Rosacea

Surv Ophthalmol. 2009 May-Jun; 54(3): 321-38Donnenfeld E, Pflugfelder SCCyclosporine has been used successfully as a systemic immunomodulator for more than two decades, and numerous studies have investigated its mechanisms of action. In 2003 an ophthalmic formulation, cyclosporine 0.05% ophthalmic emulsion, was approved by the FDA to treat dry eye disease. Topical cyclosporine emulsion has also been investigated for treatment of other ocular surface disorders that may have an immune-based inflammatory component. In these trials, cyclosporine 0.05% ophthalmic emulsion has shown efficacy for management of posterior blepharitis, ocular rosacea, post-LASIK dry eye, contact lens intolerance, atopic keratoconjunctivitis, graft-versus-host disease, and herpetic stromal keratitis. As these disorders are often refractory to other available treatments, ophthalmic cyclosporine is a welcome nontoxic adjunct or replacement to potentially toxic topical or systemic immunosuppressive therapies.

Skin Therapy Lett. 2009 Feb; 14(2): 1-3Gooderham MMany options exist for the treatment of rosacea, including topical and systemic therapies, laser and light-based therapies, and surgical procedures. A classification system for rosacea identifies 4 subtypes (i.e., erythematotelangiectatic, papulopustular, phymatous, and ocular), which may help guide therapeutic decision-making. The goals of therapy include reduction of papules, pustules, erythema, physical discomfort, and an improvement in quality of life. Standard topical treatment agents include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Second line therapies include benzoyl peroxide, clindamycin, calcineurin inhibitors, and permethrin.

J Dermatolog Treat. 2009 Jan 1; 1-3Cravo M, Miguel Canelas M, Carlos Cardoso J, Vieira R, Figueiredo ARhinophyma is a progressive and disfiguring disorder of the nose characterized by hyperplasia of the sebaceous glands and dermal tissue, representing the end-stage of rosacea. Four male patients affected by a moderate-severe rhinophyma were treated using a combined therapy with carbon dioxide laser and bipolar electrocoagulation. All patients achieved marked cosmetic results with minimal scarring. Various surgical approaches have been described to treat this condition but as yet there is no agreement in the literature on the ideal treatment. This combined method provides a bloodless operative field which allows the sculpting of the hypertrophic areas, leading to a good cosmetic outcome and a pain-free postoperative recovery.

Cutis. 2008 Dec; 82(6 Suppl): 2-16Ditre C, Wu J, Baumann LS, Rigel DThe use of natural products for skin care has become more common in the past few years. Consumers are more aware of unnatural chemicals and other toxins and are searching for natural products to use on their skin. Fortunately, a large number of botanical antioxidants exist and are being marketed as either over-the-counter or prescription skin care products. Antioxidants can have profound effects on the intracellular signaling pathways involved in skin damage and thus may be protective against photodamage as well as may prevent wrinkles and inflammation. This supplement discusses the potent effect that botanical antioxidants may have in the management of a broad range of skin issues, from photoaging to inflammatory skin conditions.

Cutis. 2009 Mar; 83(3): 119-24Del Rosso JQ, Lehman PA, Raney SGThe medical management of rosacea increasingly has involved not only the appropriate selection of topical medication but also patient education and specific recommendations regarding appropriate skin care. The recognition that epidermal barrier dysfunction and transepidermal water loss (TEWL) play a pathophysiologic role in rosacea and that skin moisturization may help to mitigate signs and symptoms of the disease has led to a deeper appreciation of the importance of proper skin care in the treatment of rosacea. Data from a percutaneous penetration study performed using human skin suggest that any of the tested moisturizer lotions may be applied either before or after azelaic acid gel 15% without a major change in the percutaneous absorption profile of azelaic acid.

P R Health Sci J. 2009 Mar; 28(1): 80-2Morales-Burgos A, Alvarez Del Manzano G, Sánchez JL, Cruz CLPersistent facial swelling may occur as a rare complication of rosacea. This finding has been referred to as lymphedematous rosacea, Morbihan's disease or persistent solid facial edema. A literature review for cases of lymphedematous rosacea revealed that the chronic inflammatory process that accompanies the disease contributes to an increase in the permeability of blood vessels. With time, the lymphatic drainage system becomes permanently impaired, leading to fluid accumulation in the affected skin. Herein, we report the case of a 58-year-old female with history of rosacea who developed bilateral periorbital swelling with associated erythema of the conjunctiva (ocular rosacea) over a 4 month period that only responded to oral corticosteroids. Biopsy revealed changes of lymphedematous rosacea.

J Drugs Dermatol. 2009 Feb; 8(2): 120-3Elewski BEA survey of people with rosacea was conducted in 2006 to gain insight into experiences with rosacea therapies and relationships with health care providers. The survey was completed by 2946 participants, of whom 2847 had been diagnosed with rosacea. Participants ranged in age from 20 to 81 years (mean age 50 years). Among those diagnosed with rosacea, 80% agreed that medication prevented their rosacea from worsening. Most respondents currently using prescription medication (82%) did not plan to discontinue its use. Among current users of medication, 46% had switched from a prior agent, usually due to the lack of improvement. Among respondents who previously switched therapies, 84% reported using some formulation of topical metronidazole. Of those respondents who discussed rosacea with their physician, 83% agreed that their physician influences their use of medication; 61% viewed their physician-in most cases a dermatologist-as a partner ...