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Rosacea is a chronic cutaneous condition with a prevalence rate ranging from 9.6% to 22% in recent studies. Facial erythema (transient and permanent) is considered a common denominator that is frequently observed in all subtypes of rosacea and is estimated to affect more than 40 million people worldwide. Brimonidine tartrate is a selective α2-adrenergic receptor agonist and is the first topical treatment approved for facial erythema of rosacea. Clinical trials have demonstrated that brimonidine tartrate provided significantly greater efficacy, compared to vehicle, for the treatment of moderate to severe erythema of rosacea. In addition, brimonidine tartrate has demonstrated a rapid onset of effect, duration of action throughout the day, and good safety profile in studies of up to 1 year. This review critically discusses the role of brimonidine tartrate for the treatment of facial erythema of rosacea by examining both clinical study data and real-world dermatologist experiences across a wide spectrum of treated patients, and concludes that it is a significant therapeutic option in the management of an unmet need of this chronic condition.

Purpose: Apremilast, an oral phosphodiesterase 4 inhibitor, was effective in clinical trials in patients with moderate plaque psoriasis (affected body surface area [BSA] 5% to 10%). However, findings from realworld clinical practice are limited. Materials and methods: An online survey and chart review was conducted among US dermatologists during October 2015 to identify clinical characteristics and 6-month treatment outcomes among patients with moderate psoriasis treated with apremilast. Results: A total of 83 dermatologists provided patient chart information at the initial and 6-month follow-up time points for 70 patients with moderate plaque psoriasis initially receiving apremilast, of whom 65 were receiving it as their primary therapy (mean age: 47.3 years; 45% were men). Among apremilasttreated patients, 91% (64 of 70) remained on apremilast and 54% were rated as having improved to mild psoriasis at follow-up; mean BSA decreased from 9.9% at initial chart review to 4.9%. There were 8 of 66 (12%) patients who experienced !1 side effect, including diarrhea (7.6%), nausea (4.5%), headache (1.5%), and abdominal pain (4.5%). Most dermatologists (68%) stated that apremilast exceeded or met their expectations. Conclusions: Most patients with moderate psoriasis receiving apremilast had improved at 6-month follow-up. Safety and tolerability were consistent with the safety profile of apremilast.

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A t tbe time of his referral, a 40-year-old white man presented witb 20 markedly discolored yellow nails with oncbodystrophy, edema of the lower extremities, the scrotum, of the dorsum of both hands, and facial puffiness. Cbronic fatigue was demonstrated by intermittent periods of somnolence during the initial pbases of evaluation.In the 12 montbs prior to this 1981 study, the patient began to experience excessive daytime somnolence progressing to the point of falling asleep at work and while driving. Friends confirmed loud snoring and restless movements during nocturnal sleep. He was referred for sleep studies after a trial of diuretic therapy and metbylphenidate hydrochloride, which failed to lessen his problems.On pbysical examination, the entire toenail and the distal portion of his fingernails presented witb thickened opaque yellow nails displaying a mild greenish discoloration at the lateral edge ( Fig. 1}. Marked alteration of tbe nail shape exbibited gross thickening, transverse ridging, distal onycbolysis, and exaggerated lateral curvature. Nails were rougb and friable, and exhibited subungual hyperkeratosis. The absence of both cuticle and lunulae were noted (Fig. 2). The acral portions of tbe upper extremities and the scrotal area appeared to be pale and cool with markedly nonpitting edema. Cardiovascular and pulmonary examinations were within normal ranges.Sleep measurements were obtained by monitoring oxygen saturation with a Hewlett-Park ear oximeter Model 47201 A: respiratory efforts were monitored with a pneumotacbograph stain gauge attached to tbe cbest wall; airflow was monitored at the mouth and nose via a Beckman Co2 gas analyzer LB-2; and cardiac activity was monitored with chest leads placed in tbe MCL mode. The recordings were made on a multichannel Electronics for Medicine on-line recorder.During the observed sleep period, tbe patient demonstrated loud snoring, agitated sleep movement, and long pe-