Children with facial morphoea managing everyday life: a qualitative study

Facial morphea is a rare chronic inflammatory skin disorder that occurs on the face and can be disfiguring. It typically appears in childhood and adolescence and may have a significant impact on self‐esteem, psychosocial outcomes and quality of life. The few studies examining quality of life in children with morphea reported mild to moderate impact. However, these studies included small numbers of facial morphea cases and used questionnaires that cannot describe the complex experience of living with this visible skin disorder. This study used qualitative methods and a social constructionism approach to understand how facial morphea affects the everyday lives of children and their parents. The study was located in Canada and ten children with facial morphea, aged 8–17 years, and 13 parents took part in individual or group interviews and were asked to create a drawing about what it was like to live with facial morphea. Findings indicated that living with facial morphea was stressful. Stress was related to children's perceptions of being different, which was linked to life transitions, reactions of others (e.g. intrusive questioning and bullying) and treatment effects (e.g. weight gain). Managing the impact of facial morphea involved hiding its physical signs, constructing explanations about what “it” is and connecting with peers. Clinicians can support children with facial morphea achieve a better quality of life by helping them learn how to respond to intrusive queries, developing opportunities for peer support and attending to the anxiety associated with illness uncertainty and medical treatment.     

The impact of rosacea on quality of life: effects of demographic and clinical characteristics and various treatment modalities

Summary Background Rosacea has a major psychosocial impact on a patient’s life. Objectives To determine the impact of rosacea on patient quality of life, the relationship of quality of life scores to clinical and demographic variables, and the change in quality of life following various treatments. Methods Patients’ demographic and clinical characteristics were recorded at their initial examination and their response to treatment and side‐effects were recorded additionally at their follow‐up examination. Rosacea severity was scored for each of four signs from 0 to 3. Patients were requested to complete Dermatology Life Quality Index (DLQI) questionnaires. Results A total of 308 patients took part in this study. Mean ± SD DLQI total score at the initial visit was 6·93 ± 5·18 and was related to patients’ age, sex, age at disease onset, subjective symptoms, triggering factors, previous treatments, rosacea severity scores and patients’ self‐assessment of ease of living with rosacea. Of these 308 patients, 164 completed the DLQI following treatment. Mean ± SD post‐treatment DLQI score was 4·36 ± 4·82. Post‐treatment scores were also related to sex, type of treatment modality, development of side‐effects, improvement of rosacea, rosacea severity scores and patients’ self‐reported ease of living with rosacea. Topical metronidazole, oral tetracycline and oral isotretinoin were observed to reduce signs and symptoms of rosacea and DLQI scores significantly at this repeat examination. Conclusions Rosacea affects patients’ lives to a moderate extent, and this can be assessed by using DLQI. DLQI is also sensitive to quality of life changes brought about by treatment of rosacea. As a preliminary result we can say that topical metronidazole, oral tetracycline and oral isotretinoin seem to improve quality of life of patients by improving lesions of rosacea more efficiently than other therapeutic agents.     

Skin tolerance, efficacy, and quality of life of patients with red facial skin using a skin care regimen containing Licochalcone A

Background Patients with rosacea and red facial skin often show sensitivity to skin care products which can exacerbate inflammation and subjective irritation. Besides pharmacologic management, special skin care is prudent to avoid cosmetically induced irritation and address cosmetic concerns. Appropriate skin care should provide gentle cleansing, UVA/UVB protection, effective moisturization, and concealing pigments to neutralize the appearance of redness. Aims To evaluate skin compatibility and efficacy of a skin care regimen containing licochalcone A (Lic A), an anti‐irritant from the licorice plant Glycyrrhiza inflata, for subjects with mild to moderate facial redness. Patients/methods Sixty‐two patients with mild to moderate red facial skin used a four‐product skin care regimen for 8 weeks. Clinical assessments of erythema and subjective irritation, cross‐polarized photography, and self‐assessment questionnaires were completed at baseline, and after 4 and 8 weeks of use. A quality of life questionnaire was given at baseline and week 8. Results Clinical evaluations, subject response, and photography confirmed very good tolerability of the regimen and effective neutralization of redness by the pigmented products. Significant improvements in average erythema scores were observed at 4 and 8 weeks (P < 0.05), and an improvement in quality of life was confirmed by the patient questionnaires. Discussion The skin care regimen containing Lic A was found to be compatible with the sensitive facial skin of patients with rosacea and improved the appearance of persistent facial redness. The products were also observed to be compatible with daily metronidazole treatment.     

