Introducing the Rosacea Research Digest
Welcome to the inaugural issue of the Rosacea Research Digest from the National Rosacea Society! In this monthly newsletter, you’ll be kept up to date on news, reviews, presentations, and recently published basic and clinical research on rosacea.
Subscriptions are included as part of professional membership in the NRS, and are also available — free for a limited time — to all healthcare professionals, patients and others interested in this common but often misunderstood disorder affecting more than 16 million Americans.
We appreciate your feedback as we develop this new resource. Please email us at digest@rosacea.org with your comments and suggestions.
Research
Rosacea is Strongly Associated with Melanoma in Caucasians.
von Stebut J, Mallach M, Schneider-Burrus S, et al. Sci Rep. 2024 May 25;14(1):11949. doi:10.1038/s41598-024-62552-8
Rosacea is often considered a cosmetic problem but is known to be associated with a variety of comorbidities. To identify such risks, we generated two age- and sex-matched real-world cohorts of 122,444 patients each with and without rosacea. In contrast to earlier studies, we found significant associations with malignant melanoma (OR 6.02, 95% CI 5.76-6.32). This association does not exist for an Asian sub-cohort, which could explain previous inconclusive or conflicting reports. Several strongly associated comorbidities like visual disturbances (ICD-10: H53-H54; OR 4.80, 4.68-4.92), metabolic disorders (E73-E79; OR 3.17, 3.11-3.22), joint problems (M25; OR 4.16, 4.08-4.25) and type 2 diabetes (E11; OR 1.62, 1.58-1.65) should be watched as a risk for rosacea patients. Rosacea is associated with some comorbidities and ethnicity may be a risk factor in melanoma development. The retrospective nature of this study and the sole use of ICD-10 code based filtering calls for future validation of our findings. Additionally, confounding factors such as skin type and previous UV exposure should be included in future studies.
Isotretinoin as a Treatment Strategy for Rosacea: A Systematic Review
Desai S, Friedman A. JAAD International. 2024 (Pre-proof). doi:10.1016/j.jdin.2024.04.009.
“A recent study out of the George Washington University School of Medicine critically evaluated available data to spotlight the benefits of using isotretinoin for rosacea. According to the university’s press release, the systematic review found a reduction in rosacea symptoms, such as improvement in skin condition and decreased flare-ups, with the use of lose-dose isotretinoin (LDI).” — Dermatology Times
Rosacea Core Domain Set for Clinical Trials and Practice: A Consensus Statement.
Dirr MA, Ahmed A, Schlessinger DI, et al. JAMA Dermatol. 2024 Apr 24. Epub ahead of print. doi:10.1001/jamadermatol.2024.0636
Importance: Inconsistent reporting of outcomes in clinical trials of rosacea is impeding and likely preventing accurate data pooling and meta-analyses. There is a need for standardization of outcomes assessed during intervention trials of rosacea.
Objective: To develop a rosacea core outcome set (COS) based on key domains that are globally relevant and applicable to all demographic groups to be used as a minimum list of outcomes for reporting by rosacea clinical trials, and when appropriate, in clinical practice.
Evidence review: A systematic literature review of rosacea clinical trials was conducted. Discrete outcomes were extracted and augmented through discussions and focus groups with key stakeholders. The initial list of 192 outcomes was refined to identify 50 unique outcomes that were rated through the Delphi process Round 1 by 88 panelists (63 physicians from 17 countries and 25 patients with rosacea in the US) on 9-point Likert scale. Based on feedback, an additional 11 outcomes were added in Round 2. Outcomes deemed to be critical for inclusion (rated 7-9 by ≥70% of both groups) were discussed in consensus meetings. The outcomes deemed to be most important for inclusion by at least 85% of the participants were incorporated into the final core domain set.
Findings: The Delphi process and consensus-building meetings identified a final core set of 8 domains for rosacea clinical trials: ocular signs and symptoms; skin signs of disease; skin symptoms; overall severity; patient satisfaction; quality of life; degree of improvement; and presence and severity of treatment-related adverse events. Recommendations were also made for application in the clinical setting.
Conclusions and relevance: This core domain set for rosacea research is now available; its adoption by researchers may improve the usefulness of future trials of rosacea therapies by enabling meta-analyses and other comparisons across studies. This core domain set may also be useful in clinical practice.
Efficacy of Treatments in Reducing Inflammatory Lesion Count in Rosacea: A Systematic Review.
Geng RSQ, Sood S, Hua N, et al. J Cutan Med Surg. 2024 May 28:12034754241253195. Epub ahead of print. doi:10.1177/12034754241253195
Rosacea is a chronic inflammatory skin condition affecting approximately 5.5% of the global population. Patients present heterogeneously with a mix of features in the central facial region, of which papules and pustules are considered to be a major feature. The identification of effective treatments for reducing inflammatory lesions in rosacea can alleviate the psychosocial burden that many rosacea patients experience, including reduced self-esteem, anxiety, and social withdrawal. The objective of this systematic review is to determine the effectiveness of topical and systemic therapies in reducing lesion count in rosacea patients.
Differences Between Steroid-Associated and Non-Steroid-Associated Rosacea: A Retrospective Study.
