Management of cutaneous rosacea: emphasis on new medical therapies

Introduction: Over the past decade, both basic science and clinical research have provided new information on pathophysiology and therapy that has led to advances in the management of rosacea. As rosacea is a very common facial skin disorder in adults of both genders and essentially all races and ethnicities, these advances can provide therapeutic benefit to many affected individuals around the world.

Areas covered: This article provides a collective review of more recent information on the pathophysiology and clinical manifestations of rosacea, and discusses individual medical therapies based on PubMed literature searches on ‘rosacea’, ‘rosacea therapies’ and each therapy that are included in this article. The perspectives of the author on management of rosacea are also included. Newer therapies and treatment concepts received greater emphasis.

Expert opinion: Management of cutaneous rosacea involves patient education, integration of proper skin care, differentiation of visible manifestations and symptoms, selecting therapies that correlate with the manifestations that are to be treated, setting realistic patient expectations on anticipated degree and time course of response and designing an overall management plan that addresses needs of the individual patient. In many cases, a combination approach is needed, and due to the chronicity of the disease long-term management is often warranted.     

Topical therapies for rosacea

Therapeutic options for rosacea include topical agents, oral therapies, laser and light treatments, and surgical procedures. Topical therapies play a critical role in the treatment of patients with papulopustular rosacea and erythematotelangiectatic rosacea, and have the ability to effectively minimize certain manifestations of the disease, including papules, pustules, and erythema. The 3 primary agents for the topical treatment of rosacea are metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Each of these therapies is approved for the treatment of rosacea and has been validated by multiple studies. Additional topical therapies including benzoyl peroxide, clindamycin, retinoids, topical steroids, calcineurin inhibitors, and permethrin are not approved for the treatment of rosacea and play variable roles in the management of this condition.     

Laser and light therapies for acne rosacea

Acne rosacea is a multifactorial, somewhat mercurial disorder that can be a challenge to control with standard pharmacologic agents. Laser and light sources have been increasingly utilized, particularly for control of the generalized erythema, flushing, and telangiectasia of rosacea. This paper will review the clinical studies presented in the literature specifically treating patients with rosacea. Long-pulsed dye lasers and intense pulsed light devices can offer patients effective treatment without the purpura of short-pulsed dye lasers. Long-term efficacy has not been studied but maintenance therapy may be necessary to control the vascular manifestations of this disease.     

Evaluation of topical metronidazole gel in acne rosacea

Topical metronidazole gel (0.75%) was compared to placebo gel in a randomized, double-blind, placebo-controlled, split-face clinical trial for the treatment of 59 patients with acne rosacea. Statistically significant differences in inflammatory lesions, erythema, and global assessments were seen at three, six, and nine weeks post-baseline in favor of the active treatment side. It did not, however, alter the telangiectatic component of the disease. No known drug-related side effects were detected, and the low topical dose along with low serum levels of metronidazole indicate a high safety profile for this therapeutic agent. This work suggests that metronidazole gel, as specifically formulated, is safe and effective in reducing the symptomatology of acne rosacea.     

Evaluation of the efficacy and tolerance of a topical gel with 4% quassia extract in the treatment of rosacea

BACKGROUND: There are various treatment options available for rosacea, depending on the subtype, but treatment is still generally unsatisfactory. Some studies have reported antiparasitic and anti-inflammatory properties of Quassia amara. AIM: To check the efficacy and safety of a topical gel with 4% Quassia amara extract in the treatment of various grades of rosacea. METHODS: A group of 30 patients with various grades of rosacea (I-IV) were investigated in a single-center, open-label study. They were treated with a topical gel with 4% Quassia amara extract for 6 weeks. Response was evaluated by the flushing, erythema, telangiectasia, papules, and pustules scores. At the end of therapy, overall improvement, safety, and tolerability were assessed. Results: Twenty-seven of 30 patients (90%) completed the study. The treatment resulted to be very effective, and the results achieved were in line with those published with topical metronidazole and azelaic acid. Safety and tolerability were excellent. ConCLUSION: Topical quassia extract could be a new, efficient, and safe weapon in the armamentarium for the management of rosacea.     

新肤螨灵霜治疗酒渣鼻

应用新肤螨灵霜和5％硫磺霜双盲对照试验治疗酒渣鼻64例(男23,女41,年龄40±12a),43例应用新肤螨灵霜,21例应用5％硫磺霜,1月2次,疗程14-20d。新肤螨灵霜的临床治愈率14％,显效49％,有效28％,总有效率91％,明显优于5％硫磺箱(P<0.01)。副作用较轻。因此,新肤螨灵霜值得在临床上试用。     

Treatment of atopic dermatitis and impact on quality of life: a review with emphasis on topical non-corticosteroids

