tretinoin and Rosacea

Microencapsulation has received extensive attention because of its various applications. Since its inception in the 1940s, this technology has been used across several areas, including the chemical, food, and pharmaceutical industries. Over-the-counter skin products often contain ingredients that readily and unevenly degrade upon contact with the skin. Enclosing these substances within a silica shell can enhance their stability and better regulate their delivery onto and into the skin. Silica microencapsulation uses silica as the matrix material into which ingredients can be embedded to form microcapsules. The FDA recognizes amorphous silica as a safe inorganic excipient and recently approved two new topical therapies for the treatment of rosacea and acne. The first approved formulation uses a novel silica-based controlled vehicle delivery technology to improve the stability of two active ingredients that are normally not able to be used in the same formulation due to potential instability and drug degradation. The formulation contains 3.0% benzoyl peroxide (BPO) and 0.1% tretinoin topical cream to treat acne vulgaris in adults and pediatric patients. The second formulation contains silica microencapsulated 5.0% BPO topical cream to treat inflammatory rosacea lesions in adults. Both formulations use the same amorphous silica sol-gel microencapsulation technology to improve formulation stability and skin compatibility parameters.

Topics: Acne Vulgaris; Adult; Benzoyl Peroxide; Child; Dermatologic Agents; Drug Combinations; Gels; Humans; Nonprescription Drugs; Pharmaceutical Vehicles; Rosacea; Treatment Outcome; Tretinoin

Acne and rosacea are common inflammatory skin conditions present in numerous racial and ethnic groups. There are distinct differences in clinical presentation, exacerbating factors, potential triggers and consequences of both conditions in individuals with skin of colour (SOC), classified as Fitzpatrick skin types III-VI. For example, acne can be complicated by the development of postinflammatory hyperpigmentation and keloid scarring in SOC, and this can influence treatment choice. Although rosacea is reported less frequently in SOC, this may be the result of delayed diagnosis or late presentation due to the difficulty in discerning the classic features of erythema in darker skin tones. In such cases, additional clues in the medical history and clinical examination may assist in making the diagnosis. This review aims to summarize nuances in both the diagnosis and management of these two common skin conditions in patients with SOC to support clinicians in providing an individualized treatment approach.

Topics: Acne Vulgaris; Adapalene; Diagnosis, Differential; Dicarboxylic Acids; Humans; Racial Groups; Rosacea; Skin Pigmentation; Tretinoin

Acne and rosacea are common inflammatory processes historically classified in the same disease category, but evolving understanding of their disparate pathophysiology and exacerbating factors have generated an enormous armamentarium of therapeutic possibilities. Patients seek over-the-counter therapies first when managing cutaneous disease; therefore, this review defines ingredients considered to be effective over-the-counter acne and rosacea products, their mechanisms, and safe formulations, including botanical components, oral supplements, and other anecdotal options in this vast skin care domain.

Topics: Acne Vulgaris; Administration, Cutaneous; Astringents; Benzoyl Peroxide; Dermatologic Agents; Detergents; Evidence-Based Medicine; Global Health; Humans; Hydroxy Acids; Kinetin; Niacinamide; Nonprescription Drugs; Phototherapy; Randomized Controlled Trials as Topic; Resorcinols; Rosacea; Salicylates; Sulfur; Sunscreening Agents; Tea Tree Oil; Treatment Outcome; Tretinoin; Zinc

Routine everyday care of skin is an essential part of optimal patient management. Common problems such as xerosis, dermatitis, eczema, psoriasis, acne, rosacea, and photodamage leave the skin vulnerable to external insults, partly as a result of varying levels of barrier dysfunction. Cosmetic surgery procedures also typically damage the stratum corneum (SC) and leave skin with a very weak barrier during recovery phase. Cleansing is an important aspect of any skin care, since it not only removes unwanted dirt, soil, and bacteria from skin, but also removes dead surface cells, preparing skin to better absorb topically applied drugs/medication. Care must be taken to minimize any further weakening of the SC barrier during cleansing. Cleansers based on mild synthetic surfactants and/or emollients that cause minimal barrier perturbation are ideal for these patients. The present paper is a brief review of four clinical trials that evaluated the efficacy and compatibility of either mild syndet bars or cleansers in patients with atopic dermatitis, acne, rosacea, or patients who had received chemical peels or Retin-A(R) (tretinoin) treatment for sustained photodamage.

