Rosacea Research Digest - September 30, 2024 (copy)
Correction: Apologies for the duplicate email. The URL for the Refinery29 article was incorrect. It has been corrected in this version.
The Rosacea Research Digest from the National Rosacea Society keeps you up to date on recently published basic and clinical research on rosacea, as well as news, reviews, and presentations. 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
Causal roles of skin and gut microbiota in skin appendage disorders suggested by genetic study.
Zhu Y, Liu W, Wang M, et al. Front Immunol. 2024 Sep 10;15:1427276. doi:10.3389/fimmu.2024.1427276
Objectives: There is evidence from observational studies that human microbiota is linked to skin appendage disorders (SADs). Nevertheless, the causal association between microbiota and SADs is yet to be fully clarified.
Methods: A comprehensive two-sample Mendelian randomization (MR) was first performed to determine the causal effect of skin and gut microbiota on SADs. A total of 294 skin taxa and 211 gut taxa based on phylum, class, order, family, genus, and ASV level information were identified. Summary data of SADs and eight subtypes (acne vulgaris, hidradenitis suppurativa, alopecia areata, rogenic alopecia, rosacea, rhinophyma, seborrhoeic dermatitis, and pilonidal cyst) were obtained from the FinnGen consortium. We performed bidirectional MR to determine whether the skin and gut microbiota are causally associated with multiple SADs. Furthermore, sensitivity analysis was conducted to examine horizontal pleiotropy and heterogeneity.
Results: A total of 65 and 161 causal relationships between genetic liability in the skin and gut microbiota with SADs were identified, respectively. Among these, we separately found 5 and 11 strong causal associations that passed Bonferroni correction in the skin and gut microbiota with SADs. Several skin bacteria, such as Staphylococcus, Streptococcus, and Propionibacterium, were considered associated with multiple SADs. As gut probiotics, Bifidobacteria and Lactobacilli were associated with a protective effect on SAD risk. There was no significant heterogeneity in instrumental variables or horizontal pleiotropy.
Conclusions: Our MR analysis unveiled bidirectional causal relationships between SADs and the gut and skin microbiota, and had the potential to offer novel perspectives on the mechanistic of microbiota-facilitated dermatosis.
How does illness perception affect the quality of life and sun protection behaviors of rosacea patients?
Tu KY, Jung CJ, Shih YH, Chang ALS. Front Immunol. 2024 Jul 29;15:1403798. doi:10.1111/phpp.12998
Background: Previous studies have noted the link between rosacea severity and quality of life, but there is limited understanding of how disease perception impacts these aspects. Additionally, sun exposure is identified as a common trigger for rosacea flare-ups, emphasizing the importance of sun protection practices in managing the condition. This cross-sectional study aims to fill the gap in the literature by investigating the relationship between clinical severity, disease perception, quality of life, and sun protection behaviors in rosacea patients.
Methods: Questionnaires assessing the quality of life, illness perception, sun protection behaviors, sun protection decisional balance, and its potential predictors were completed by 120 rosacea patients and 120 controls.
Results: Patients exhibited a higher prevalence of sun protection behaviors than the control group (24.15 ± 5.76 vs. 17.63 ± 5.56, p < 0.001) and demonstrated greater determination in adhering to sun protection practices (13.43 ± 2.37 vs. 9.40 ± 3.09, p < 0.001). Hierarchical linear regression analyses showed that quality of life was related to clinical severity, illness perception (consequences, illness coherence, emotional representations), causal attribution (risk factors, immunity), and sun protection decisional balance variables (R2 = 0.45, F = 7.39, p < 0.001). Also, the perceived pros and cons of sun protection behaviors were predicted by illness perception (treatment control), causal attribution (risk factors, immunity, chance/accident), and quality of life variables (R2 = 0.24, F = 2.59, p = 0.004).
Conclusions: Providing more information to rosacea patients can improve their disease perception and quality of life, increasing adherence to sun protection behaviors.
A cosmetic regimen formulated to address the multi-modal pathogenesis of rosacea demonstrates efficacy for treating facial redness and skin's appearance.