Kim TM, Cho S. Acta Derm Venereol. 2024 May 6;104:adv40045. doi:10.2340/actadv.v104.40045
Excessive use of topical steroids for over 2 months is well known to cause steroid-induced rosacea, with mechanisms such as rebound vasodilation and pro- inflammatory cytokine secretion proposed as pathogenesis. Specifically, when applied to the facial area, the thin corneal layer and high skin permeability through numerous sebaceous glands increase the risk. It is known that the risk of adrenocortical insufficiency due to the use of topical steroids increases when they are used on areas with thin skin, such as the face, or when high-potency steroids are used for an extended period. While there exists descriptive research on the clinical classification and accompanying symptoms of steroid-associated rosacea based on lesion distribution, in-depth investigation into its clinical and laboratory characteristics is lacking.
The Role of Vitamins and Nutrients in Rosacea.
Algarin YA, Pulumati A, Jaalouk D, et al. Arch Dermatol Res. 2024 May 2;316(5):142. doi:10.1007/s00403-024-02895-4
Rosacea is a common inflammatory skin condition displaying symptoms like flushing, erythema, papules, and pustules. Oral antibiotics, despite long-term adverse effects, are often used due to topical treatment limitations, underscoring the need for cost-effective choices like dietary modifications. Our review investigates the role of vitamins and minerals in rosacea, and provides evidence-based recommendations for supplementation and topical treatment of these nutrients for rosacea. An online search was performed on PubMed, Web of Science, Science Direct, Google Scholar, and ClinicalTrials.gov from 1998 to 2023. Included studies were summarized and assessed for quality and relevance in rosacea management. Varied outcomes emerged concerning the impact of essential vitamins and minerals on rosacea treatment. Vitamin A derivatives, specifically oral isotretinoin, demonstrated significant efficacy, with a 90% reduction in lesions, complete remission in 24% of patients, and marked improvement in 57% of patients. Vitamin B3 derivatives, such as topical 1-methylnicotinamide 0.25% and NADH 1%, improved symptoms in 76.4% (26/34) and 80% of patients, respectively. Outcomes for vitamin D, vitamin C, and zinc supplementation varied across studies. However, zinc sulfate solution 5% significantly reduced acne rosacea severity for patients with 40% and 60% exhibiting a moderate or good response, respectively. Omega-3 fatty acids showed significant improvement in alleviating xerophthalmia in 64% of patients with ocular rosacea. Vitamins and minerals hold potential in managing rosacea symptoms, offering a safe and cost-effective alternative or adjunctive treatment option. Currently, there are no established recommendations regarding their supplementation for rosacea. Studies assessing serum levels of vitamins and minerals in relation to rosacea are warranted, as this avenue holds potential for future advancements in the field.
Microencapsulated Benzoyl Peroxide for Rosacea in Context: A Review of the Current Treatment Landscape.
Desai SR, Baldwin H, Del Rosso JQ, et al. Drugs. 2024 Mar;84(3):275-284. Epub 2024 Feb 29. doi:10.1007/s40265-024-02003-w
Rosacea, a chronic skin condition affecting millions of people in the USA, leads to significant social and professional stigmatization. Effective management strategies are crucial to alleviate symptoms and improve patients' quality of life. Encapsulated benzoyl peroxide 5% (E-BPO 5%) is a newly FDA-approved topical treatment for rosacea that shows promise in enhancing therapeutic response and minimizing skin irritation. This review aims to assess the role of recently FDA approved E-BPO 5% in the current treatment landscape for rosacea management, as it is not yet included in clinical guidelines that predominantly rely on older approved therapies. The review focuses on randomized controlled trials conducted in English-speaking adults. It evaluates the efficacy, safety, and tolerability of various US Food and Drug Administration (FDA)-approved agents used for rosacea treatment, including E-BPO cream, metronidazole gel, azelaic acid gel and foam, ivermectin cream, minocycline foam, oral doxycycline, brimonidine gel, and oxymetazoline HCl cream. Existing therapies have been effective in reducing papulopustular lesions and erythema associated with rosacea for many years. E-BPO 5% offers a promising addition to the treatment options due to its microencapsulation technology, which prolongs drug delivery time and aims to improve therapeutic response while minimizing skin irritation. Further research is necessary to determine the exact role of E-BPO 5% in the therapeutic landscape for rosacea. However, based on available evidence, E-BPO 5% shows potential as a valuable treatment option for managing inflammatory lesions of rosacea, and it may offer benefits to patients including: rapid onset of action, demonstrated efficacy by Week 2, excellent tolerability, and sustained long-term results for up to 52 weeks of treatment.
Assessment of the Reliability and Clinical Applicability of ChatGPT's Responses to Patients' Common Queries About Rosacea.
Yan S, Du D, Liu X,et al. Patient Prefer Adherence. 2024 Jan 31;18:249-253. doi:10.2147/PPA.S444928
Objective: Artificial intelligence chatbot, particularly ChatGPT (Chat Generative Pre-trained Transformer), is capable of analyzing human input and generating human-like responses, which shows its potential application in healthcare. People with rosacea often have questions about alleviating symptoms and daily skin-care, which is suitable for ChatGPT to response. This study aims to assess the reliability and clinical applicability of ChatGPT 3.5 in responding to patients' common queries about rosacea and to evaluate the extent of ChatGPT's coverage in dermatology resources.
