Improvement of Rosacea Symptoms in a 62-year-old Man with the Treatment of Iranian Traditional Medicine (original) (raw)
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Dermatology Review
Rosacea is a chronic inflammatory skin disease characterised by periods of remission and subsequent relapses typically provoked by environmental factors. Eruptions located on the face are easily visible and may be difficult to conceal, which leads to a decrease in patients' self-esteem, quality of life, and general well-being. Since the aetiology of rosacea is multifactorial and not entirely understood, and the clinical characteristics and course of the disease are heterogeneous, therapy may be challenging. While a complete cure is not possible, in the majority of cases clinical improvement and long-term remission are satisfying both to the patient and physician. In recent years, the therapeutic approach has been significantly modified. Currently, the focus is placed on the need to personalise the treatment process and adapt it to the patients' phenotypic characteristics. Combination therapies and new variants of existing topical and systemic drugs are increasingly being recommended. The mainstays of therapy are antiinflammatory agents. Proper skin care-along with the identification and avoidance of factors known to trigger consecutive episodes of rosacea-are also essential.
BACKGROUND: Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved. Frequently it can be controlled, but it is not clear which treatments are most effective. OBJECTIVES: To assess the evidence for the efficacy and safety of treatments for rosacea. SEARCH STRATEGY: We searched the Skin Group Specialised Register (February 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to February 2005), EMBASE (1980 to February 2005), BIOSIS (1970 to March 2002) and the Science Citation Index (1988 to February 2005). Reference lists of trials and key review articles were searched. Relevant manufacturers and experts were contacted. SELECTION CRITERIA: Randomised controlled trials in people with moderate to severe rosacea were included. Studies judged by the authors to have seriously flawed methodology were excluded. DATA COLLECTION AND ANALYSIS: Study selection, assessment of methodological quality, data extraction and analysis were carried out by two independent authors. Disagreements were resolved by discussion and consensus. MAIN RESULTS: The evidence provided by twenty-nine included studies was generally weak because of poor methodology and reporting. One of our primary outcome measures, 'quality of life', was not assessed in any of the studies. Only two studies of ocular rosacea were included. Pooled data from two trials involving 174 participants indicated that according to the participants, topical metronidazole is more effective than placebo (odds ratio (OR) 5.96, 95% confidence interval (CI) 2.95 to 12.06). Data pooled from three between-patient trials showed a clear improvement in the azelaic acid group; the rates of treatment success were approximately 70 to 80% versus 50% to 55% (OR 2.45, 95% CI 1.82 to 3.28). A within-patient trial of azelaic cream versus placebo could not be pooled with the other three studies, but also showed good evidence of efficacy. Data pooled from three studies of oral tetracycline versus placebo involving 152 participants showed that, according to physicians, tetracycline was effective (OR 6.06, 95% CI 2.96 to 12.42). Some evidence of efficacy of oral metronidazole was provided by one small study. AUTHORS' CONCLUSIONS: The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. There is insufficient evidence concerning the effectiveness of other treatments. Good RCTs looking at these treatments are urgently needed.
Interventions for rosacea (2011)
Abstract Background Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some patients. A range of treatment options are available but it is unclear which are the most effective. Objectives To assess the evidence for the efficacy and safety of treatments for rosacea. Search strategy In February 2011 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers. Selection criteria Randomised controlled trials in people with moderate to severe rosacea. Data collection and analysis Study selection, data extraction, assessment of risk of bias, and analyses were carried out by two independent review authors. Main results Fifty-eight trials, including 27 from the original review, comprising 6633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. Only two studies assessed our primary outcome 'quality of life'. Pooled data from physician assessments in three trials provided some evidence that metronidazole was more effective compared to placebo (RR 1.95, 95% CI 1.48 to 2.56). Three trials provided data, based on participants' assessments, illustrating azelaic acid was more effective than placebo (RR 1.52, 95% CI 1.32 to 1.76). Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doses of doxycycline, but there was evidence of less adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54). One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea (for all outcomes). Authors' conclusions Although the majority of included studies were assessed as being at high or unclear risk of bias there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required. -------------------------------------------------------------------------------- Plain language summary Interventions for Rosacea Rosacea is a common skin condition causing flushing, redness, red pimples, and pustules on the face, which should not be confused with acne. It can also cause inflammation of the eyes or eyelids, or both. Some people can develop a thickening of the skin, especially of the nose, which is called rhinophyma. Because rosacea is a chronic disease the effect of treatment on quality of life is very important to the individual. A range of treatment options are available which include several topical and oral antibiotics, azelaic cream, topical and systemic retinoids, and light-based therapies, e.g. laser therapy. This review found that in 3 clinical trials with 334 participants, topical metronidazole was more effective than placebo. Although most of the studies did not specifically address participants' satisfaction with treatment, they did nevertheless confirm the effectiveness of some of the treatments, expressed as a reduction in lesion counts, but these evaluations were largely physician-assessed. Three clinical trials involving 778 participants provided some evidence that topical azelaic acid cream was more effective than placebo. Two studies reported that the anti-inflammatory dose of doxycycline (40 mg) was more effective than placebo, confirmed by another study which also reported a lower risk of side-effects with the 40 mg dose rather than the 100 mg dose. Cyclosporine 0.05% ophthalmic emulsion appears to be more effective than artificial tears for rosacea of the eyes. Future research should aim to provide reliable evidence for people to make informed decisions about whether other widely-available treatments are effective in managing rosacea, i.e. other oral tetracyclines, isotretinoin, and treatments used for rosacea of the eyes, in addition to investigating the potential role of sunscreens and dietary change.