Farris PK, Gerstein FH, Baldwin HE, Draelos ZD. J Drugs Dermatol. 2024 Sep 1;23(9):757-763. doi:10.36849/JDD.8460
Background: The treatment of rosacea is complicated as there are multiple pathogenic factors in play resulting in a myriad of clinical signs and symptoms including facial redness.
Objective: The primary objective was to evaluate the efficacy and tolerability of a non-prescription anti-redness regimen in patients with rosacea.
Methods: Thirty subjects with rosacea-induced facial erythema were enrolled in this single site, monadic study. The test regimen consisted of a treatment serum, redness-reducing moisturizer, and sunscreen. The test products are formulated with ingredients curated to address the multifactorial pathogenesis of facial redness. Investigator and subject self-assessment for efficacy and tolerability were performed at baseline, weeks 4 and 8. Non-invasive assessments for facial redness and skin hydration were conducted at all time points.
Results: Investigator grading showed significant improvement in facial redness of 21% at week 4 and 32% at week 8. Skin's appearance improved as early as 4 weeks while at 8 weeks there was statistically significant improvement in fine lines 15%, radiance/brightness 37%, tactile roughness 44%, visual roughness 41%, and 26% in overall appearance. Non-invasive assessments showed statistically significant improvement in skin hydration of 28% at week 4 and facial redness of 21% by week 8. No tolerability issues were identified by the investigator.
Conclusion: Patients with rosacea often turn to over-the-counter products to reduce facial redness and improve skin's appearance. In this study, a cosmetic skincare regimen designed to reduce facial redness demonstrated efficacy and tolerability in subjects with rosacea.
Rosacea and autoimmune liver diseases: a two-sample Mendelian randomization study.
Nobeyama Y. J Dermatol. 2024 Aug 10. Epub ahead of print. doi:10.1111/1346-8138.17411
Rosacea and autoimmune liver diseases (AILDs) are diseases closely associated with immune system abnormalities. AILDs primarily includes autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). Currently, research on the association between these two conditions is limited. Therefore, this study employed the bidirectional Mendelian randomization (MR) method to investigate potential causal relationships between rosacea and AILDs based on genetic predictions. Summary data related to Rosacea, AIH, PSC, and PBC were obtained from public genome-wide association studies (GWAS). The inverse variance weighted (IVW) method was used as the primary analytical approach, supplemented by the MR-Egger, weighted mode method, weighted median, and simple mode. A series of sensitivity analyses were also conducted to identify heterogeneity and pleiotropy effects. The MR analysis results indicated a significant increase in the risk of rosacea being associated with PBC (OR = 1.09, 95% CI = 1.02-1.18, P = 0.014), but no such association was found with AIH or PSC. Furthermore, this study did not find a significant impact of rosacea on the risk of AILDs. This study represents the first in-depth exploration of the potential causal relationship between rosacea and AILDs using MR analysis. These findings suggest an increased risk of rosacea among PBC patients.
Clinical efficacy of 595 nm pulsed dye laser in combination with supramolecular salicylic acid in the treatment of rosacea.
Lei W, Chen H, Chen L, et al. Arch Dermatol Res. 2024 Aug 24;316(8):579. doi:10.1007/s00403-024-03290-9
Objective: This research was aimed at ascertaining the clinical effects of 595 nm pulsed dye laser (PDL) in combination with supramolecular salicylic acid (SSA) in the treatment of rosacea.
Methods: Eighty-four patients with rosacea were selected, of which 42 patients treated with PDL alone were considered as the control group, and 42 patients treated with 595 nm PDL in combination with 30% SSA were regarded as the observation group. The treatment continued for 4 months in the two groups. Clinical symptom scores, skin barrier function indicators, serum inflammatory factors, Acne⁃QOL scores and adverse reactions between the two groups were compared.
