Applying the phenotype approach for rosacea to practice and research

Tan, Jerry; Berg, Mats; Gallo, Richard L.; Rosso, J.Q. Del

doi:10.1111/bjd.16815

Cited by 34 publications

(44 citation statements)

References 27 publications

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“…Recently, the classification system was changed from subtype-based to phenotype-based to increase diagnostic and presentation accuracy, but as many trials predate the updated phenotype approach, the subtype-based system still dominates rosacea literature. 8,[10][11][12] To achieve optimal results, rosacea treatment is preferably adjusted to clinical symptoms and disease severity. 3,13,14 However, the variety of clinical manifestations among individual patients and presence of various classification systems make standardization and quantification of rosacea measurements challenging.…”

Section: What Does This Study Add?mentioning

confidence: 99%

“…Initially, four rosacea subtypes were described: erythematotelangiectatic, papulopustular, phymatous and ocular. Recently, the classification system was changed from subtype‐based to phenotype‐based to increase diagnostic and presentation accuracy, but as many trials predate the updated phenotype approach, the subtype‐based system still dominates rosacea literature . To achieve optimal results, rosacea treatment is preferably adjusted to clinical symptoms and disease severity .…”

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confidence: 99%

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Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

et al. 2019

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Summary Background Rosacea assessment and therapy monitoring can be challenging to standardize, as most clinical evaluation systems are prone to interobserver variability and not always validated. Therefore, objective, reliable and preferably noninvasive measurement tools are needed. Objectives To give insight into available noninvasive imaging techniques and biophysical methods in rosacea by performing a systematic review. Methods PubMed, Embase, Cochrane and Web of Science databases were searched until 1 September 2018 in accordance with PRISMA guidelines, to identify studies providing original data about objective noninvasive imaging and/or biophysical skin measurement techniques for diagnosis, assessing severity or therapy monitoring of adult patients with cutaneous facial rosacea. Risk of bias of included articles was assessed with the Cochrane Risk of Bias tool, Quality in Prognosis Studies tool, and the Newcastle–Ottawa Scale. Results A total of 78 studies were included, describing 14 imaging and biophysical methods. Widespread information about (sub)surface cutaneous morphology and functionality was obtained. Methodological study quality was relatively low and interstudy outcome variability was large. Several tools show promising value in research settings: for treatment follow‐up Demodex mites are countable with reflectance confocal microscopy, spectrometry can quantify erythema, and rosacea severity could be objectified with skin hydration‐ and transepidermal water loss measurements. Conclusions This systematic review describes the spectrum of noninvasive imaging and biophysical methods in rosacea assessment, giving multifaceted information about structure and properties of rosacea skin, especially useful for research purposes. Larger studies with good methodological quality are needed to create validated protocols for further implementation into research. What's already known about this topic? Rosacea is a chronic inflammatory skin disease with a variety of clinical manifestations. Most clinical evaluation systems are subjective, not always validated, and subsurface skin processes remain unnoticed. Currently, different types of noninvasive measurement tools are available for rosacea assessment and therapy monitoring, but a comprehensive overview is lacking. What does this study add? Seventy‐eight publications were included, describing 14 imaging and biophysical tools, providing a wide range of information about rosacea skin morphology and functionality. Reflectance confocal microscopy and spectrometry are especially promising in therapy monitoring and skin barrier measurements for rosacea severity assessment. Larger studies with better methodological quality are needed to create validated protocols for implementation into research.

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Section: What Does This Study Add?mentioning

confidence: 99%

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confidence: 99%

Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

et al. 2019

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“…It typically affects the central face. A number of clinical phenotypes such as fixed centrofacial erythema, phymatous changes, papules and pustules, flushing, telangiectasia, ocular manifestations are recognized [1,2]. In terms of pathogenesis, neurovascular dysregulation and aberrant innate immune response are two of the described abnormalities supposed to be involved in rosacea development, both of which can lead to cutaneous inflammation [3].…”

Section: Introductionmentioning

confidence: 99%

Characterization and Analysis of the Skin Microbiota in Rosacea: Impact of Systemic Antibiotics