Mental health in patients with systemic sclerosis: a controlled investigation

Background Despite the undeniable impact of systemic sclerosis (SS) on quality of life, only a few studies so far have focused on its psychiatric or psychological aspects. We aimed at assessing psychiatric symptoms and self‐image in inpatients with SS and comparing them with patients with either a very mild skin condition or a serious skin condition. Methods Three groups were recruited: (i) 38 consecutive female inpatients with SS; (ii) 38 age‐matched female outpatients with melanocytic naevi; (iii) 35 age‐matched female inpatients with melanoma. All participants completed the Zung Anxiety Scale, the Zung Depression Scale and a self‐report questionnaire measuring self‐perceived personal qualities. Patients with SS were also clinically interviewed by a psychologist. Results The clinical interview revealed the presence of a psychiatric disorder in most (81%) patients with SS. The Zung scales corroborated the presence of mild to moderate anxiety and depression among patients with SS, who scored significantly higher than patients with either naevi or melanoma on both scales. Scores on the questionnaire assessing self‐perceived personal qualities were very similar in the three groups and indicated a fairly high level of self‐esteem. Conclusions This study suggested that psychosocial issues are quite relevant in patients with SS and underscored the need for a biopsychosocial approach to the clinical management of these patients. Timely detection of psychosocial difficulties and appropriate psychological or psychiatric intervention may represent important steps toward better adherence to medical treatment and improved psychological well‐being and quality of life.     

A randomized, single-blind, placebo-controlled, split-face study with pimecrolimus cream 1% for papulopustular rosacea

Background Rosacea is a common inflammatory skin disorder for which the pathogenesis is unclear. Currently, there is no cure for rosacea, and it seems that standard therapies have focused mainly on minimizing inflammation. Objectives The aim of this study is to investigate the potential efficacy, tolerability and safety profile of 1% pimecrolimus cream for the treatment of rosacea. Methods Twenty‐five patients with papulopustular rosacea were enrolled to a randomized, single‐blinded, placebo‐controlled, split‐face trial of pimecrolimus cream 1% consisting 4 week treatment and 2 week follow‐up period. The patients were instructed to apply first the ‘left side cream’ labelled placebo cream (Ultrabase cream, Intendis GmbH, Berlin, Germany) to the left hemi‐face then the ‘right side cream’ labelled 1% pimecrolimus cream (Elidel; Novartis Pharma, Nuremberg, Germany) to the right hemi‐face, twice daily. They were informed to apply a standard amount of each cream with the fingertip‐unit and not allowed to use any other agent concomittantly other than sunblock. Clinical evaluation and subjective severity assessment were obtained along with photographic documentation at baseline, first, second, and fourth weeks of the therapy and at the follow‐up visit. Rosacea severity score for each sign of erythema, papules, pustules, oedema, and telengiectesia were graded from 0 to 3. Patients were questioned for the subjective symptoms, overall improvement on appearance and side‐effects. Results Twenty‐four patients completed the study with an exceptional compliance and tolerable safety profile. One patient withdrew from the study due to severe flare‐up reaction affecting both hemi‐faces. The mean baseline total rosacea severity scores were 5.06 + 1.29 for both sides and reduced to 2.5 ± 1.06 vs. 3.25 ± 1.24 on pimecrolimus vs. placebo applied sides without the significance (P = 0.06). There was not any significant difference concerning each rosacea sign scores and total rosacea severity scores except for the significant improvement in erythema score and total rosacea severity score obtained on the pimecrolimus‐applied hemi‐face at 2nd week of therapy (P =0.01 and P = 0.03, respectively). The reduction rates of the mean subjective severity scores at 4th week were 49.77% vs. 38.89% for pimecrolimus vs. placebo, respectively, without a statistical significance (P = 0.15). Subjective symptoms responded well in 54.16% of patients concerning pimecrolimus application compared with 12.50% for the placebo application. The side‐effects were mostly transient local irritations. Conclusion Our data implicated that pimecrolimus cream is not superior to placebo except for its efficacy on erythema. We believe that pimecrolimus cream can be a treatment option for rosacea patients with high erythema score for whom an initial accelerated improvement is needed. We believe further studies with topical pimecrolimus cream on larger study groups with different subtypes and severity of rosacea will clarify the potential effect of pimecrolimus cream for the treatment of rosacea.     