Systematic review of rosacea treatments
BACKGROUND: Rosacea is a common chronic skin and ocular condition. It is unclear which treatments are most effective. We have conducted a Cochrane review of rosacea therapies. This article is a distillation of that work. OBJECTIVE: We sought to assess the evidence for the efficacy and safety of rosacea therapies. METHODS: Multiple databases were systematically searched. Randomized controlled trials in people with moderate to severe rosacea were included. Study selection, assessment of methodologic quality, data extraction, and analysis were carried out by two independent researchers. RESULTS: In all, 29 studies met inclusion criteria. Topical metronidazole is more effective than placebo (odds ratio 5.96, 95% confidence interval 2.95-12.06). Azelaic acid is more effective than placebo (odds ratio 2.45, 95% confidence interval 1.82-3.28). Firm conclusions could not be drawn about other therapies. LIMITATIONS: The quality of the studies was generally poor. CONCLUSIONS: There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. More well-designed, randomized controlled trials are required to provide better evidence of the efficacy and safety of other rosacea therapies. PMID: 17190628 [PubMed - indexed for MEDLINE] Publication Types, MeSH Terms, SubstancesPublication Types: ReviewMeSH Terms:Administration, CutaneousAdministration, OralAnti-Bacterial Agents/administration & dosageAnti-Bacterial Agents/therapeutic useBenzoyl Peroxide/administration & dosageBenzoyl Peroxide/therapeutic useCosmeticsDicarboxylic Acids/administration & dosageDicarboxylic Acids/therapeutic useDietDouble-Blind MethodDrug Therapy, CombinationHumansMetronidazole/administration & dosageMetronidazole/therapeutic useOmeprazole/administration & dosageOmeprazole/therapeutic usePermethrin/administration & dosagePermethrin/therapeutic useRandomized Controlled Trials as TopicResearch Design/standardsRosacea/drug therapy*Single-Blind MethodSunscreening Agents/administration & dosageSunscreening Agents/therapeutic useTetracyclines/administration & dosageTetracyclines/therapeutic useTreatment OutcomeSubstances:Anti-Bacterial AgentsCosmeticsDicarboxylic AcidsSunscreening AgentsTetracyclinesazelaic acidMetronidazolePermethrinOmeprazoleBenzoyl Peroxide LinkOut - more resourcesFull Text Sources:Elsevier ScienceEBSCOMD ConsultOhioLINK Electronic Journal CenterOvid Technologies, Inc.Swets Information ServicesMedical:Rosacea - MedlinePlus Health InformationMolecular Biology Databases:PERMETHRIN - HSDBOMEPRAZOLE - HSDBMETRONIDAZOLE - HSDBBENZOYL PEROXIDE - HSDBSupplemental Content Related citations Review Interventions for rosacea. [Cochrane Database Syst Rev. 2005] Review Interventions for rosacea. van Zuuren EJ, Graber MA, Hollis S, Chaudhry M, Gupta AK, Gover M. Cochrane Database Syst Rev. 2005 Jul 20; (3):CD003262. Epub 2005 Jul 20.Review Interventions for rosacea. [Cochrane Database Syst Rev. 2004] Review Interventions for rosacea. van Zuuren EJ, Graber MA, Hollis S, Chaudhry M, Gupta AK. Cochrane Database Syst Rev. 2004; (1):CD003262. Review Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials. [Arch Dermatol. 2006] Review Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials. Liu RH, Smith MK, Basta SA, Farmer ER. Arch Dermatol. 2006 Aug; 142(8):1047-52. Review The rigor of trials evaluating Rosacea treatments. [Cutis. 2005] Review The rigor of trials evaluating Rosacea treatments. van Zuuren EJ, Graber MA. Cutis. 2005 Mar; 75(3 Suppl):13-6; discussion 33-6. Review A review of the diagnosis and treatment of rosacea. [Postgrad Med. 2010] Review A review of the diagnosis and treatment of rosacea. Scheinfeld N, Berk T. Postgrad Med. 2010 Jan; 122(1):139-43. See reviews... See all... All links from this record Related Citations Calculated set of PubMed citations closely related to the selected article(s) retrieved using a word weight algorithm. Related articles are displayed in ranked order from most to least relevant, with the “linked from” citation displayed first.Compound (MeSH Keyword) PubChem chemical compound records that are classified under the same Medical Subject Headings (MeSH) controlled vocabulary as the current articles.Substance (MeSH Keyword) PubChem chemical substance (submitted) records that are classified under the same Medical Subject Headings (MeSH) controlled vocabulary as the current articles.