Woo

Lee

Cho

et al. 2020

JCM

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Systemic antibiotics are extensively used to control the papules and pustules of rosacea. Hence, it is crucial to understand their impact on the rosacea skin microbiota which is thought to be perturbed. The purpose of this study was to compare the makeup and diversity of the skin microbiota in rosacea before and after taking oral antibiotics. We also compared the skin microbiota at baseline according to age and rosacea severity. A longitudinal cohort study was performed on 12 rosacea patients with papules/pustules and no recent use of oral and topical antimicrobials/retinoids. Patients were prescribed oral doxycycline, 100 mg, twice daily for six weeks. Skin areas on the cheek and nose were sampled for 16S ribosomal RNA gene sequencing at baseline, and after six weeks of doxycycline treatment. Eleven females and one male aged 20–79 (median 51) with a median Investigator’s Global Assessment score of 3 (moderate) were enrolled. At baseline, Staphylococcus epidermidis was the most dominant species followed by Cutibacterium acnes (formerly Propionibacterium acnes). In the 60 Over-age group, the prevalence of Cutibacterium acnes was lower than that of the 60 & Under-age group. Rosacea severity increased with age and was associated with a decrease in the relative abundance of Cutibacterium acnes and an increase of Snodgrassella alvi. Across all subjects, antibiotic treatment reduced clinical rosacea grades and was associated with an increase in the relative abundance of Weissella confusa (P = 0.008, 95% CI 0.13% to 0.61%). Bacterial diversity (alpha diversity) was not significantly altered by antibiotics treatment. Principal coordinates analysis showed mild clustering of samples by patient (ANOSIM, Analysis of Similarity, R = 0.119, P = 0.16) and scant clustering with treatment (ANOSIM, R = 0.002; P = 0.5). In conclusion, we believe that rosacea has a unique age-dependent characteristic (i.e., severity). Although we were not able to pinpoint a causative microbiota, our study provides a glimpse into the skin microbiota in rosacea and its modulation by systemic antibiotics.

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“…Minor features such as burning or stinging sensation, facial edema, and dry appearance can also contribute to diagnosis 4 . Apart from these cutaneous findings, ocular manifestation should not be overlooked 5 …”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety results of micellar water, cream and serum for rosacea in comparison to a control group

Guertler

Jøntvedt

Clanner‐Engelshofen

et al. 2020

J of Cosmetic Dermatology

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Background Rosacea is a common inflammatory skin disorder with centrofacial erythema, flushing, telangiectasia, papules/pustules, and possible ocular or phymatous manifestation. Patients’ skin is particularly sensitive to chemical and physical stimuli leading to burning, stinging, dryness, and skin tightness. Objective Dermatological evaluation of the efficacy and safety of skin care products designed for centrofacial erythema in rosacea patients, in comparison with a control group using objective measurements. Rosacea symptoms (itching, tension, warmth, burning, dryness) and quality of life were examined. Methods Sixty Caucasians with centrofacial erythema were enrolled in an 8‐week prospective study, fifty of them exclusively using the study products (micellar water, cream, and serum) with ten participants randomly assigned to a control group. Patients were evaluated at baseline (V0), at 4 weeks (V1), and at 8 weeks (V2). Three‐dimensional objective measurements (VECTRA®) as well as standardized questionnaires were used. Results Results were compared with the control group. A significant reduction of 16% in skin redness as indicated by VECTRA® analysis was seen in the intervention group comparing V0‐V2. Furthermore, rosacea‐associated symptoms diminished by 57.1%, while life quality of affected patients within the intervention group improved by 54.5% comparing V0‐V2, respectively. Conclusions A skin care regime suitable for sensitive and redness‐prone skin led to an enhanced clinical appearance, to a decrease of associated symptoms in rosacea patients, and to an improved life quality.

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Applying the phenotype approach for rosacea to practice and research

Cited by 34 publications

References 27 publications

Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

Characterization and Analysis of the Skin Microbiota in Rosacea: Impact of Systemic Antibiotics

Efficacy and safety results of micellar water, cream and serum for rosacea in comparison to a control group

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