Patient experiences and outcomes following facial skin cancer surgery: A qualitative study

Early melanoma and non‐melanoma skin cancer of the facial area are primarily treated with surgery. Little is known about the outcomes of treatment for facial skin cancer patients. The objective of the study was to identify concerns about aesthetics, procedures and health from the patients' perspective after facial skin surgery. Semi‐structured in‐depth interviews were conducted with 15 participants. Line‐by‐line coding was used to establish categories and develop themes. We identified five major themes on the impact of skin cancer surgery: appearance‐related concerns; psychological (e.g., fear of new cancers or recurrence); social (e.g. impact on social activities and interaction); physical (e.g. pain and swelling) concerns and satisfaction with the experience of care (e.g., satisfaction with surgeon). The priority of participants was the removal of the facial skin cancer, as this reduced their overall worry. The aesthetic outcome was secondary but important, as it had important implications on the participants' social and psychological functioning. The participants' experience with the care provided by the surgeon and staff also contributed to their satisfaction with their treatment. This conceptual framework provides the basis for the development of a new patient‐reported outcome instrument.     

Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection

Free‐living amebae are ubiquitous in our environment, but rarely cause cutaneous infection. Balamuthia mandrillaris has a predilection for infecting skin of the central face. Infection may be restricted to the skin or associated with life‐threatening central nervous system (CNS) involvement. We report a case of a 91‐year‐old woman, who presented with a non‐healing red plaque over her right cheek. Several punch biopsies exhibited non‐specific granulomatous inflammation without demonstrable fungi or mycobacteria in histochemical stains. She was treated empirically for granulomatous rosacea, but the lesion continued to progress. A larger incisional biopsy was performed in which amebae were observed in hematoxylin‐eosin stained sections. These were retrospectively apparent in the prior punch biopsy specimens. Immunohistochemistry and polymerase chain reaction studies identified the organisms as Balamuthia mandrillaris. Cutaneous infection by B. mandrillaris is a rare condition that is sometimes complicated by life‐threatening CNS involvement and which often evades timely diagnosis due to its rarity and nonspecific clinical manifestations. Moreover, these amebae are easily overlooked in histopathologic sections because of their small number and their resemblance to histiocytes. Dermatopathologists should be familiar with the histopathologic appearance of these organisms and include balamuthiasis and other amebic infections in the differential diagnosis of granulomatous dermatitis.     

Recognition of need in health care consultations: a qualitative study of people with psoriasis

Background Psoriasis is a life‐long inflammatory condition that can impact on quality of life, psychological and social functioning. Previous literature suggests patient dissatisfaction with psoriasis management; however, little is known about people’s specific experiences of health care consultations. Objectives The study aimed to explore in depth the perspectives of people living with psoriasis including coping responses, self‐care strategies and how consultations with health care professionals in both primary and secondary care are experienced. Methods Qualitative semistructured interviews were carried out with a diverse sample of 29 people with psoriasis generated purposively and recruited from community sources in North West England. Interviews were coded using Framework Analysis to produce a thematic framework incorporating key emerging issues and concepts. Results Participants experienced psoriasis as a complex condition involving physical, psychological and social challenges, as well as issues of control, but perceived that these were largely unacknowledged by practitioners in health care consultations. Practitioners were perceived as lacking knowledge and expertise in the management of psoriasis, lacking empathy with the effects of psoriasis and failing to manage it as a long‐term condition. This perceived lack of support resulted in some participants withdrawing from conventional health service providers and seeking alternative sources of help. Conclusions Psoriasis needs to be recognized and managed as a complex long‐term condition with emotional and social needs that are addressed alongside appropriate diagnosis and regular reviews of treatments which may involve referrals to specialist care.     