Rosacea Treatment using Essential oils and Plant Extract
International Journal of Pharmaceutical Biological Archive, 2012
Rosacea is a chronic inflammatory condition of the facial skin that affects the blood vessels along with the pilosebaceous units. Rosacea is commonly seen in the people having fair complexion belonging to the north and the west Europe, although it may affect the people of any skin color.The symptoms may wax and wane during the short term, Rosacea may also progress with time.The patient complaints of flushing, blushing and sensitive skin, and their skin may be especially irritated with the topical preparations. FDA approved standard treatments include azelaic acid, metronidazole, oral antibiotics like tetracyclines, in particular minocycline and doxycycline. Topical treatments include clindamycin, subantimicrobial-dose doxycycline and sulfur products. Azithromycin and controlled release minocycline may be the options for Rosacea treatment, but they are not approved by the FDA as a proper agent for Rosacea treatment. Natural treatment may be an answer for the expensive prescribed medications by comparatively overcoming the side effects that are associated to them. By the use of natural moisturizing ingredients the patient may get the entire cure they need for effective Rosacea treatment; Aloe, Burdock, Chamomile, Vetiver, Rosemary, geranium and various extracts are the ingredients employed for treatment of Rosacea. The review outlines the Rosacea treatment by Cosmeceutical formulations constituting essential oils and herbal extracts. The objective of this study was to highlight the treatment of Rosacea using the herbal extract and essential oils overcoming the side effects produced by antimicrobial drugs.
A clinical overview on acuteness of rosacea
The Pharma Innovation Journal, 2020
Rosacea is a chronic inflammatory condition of the central facial skin affecting the blood vessels and pilosebaceous units. It is a common skin state that causes redness and visible blood vessels particularly in facial region. Generally, there are two types of rosacea based on either "performed" clinical or patient adopted analysis of rosacea. The etiology and pathophysiology are poorly understood. It may also produce small, red pus-filled bumps. These signs and symptoms may flare up for weeks to months and then go away for a while. In some circumstances it can be mistaken for acne, other skin problems or natural rosiness. Rosacea has a variety of triggers: lead to deliver of diverse mediators like endothelial cells, keratinocytes, macrophages, T1 and T17 cells. In addition, these trigger factors directly spread to the nurvous system, lead to the reflection of rosacea injury. Rosacea can affect anyone but it is most common in middle-aged women who have light skin. There is no permanent cure for rosacea, but treatment can control and reduce the signs and symptoms. Patients generally complaints of flushing and blushing and sensitive skin, and their skin may be especially irritated by any kind of topical preparations. Rosacea has a variety of triggers; however, they may be unnoticed by the patient. Validated treatments and drugs approved by the FDA which includes ivermectin, oxymetazoline hydrochloride, azelaic acid, topical metronidazole, and oral tetracyclines, in particular minocycline and doxycycline, brimonidine etc. Here, the aim of present strategies to sum up the modern concept along with diagnosis and address a symptom-based approach in the management of patients with rosacea.
Background: Rosacea is a common chronic skin disease affecting the face. There are numerous treatment options, but it is unclear which are the most effective. Objective: To assess the evidence for the efficacy and safety of treatments for rosacea. Methods: Searches included the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers (updated February 2011). Randomized controlled trials in people with moderate to severe rosacea were included. Results: Fifty-eight trials, including 27 from the original review, comprising 6,633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. There was some evidence that topical metronidazole and azelaic acid were more effective than placebo. Two trials indicated that doxycycline 40 mg was more effective than placebo. There was no statistically significant difference in effectiveness between doxycycline 40 mg and 100 mg and with evidence of less adverse effects. One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea. Conclusions: Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required.