Topics: Acne Vulgaris; Clinical Trials as Topic; Dermatitis, Atopic; Detergents; Humans; Hydroxy Acids; Rosacea; Severity of Illness Index; Skin Care; Skin Diseases; Surface-Active Agents; Tretinoin

Topics: Administration, Topical; Clinical Trials as Topic; Eczema; Facial Dermatoses; Humans; Keratolytic Agents; Rosacea; Skin Aging; Tretinoin

Topics: Adult; Female; Humans; Regional Blood Flow; Rosacea; Skin; Tretinoin

Topics: Diagnosis, Differential; Humans; Photosensitivity Disorders; Rosacea; Skin; Tretinoin

Isotretinoin is a new orally active retinoic acid derivative for the treatment of severe refractory nodulocystic acne. The pharmacological profile of isotretinoin suggests that it acts primarily by reducing sebaceous gland size and sebum production, and as a result alters skin surface lipid composition. Bacterial skin microflora is reduced, probably as a result of altered sebaceous factors. Isotretinoin 1 to 2 mg/kg/day for 3 to 4 months produces 60 to 95% clearance of inflammatory lesions in patients with severe, recalcitrant nodulocystic acne, with evidence of continued healing and prolonged remissions in many patients after treatment withdrawal. Doses as low as 0.1 mg/kg/day have also proven successful in the clearance of lesions; however, with such low doses the duration of remission after discontinuation of therapy is usually shorter. Encouraging results have also been seen in small numbers of patients with rosacea, Gram-negative folliculitis, Darier's disease, ichthyosis and pityriasis rubra pilaris, the response in keratinising disorders resembling that with the related drug etretinate. While long term follow-up studies in these patients have not been reported, prolonged remission after withdrawal of isotretinoin in disorders of keratinisation is unlikely, as with other drugs used in these conditions. Isotretinoin is only partially effective in psoriasis, in contrast to etretinate which is very effective in psoriasis but ineffective in severe acne. Some encouraging results have also been reported with isotretinoin in patients with squamous and basal cell carcinomas, but isotretinoin has proven unsuccessful in non-squamous cell epithelial and non-epithelial cancer. Side effects affecting the mucocutaneous system occur in nearly all patients receiving isotretinoin, but rarely lead to drug withdrawal. Raised serum triglyceride levels are also commonly reported. The possibility of long term spinal or skeletal bone toxicity may restrict the use of isotretinoin in severe disorders of keratinisation requiring prolonged administration. Isotretinoin is strictly contraindicated in women of childbearing potential due to its severe teratogenic properties, unless an effective form of contraception is used. Thus, isotretinoin offers an effective advance on the treatment options available in a difficult therapeutic area - those patients with severe, nodulocystic acne not responding to 'traditional' therapy.

Topics: Acne Vulgaris; Animals; Anti-Inflammatory Agents; Carcinogens; Cell Differentiation; Cell Division; Humans; Immunity; Isotretinoin; Kinetics; Mutagens; Psoriasis; Rosacea; Sebaceous Glands; Skin; Skin Absorption; Skin Diseases; Skin Neoplasms; Teratogens; Tissue Distribution; Tretinoin

Papulopustular acne rosacea is a chronic inflammatory condition which can be difficult to treat. Many patients are unwilling to use systemic medications, and single topical agents alone may not address all the symptoms of rosacea. A combination topical clindamycin phosphate 1.2% and tretinoin 0.025% gel is efficacious for acne vulgaris, and may be helpful for rosacea, since acne vulgaris and rosacea shares many similar clinical and histologic features.. To assess the preliminary efficacy and safety of a combination gel consisting of clindamycin phosphate 1.2% and tretinoin 0.025% on papulopustular rosacea after 12 weeks of usage.. Randomized, double-blind, placebo controlled two site study of 79 participants with moderate to severe papulopustular acne rosacea using both physician and subjects' validated assessment tools. Primary endpoint consisted of statistically significant reduction in absolute papule or pustule count after 12 weeks of usage.. There was no significant difference in papule/pustule count between placebo and treated groups after 12 weeks (P=0.10). However, there was nearly significant improvement in physicians' assessments of the telangiectasia component of rosacea (P=0.06) and erythematotelangiectatic rosacea subtype (P=0.05) in treated versus placebo group after 12 weeks. The only significant adverse event different was facial scaling, which was significantly increased in treated group (P=0.01), but this did not result in discontinuation of study drug.. A combination gel of clindamycin phosphate 1.2% and tretinoin 0.025% may improve the telangiectatic component of rosacea and appears to better treat the erythemotelangiectatic subtype of rosacea rather than papulopustular subtype. Our preliminary study suggests that future studies with much larger sample size might confirm our findings.