Positive correlation between serum immunoreactivity to Demodex‐associated Bacillus proteins and erythematotelangiectatic rosacea

Background Rosacea is a chronic inflammatory condition that affects the skin of the face and the eyes. Erythematotelangiectatic rosacea is characterized by flushing, oedema and telangiectasia. Patients with rosacea demonstrate elevated densities of Demodex mites in their skin compared with controls. A bacterium (Bacillus oleronius) isolated from Demodex mites from a patient with papulopustular rosacea has been demonstrated to produce antigenic proteins that may play a role in papulopustular and ocular rosacea. Objectives To establish whether there was a correlation between the reactivity of sera from patients with erythematotelangiectatic rosacea to Bacillus antigens, and to characterize the proteins to which these patients showed reactivity. Methods Serum samples from patients with erythematotelangiectatic rosacea and controls were examined for reactivity to Bacillus proteins by Western blot analysis. Proteins to which the sera reacted were excised from gels, trypsin digested, and putative identities were assigned following liquid chromatography‐mass spectrometry (LC‐MS) analysis. Results Eighty per cent (21/26) of patients with erythematotelangiectatic rosacea showed serum reactivity to the 62‐ and 83‐kDa proteins of B. oleronius, compared with 40% (9/22) of controls (P = 0·004). The 62‐kDa protein was characterized by LC‐MS and showed homology to groEL chaperonin, which provokes a strong immune response in mammals. The 83‐kDa protein showed homology to aconitate hydratase, of which expression is increased in bacteria under oxidative stress, and which is highly immunogenic. Conclusions The majority of patients with erythematotelangiectatic rosacea show serum reactivity to two proteins from B. oleronius, suggesting that this bacterium may play a role in the induction of this condition. The two proteins to which patient sera reacted were found to be similar to a heat shock protein and an enzyme involved in regulating the stress response of the bacterium.     

Quantification of Demodex folliculorum by PCR in rosacea and its relationship to skin innate immune activation

The aim of this study is to quantify D. folliculorum colonisation in rosacea subtypes and age‐matched controls and to determine the relationship between D. folliculorum load, rosacea subtype and skin innate immune system activation markers. We set up a multicentre, cross‐sectional, prospective study in which 98 adults were included: 50 with facial rosacea, including 18 with erythematotelangiectatic rosacea (ETR), and 32 with papulopustular rosacea (PPR) and 48 age‐ and sex‐matched healthy volunteers. Non‐invasive facial samples were taken to quantify D. folliculorum infestation by quantitative PCR and evaluate inflammatory and immune markers. Analysis of the skin samples show that D. folliculorum was detected more frequently in rosacea patients than age‐matched controls (96% vs 74%, P < 0.01). D. folliculorum density was 5.7 times higher in rosacea patients than in healthy volunteers. Skin sample analysis showed a higher expression of genes encoding pro‐inflammatory cytokines (Il‐8, Il‐1b, TNF‐a) and inflammasome‐related genes (NALP‐3 and CASP‐1) in rosacea, especially PPR. Overexpression of LL‐37 and VEGF, as well as CD45RO, MPO and CD163, was observed, indicating broad immune system activation in patients with rosacea. In conclusion, D. folliculorum density is highly increased in patients with rosacea, irrespective of rosacea subtype. There appears to be an inverse relationship between D. folliculorum density and inflammation markers in the skin of rosacea patients, with clear differences between rosacea subtypes.     

Rosacea or photodamaged skin? Use of brimonidine gel in differentiating erythema in the two conditions

In this case report, we detail the response of a 37‐year‐old Caucasian man with an overlap of erythematotelangiectatic rosacea and telangiectatic photoaging to brimonidine tartrate gel. With the application of brimonidine only on half of his face, skin analysis images, clinician's and patient's assessment showed that there was significant improvement in the erythema. This case has lent insight into how brimonidine can be used to assess the extent of photoaging by eliminating the erythema of rosacea to some degree. We propose that it can be used as a non‐invasive test to differentiate between the two conditions, sparing patients from skin biopsies and molecular analysis.     

