Rosacea

Rosacea is a chronic disease with a profound impact on quality of life. Although there are a range of treatments for its many manifestations, some cases are difficult to treat. Sbidian et al. show in this double-blind, randomized, placebo-controlled trial that low-dose isotretinoin can be effective in treating difficult-to-treat and frequently relapsing papulopustular rosacea.

Skin diseases are considered as major public health problems. Early diagnosis of skin diseases is crucial for patients to get the treatment on time. However, several factors make difficult to access medical care. For instance, physical disability, physiological problems, old age, distance, limited medical expertise in rural areas, climate conditions and employment. Also, long diagnosing time and high cost can discourage people from receiving dermatological care. The increasing availability and easy to use of smartphone applications has allowed significant growth of smartphones. Various smartphone applications have been introduced in different areas of medicine. They are becoming important particularly in dermatology since dermatological diseases are usually visible by human eyes and diagnosis is mainly based on visual screening of the lesions and pattern recognition. Therefore, patients can have active roles in their health-management using these applications. However, is it possible to diagnose skin diseases automatically with the advancements in mobile technologies and deep learning-based methodologies? To answer this question, in this paper, recent smartphone applications have been reviewed.

BACKGROUND:

Rosacea is currently diagnosed by consensus-defined primary and secondary features and managed by subtype. However, individual features (phenotypes) can span multiple subtypes, which has implications for clinical practice and research. Adopting a phenotype-led approach may facilitate patient-centred management.

OBJECTIVES:

To advance clinical practice by obtaining international consensus to establish a phenotype-led rosacea diagnosis and classification scheme with global representation.

METHODS:

Seventeen dermatologists and three ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and severity evaluation. All voting was electronic and blinded.

RESULTS:

Consensus was achieved for transitioning to a phenotype-based approach to rosacea diagnosis and classification. Two features were independently considered diagnostic for rosacea: persistent, centrofacial erythema associated with periodic intensification; and phymatous changes. Flushing, telangiectasia, inflammatory lesions and ocular manifestations were not considered individually diagnostic. The panel reached agreement on dimensions for phenotype severity measures and established the importance of assessing the patient burden of rosacea.

CONCLUSIONS:

The panel recommended an approach for diagnosis and classification of rosacea based on disease phenotype. This article is protected by copyright. All rights reserved.

Tesis de Licenciatura en Comunicación y Periodismo que hace un análisis de los argumentos del uso del color rosa mexicano en la imagen institucional de la Ciudad de México durante el gobierno de Miguel Ángel Mancera Espinosa, gestión que duró del 2012 al 2018. Además, compara los argumentos con los significados socioculturales del color rosa en la teoría y psicología del color. La investigación toma específicamente comunicados, discursos, manuales y documentos publicados o pronunciados, donde se hable de las razones del uso del color rosa dentro de la imagen institucional. Se persigue comprobar si los argumentos dados por la administración de Mancera son verdaderos. Al obtener los resultados del análisis, se concluye que la verdad en los argumentos de Mancera es parcial, dependiendo de los elementos del discurso examinados y de los teóricos que se emplean para el estudio, los cuales son Chaïm Perelman, John Langshaw Austin y Jürgen Habermas.

Background A transition from a subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorization by predefined subtypes. The ROSacea COnsensus (ROSCO) 2017 recommendations further support this transition and align with guidance from other working groups.
Objectives To update and extend previous global ROSCO recommendations in line with the latest research and continue supporting uptake of the phenotype approach in rosacea through clinical tool development.
Methods Nineteen dermatologists and two ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and man agement. Voting was electronic and blinded.
Results Delphi statement s on which the panel achieved consensus of ≥ 75% voting ‘Agree’ or ‘Strongly agree’ are presented. The panel recommends discussing disease burden with patients during consultations, using four questions to assist conversations. The primary treatment objective should be achievement of complete clearance, owing to previously established clinical benefits for patients. Cutaneous and ocular feat ures are defined. Treatments have been reassessed in line with recent evidence and the prior treatment algorithm updated. Combination therapy is recommended to benefit patients with multiple features. Ongoing monitoring and dialogue should take place between physician and patients, covering defined factors to maximize outcomes. A prototype clinical tool (Rosacea Tracker) and patient case
studies have been developed from consensus statements.
Conclusions The current survey updates previous recommendations as a basis for local guideline development and provides clinical too ls to facilitate a phenotype approach in practice and improve rosacea patient management.

Many 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.