Results: After treatment, levels of inflammatory factors, clinical symptom scores, transdermal water loss, and oil volume were decreased, and epidermal water content and Acne-QOL scores were increased in both groups (all P < 0.05), and the changes in the observation group were more pronounced versus the control group (all P < 0.05). The difference in the incidence of adverse reactions was not statistically significant between the two groups (P > 0.05).
Conclusion: 595 nm PDL in combination with SSA is safe in the treatment of rosacea.
Lipid-laden floret-like multinucleated giant cells: A novel histopathologic observation in rhinophyma.
Daruish M, Patalay R, Calonje E, Stefanato CM. Am J Dermatopathol. 2024 Sep 17. Epub ahead of print. doi:10.1097/DAD.0000000000002834
Rhinophyma is the advanced stage of rosacea and manifests clinically with disfigurement of the nose. The histopathology has been classified into classical and severe types. We studied the clinicopathological characteristics of 8 cases with the diagnosis of rhinophyma. In 5 of 9 specimens, floret-like multinucleated giant cells containing lipid were identified. This finding, to the best of our knowledge, has not been previously described.
Case Reports
Rosacea fulminans in pregnancy: A case report and review.
Yao QH, Liu ZH. Clin Cosmet Investig Dermatol. 2024 Sep 4;17:1999-2007. doi:10.2147/CCID.S481939
Rosacea is a common dermatosis with multiple pathogeneses, among which, rosacea fulminans may serve as a rare but severe subtype. This inflammatory disease usually presents as abrupt multiple erythema, pustules, and nodules localized on the face. Pregnancy and related changes of hormone levels may play a key role in the development and progression of the disease, although the exact mechanisms are unknown. In particular, treatment options, which includes systemic glucocorticosteroids, isotretinoin, and partial oral antibiotics, may be limited in pregnancy. Owing to the limited number of reported cases, standard diagnosis, treatment, and management guidelines remain unclear. Here, we report a case of rosacea fulminans happening in pregnancy treated successfully with oral erythromycin and short-term glucocorticosteroids, and share our review of the characteristics of RF cases during pregnancy.
Die-off reaction of Demodex mites after treating demodicosis with oral ivermectin: A case report.
Paichitrojjana A, Paichitrojjana A. JAAD Case Rep. 2024 Jul 26;52:1-3. doi:10.1016/j.jdcr.2024.07.006
We report a case of a patient with demodicosis who experienced a die-off reaction of Demodex mites following oral ivermectin treatment.
News
Isotretinoin’s Role in Rosacea Treatment
Dermatology Times
Isotretinoin has been explored for rosacea due to its anti-inflammatory and sebum-reducing effects. Despite its potential to induce remissions, isotretinoin's use remains limited, partly due to concerns about teratogenicity. However, researchers believe low-dose isotretinoin (LDI) (≤0.5 mg/kg/d) may offer a safer alternative with fewer adverse events, leading a recent review and meta-analysis to assess the efficacy of LDI in treating rosacea.
New Standards Bolster Rosacea Research
NRS Blog
As a first step in a unique undertaking to boost rosacea research results by standardizing its study, a group of investigators including 63 experts from 17 countries as well as 25 rosacea patients have identified eight key aspects of the treatment or experience of rosacea, called core domains. Their use is expected to make it easier than ever for researchers, clinicians and pharmaceutical companies to amass meaningful information on how to better diagnose and treat this widespread disorder, according to a recent report in the journal JAMA Dermatology.
Rosacea Treatment: Letting the Patient Lead the Way
Dermatology Times
During her presentation at Maui Derm NP+PA Fall 2024, Hilary Baldwin, MD, discussed the current treatment landscape for rosacea, focusing on share decision-making and patient buy in.
Is My Sex Life Making My Rosacea Worse?
Refinery29
“I love it when you go all red,” said my boyfriend, looking lovingly at me post-sex. I was mortified. I burrowed into the nearest pillow and slunk off to the bathroom. “Red” was an understatement; I was covered in maroon blotches and my face felt hot to the touch. This wasn’t my first rodeo (for my skin, that is). I have rosacea, a chronic inflammatory condition that affects approximately 16 million people in the US.