The life experiences of psoriasis patients receiving biologics

Psoriasis is a common chronic skin disease that affects approximately 2-4 % of the western population. It is associated with comorbidities (illnesses that occur alongside psoriasis) such as psoriatic arthritis and cardiovascular diseases. It is well documented that psoriasis has a negative impact on patients’ quality of life and is associated with both depression and anxiety. The use of a type of medicine called biologics leads to physical improvement of psoriasis, and greater confidence. While biologics may change patients’ lives, how patients perceive these changes is not well known. This study aimed to find out the everyday life experiences of patients with psoriasis who are treated with biologics. The authors observed participants’ outpatients consultations, to gain insight into the interaction, communication and issues discussed during consultations, and to grasp a sense of the lived experiences of the participants. Individual interviews were also held with some patients. When patients with psoriasis receive biological treatment it was experienced as a turning point, with a significant impact on physical, psychological and emotional levels. However, psychological consequences, such as isolation and social withdrawal, seemed to be a part of the patient's identity; the negative perceptions of psoriasis left marks behind that affected the patient's self-image. Put in another way: having clear skin did not necessarily lead to feelings of having clear skin. Patients feared discontinuance of their biological treatment which resulted in insecurity, and they were reluctant to initiate discussion about these concerns with healthcare professionals. Receiving transformative treatment is complex, with psychological issues not addressed or solved simply by receiving biologics. Healthcare professionals may find it helpful to be aware that even patients whose treatment is successful may be reluctant to discuss their concerns about treatment, and that patients should be given time and opportunities to discuss these concerns. Linked Article:   Trettin et al. Br J Dermatol 2020; 183 :516–523 .     

Risk factors associated with rosacea

Background Although rosacea is a common disease, the cause of disease is still a mystery –Helicobacter pylori infection, genetic predisposition, climatic factors, and detrimental habits are implicated as triggers of rosacea. Objective The aim of current study is to evaluate several suspected risk factors coincidently. Methods Patients with rosacea from a dermatology clinic and skin‐healthy controls from an randomly selected employees' population enrolled the study. Skin status were evaluated by one and same dermatologist. Participants were queried for age, gender, sun‐reactive skin type, and detrimental habits using a questionnaire; blood samples for detecting Helicobacter pylori serostatus were collected. Results Totally 145 skin‐healthy controls and 172 subjects either with flushing episodes or established rosacea included the study. In multivariate analysis, rosacea patients had significantly higher chance to have photosensitive skin types (OR 1.75; 95% CI 1.01–3.04; P < 0.05), positive family history to rosacea (OR 4.31; 95% CI 2.34–7.92; P < 0.0001) or previous smoking status (OR 2.01; 95% CI 1.07–3.80; P < 0.05) comparing with skin‐healthy controls. There were no statistically significant differences either in gender, Helicobacter pylori serostatus, caffeine intake, alcohol consumption, occupational environment, or education level between rosacea patients and controls. Conclusion Rosacea is foremost associated with familial predisposition. There is no association between Helicobacter pylori infection and rosacea in current study.     

Incidence and prevalence of rosacea: a systematic review and meta‐analysis

Rosacea is a common chronic skin condition usually localised in the central part of the face. It is characterised by areas of intermittent or persistent redness, small and superficial dilated blood vessels, small red spots and bumps and some people experience eye symptoms such as dryness, irritation and swollen red eyelids. Rosacea can affect both men and women of all ages, but is most common among fair‐skinned women over the age of 30. The global frequency of rosacea remains unknown, although it is a common condition associated with other diseases outside the skin. The aim of this study was to examine the worldwide frequency of rosacea. The authors did this by examining globally published literature from medical databases reporting the frequency of rosacea. They examined both the frequency in the general population as well as among dermatology outpatients to better understand the absolute burden of this condition. A total of 32 studies were included examining a total of 41 populations with 26 519 836 individuals. Twenty‐two populations were from Europe, 3 from Africa, 4 from Asia, 9 from North America, and 3 from South America. The authors found a frequency of rosacea of 5.46% in the general population and 2.39% among dermatology outpatients. The frequency of rosacea depended on the diagnostic method with higher estimates in questionnaire studies of rosacea symptoms and lower estimates in health registries (i.e. databases). Rosacea was found to affect both women and men equally, and mostly those aged 45–60 years.     

