Rosacea

NOD2/CARD15 belongs to the N-terminal caspase recruitment domain family of proteins involved in regulating NF-kB activation in response to inflammatory stimuli transduced through Toll-like receptors. Mutations and polymorphisms in the NOD2/CARD15 gene reduce antibacterial responses and are associated with granulomatous inflammatory conditions such as Blau syndrome and early-onset sarcoidosis. The polymorphism R702W (arginine to tryptophan) is strongly associated with susceptibility to Crohn's disease in Caucasian populations. Skin abnormalities (other than cutaneous manifestations of Crohn's disease) have not been previously associated with R702W. We report on a female patient homozygous for R702W who developed granulomatous rosacea at the age of 12 years old. From the occurrence in the context of Crohn associated with R702W, we speculate that granulomatous rosacea may be an entity distinct from other forms of rosacea , which are associated with increased production of antiba...

Lymphedema typically affects a whole limb. Rarely, lymphedema can present as a circumscribed plaque or an isolated skin tumor. OBJECTIVE: To describe the clinical and pathologic characteristics and etiologic factors of localized lymphedema. METHODS: Case-control study of skin biopsy and excision specimens histologically diagnosed with lymphedema and presenting as a localized skin tumor identified during a 4-year period. RESULTS: We identified 24 cases of localized lymphedema presenting as solitary large polyps (11), solid or papillomatous plaques (7), pendulous swellings (4), or tumors mimicking sarcoma (2). Patients were 18 females and 6 males with a mean age of 41 years (range 16-74). Anogenital involvement was most frequent (75%)--mostly vulva (58%), followed by eyelid (13%), thigh (8%) and breast (4%). Causative factors included injury due to trauma, surgery or childbirth (54%), chronic inflammatory disease ( rosacea , Crohn's disease) (8%), and bacterial cellulitis (12%). Eigh...

Topical and oral antibiotic/anti-inflammatory agents are mainstays of therapy for rosacea . However, costs and efficacies of these therapies vary widely. Objective: To determine relative cost-effectiveness of common therapeutic regimens using published data. METHODS: Average daily costs (ADC) were determined based on treatment frequency and estimated gram usage for facial application of topical regimens of metronidazole (0.75%, 1%), azelaic acid (15%, 20%), sodium sulfacetamide and sulfur 10%/5%, and oral regimens of tetracycline, doxycycline, and isotretinoin. The ADC was compared with published efficacy rates from clinical trials, with efforts to standardize outcome measures. Based on these efficacy rates, costs per success were calculated and combined with office visit costs to estimate the total cost for each treatment for a 15-week period. RESULTS: The medication cost per treatment success of topical regimens ranged from $60.90 ($205.40, total, including office visits) for metroni...

Cutis. 2009 Apr; 83(4): 198-204Chen AY, Zirwas MJSteroid-induced rosacealike dermatitis (SIRD) is an eruption composed of papules, pustules, papulovesicles, and sometimes nodules with telangiectatic vessels on a diffuse erythematous and edematous background. It results from prolonged topical steroid use or as a rebound phenomenon after discontinuation of topical steroid. There are 3 types of SIRD that are classified based on the location of the eruption: perioral, centrofacial, and diffuse. Diagnosis of this disease entity relies on a thorough patient history and physical examination. Treatment involves discontinuation of the offending topical steroid and administration of oral and/or topical antibiotics. Topical calcineurin antagonists should be considered as alternative or adjunctive therapies for patients who do not respond to traditional treatments. Dermatologists may need to provide psychological support during office visits for patients who have difficulty dealing with the disco...

Allergen Inc has launched Aczone, a topical gel formulation of the antibacterial, anti-inflammatory agent dapsone, for the potential treatment of acne vulgaris . Oral dapsone has demonstrated efficacy in acne, but was associated with severe side effects such as anemia, which was particularly serious in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Aczone was developed to overcome this limitation, and is formulated using solvent-microparticle technology for improved absorption and action and for fewer side effects. In a phase I clinical trial, systemic exposure to dapsone was 126-fold lower following treatment with Aczone compared with oral dapsone. Aczone significantly reduced lesion counts in patients with acne in phase III trials, and was particularly effective in reducing inflammatory lesions. In a phase IV trial, Aczone was safely applied to patients with G6PD deficiency without inducing anemia. Phase IV trials in patients with acne were ongoing at the time of ...

A 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 in managing their rosacea . "Results of a n...

Seborrheic dermatitis, characterized by erythema and/or flaking or scaling in areas of high sebaceous activity, affects up to 5% of the US population and often appears in conjunction with other common skin disorders, such as rosacea and acne . Despite ongoing research, its etiology is puzzling. Increased sebaceous and hormonal (androgenic) activity is thought to play a part. Recent evidence suggests an important role for individual susceptibility to irritant metabolites of the skin commensal Malassezia, most probably M globosa. Current approaches thus include agents with antifungal as well as antikeratinizing, and anti-inflammatory activity. Azelaic acid, which has all 3 properties, may be a useful addition to first-line management, which now comprises of topical steroids, the immunosuppressant agents tacrolimus and pimecrolimus, azoles and other antifungals, and keratolytic agents. A recent exploratory study supports the efficacy and safety of azelaic acid 15% gel in seborrheic dermat...