Atopic dermatitis (AD) is a chronic skin disease with increasing prevalence and rising costs. Stigmatisation and pruritus are only some aspects of potential quality-of-life (QOL) impairments. AD is not curable and repeated treatments are often necessary. At present, treatment with topically-applied corticosteroids is state-of-the-art for mild to moderate flare-ups. However, many patients are worried about the use of corticosteroids due to the widespread fear of adverse effects. In this review the present literature is analysed concerning impact on quality of life for topically-applicable alternatives to the state-of-the-art treatment. For comparison reasons, data from other treatment modalities are additionally given. Characteristics of studies were analysed using 'general' (year and mode of publication, type and aim of study, number of patients, and clinical measurement) and 'QOL specific' criteria (type and number of QOL measurements including relevance for study aim and age group, validation in used language, sensitivity to change, and improvement at end of study). QOL data are published only in the minority of studies evaluating treatment efficacy and do not cover the variety of possible therapies. Data are available for tacrolimus, pimecrolimus, UVA/UVB combination and UVB narrowband (topical non-corticosteroidal treatments), as well as for topical corticosteroids, cyclosporin, and inpatient treatment. All studies provided a marked improvement in quality of life after therapy. One study assessed quality of life after a treatment-free follow-up period obtaining a clear increase in impact on quality of life. Since studies used different QOL measurements and vary in inclusion criteria, treatment schedules and presentation of results, a comparison of QOL improvement is not recommended. A single randomised study compared topically applied non-corticosteroidal treatment (UVA/UVB combination) with another treatment modality (cyclosporin) and found no difference in QOL improvement. At present, there is a clear lack of controlled randomised studies evaluating different active treatment modalities and their impact on quality of life. Consensus meetings are desirable to formulate guidelines for the selection and correct use of QOL measurements. Patients' fear of side effects (e.g. concerning corticosteroids) should be integrated in QOL questionnaires for evaluation of possible compliance problems and real costs. Since relapse after treatment is frequent in AD, QOL measurements should also be performed after a treatment-free follow-up period. At present, we can not answer the question 'which treatment best improves quality of life in AD?'.     

口服与外用痤疮治疗药物市场分析

虽然口服用痤疮治疗药物品种数量与外用制剂相差较大,但我国样本医院的购药金额却显示两者旗鼓相当.在研口服用痤疮治疗药物中,Rambazole可提高内源性维A酸水平,曾一度备受关注,但目前研究末见进展.同时,随着透皮给药技术的发展,脂质体、多聚体和微乳等多种制剂有望进一步优化痤疮外用制剂,其应用日渐广泛.     

壬二酸乳膏联合克拉霉素治疗玫瑰痤疮的疗效观察

目的 观察壬二酸乳膏联合克拉霉素治疗玫瑰痤疮的临床疗效。方法 选取2020年1月—2022年1月天津市宝坻区人民医院收治的80例玫瑰痤疮患者,按照随机数字表法将所有患者分为对照组和治疗组,每组各40例。对照组口服克拉霉素片,250 mg/次,2次/d。治疗组在对照组基础上外用壬二酸乳膏,早晚温水洁面后于痤疮处将本品均匀薄涂,用力涂搽使其深入皮肤,每日早晚各1次。两组疗程均为8周。观察两组的临床疗效,比较治疗前后两组阵发性潮红发作频率,相关量表[持续性红斑医生评估量表（CEA）、研究者整体评价（IGA）、皮肤病生活质量指数（DLQI）]评分,面部皮损处皮肤生理指标（角质层厚度、真皮乳头密度、真皮乳头毛细血管直径）及毛囊蠕形螨感染情况（受累毛囊数量、蠕形螨感染密度、蠕形螨总数）。结果 治疗后,治疗组总有效率为92.5%,显著高于对照组的75.0%(P<0.05)。治疗后两组阵发性潮红发作频率和CEA评分、IGA评分、DLQI评分均显著降低（P<0.05）;且治疗组下降更显著（P<0.05）。治疗后,两组面部皮损处角质层厚度和真皮乳头密度均显著增加,真皮乳头毛细血管直径均显...     

Current immune therapies of autoimmune disease of the nervous system with special emphasis to multiple sclerosis

Autoimmune diseases of the nervous system such as myasthenia gravis, inflammatory demyelinating polyneuropathies, multiple sclerosis and others are still not curable. Yet the introduction of modern immune therapies could significantly improve the prospects of many patients affected by these disorders. In addition to steroids and immunosuppression i.v. immunoglobulins are used for treatment of myasthenia gravis and chronic inflammatory demyelinating polyneuropathy. Interferons, glatiramer acetate, natalizumab and fingolimod are applied in multiple sclerosis. The ever-improving efficacy of the drugs has to be balanced against the increasing risk of possible severe adverse effects.     

