Tacrolimus ointment for the treatment of steroid-induced rosacea: a preliminary report

BACKGROUND: Excessive topical corticosteroid application to facial areas commonly leads to steroid-induced rosacea. This may be a recalcitrant problem that requires months of antibiotic and anti-inflammatory therapy before it resolves. OBJECTIVE: The purpose of this article is to review the use of tacrolimus ointment, a macrolide anti-inflammatory ointment for the treatment of 3 patients with steroid-induced rosacea. METHODS: Three patients with steroid-induced rosacea applied tacrolimus ointment, 0.075% twice daily for 7 to 10 days. Patients were also instructed to avoid topical corticosteroid use and other rosacea-aggravating substances including caffeine, spicy foods, alcohol, hot fluids, and fluoride. Patients were observed for tenderness, erythema, and relief of pruritus. RESULTS: Pruritus, tenderness, and erythema were resolved in all 3 patients after 7 to 10 consecutive days' use of tacrolimus 0.075% ointment in conjunction with avoidance of topical steroids, caffeine, spicy food, alcohol, hot fluids, and fluoride. CONCLUSION: This preliminary study demonstrates that tacrolimus 0.075% ointment may be effective for patients with steroid-induced rosacea, when combined with avoidance of topical steroid use, as well as avoidance of other agents known to aggravate rosacea (caffeine, spicy foods, alcohol, hot fluids, and fluoride).     

The effect of azithromycin on reactive oxygen species in rosacea

BACKGROUND: Recent evidence suggests that inflammation in rosacea is associated with generation of reactive oxygen species (ROS) that are released by inflammatory cells. The efficacy of current therapeutic agents for rosacea such as tetracyclines and metronidazole has also been attributed to their antioxidant properties. Recently, a macrolide antibiotic, azithromycin, has been found to be an effective alternative in the treatment of rosacea. AIM: We planned a study to evaluate the antioxidant effects of azithromycin on ROS in rosacea. We compared basal ROS concentrations measured in the facial skin of patients with rosacea with the post-treatment levels and with those of healthy controls. METHODS: Facial skin biopsies of 17 papulopustular patients with rosacea and 25 healthy controls were taken. Rosacea patients were assigned to receive oral azithromycin 500 mg on three consecutive days each week for 4 weeks. The total number of inflammatory lesions (the sum of papules and pustules) on the face of each patient with rosacea was counted at each visit. The luminol- and lucigenin-enhanced chemiluminescence (CL) levels of patients with rosacea were measured before and after 4 weeks of treatment and compared with those of healthy controls. RESULTS: Rosacea patients had higher ROS levels than healthy controls (P < 0.001). A statistically significant decrease of both luminol- and lucigenin-enhanced CL levels were observed in patients with rosacea after treatment with azithromycin (t = 4.602, P < 0.001; vs. t = 4.634, P < 0.001, respectively). CONCLUSION: Rosacea patients have higher ROS levels than healthy controls. The results of our study support the antioxidant properties of azithromycin in rosacea.     

Immunopathological studies on rosacea

Seven patients with papulo-pustular rosacea were investigated with immunofluorescence (IF) techniques. Indirect IF has been performed also with antibodies eluted from circulating lymphoid cells. Besides confirming the data in the literature on the positivity of the basal zone, anticollagen antibodies were found, and eluted antinuclear antibodies were detected against nuclei of cells in the epidermis and dermis, namely, scattered dermal, endothelial and eccrine duct cells.     

Granulomatous rosacea

Rosacea is classified into four clinical subtypes, namely erythematotelangiectatic, papulopustular, phymatous, and ocular. There is also a granulomatous variant, which is recognized in the rosacea spectrum. The objective of this study is to take a closer look at the different histopathologic patterns and cellular compositions seen in granulomatous rosacea and their correlation to the clinical presentation. Facial biopsies from patients previously identified with a clinical diagnosis consistent with rosacea, and who demonstrated a granulomatous infiltrate upon histopathologic examination, were reviewed and the results were correlated to the clinical presentation. Four distinct histopathologic granulomatous patterns were identified, namely nodular, perifollicular, diffuse, and a combined perifollicular and nodular patterns. The clinical presentation varied greatly among patients and failed to correlate to the microscopic findings. The varied clinical features seen in our study favors the theory that granulomatous rosacea is not a clinical subtype of rosacea per se, but a distinct histological variant, which can be found in most of its clinical spectrum.     

Pediatric rosacea

Rosacea is a condition most commonly associated with adults; however, various forms exist in the pediatric population and need to be considered when a child presents with a facial rash. Acne rosacea, steroid rosacea, granulomatous periorificial dermatitis, and other variants of rosacea are presented here and are distinguished from their numerous mimickers. Various topical and systemic therapeutic options exist for the treatment of rosacea with several adjustments and considerations that must be taken into account when treating a child.     

