rosacea

Demodex spp., a cosmopolitan mite, can exist as a commensal or parasitic organism. This study aimed to investigate the prevalence of Demodex spp. infestation in patients with common skin diseases and explore the potential association between demodicosis and these conditions in Urmia, northwest Iran.

A total of 246 patients attending the Skin Polyclinic of Iranian Urmia Taleghani Hospital were enrolled in the study. Samples were taken from the nose wings, cheeks, and forehead regions of the face area of the persons using the standard superficial skin biopsy method.

Demodicosis was detected in 43 (16.3%) patients, with 42 cases attributed to D. folliculorum and 1 case to D. brevis infestation. The highest positivity was found in the 31‒50 (21.4%) and 51‒72 (22.2%) age groups. In the rela tionship between demodicosis and skin diseases, Demodex spp. was found in 13 (32.5%) of 40 patients who had skin disease; 6 of these patients with rosacea (42.9%) and 7 with eczema (29.2%). Mite infestation was found in 6 (37.5%) of 16 patients who had hemodialysis due to renal insufficiency. Furthermore, 46.7% of positive patients reported using common goods. The prevalence of demodicosis was similar among patients residing in villages (17.2%) and cities (17.6%).

This study sheds light on the potential association between Demodex infestation and common skin diseas es such as rosacea and eczema in Urmia, Iran. Therefore, there is a pressing need to augment research endeavors on de modicosis.

The evidence has shown the relationship between the microbiota of the face and several skin conditions. However, for rosacea patients, the changes in the facial skin microbiota still remain unknown.

This study was performed to explore the correlation between the facial skin microbiota and rosacea and analyze and characterize the facial skin microbiota of rosacea patients in comparison to healthy controls using 16S rDNA amplicon sequencing.

A total of 27 rosacea patients and 25 healthy controls were matched. TheDNAwas extracted from participants’ skin swabs taken from the nose, chin, forehead, and bilateral cheeks. The V3V4 region of the 16S rRNA gene was sequenced using Illumina MiSeq technology. The diversity of the face skin microbiota was examined using alpha and beta diversity. Utilizing linear discriminant analysis effect size (LEfSe), the quantitative study of biomarkers in the two groups was carried out. Clusters of orthologous groups and Kyoto encyclopedia of genes and genomes function predictions were made at the genus level utilizing phylogenetic investigation of communities by reconstruction of unobserved states.

The alpha diversity of the facial skin microbiota increased significantly in rosacea patients, and beta diversity showed substantial differences between the rosacea and healthy control groups. The facial skin microbiota community structure changed in rosacea patients; however, the dominant strains were the same as in healthy controls, both being Propionibacterium acnes and Staphylococcus epidermidis. The LEfSe demonstrated that Xanthomonas, Acinetobacter, and Pseudomonas were enriched in the rosacea patients; nevertheless, Corynebacterium, Finegoldia, and Peptoniphilus were enriched in the healthy controls. The rosacea patients showed significantly decreased expression in the pathways of membrane transport, carbohydrate metabolism, metabolic diseases, amino acid transport and metabolism, carbohydrate transport and metabolism, transcription, and inorganic ion transport and metabolism.

The facial skin microbiota diversity and community structure changed, and the expression of several metabolic pathways was downregulated in the rosacea patients in comparison to the healthy controls, which might outline new strategic methods for the surveillance, diagnosis, and treatment of rosacea.