Topics: Administration, Cutaneous; Adult; Aged; Anti-Bacterial Agents; Clindamycin; Dermatologic Agents; Double-Blind Method; Drug Combinations; Female; Follow-Up Studies; Gels; Humans; Male; Middle Aged; Pilot Projects; Rosacea; Severity of Illness Index; Treatment Outcome; Tretinoin

Rosacea is a common, chronic, and poorly understood dermatological condition characterized by an inflammatory component composed of papules and pustules and a vascular component composed of flushing and erythema. Current treatment options include topical, systemic, and light-based methods, each of which focuses on either the inflammatory or the vascular component. Retinoids are not routinely indicated as treatment because of the common conception that they would be too inflammatory for the sensitive rosacea patient. However, photodamage may play a role in rosacea and tretinoin is well-known to repair photodamage. Thirty rosacea subjects were enrolled to assess their response to the use of clindamycin phosphate 1.2% and tretinoin 0.025% gel (ZIANA; Medicis Pharmaceutical Corporation, Scottsdale, AZ) for a period of 12 weeks. The results showed a dramatic decrease in pustules and papules without any significant inflammation or overall intolerance. No improvement in facial redness was achieved. Based on our results, more investigation of topical retinoids for rosacea treatment is prudent.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Clindamycin; Diagnostic Self Evaluation; Double-Blind Method; Drug Combinations; Female; Gels; Humans; Irritants; Keratolytic Agents; Male; Middle Aged; Rosacea; Skin; Skin Pigmentation; Tretinoin; Young Adult

Twenty-two patients with severe or recalcitrant rosacea were divided into three treatment groups in a randomized, double-blind trial that compared low-dose oral isotretinoin (10 mg/d), topically applied tretinoin (0.025% cream), and the combined use of both isotretinoin and tretinoin. For the first 16 weeks of the trial, subjects received one of these three trial regimens. For the final 16 weeks, isotretinoin was withheld while tretinoin cream or a placebo cream was continued.. Twenty subjects completed the trial. Each treatment produced therapeutic benefits with regard to the number of papules and pustules and erythema. Treatment with oral isotretinoin appeared to give a more rapid onset of improvement, but there were no differences between the groups after 16 weeks. This level of improvement continued during the succeeding 16 weeks of observation whether the subjects used the tretinoin or the placebo cream. Adverse events were minimal and well tolerated in all groups.. Low-dose oral isotretinoin and topical tretinoin cream therapy appear to be beneficial in the treatment of severe or recalcitrant rosacea. No additive benefit is noted with the combined use of these two modalities.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin

A follow up investigation was done on forty-seven patients of the German multicenter study with severe and long standing rosacea who had been treated with isotretinoin (0.5 mg/kg bw/day) over twelve or twenty weeks. During the post-treatment follow up which lasted an average of fifty-seven weeks, seven relapses were registered whereas forty patients remained in remission. After drug withdrawal, both the percentage of patients without inflammatory lesions (pustules, papules or nodules) as well as the mean values of inflammatory lesions remained almost constant over the whole observation period.

Topics: Clinical Trials as Topic; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Recurrence; Rosacea; Time Factors; Tretinoin

A multicenter trial of isotretinoin in severe papulopustular rosacea in adult patients was undertaken to evaluate the efficacy and safety of this treatment. A 20-week course of therapy was instituted in 92 patients from 11 dermatology departments. At the end of the study period, isotretinoin was found to be highly effective in the clearing of refractory rosacea lesions.