A pilot randomized controlled trial to examine the feasibility and efficacy of an educational nursing intervention to improve self‐management practices in patients with mild‐moderate psoriasis

Background Large numbers of people are expected to self‐manage their skin condition, but limited attention has been given to studies of self‐management in psoriasis, neither clearly highlighting the challenge nor seeking to develop interventions to support its effectiveness. Objectives 1. To test the feasibility of a new educational intervention to enable people with psoriasis to self‐manage more effectively an adequately powered multi‐centred trial design through piloting. Method Pilot randomized controlled trial with adults (n = 64) with mild‐moderate psoriasis in Primary Care in the United Kingdom. Both groups continued with usual treatment. A theory‐based educational intervention was designed. The primary outcome measure was the Dermatology Life Quality Index (DLQI). Secondary measures included the Psoriasis Area and Severity Index (PASI) and qualitative feedback from participants. Assessment of the feasibility of the intervention included recruitment and acceptability to participants. Results Delivery of the intervention was feasible and positively evaluated. Recruitment strategies and the intervention need minor modification. As a pilot study there was insufficient power to detect significant score changes. Sub group analysis of participants with a PASI or DLQI of >6 indicated a modest reduction in PASI in the intervention group which demonstrates a trend that may indicate that this intervention has potential value for people with moderate psoriasis when combined with qualitative data. Conclusion This study highlights the feasibility of delivering a self‐efficacy based educational intervention for people with mild‐moderate psoriasis in primary care establishing the numbers and design required for an adequately powered multi‐centred trial.     

The association of dermatologist-diagnosed and self-reported skin diseases with skin-related quality of life in Latino migrant farmworkers

Background Skin diseases are known to affect the quality of life (QoL), but data to support this are based on clinical samples. Few data document the skin‐related QoL in the general population, and whether its association differs with self‐reported or dermatologist‐diagnosed skin ailments. Farmworkers are at high risk for skin diseases, and are an appropriate population in which to explore these associations. Objectives To compare the association between skin‐related QoL and workers’ self‐reports of skin conditions or dermatologist‐diagnosed skin diseases over the course of a work season. Methods Three hundred and four Latino farmworkers were recruited from 45 randomly selected residential sites in North Carolina, USA, for longitudinal surveillance. The participants were interviewed up to five times at 3‐week intervals and the reported skin problems and Dermatology Life Quality Index (DLQI) were recorded. Nine digital photographs were taken of each participant. A board‐certified dermatologist rated each for the presence of specific skin diseases. Results An impact of skin disease on QoL was reported in 16% of interviews. In multivariate analyses with self‐reported skin problems, feet or skin fungus, rash, itching, and poison ivy were predictors of QoL. Dermatologist‐diagnosed inflammatory diseases and pigmentary disorders were significant predictors of QoL. The association was stronger for self‐reported skin problems than for dermatologist‐diagnosed conditions. Conclusions In a population of farmworkers, skin problems had a clinically significant impact on QoL. Itch‐related conditions and cosmetic conditions, such as acne and melasma, were important determinants of QoL. Treatment for these conditions in this population may enhance QoL.     

Recombinant erythroid differentiation regulator 1 inhibits both inflammation and angiogenesis in a mouse model of rosacea

The erythroid differentiation regulator 1 (Erdr1), which is a novel and highly conserved factor, was recently reported to be negatively regulated by IL‐18 and to play a crucial role as an antimetastatic factor. IL‐18 is a proinflammatory cytokine that functions as an angiogenic mediator in inflammation. Rosacea is a chronic inflammatory skin disorder that is characterized by abnormal inflammation and vascular hyperactivity of the facial skin. To determine whether Erdr1 contributes to the regulation of the chronic inflammatory process in the development of rosacea, an immunohistochemical analysis was performed in healthy donors and patients with rosacea. In this study, we showed that Erdr1 was downregulated, whereas IL‐18 was upregulated, in patients with rosacea, which led us to question the role of Erdr1 in this disorder. Moreover, a rosacea‐like BALB/c mouse model was used to determine the role of Erdr1 in rosacea in vivo. LL‐37 injection induced typical rosacea features, including erythema, telangiectasia and inflammation. Treatment with recombinant Erdr1 (rErdr1) resulted in a significant reduction of erythema, inflammatory cell infiltration (including CD4⁺ and CD8⁺ T cells), and microvessel density with vascular endothelial growth factor (VEGF). Taken together, our findings suggest that rErdr1 may be involved in attenuating the inflammation and angiogenesis associated with the pathogenesis of rosacea. Thus, these results provide new insight into the mechanism involved in this condition and indicate that rErdr1 could be a potential target for therapeutic intervention of rosacea.     