Brimonidine tartrate is an alpha-2 adrenergic receptor agonist approved for treating rosacea. This study aimed to assess the efficacy and safety of a brimonidine gel in rosacea patients with skin types III and IV.
This study was a phase II before-after clinical study in 20 patients with moderate to severe rosacea treated with brimonidine 0.33% gel. Clinician’s Erythema Assessment (CEA), Patients’ Self-Assessment (PSA), skin erythema (ΔE), lightness (ΔL), and biophysical parameters were measured before treatment and 4 and 8 weeks later. Ultrasound parameters were also measured at the same time points.
Eighteen patients completed the study. CEA and PSA decreased significantly from 3.05 to 2.10 and 2.15 after 4 weeks and 2.20 and 2.15 after 8 weeks, respectively (P<0.01 for both). Furthermore, ΔE and ΔL, as well as the skin erythema index, improved after 4 weeks of treatment. The skin echo density of both the epidermis and dermis also increased after 8 weeks (P<0.05). During the study, no serious adverse events occurred other than some reports of temporary moderate redness.
Daily application of brimonidine 0.33% gel is safe and effective for the treatment of rosacea in darker skin types.

Once popularly known as whiskey nose or rum blossom, rhinophyma is a permanent thickening of the nasal skin composed of confluent erythematous papules and prominent follicles. The etiology is not fully known, but many authors describe rhinophyma as the fourth stage of acne rosacea, a chronic inflammatory cutaneous disease characterized by erythema, telangiectasia, papules, pustules, and edema. It is benign yet disfiguring and can be stigmatizing. Here, we report the case of a 54-year-old man who presented with a mass on the nose that had slowly grown over the prior two years. He had a history of acne, treated with isotretinoin 10 mg daily by a dermatologist, one year before the onset of this mass. Examination from the frontal view revealed asymmetric, diffuse, multilobulated skin hypertrophy over the middle and lower nasal vault. On the basal view, there was a 10 x 7 mm epithelizing ulceration over the right alar rim. He underwent a partial-thickness resection of the hypertrophied nasal skin, and the resulting wound was left to heal via secondary intention, with a good cosmetic outcome.

Patients admitted in especial units such as coronary care unit (CCU) require intensive care for different aspects including skin problems. Here in this report we aimed to perform a survey on different skin lesions in patients admitted in CCU by the time of admission and when discharging.

In this cross-sectional study, we had a survey on 200 patients admitted in CCU in AL-Zahra hospital, Isfahan. A dermatologist observed and examined each patients for any skin lesions by the time of admission and when discharging from CCU.

Here we showed that 15 percent of patients admitted in CCU have at least one skin lesion and also we indicated that seborrhea dermatitis and then rosacea have the most prevalence by the time of admission in CCU. Other skin lesions were acute skin failure. We also showed that prevalence of bed sore and pressure sores increased amazingly during admission.

Rosacea, seborrhea dermatitis and drug allergic reactions after pressure sores are the most frequent skin lesions in CCU and there might be an association between rosacea and cardiovascular diseases.

Rhinophyma is an uncommon subtype of rosacea, the clinical diagnosis of which is straightforward. However, localized, especially well-circumscribed,  rhinophyma is a very rare condition, which requires a paraclinical assessment to be accurately diagnosed.   Case Report: We report a 48-year-old male patient who presented with a well-circumscribed and dark red tumoral mass of 28 mm in diameter and smooth consistency in the right nasal ala. The patient had no former and concomitant characteristic skin lesions on the other part of his face. Histopathology and immunohistochemistry assessments documented the diagnosis of rhinophyma.  

To the best of our knowledge, this is the first case report of well-circumscribed localized rhinophyma. This lesion can be treated by CO2 laser in a fast and efficient manner with esthetically satisfactory outcome and no significant complications.

Rosacea is a chronic inflammatory disease of unknown etiology. Few studies have been published on the use of oral ivermectin in the treatment of the inflammatory subset of rosacea. The aim of the present research was to evaluate the efficacy and safety of oral ivermectin prescribed for a series of patients with inflammatory rosacea. On a weekly basis, 29 patients with papulopustular rosacea were orally given ivermectin at a dose of 200 µg/kg before meal for three consecutive weeks. Subjects were evaluated weekly and during the follow-up period for two successive treatment-free months. After 3 doses of ivermectin, there was a significant reduction in the total count of inflammatory lesions compared to the base line (the mean was reduced from 51.6±27.4 to 21±14.7) (P<0.05). At the end of the two-month follow-up period, more reduction was observed in inflammatory lesions (mean was reduced to 9.3±7), and 62% of the patients showed excellent responses to the treatment (? 80% reduction in the lesions). Nausea was reported in 10%. A three-week use of oral ivermectin is an effective, safe, and well-tolerated approach to treating inflammatory rosacea