Topics: Administration, Oral; Adolescent; Adult; Aged; Blepharitis; Cholesterol; Clinical Trials as Topic; Conjunctivitis; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin; Triglycerides; Uveitis, Anterior

Isotretinoin (Accutane) is a lately developed synthetic oral retinoid for treatment of severe forms of cystic acne resistant to therapy. Its pharmacological effect principally consists in decreased size of the sebaceous glands, reduced sebum production, as well as alteration of the bacterial micropopulation. At a dosage of 0.5 mg up to 1.0 mg/kg body weight daily, isotretinoin led to significant reduction of the inflammatory skin eruptions and long-lasting remission after discontinuation of the drug. With regard to 18 patients suffering from rosacea, the application of Accutane brought about satisfactory results, as well. Mucocutaneous side-effects were almost compulsory, but did never lead to discontinuation of the treatment. Because of its teratogenity, isotretinoin must not be applied in case of gravidity. Accutane offers new modes of therapy with respect to patients suffering from nodulocystic acne or severe rosacea which did not respond to common forms of treatment.

Topics: Acne Vulgaris; Adolescent; Aged; Clinical Trials as Topic; Etretinate; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tablets; Tretinoin

Good to excellent clinical results have been obtained in the treatment of severe inflammatory acne (acne conglobata, acne fulminans, and acne conglobata with hidradenitis and dissecting cellulitis of the scalp) with orally administered isotretinoin (13-cis-retinoic acid). Similar promising results have been obtained in patients with severe rosacea and gram-negative folliculitis. Isotretinoin probably has multiple modes of action, including (1) inhibition of sebaceous gland activity, (2) inhibition of the growth of Propionibacterium acnes within the follicle, although the retinoid is not antibacterial, (3) inhibition of inflammation, and (4) alteration of the pattern of keratinization within the follicle, as demonstrated by light and ultrastructural studies.

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Enterobacteriaceae Infections; Female; Folliculitis; Humans; Isomerism; Isotretinoin; Male; Rosacea; Skin; Tretinoin

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Adult; Aged; Clinical Trials as Topic; Drug Evaluation; Female; Gels; Humans; Male; Middle Aged; Ointments; Rosacea; Solutions; Tretinoin; Vitamin A

Topics: Acne Vulgaris; Anti-Bacterial Agents; Clindamycin; Female; Humans; Keratolytic Agents; Male; Plant Oils; Rosacea; Salicylic Acid; Sesquiterpenes; Tretinoin

A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40 mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole.

Topics: Adapalene; Anti-Infective Agents; Cyclosporine; Dermatologic Agents; Dicarboxylic Acids; Humans; Immunosuppressive Agents; Isotretinoin; Keratolytic Agents; Metronidazole; Mite Infestations; Naphthalenes; Rosacea; Sulfacetamide; Tacrolimus; Tetracycline; Toluidines; Tretinoin

A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40 mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole.

Topics: Anti-Infective Agents; Cyclosporine; Dermatologic Agents; Dicarboxylic Acids; Humans; Immunosuppressive Agents; Isotretinoin; Keratolytic Agents; Lasers, Dye; Metronidazole; Mite Infestations; Naphthalenes; Phototherapy; Rosacea; Sulfacetamide; Tacrolimus; Tetracycline; Toluidines; Tretinoin

Isotretinoin is effective in the treatment of severe acne and rosacea. Both parent drug and its main metabolite 4-oxo-isotretinoin are potentially teratogenic compounds and contain a carboxylic acid moiety. In the presence of ethanol, naturally occurring as well as synthetic retinoids also containing a carboxylic acid moiety are capable of undergoing an ethyl esterification with the metabolic formation of more lipophilic compounds with a much longer terminal half-life.. To determine if isotretinoin (13-cis-RA), its main metabolite 4-oxo-isotretinoin (4-oxo-13-cis-RA), and other possible metabolites in the presence or absence of ethanol are converted to their corresponding ethyl derivatives in patients with severe acne or rosacea after multiple isotretinoin dosing. In addition, pharmacokinetic parameters of the parent drug and its 4-oxo metabolite were determined.. Eleven patients with severe acne or rosacea were treated with isotretinoin daily for 3 months and investigated pharmacokinetically during 24 h after 1 month of treatment and for up to 28 days after discontinuation of therapy. A possible influence of ethanol was evaluated using a simple self-administered questionnaire and by measuring serum ethanol levels during treatment. The concentrations of isotretinoin, 4-oxo-isotretinoin and possible ethylated and nonethylated metabolites were measured by reverse-phase high-performance liquid chromatography.. Although seven of 11 patients had a considerable weekly alcohol intake, no endogenous synthesis of ethyl derivatives of isotretinoin, the main 4-oxo metabolite or the all-trans compounds was chromatographically detectable in any of the patients' plasma samples during the treatment period. Multiple dose pharmacokinetic data for the parent drug and its main metabolite were comparable to previous studies.. The metabolism and pharmacokinetics of isotretinoin and its main metabolites are not influenced by ethanol during long-term isotretinoin treatment. After ceasing long-term isotretinoin therapy the recommended period of 1 month for using anticonceptive measures in fertile women seems adequate.

