patients. The mean (SD) duration of long-term antibiotic treatment was 87.68 (145.99) days and for patients with ocular rosacea was slightly longer, 108.34 (176.74) days [p .0001]. The majority of antibiotic courses were shorter than 3 months (80.04%) for the entire sample and the subset with ocular rosacea (53.64% [p = .007]).Patient adherence is uncertain and database lacks information on rosacea severity and clinical outcomes.The majority of oral antibiotic course durations follow guidelines. Costs of antibiotic therapy were lower for shorter courses and those utilizing generic medications; the cost-effectiveness of these modifications has not been investigated.

Purpose: To report a case of severe ocular rosacea following ipilimumab plus nivolumab treatment in a patient with metastatic malignant skin melanoma. Methods: Case report and review of the literature. Results: A 68-year-old male with newly diagnosed metastatic malignant cutaneous melanoma was treated with first-line ipilimumab plus nivolumab, which resulted in a partial response. Four months after initiation of treatment, the patient developed red eyelids and conjunctivae, with painful gritty eyes, limiting his capacity to read. Following a diagnosis of severe ocular rosacea and dry eyes, treatment including corticosteroids, antimicrobial agents, and eyelid hygiene was started, and within 3 months, the ocular complaints resolved. Conclusion: Treatment with checkpoint inhibitor immunotherapy for metastatic melanoma may trigger several ocular immune-related adverse events. This case describes severe ocular rosacea as an adverse event following ipilimumab plus nivolumab treatment.

Purpose: The objective of the study is to compare the frequency of Demodex on the eyelash follicle of patients with rosacea and referents without rosacea or ophthalmological disorders. Methods: This is a comparative, open, observational, and cross-sectional study that included 41 patients diagnosed with rosacea and 41 referents without rosacea diagnosis or ophthalmic alterations. The individuals underwent a slit-lamp examination in which two eyelashes per eyelid were removed with fine forceps. The presence of Demodex was sought by direct visualization under a light microscope. The results were expressed as “positive” when at least one mite on one lash was found and “negative” when no mite was identified. Chi-square test was used to compare the presence of mites in both groups. Results: Eighty-two study individuals (45 females and 37 males) were included, of which 41 patients were diagnosed with rosacea and 41 were without rosacea or ophthalmic alterations. The average mean age was 37 years with a minimum of 19 and a maximum of 87 years. Of the 41 patients with rosacea, 31 had erythematotelangiectatic rosacea and 10 had papulopustular rosacea. There were no patients with phymatous or ocular rosacea. The presence of Demodex was found in 32 patients: 24 patients with rosacea diagnosis (16 of the erythematotelangiectatic subtype and 8 of papulopustular subtype) and 8 patients without rosacea or ophthalmic alterations (P ≤ 0.001). Conclusion: Rosacea was found to be a statistically significant risk factor for Demodex infestation in eyelashes, irrespective of age and sex, with a higher prevalence in papulopustular variety.

Introduction Povidone iodine (PVP-I) 10% aqueous solution is a commonly utilized anti-septic employed for sterilization of the ocular surface prior to interventional procedures. Dimethylsulfoxide (DMSO) is a well-known skin penetration agent scarcely utilized in ophthalmic drug formulations. We describe here a low-dose formulation of 1% PVP-I (w/w) in a gel containing DMSO for use in the setting of recalcitrant rosacea blepharoconjunctivitis. A review of the ocular uses of dimethylsulfoxide is also presented. Case report A 78-year-old male presented with chronic, long-standing blepharitis involving both the anterior and posterior lid margins. Posterior lid and skin inflammatory changes were consistent with ocular rosacea. Previous oral and topical therapies had been largely ineffective at controlling his condition. Conclusion The topical PVP-I/DMSO system was effective in abating the signs and symptoms of rosacea blepharoconjunctivitis. Further investigation of this novel agent is warranted. Electronic supplementary material The online version of this article (doi:10.1007/s40123-015-0040-4) contains supplementary material, which is available to authorized users.

Background In paediatric rosacea, ocular symptoms are often predominant. Literature about systemic therapy of paediatric ocular rosacea is sparse, though. Objective Analysis of children with ocular rosacea treated systemically, particularly addressing remission and recurrence rates. Methods Retrospective study reviewing the medical records of children with ocular rosacea treated with systemic antibiotic therapy. Nine out of 19 patients were chosen for detailed analysis. To our knowledge, this is the first study in paediatric ocular rosacea requiring systemic therapy with a larger patient group and a longer follow-up (mean follow-up = 30.2 months). Results Seventeen patients (89.5%) suffered from blepharitis, 15 patients (78.9%) from conjunctivitis, twelve patients (63.2%) from chalazia/styes and nine female patients (47.4%) from corneal involvement. We used erythromycin (n = 9) or roxithromycin (n = 1) in patients younger than eight years and doxycycline (n = 8) or minocycline (n = 1) in patients older than eight years. Seven out of nine patients treated with erythromycin, one out of eight patients treated with doxycycline and the patient treated with minocycline achieved a complete remission of ocular and cutaneous symptoms. Two out of nine patients treated with erythromycin, seven out of eight patients treated with doxycycline and the patient treated with roxithromycin achieved a partial remission. Relapses occurred in the patient treated with minocycline (cutaneous), two out of eight patients treated with doxycycline (ocular and cutaneous) and one out of nine patients treated with erythromycin (cutaneous). Conclusion To achieve a complete remission of cutaneous and ocular rosacea, a long-term anti-inflammatory treatment of at least six months is necessary. The remission and relapse rates after successful treatment seem to be lower than in adults as all nine patients treated with erythromycin achieved a complete remission and did not show any relapse. This article is protected by copyright. All rights reserved.