Different aspects of rhinophyma were described: history, etiopathogeny, histopathology, epidemiology, clinical, differential diagnoses, treatments and prognosis. It is emphasized that it is a localized disease in the nose associated to general disorders, and that it brings psychological and social problems. We present a case operated with plastic surgery. The authors present a hypothesis about the etiopathogeny and pathophysiology of the disease and consider rhinophyma treatments as palliative and non-curative. /
Resumen: Se describen distintos aspectos del rinofima: historia, etiopatogenia, histopatología, epidemiologia, clínica, diagnósticos diferenciales, tratamientos y pronóstico. Se hace hincapié en que es una enfermedad localizada en la nariz asociada a desórdenes generales, y que repercute en las áreas psicológica y social. Se presenta un caso clínico operado con cirugía plástica. Los autores plantean una hipótesis sobre la etiopatogenia y la fisiopatología de la enfermedad; y consideran a los tratamientos de rinofima como paliativos y no curativos.

A number of different proteases and their inhibitors have a role in skin physiology and in the pathophysiology of inflammatory skin diseases. Proteases are important in the desquamation process and orderly regulation of the skin's barrier function. On the basis of the catalytic domain, proteases are classified into aspartate-, cysteine-, glutamate-, metallo-, serine-, and threonine proteases. Particularly, serine proteases (SPs) contribute to epidermal permeability barrier homeostasis, as acute barrier disruption increases SP activity in skin and inhibition by topical SP inhibitors accelerated recovery of barrier function after acute abrogation. In rosacea, increased levels of the vasoactive and inflammatory host-defense peptide cathelicidin LL-37 and its proteolytic peptide fragments were found, which were explained by an abnormal production of tryptic activity originating from kallikrein-related peptidase (KLK) 5. It is therefore possible that also other proteases, even from m...

Це видання є першою спробою подати доступну авторам інформацію про причини, патогенез, клінічні прояви, діагностику і лікування актинічного кератозу. Метою написання монографії було бажання ознайомити дерматологів, косметологів, лікарів загальної практики, онкологів і лікарів-інтернів з основними принципами діагностики, лікування і профілактики актинічного кератозу, який є маловивченим і рідко діагностується в Україні. На думку авторів ця праця буде сприяти розширенню знань лікарів про актинічний кератоз і покращенню ефективності їх практичної роботи з пацієнтами.

To observe the main ocular manifestations of patients with rosacea and to evaluate the cost-benefit of supplementary diagnostic examinations. Twenty patients with acne rosacea from the Dermatology Service of the São Paulo Federal University (UNIFESP) were interviewed through a questionnaire, submitted to ophthalmologic examination and tested with Schirmer I, fluorescein and rose Bengal staining, impression cytology and conjunctival scrub. The costs of these examinations were abstracted from the Public Health System's values (SUS), Brazilian Medical Association values (AMB) and values charged by a private service. Twenty patients were enrolled initially in the study, but only 16 completed it. Eleven patients were female (55%), 19 were white (95%) and the average age was 56 years. All patients had at least one complaint related to rosacea. The most common symptoms were itching (40%), tearing (35%), foreign body sensation (30%). The most common signs were telangiectasis of lid marg...

Rhinophyma is a clinical manifestation of rosacea, found mostly on men aged 30 to 50 years and usually accompanied by other forms of rosacea. Nose shape is deformed, changing the face beyond recognition and is associated with important negative stigma. Rosacea can be treated combining surgery and laser therapy, respectively mild-to-moderate cases of rhinophyma can be treated with CO 2 laser surgery, while more severe cases are treated with a combination of surgery and laser. We present a patient with rhinophyma, which neglected the disease, and was treated by surgical removal, and we also discuss the clinical and therapeutical aspects of rynophima.

Persistent 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.

Rosacea is the most common inflammatory skin disease. It is characterized by erythema, inflammatory papules and pustules, visible blood vessels, and telangiectasia. The current treatment has limitations and unsatisfactory results. Pioglitazone (PGZ) is an agonist of peroxisome proliferator-activated receptors (PPARs), a nuclear receptor that regulates important cellular functions, including inflammatory responses. The purpose of this study was to evaluate the permeation of PGZ with a selection of penetration enhancers and to analyze its effectiveness for treating rosacea. The high-performance liquid chromatography (HPLC) method was validated for the quantitative determination of PGZ. Ex vivo permeation experiments were realized in Franz diffusion cells using human skin, in which PGZ with different penetration enhancers were assayed. The results showed that the limonene was the most effective penetration enhancer that promotes the permeation of PGZ through the skin. The cytotoxicity ...