Topics: Acne Vulgaris; Adult; Alcohol Drinking; Chromatography, High Pressure Liquid; Dermatologic Agents; Ethanol; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Surveys and Questionnaires; Tretinoin; Young Adult

A 9-year-old female developed facial papules and pustules since four years. Clinically, perioral dermatitis was suspected. Different topical therapy regimens and systemic anibiotics had been unsuccessful and a skin biopsy showed granulomatous (lupoid) rosacea. Only systemic antibiotic treatment with minocyclin led to healing of the skin lesions. While granulomatous rosacea-like dermatitis is more frequently diagnosed in adults, it is only rarely encountered in children where, in most of the cases, it represents a therapeutic challenge.

Topics: Anti-Bacterial Agents; Biopsy; Child; Drug Resistance; Drug Therapy, Combination; Female; Humans; Minocycline; Permethrin; Retreatment; Rosacea; Roxithromycin; Skin; Tretinoin

We report the observation of delayed wound healing and keloid formation in three patients, following dermabrasion or Argon laser treatment administered while they were receiving isotretinoin for acne or rosacea.

Topics: Acne Vulgaris; Adult; Aged; Dermabrasion; Female; Humans; Isomerism; Isotretinoin; Keloid; Laser Therapy; Male; Rosacea; Tretinoin; Wound Healing

Twenty patients with severe rosacea were treated with isotretinoin for 3-6 months. Six patients initially received 1.0 mg/kg and 14 patients 0.5 mg/kg of isotretinoin. The response was good or excellent in all patients and the papulopustular lesions in particular cleared promptly. Patients receiving 1.0 mg/kg of isotretinoin experienced more side-effects and the dose had to be lowered in five of the six patients. Seventeen of the 20 patients had no relapses during a follow-up of one year showing that isotretinoin has a long-lasting favourable effect in rosacea.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Isomerism; Isotretinoin; Male; Middle Aged; Nasal Mucosa; Recurrence; Rosacea; Time Factors; Tretinoin; Xerostomia

Acne rosacea has been considered to be a rare disease among black patients. Three cases of rosacea in blacks are described and illustrated. Acne rosacea may be more common in black patients than heretofore believed.

Topics: Black People; Humans; Isotretinoin; Male; Middle Aged; Minocycline; Rosacea; Tretinoin

Thirteen patients of both sexes, affected by a severe form of a papular rosacea, were treated with 13-cis retinoic acid (1 mg/kg/day) for two months. One patient interrupted the treatment after 15 days because of severe blepharitis. The size and number of papules were progressively reduced from the 2nd week, reaching complete regression at the 6th week. Three patients complained of mild blepharitis, nine developed dry cheilitis.

Topics: Adult; Aged; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin

13 patients of both sexes, affected by a severe form of papular rosacea, were treated with 13-cis retinoic acid (1 mg/kg/day) for 2 months. One patient interrupted the treatment after 15 days because of severe blepharitis. The size and number of papules were progressively reduced from the 2nd week, reaching complete regression at the 6th week. Three patients complained of mild blepharitis, 9 patients developed dry cheilitis.

Topics: Adult; Aged; Blepharitis; Cheilitis; Drug Eruptions; Drug Evaluation; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin; Triglycerides

Fifteen patients with acne and 4 with rosacea were treated topically with 0.2% isotretinoin cream twice a day for 16 weeks. Inflammatory lesions responded better (30 +/- 22 versus 15 +/- 12) than non-inflammatory lesions (23 +/- 44 versus 17 +/- 24). Neither the "causal level" (123 +/- 85 versus 130 +/- 66 micrograms/cm2 nor the "replacement sum" (70 +/- 29 versus 77 +/- 30 micrograms/cm2) were changed (lipometer assay). In 150 adult male Syrian hamsters 1-2 drops of isotretinoin in concentrations varying from 0.3% to 0.001% and arotinoid ranging in concentration from 0.3% to 0.00001% in acetone were applied to the left ventral ear or the left flank organ twice a day (5/7 days) for 21 days. In higher concentrations there was a significant reduction in sebaceous gland size. Arotinoid, however, is extremely toxic. Even in concentrations as low as 0.00001% the animals showed severe side-effects within the 1st week.