Helicobacter pylori (H. pylori) is one the most infectious microorganism of human disease found in half of the world’s population. Despite intense investigations into the spread of rosacea, the precise etiology remains unclear. There are theories, which suggest H. pylori as a predisposing factor for the occurrence. This study aimed at determining the prevalence of H. pylori in patients with rosacea.
This analytical-descriptive study was conducted on patients with rosacea disease attending Tabriz University of Medical Sciences Dermatology Clinics from October 2011 to January 2011. Patients, who were 18- to 65-year-olds with confirmed rosacea diagnosis, were included in the study. All patients were referred to a dermatologist and the severity of rosacea was categorized in 3 grades of mild, moderate and severe. Then H. pylori infection was investigated using H. pylori stool antigen. P values of less than 0.05 were considered statistically significant.
Out of 63 patients with rosacea, 35 patients (55.55%) were male and 28 patients (44.44%) were female. Based on the rosacea categorization, 11 (17.46%), 32 (50.79%), and 20 (31.74%) patients had respectively severe, moderate, and mild rosacea. There was no statistical significant difference regarding age and gender between different severities (P = 0.39). Forty patients (63.4%) out of all 63 were positive for H. pylori on stool antigen examination. There was no statistically significant association between H. pylori infection and gender (P = 0.87) or age (P = 0.62). There was a statistically significant difference between patients with H. pylori negative and positive test results considering severity (P = 0.013).
In conclusion, although no association between rosacea and H. pylori infection was seen, there was a significant association between H. pylori infection and cases of severe rosacea.

To describe a case of severe rosacea with ocular involvement.
Case Report: A 28‑year‑old female patient presented with extensive facial and ocular eruptions. She had a history of treatment with oral prednisolone due to the clinical diagnosis of lupus erythematosus (LE), which had resulted in transient improvement of the lesions, but was followed by exacerbation of the lesions. With the clinical diagnosis of severe oculofacial rosacea, she was successfully treated with oral doxycycline, steroid eye drops, and ocular lubricants. Histopathological features of skin biopsy were consistent with rosacea in the context of infection with Demodexfolliculorum. After four years, a relapse of the oculofacial lesions occurred, for which retreatment with oral tetracycline, steroid eye drops, and ocular lubricants was administered.
 Rosacea can be extremely severe and disfiguring, and it can be misdiagnosed as the pathognomonic butterfly rash of LE. Demodex carriage in rosacea is consistent and may play a significant role in the severe forms.

Rosacea is a chronic skin disease affecting the facial area. The causative agents are unknown. Demodex mites can cause rosacea in human beings.. In this article five cases of rosacea due to Demodex folliculorum are reported. The first case was a 26-year-old male wrestler. The second case was a 4-year-old-boy with immunodeficiency syndrome, the third case was a 29-year-old lady, the fourth was a 7-year old boy and the fifth was a 36-year-old female. All patients were suffering from erythema, itching, inflammation and in some cases acne-like pustules in their face. The first case was suffering from lesions on his neck as well. All patients were referred to the Iran-Zamin diagnostic laboratory for fungal examination. Scraping from the lesions and slide preparation in 20% KOH and microscopic examination revealed D. folliculorum. Scotch tape examination of the lesion on the neck of the first patient indicated the tinea versicolor. The patients referred to dermatologists for treatment.. Clinical similarities of rosacea, fungal diseases and demodicosis might cause unsuitable therapy. Pretreatment examination and identification of disease agent lead to the appropriate management and treatment of the patients..