Methods: Based on a qualitative analysis of the literature on the queries from rosacea patients, we have extracted 20 questions of patients' greatest concerns, covering four main categories: treatment, triggers and diet, skincare, and special manifestations of rosacea. Each question was inputted into ChatGPT separately for three rounds of question-and-answer conversations. The generated answers will be evaluated by three experienced dermatologists with postgraduate degrees and over five years of clinical experience in dermatology, to assess their reliability and applicability for clinical practice.
Results: The analysis results indicate that the reviewers unanimously agreed that ChatGPT achieved a high reliability of 92.22% to 97.78% in responding to patients' common queries about rosacea. Additionally, almost all answers were applicable for supporting rosacea patient education, with a clinical applicability ranging from 98.61% to 100.00%. The consistency of the expert ratings was excellent (all significance levels were less than 0.05), with a consistency coefficient of 0.404 for content reliability and 0.456 for clinical practicality, indicating significant consistency in the results and a high level of agreement among the expert ratings.
Conclusion: ChatGPT 3.5 exhibits excellent reliability and clinical applicability in responding to patients' common queries about rosacea. This artificial intelligence tool is applicable for supporting rosacea patient education.
Case Reports
"Demodicosis" Mimicking PreSeptal Cellulitis: Severe Periocular and Facial Inflammation Caused by "Normal" Skin Flora.
Desire GM, Stagner AM, Lin LW, Lefebvre DR. Ophthalmic Plast Reconstr Surg. 2024;40(3):e72-e74. doi:10.1097/IOP.0000000000002590
Due to their relatively high prevalence and commensalism, the pathogenicity of Demodex mites has been debated. Recent data, however, show Demodex to be associated with skin and ocular surface diseases such as rosacea, blepharitis, and keratitis. Here the authors report the first known case, to the best of the their knowledge, of Demodex infestation mimicking preseptal cellulitis in an adult human. A 29-year-old male bilaterally blind from advanced retinopathy of prematurity presented with a 2-month history of right-greater-than-left upper eyelid and periocular/cheek swelling, redness, and ocular discharge that did not resolve with oral antibiotics or oral steroids. Based on MRI findings, biopsies of the right lacrimal gland, right orbital fat, and right upper eyelid preseptal skin were obtained which revealed marked intrafollicular Demodex mite density and budding yeasts in the upper eyelid skin. This case serves to alert clinicians to this entity that may not otherwise be usually considered in ophthalmic clinical practice.
Sporotrichosis Mimicking Rosacea Lesions: A Case Report.
Hong YS, Liu LF, Hu HH. Clin Cosmet Investig Dermatol. 2024;17:1033-1036. Published 2024 May 7. doi:10.2147/CCID.S461558
Sporotrichosis is a subacute or chronic infectious disease caused by sporothrix. It is mainly caused by Sporothrix inoculation after accidental skin injury during human labor. The clinical manifestations of sporotrichosis are variable, ranging from nodules, plaques, ulcers, verrucous lesions, and subcutaneous masses. Some reports indicate that sporotrichosis can mimic psoriasis-like lesions. We herein report a case of sporotrichosis mimicking rosacea lesions. In addition, the patient had a history of nasal trauma, and we believe that the patient was inoculated with Sporothrix after the nasal skin was damaged during labor activities. The patient was given itraconazole 200 mg orally daily for 3 months, which effectively resolved the rash.
News
Optimizing Skin Care in Rosacea Management
The Dermatologist
The Dermatologist recently talked with Hilary Baldwin, MD, to discuss the significance of gentle cleansing, moisturization, and sunscreen use in alleviating rosacea symptoms and enhancing treatment outcomes. In this interview, Dr. Baldwin identifies skin care product ingredients that may exacerbate rosacea and provides valuable insights into selecting suitable products.
Jessner’s Lymphocytic Infiltration of the Skin Mimicking Rosacea: A Rare Case Presentation
Dermatology Times
Jessner’s Lymphocytic Infiltration of the Skin (JLIS) is a rare chronic condition that often mimics pseudo-T-cell lymphoma. Characterized by a benign CD8+ polyclonal reactive skin condition, JLIS predominantly features CD4+ T cell infiltration. Chinese clinical researchers recently presented and published a unique case of JLIS in a 35-year-old woman, manifesting as erythematous papules and infiltrative plaques on the nose and upper jaw, resembling rosacea.
New Products Earn NRS Seal Of Acceptance
NRS weblog
The collection of skin care and cosmetic products that have earned the NRS Seal of Acceptance is growing, indicating they are suitable for use on sensitive rosacea skin.
Treatments For Seborrheic Dermatitis And Rosacea Discussed At AAD Annual Meeting
NRS weblog
Medical therapy for seborrheic dermatitis and rosacea, skin disorders that frequently occur together in patients, was discussed at the recent American Academy of Dermatology annual meeting in San Diego.