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Adult; Animals; Benzoates; Cricetinae; Dose-Response Relationship, Drug; Female; Humans; Isotretinoin; Male; Mesocricetus; Retinoids; Rosacea; Sebaceous Glands; Tretinoin

Regarding treatment of acne vulgaris and rosacea, there is not much difference between hospital and practice nor among practicing dermatologists. Most of the assistants performing the important physical-manual treatment have had the same training. After analytical conversation and etiologic as well as diagnostic classification, the patients undergo the following manual treatment: cleansing, astringing, removing of comedones, massage, face pack, and covering with tinted emulsion. At home, acne: cleansing, massage, skin lotion, vitamin A acid, benzoylperoxide, antibacterial therapy; in serious male cases of acne conglobata, Roaccutan. Rosacea: antiseptic (antibiotic) treatment (topically and systemically), metronidazole (Arilin); in serious male cases, Roaccutan.

Topics: Acne Vulgaris; Benzoyl Peroxide; Combined Modality Therapy; Erythromycin; Feeding Behavior; Humans; Rosacea; Tetracycline; Tretinoin

Topics: Acne Vulgaris; Administration, Oral; Humans; Isotretinoin; Rosacea; Tretinoin

The paper presents clinical and laboratory data on 13-CIS-retinoic acid treatment in rosacea. Good-to-excellent results are reported for severe forms of rosacea. Side effects were tolerable and could easily be controlled. The role of sebaceous gland function was documented by both histological and skin sebum parameters. Diminution of sebaceous gland size and the decrease of skin sebum with alteration of single sebum fractions correspond with findings in acne. According to the findings the alteration of sebaceous gland function is one model of drug action in rosacea. Thus sebaceous gland dysfunction may play an important role in the pathogenesis of rosacea.

Topics: Adult; Aged; Female; Humans; Isotretinoin; Lipids; Male; Middle Aged; Rosacea; Sebaceous Glands; Sebum; Skin; Tretinoin

Topics: Adult; Humans; Isotretinoin; Male; Rosacea; Tretinoin

Topics: Adult; Female; Humans; Isotretinoin; Lipids; Liver Function Tests; Male; Middle Aged; Rosacea; Tretinoin

Seven patients with severe rosacea were treated with 1 mg/kg per day isotretinoin for 12 wk. There were significant increases in serum triglyceride (p less than 0.001) and cholesterol (p less than 0.001). Triglyceride associated with very low density lipoprotein (VLDL), low density lipoprotein (LDL) and high density lipoprotein (HDL) increased (p less than 0.01), cholesterol in VLDL and LDL increased (p less than 0.01), and levels of HDL cholesterol decreased (p less than 0.01). There were changes in indices of liver function, with increased levels of gamma-glutamyltransferase (GGT) (p less than 0.01), alkaline phosphatase (ALP) (p less than 0.01) and aspartate aminotransferase (AST) (p less than 0.01), and decreased bilirubin levels (p less than 0.05). Although levels of thyroxine and triiodothyronine were lower after treatment (p less than 0.05), there were no changes in basal levels of thyroid-stimulating hormone (TSH), luteinizing hormone (LH) or follicle-stimulating hormone (FSH), and responses to thyrotrophin releasing hormone (TRH) and luteinizing hormone releasing hormone (LHRH) were unchanged. These changes may partially be explained by induction of hepatic microsomal enzymes by isotretinoin.

