Differential diagnoses of psoriasis
M. Alan Menter, Caitriona Ryan in Psoriasis, 2017
Rosacea is a chronic inflammatory disorder of the facial skin characterized by transient or persistent facial flushing, erythema, telangetasia, and often papules and pustules, typically involving the central face (nose, forehead, cheeks, and chin).99 Subtypes of rosacea include erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea.99 Rosacea is a common disease, considered more common in fair-skinned individuals.100 Women are more affected than men. It is most common from 30 to 50 years of age, but can be seen in all ages.100 The development of rhinophyma is more common in men.100 Etiology remains unknown. Patients often report burning and erythema is triggered by irritants such as heat, sun exposure, alcohol, emotion, stress, hot drinks, and spicy food.99,100 Histopathology shows dilated superficial capillaries, solar elastosis with variable inflammation from mild perivascular lymphohistiocytic infiltrate to perifollicular, and perivascular infiltrate in papular rosacea.100,101 Foreign-body giant cells may be observed.100,102 Some lesions can contain granulomas which can be epitheliod, elastolytic, or palisaded around altered collagen.100–102 Demodex folliculorum is often observed.100
Topical Photodynamic Therapy for Skin Diseases: Current Status of Preclinical and Clinical Research, Nanocarriers and Physical Methods for Photosensitizer Delivery
Andreia Ascenso, Sandra Simões, Helena Ribeiro in Carrier-Mediated Dermal Delivery, 2017
Rosacea is another common skin disease of unknown cause and frequently treated with conventional antibiotics, which are tetracycline and metronidazole [134]. The rosacea symptoms involve redness area and inflamed skin lesions particularly on the nose, forehead, cheeks and chin and it can affect women more than men between the 30 and 50 years old. 134 reported clinical results of the combined PDT and standard treatment using tetracycline and metronidazole. The treated skin cleared in three of the four patients. Treatment with light alone did not appear to have any effect. In one of the patients, there was no relapse during a 9-month follow-up. In two patients, remissions lasted 3 months [134]. Others studies in a series of rosacea patients using MAL-PDT showed good results in 10 out of 17 patients, and fair results in other 4 patients suggesting an apparent effect of MAL-PDT on rosacea [135].
Flushing and Blushing
Frank C. Powell, Jonathan Wilkin in Rosacea: Diagnosis and Management, 2008
As we have already noted Charles Darwin was one of the first people to study flushing and blushing. In his book, The expressions of the Emotions in Man and Animals published in 1872, he described the progressive evolution of a flush up the sides of the neck to the cheeks and forehead (2). He suggested an association between a “nervous predisposition” and flushing, and pointed out that individuals who flushed frequently were “psychologically vulnerable.” He noted that animals (apart from monkeys) did not flush and none blushed which he related to their lack of emotional sensibility. Following Darwin’s famous publication the association between facial reddening and emotions became firmly embedded in the public psyche. This has lead inadvertently to some curious theories relating to the etiology of rosacea.
It takes one to know one: exploring patient dialogue on rosacea web-based platforms and their potential for significant harm
Published in Journal of Dermatological Treatment, 2019
Laura H. Riddoch
Rosacea is a chronic skin condition, characterized by erythema and flushing, mostly affecting the face. The rash often presents with inflammatory pustules and papules, primarily affecting the nose, forehead and cheeks, sometimes with telangiectasia. There are four subtypes of rosacea: erythematotelangiectatic, papulopustular, phymatous and ocular (1). Rosacea is a common condition, affecting 1 in 10 people, primarily middle-aged Caucasian women (2). Although the causes of rosacea are unclear, it is speculated that there is an underlying inflammatory mechanism which may be influenced by the nervous system, vascular abnormalities and/or Demodex folliculorum mites (3). Coinciding with this multifactorial origin, flare-up triggers have been reported to include UV exposure, spicy foods, emotional stress, exercise, temperature extremes and stimulants such as caffeine or alcohol (2). These triggering events are different for various patients.
A case of fractional microneedling radiofrequency induced rosacea
Published in Journal of Cosmetic and Laser Therapy, 2019
Zehra Aşiran Serdar, Ezgi Aktaş Karabay
A 61-year-old woman was referred to our clinic with the complaints of wrinkles. On dermatological examination, she had some age-related findings on her face including; wrinkles, fine lines, laxity (Figure 1). After discussing the treatment options with the patient, we decided to apply FMR treatment. She received 3 sessions of FMR treatment with four-week-intervals. In each session, topical anesthesia with lidocaine and prilocaine combination was applied 20 min before the treatment. After cleansing the skin, the FMR treatment was performed (Scarlet S, Viol Co. Ltd, South Korea). After the first 2 sessions, no side effects were seen. 5 days after the third treatment the patient developed severe erythema and multiple papulopustular lesions with the sensation of burning developed on her face, predominantly on the malar regions, edema was also noticed on the face (Figure 2). Two years prior she had the diagnosis of rosacea which resolved with medical treatment, and at the current time was not on any treatment. Based on the clinical findings, diagnosis of rosacea was made. Topical metronidazole combined with neodymium-doped yttrium aluminum garnet (Nd: YAG) laser treatment was started and rosacea lesions showed slight improvement. The patient is still receiving treatment of rosacea.
Ivermectin 1% (CD5024) for the treatment of rosacea
Published in Expert Opinion on Pharmacotherapy, 2018
Dev R. Sahni, Steven R. Feldman, Sarah L. Taylor
Ivermectin in oral form has traditionally been utilized as a treatment for refractory or severe cases of scabies. Although the use of oral ivermectin in treatment of rosacea is not common practice, doing so may, potentially, be enhancing resistance of the organism involved in scabies (Sarcoptes scabiei). Though a direct link between topical and oral resistance has not yet been demonstrated, clinicians should be aware of this potential issue when prescribing this medication. Other approaches to modify the cutaneous biome offer an interesting new area of research that will hopefully enhance the treatment of rosacea as well as help overcome the hurdle of poor adherence to topical treatment. The underlying cause (or causes) of rosacea remains unknown. However, exciting scientific investigations relating to the pathogenesis, clinical progression, and cellular components such as microbiome and genetic alteration will continue to pave the way for development of new advances in the medical treatment of rosacea and patient adherence to treatment.
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