当归苦参丸联合克林霉素磷酸酯凝胶治疗玫瑰痤疮的临床研究

目的 探讨当归苦参丸联合克林霉素磷酸酯凝胶治疗玫瑰痤疮的临床疗效。方法 选择2019年11月—2022年8月天津市北辰医院收治120例玫瑰痤疮者,随机分为对照组（60例）和治疗组（60例）。对照组患者外涂克林霉素磷酸酯凝胶,2次/d。在对照组的基础上,治疗组口服当归苦参丸,6 g/次,2次/d。两组服药8周。观察两组患者临床疗效,比较治疗前后两组患者症状缓解时间,皮肤病生活质量量表（DLQI）,血清炎性因子肿瘤坏死因子-α（TNF-α）、抗菌肽-37（LL-37）、白细胞介素-6（IL-6）和干扰素-γ（INF-γ）水平及不良反应情况。结果 治疗后,治疗组患者临床有效率为98.33%,明显高于对照组（83.33%,P＜0.05）。治疗后,治疗组患者症状缓解时间均早于对照组（P＜0.05）。治疗后,两组患者DLQI评分均明显下降（P＜0.05）,且治疗组的DLQI评分低于对照组（P＜0.05）。治疗后,两组患者LL-37、IL-6、TNF-α水平均低于治疗前,而IFN-γ水平高于治疗前（P＜0.05）,且治疗组血清炎性因子水平明显好于对照组（P＜0.05）。治疗后,治疗组不良反应发生率（5.00%）明显低于对照组（11.67%,P＜0.05）。结论 当归苦参丸联合克林霉素磷酸酯凝胶治疗玫瑰痤疮效果确切,可显著改善症状,有效降低炎性反应。     

The efficacy of topical tazarotene monotherapy and combination therapies in psoriasis

Tazarotene (Tazorac^®, Allergan, Inc.) is the first topical retinoid approved for the treatment of plaque psoriasis. It has a similar onset of action compared to potent topical steroids and has the advantage of a longer remission. The common side effects associated with the drug include skin irritation (including pruritus), erythema and a burning sensation. To overcome some of these shortcomings, it has been used in combination with steroids, calcipotriene and phototherapy. Combination therapy not only results in a decrease in adverse side effects, but also enhanced efficacy. Clinical study data have shown that combination therapy is just as important as tazarotene monotherapy, if not more.     

The efficacy of topical tazarotene monotherapy and combination therapies in psoriasis

Tazarotene (Tazorac, Allergan, Inc.) is the first topical retinoid approved for the treatment of plaque psoriasis. It has a similar onset of action compared to potent topical steroids and has the advantage of a longer remission. The common side effects associated with the drug include skin irritation (including pruritus), erythema and a burning sensation. To overcome some of these shortcomings, it has been used in combination with steroids, calcipotriene and phototherapy. Combination therapy not only results in a decrease in adverse side effects, but also enhanced efficacy. Clinical study data have shown that combination therapy is just as important as tazarotene monotherapy, if not more.     

Influence of human nail etching for the assessment of topical onychomycosis therapies

The purpose of this investigation was to study the physico-chemical properties of hot-melt extruded films containing ketoconazole and to determine the influence of 'nail etching' on film bioadhesion and drug permeability for the assessment of topical onychomycosis therapies. Hot-melt extrusion (HME) was used to prepare films containing 20% w/w ketoconazole. Ketoconazole 0.125% gel was also prepared using Carbopol 974P NF. Films were processed at a temperature range of 115-120 degrees C utilizing a Killion extruder (KLB-100), and were evaluated for post-extrusion drug content, content uniformity, bioadhesion, thermal behavior and nail drug permeation. The extruded films demonstrated excellent content uniformity and post-processing drug content. Tensile and peel tests were recorded to determine the bioadhesive profiles. In this study, work of adhesion and peak adhesive force determinations using the peel tests provided more sensitive results for evaluating the bioadhesivity of the HME films than the tensile tests. The in vitro permeability profiles have demonstrated, that nail samples treated with an 'etchant' demonstrated a significant increase in drug permeability compared to control. Differential scanning calorimetry (DSC) thermograms indicated that ketoconazole was in solid solution within the HME films. These findings are encouraging for the future design and formulation of novel drug delivery systems for the topical treatment of onychomycosis.     

Epidemiology, prevention and treatment of viral hepatitis with emphasis on new developments

There are a large number of viruses, such as cytomegalovirus, Epstein-Barr, Herpes simplex, mumps, varicella, yellow fever, etc., known to cause inflammatory disease of the liver, but the term viral hepatitis generally refers to the five well described hepatotropic viruses which are divided into enteral and parenteral groups based on their mode of transmission. Hepatitis A and E viruses are enterically transmitted by the faecal-oral route and do not exist in a chronic carrier state. Hepatitis B, C and D viruses are parenterally transmitted, occur both in the acute and chronic forms, and, when they persist in a chronic carrier state, they serve as a reservoir for infection and give rise to chronic hepatitis, cirrhosis and hepatocellular carcinoma. Hepatitis G virus has recently been described but its significance in the causation of human liver disease is yet to be established. Also, the most recently described TT virus in patients with post-transfusion hepatitis awaits further studies. Acute sporadic and epidemic viral hepatitis are common world-wide, mostly in the developing countries, including Ethiopia, and account for high morbidity and mortality, especially among pregnant women. Chronic infection with hepatitis B virus is a significant problem on a global scale, affecting over 300 million people. Hepatitis C virus infection is probably the most common cause of chronic viral hepatitis, end-stage liver disease and hepatocellular carcinoma in the world, especially in sub-Saharan Africa, including Ethiopia. Therefore, this article will review and highlight the relevant epidemiological, preventive and therapeutic aspects of viral hepatitis with emphasis on new developments and recent data obtained from Ethiopian studies.