Rosacea Research Digest - July 31, 2024
The Rosacea Research Digest from the National Rosacea Society keeps you up to date on news, reviews, presentations, and recently published basic and clinical research on rosacea. It goes out on the last weekday of each month.
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
Erenumab for Treatment of Persistent Erythema and Flushing in Rosacea: A Nonrandomized Controlled Trial.
Wienholtz NKF, Christensen CE, Do TP, et al. JAMA Dermatol. 2024 Jun 1;160(6):612-619. doi:10.1001/jamadermatol.2024.0408
Objective: Treatment of erythema and flushing in rosacea is challenging. Calcitonin gene-related peptide (CGRP) has been associated with the pathogenesis of rosacea, raising the possibility that inhibition of the CGRP pathway might improve certain features of the disease.
Potential Role of Calcitonin Gene-Related Peptide Inhibitors in the Treatment of Rosacea Flushing and Erythema.
Barbieri JS. JAMA Dermatol. 2024;160(6):620. doi:10.1001/jamadermatol.2024.0397
While many treatments are available for papules and pustules of rosacea, few are available for erythema and flushing. The 2019 Global Rosacea Consensus Panel recommends general skincare, β-blockers (eg, propranolol and carvedilol), and α-adrenergic agents (eg, brimonidine and oxymetazoline) for flushing and vascular lasers for persistent erythema. Because these treatments may not always be effective or tolerated, there remains an unmet need for additional options that can address symptoms of flushing and erythema in rosacea.
Calcitonin Gene-Related Peptide Inhibition and Development of Acne and Rosacea.
Thang CJ, Lai J, Garate D, Golovko G, et al. JAMA Dermatol. 2024 Jul 10:e242182. Epub ahead of print. 10.1001/jamadermatol.2024.2182
Calcitonin gene-related peptide (CGRP) is a neuropeptide that triggers vasodilation and inflammation. CGRP signaling has been implicated in migraine and rosacea pathogenesis. CGRP inhibitor (CGRPi) monoclonal antibodies (mAbs) and nonpeptide small molecules (gepants) are effective for migraine treatment, and patients with migraines and rosacea have experienced improvement in rosacea symptoms after receiving CGRPi mAbs. CGRP may also be involved in acne pathogenesis because its receptor is expressed in sebaceous glands, and CGRP signaling mediates inflammation triggered by Cutibacterium acnes.
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.
Beyond the Surface: Understanding Demodex and Its Link to Blepharitis and Facial Dermatoses.
Chioveanu FG, Niculet E, Torlac C, et al. Clin Ophthalmol. 2024 Jun 24;18:1801-1810. doi:10.2147/OPTH.S440199
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.
Five-blade scratcher for treating severe rhinophyma: A retrospective study.
Zheng YP, He XF, Zhang YF, et al. World J Clin Cases. 2024 Jul 16;12(20):4180-4190. doi:10.12998/wjcc.v12.i20.4180
Rhinophyma is known as a late-stage subtype of rosacea. This study aims to observe the clinical effectiveness and recurrence of severe rhinophyma with Xia’s surgical five-blade scratcher treatment. We assessed the Global Flushing Severity Score, Clinician Erythema Assessment, Rhinophyma Severity Index, Glasgow Benefit Inventory, and satisfaction and recurrence of Xia’s surgical five-blade scratcher treatment preoperatively and 6 months and 5 years postoperatively. Five-blade scratcher treatment was safe, effective, and economical, with less bleeding, less scar, low recurrence rates, and high patient satisfaction. It offers an alternative to conventional surgery for severe rhinophyma.
Efficacy of Low-Dose Isotretinoin in the Treatment of Rosacea: A Systematic Review and Meta-Analysis.
Assiri A, Hobani AH, AlKaabi HA, et al. Cureus. 2024 Mar 27;16(3):e57085. doi:10.7759/cureus.57085
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.
Case Reports
Extrafacial Rosacea-A Diagnostic Challenge.
Krishnaram AS, Sriram CK, Abirami K, Ilavendiran S. Indian Dermatol Online J. 2024 May 20;15(4):695-697. doi:10.4103/idoj.idoj_571_23
A 40-year-old male, who is a driver, presented to our department with erythematous skin lesions over both the arms for the past 10 months. The lesions were occasionally pruritic and exacerbated during summer. There were no co-morbidities. Personal history was unremarkable. He had taken multiple treatments, both topical and oral, without appreciable improvement. The nature of drug therapy was not known.
Treatment of rosacea with upadacitinib and abrocitinib: case report and review of evidence for Janus kinase inhibition in rosacea.
Zhang T, Liu X, Zhang L, Jiang X. Frontiers in Immunology. 2024;15. 10.3389/fimmu.2024.1416004
Conventional rosacea treatments are not uniformly pervasive, and the adverse reactions can potentially constrain their utility. The clinical use of JAK1 inhibitors upadacitinib and abrocitinib in the treatment of refractory rosacea has rarely been explored. We presented two cases of patients who received the JAK1 inhibitor upadacitinib and four cases of patients who received the JAK1 inhibitor abrocitinib for the treatment of refractory rosacea.
Ocular rosacea without facial erythema involvement manifesting as bilateral multiple recurrent chalazions: A case report.
Han XM, Zhou YM, Cen LS. World J Clin Cases. 2024 Jun 16;12(17):3253-3258. doi:10.12998/wjcc.v12.i17.3253
In addition to the non-specific symptomatology of ocular rosacea, currently, there are no reliable diagnostic tests for the disease, which may lead to its misdiagnosis. Here, we report a case of ocular rosacea presenting with multiple recurrent chalazion on both eyelids.
News
While Rosacea Awareness Grows, Treatments Need More Attention
NRS weblog
A recent National Rosacea Society survey found that 65% of rosacea sufferers were aware of the disease before their diagnosis. However, that percentage varied depending on how long ago diagnosis occurred.
10 Top Rosacea Triggers and How to Tame Them
Everyday Health
These top tips can help you steer clear of the most common triggers of rosacea. They'll help your treatment work better, too, experts say.
The Link Between Stress and Rosacea: What to Know
Healthline
Research suggests that stress can worsen rosacea symptoms or trigger flare-ups. Meanwhile, rosacea symptoms like skin swelling and burning may also cause stress, creating a cycle.
Ask the Expert: How diet impacts rosacea and how to manage it
YouTube
Dr. Elika Hoss of the Mayo Clinic answers questions from rosacea sufferers.