激光个性化治疗酒渣鼻的疗效分析

目的观察不同分期酒渣鼻采用不同激光治疗的临床疗效。方法根据患者病情所处的不同阶段,个性化制定治疗方案:红斑期(Ⅰ期)患者采用强脉冲光(IPL)消除毛细血管,收缩毛孔;丘疹脓疱期(Ⅱ期)患者采用585nm脉冲染料激光(PDL)凝固较粗血管;鼻赘期(Ⅲ期)患者采用超脉冲CO2合并铒点阵激光切割气化鼻赘,收缩毛孔;Ⅱ期和Ⅲ期患者在治疗的后期均可采用IPL去除残余红斑,收缩毛孔。每次治疗2～3个月后观察疗效,及治疗次数对疗效的影响。结果 40例患者临床痊愈率达70%,总有效率达92.5%,无色素沉着及瘢痕等并发症。结论针对不同分期酒渣鼻使用个性化激光治疗方案,效果好,安全性高,值得推广。     

The effect of recurrent pulsed dye laser treatments in rosacea patients

Background: Rosacea is common chronic skin condition and is known to have a negative impact on patient’s quality of life. The use of pulsed dye laser treatment to improve quality of life is well documented in the literature. Prior work has emphasized a single series of laser treatments but we investigated the effect of recurrent pulsed dye laser treatment on patient’s symptomatology and quality of life. Methods: We designed an 8 question survey about patient’s rosacea symptoms, prior treatments, effectiveness of prior treatments, benefit of the laser treatments, and number of laser treatments. The survey (Figure 1) was offered to all patients over the age of 18 who were beginning or currently undergoing pulsed dye laser treatments who previously failed medical management for their erythematotelangiectatic rosacea. Results: Fifty patients completed the study. Patients had significant improvement in symptoms and show statistically significant benefit of repeated pulse dye laser treatment for rosacea versus a single series of treatments. Conclusion: Our study is unique in that it provides evidence that recurrent pulse dye laser treatments are beneficial to patients by improving quality of life and decreasing symptoms. This finding supports the notion that chronic treatment is needed for this chronic disease.     

Pathophysiology of rosacea: redness, telangiectasia, and rosacea

The pathophysiology of rosacea involves a large number of factors that are at times difficult to correlate. There is not a single physiopathological model. Nevertheless, today it seems to have been established that two essential factors are involved: vascular and inflammatory. The disease occurs in individuals with a predisposition, mainly a light phototype subjected to substantial variations in climate. On a background of primary vascular anomaly, external factors (climate, exposure to ultraviolet rays, cutaneous flora, etc.) contribute to the development of abnormal superficial blood vessels, with a low permeability. The edema that results undoubtedly favors the colonization and multiplication of Demodex folliculorum. This parasite creates inflammation, directly and indirectly, which is seen in the papules and pustules as well as granulomas. Inflammation from rosacea is also characterized by innate immune system anomalies, with an increase in the expression of epidermal proteases and production of pro-inflammatory cathelicidin peptides. In addition, facial hypersensitivity exists, even though the cutaneous barrier is not altered. Finally, rhinophyma remains poorly explained; the vascular abnormalities induce local production of transforming growth factor β1 (TGF-β1) capable of creating fibrosis and therefore cutaneous thickening.     

洒渣鼻的病理组织学研究

本文对32例酒渣鼻患者皮损标本进行病理组织学和超微结构的观察.发现本病主要为炎症反应,浸润的炎症细胞主要是淋巴细胞、浆细胞、组织细胞和肥大细胞.淋巴细胞渗入表皮细胞间隙和毛囊上皮.较多的肥大细胞有显著的脱颗粒现象.     

Treatment of rosacea

Rosacea is an inflammatory disease of the face and eyes. Treatment is adjusted to the site of the disease and its severity.     

Physiopathology of rosacea. Redness, telangiectasia, and rosacea

The physiopathology of rosacea involves a large number of factors that are at times difficult to correlate. There is not a single physiopathological model. Nevertheless, today it seems to have been established that two essential factors are involved: vascular and inflammatory. The disease occurs in individuals with a predisposition, mainly a light phototype subjected to substantial variations in climate. On a background of primary vascular anomaly, external factors (climate, exposure to ultraviolet rays, cutaneous flora, etc.) contribute to the development of abnormal superficial blood vessels, with a low permeability. The edema that results undoubtedly favors the colonization and multiplication of Demodex folliculorum. This parasite creates inflammation, directly and indirectly, which is seen in the papules and pustules as well as granulomas. Inflammation from rosacea is also characterized by innate immune system anomalies, with an increase in the expression of epidermal proteases and production of pro-inflammatory cathelicidin peptides. In addition, facial hypersensitivity exists, even though the cutaneous barrier is not altered. Finally, rhinophyma remains poorly explained; the vascular abnormalities induce local production of transforming growth factor β 1 (TGF-β1) capable of creating fibrosis and therefore cutaneous thickening.     

Stinging and rosacea

A total of 32 rosacea patients (25 with the papulopustular type of rosacea and 7 with the erythematotelangiectatic type) and 32 healthy persons were single-blind tested with a solution of 5% lactic acid and pure water applied to their cheeks. Twenty-four patients and 6 controls reacted positively as "stingers" (p<0.001) in this objective test of sensitive skin. All 7 of the patients with erythematotelangiectatic rosacea, but only 17/25 with the papulopustular type, were stingers (n.s.). The reason why some patients react with subjective symptoms, such as itching, burning, stinging, prickling or tingling, is unclear. The findings in this study are not surprising, but do support the theory that impairment due to different stimuli, most likely because of vascular sensitivity, is a central mechanism in the aetiology of rosacea. The correlation between sensitive vessels and sensitive skin has, however, not yet been determined.