Association between rosacea severity and relative muscle mass: A cross‐sectional study

Rosacea is thought to be associated with factors involved in metabolic syndrome (MetS). Muscle mass has a beneficial role in preventing MetS, but its link to rosacea remains unknown. We sought to investigate the association between rosacea severity and relative skeletal muscle mass. A cross‐sectional study was conducted on subjects who attended a skin check‐up program at the Kangbuk Samsung Hospital Health Screening Center between 2014 and 2016. Polarized light photographs of the face were taken and evaluated by two dermatologists. Skeletal muscle mass index (SMI, [%] = total skeletal muscle mass [kg] / bodyweight [kg] × 100) was estimated using a bioelectrical impedance analyzer. A logistic regression model was used to evaluate an association between SMI and rosacea. Of 110 rosacea subjects who were finally enrolled, 17 (15.5%) and 93 (84.5%) were classified as having papulopustular and erythematotelangiectatic rosacea, respectively. Categories of SMI comprised the following tertiles: 22.86–38.40%, 38.41–43.44% and 43.45–80.65%. In severity, compared with mild rosacea (75.5%), moderate rosacea (24.5%) incrementally increased as SMI decreased (P_trend < 0.01). Severe rosacea was not observed. After adjustment for age and sex, odds ratios (95% confidence intervals) for moderate rosacea comparing SMI tertiles 1 and 2 to the highest tertile (reference) were 5.66 (1.22–26.20) and 4.43 (1.12–17.55), respectively (P_trend = 0.03). This association was present in women with marginal significance (P_trend = 0.06), but not in men. Relative muscle mass is negatively associated with an increased risk of more severe rosacea, suggesting that skeletal muscle can have a protective effect on rosacea exacerbation.     

Well being,psychopathology and coping strategies in psoriasis compared with atopic dermatitis: a controlled study

Background There is a vast literature describing the association between psoriasis, atopic dermatitis (AD) and psychological distress. Some of these studies were uncontrolled and others used non‐dermatological diseases as control, but only a few used chronic skin diseases as controls. Objective To compare well being, psychopathology and coping strategies of psoriatic, AD and healthy controls in a prospective case‐control study. Methods Thirty‐seven psoriatic patients and 31 AD patients were recruited from the Hadassah Ein Karem Hospital, Jerusalem, Israel, outpatient and inward clinic. The participants in the control group were 31 healthy workers and volunteers with no dermatological diseases from Kaplan Hospital, Rehovot, Israel. We used self‐report questionnaires [Mental Health Inventory (MHI) and Adjustment to Chronic Skin Diseases Questionnaire (ACSD)], a projective technique (Hand Test) and assessment tools (Clinical Global Impression). Results Psoriatic patients experienced reduced well being (P = 0.007) and more anxiety and depression (P = 0.018) than normal controls. Psoriatic patients also displayed more severe psychopathology (P = 0.039) a more passive attitude towards life, and loss of meaning in life (P = 0.001) as measured by the projective technique compared with AD patients and normal controls. Conclusions We propose two explanations, derived from the psychological and the psycho‐neuro‐immunological domains. First, greater mental distress in psoriasis is because of the greater stigma it bears compared with AD. Alternatively, we hypothesize that the psoriatic inflammatory process may possibly have a direct central nervous system effect.     

The importance of stressful family events in psoriatic patients: a retrospective study

Background Psychosomatic stress events are believed to play an important role in psoriasis either by inducing or worsening the disease. Objective In this article, we compared the role of family stress events against other types of stress events on the psychological well being of patients and on their skin disease. We used our sample of psoriasis patients with said stress events. Method Patients underwent a dermatological examination which was evaluated through the PASI index. Simultaneously, they underwent interviews for psychological evaluations. The Hamilton scales were administered to assess anxiety and depression (Ham‐A scores significant >20, Ham‐D >15). Results It has been demonstrated that family stress influences the psychological well being more than other types of daily stress events. In fact, people with family stress events reported higher value HAM‐A (P = 0.03) and HAM‐D (P = 0.02) compared with those who reported other types of stress events. Women reported higher values of HAM‐A and HAM‐D than men. The value of PASI in the two groups (with family stress events and those with other stress events) was not statistically significant. Conclusion Results obtained from this analysis show the importance of family stress events on the quality of life and on psychiatric and dermatological status. For the psychological morbidity, a parallel approach of both bio‐psychiatric and skin care is recommended, especially for women.