Topics: Adult; Cholesterol; Female; Humans; Isotretinoin; Lipids; Lipoproteins; Liver; Liver Function Tests; Male; Middle Aged; Rosacea; Thyroid Function Tests; Thyroid Hormones; Tretinoin; Triglycerides

Forty patients suffering of different forms of acne (papulo-pustular, nodulo-cystic, conglobata, rosacea), all in severe conditions and non-responding to other treatments, have been administered 13-cis-retinoic acid p.o. The treatment resulted in a complete and ultimate healing in 31 pts (77.5%) and a marked amelioration in the remaining 9 cases. The initial drug dosage was 40 mg/die (an average of 0.66 mg/kg/die) but it was reduced along the treatment to 2.5 mg/die, a still effective dose. The average treatment duration was 24 weeks (range: 12 to 40). The tolerance was generally excellent, but some adverse effect have been recorded, mainly localized in the skin and mucosa. Increases of total serum cholesterol (66% of the cases) and of triglyceride (72%) level have been observed. This effect was reversible at the end of the treatment. As a conclusion we can confirm that the 13-cis-retinoic acid is the most effective drug for the pharmacotherapy of severe acne.

Topics: Acne Vulgaris; Adult; Alkaline Phosphatase; Alopecia; Cholesterol; Drug Tolerance; Epistaxis; Female; Humans; Isotretinoin; Male; Pruritus; Rosacea; Transaminases; Tretinoin; Triglycerides

Twenty-one patients with severe acne (acne papulopustulosa, acne conglobata, acne cystica), six patients with severe rosacea (rosacea paulopustulosa, rosacea conglobata, rhinophyma), and three patients with tuberous sclerosis were treated with 13-cis-retinoic acid for 6-48 weeks. Most patients had been previously treated with dermabrasion, antibiotics or metronidazole. Dependent on the severeness of the pathological symptoms 13-cis-retinoic acid was administered at a dose of 0.2 to 0.5 mg/kg body weight and was then reduced every 4 weeks. We confirm the sebostatic and antiinflammatory effect of the 13-cis-retinoic acid and long-lasting remissions. Side effects had not been serious.

Topics: Acne Vulgaris; Adenoma; Administration, Oral; Adolescent; Adult; Aged; Female; Humans; Isomerism; Isotretinoin; Male; Middle Aged; Rosacea; Sebaceous Gland Neoplasms; Tretinoin

A 67-year-old male patient, with a history of palmar psoriasis for 8 years, developed a rosacea-like eruption during Tigason (Ro-10-9359) treatment. Strict relationship between Tigason intake and skin symptoms was proved by double introduction of the drug and the patient's previous history. This retinoid side effect is very unusual and we are unable to give any explanation for it.

Topics: Aged; Etretinate; Hand; Humans; Male; Psoriasis; Rosacea; Tretinoin

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Inflammatory Agents; Female; Folliculitis; Humans; Isotretinoin; Male; Rosacea; Skin Diseases; Tretinoin

13-cis-retinoic acid was given with good results to 7 patients with exceptionally severe rosacea. Side effects were transitory and of minor consequence and subsided quickly on reduction of the dosage and topical application of mild cosmetics. The long-lasting remissions recorded to date indicate that 13-cis-retinoic acid may prove a new and successful approach to the treatment of rosacea.

Topics: Administration, Topical; Adult; Aged; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tetracyclines; Tretinoin

Retinoids possess regulatory influences on growth and differentiation of epithelial tissues. They induce a population of keratinozytes with normal pattern of differentiation, they have antiproliferative properties, and they show antineoplastic effects by inhibition of malignant transformation of cells in vitro. Also the dermis undergoes distinct alterations under oral administration of retinoids. By stimulating T-lymphocytes and by inhibition of neutrophil migration retinoids seem to develop immunmodulating and antiinflammatory effects. The aromatic retinoid Etretinate is therapeutically used in severe forms of psoriasis and in various genodermatoses with disorders of keratinization as for example ichthyosis, dyskeratosis follicularis Darier, and pityriasis rubra pilaris.

Topics: Acne Vulgaris; Administration, Oral; Etretinate; Humans; Isomerism; Isotretinoin; Psoriasis; Rosacea; Skin Diseases; Tretinoin

Topics: Acne Vulgaris; Adolescent; Adult; Aged; Female; Hair; Humans; Isomerism; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin

Thirteen patients with severe rosacea (rosacea papulopustolosa, rosacea conglobata, and rhinophyma) were treated orally with 0.05, 0.5, or 1.0 mg/kg body weight 13-cis-retinoic acid (isotretinoin, Ro 4-3780) for 12-28 weeks. All patients had been treated previously with high doses of tetracyclines, metronidazole, or dermabrasion, etc., with no or only limited success. The therapeutic effect following 13-cis-retinoic acid was excellent. Inflammatory lesions regressed by 50% within 2 weeks, and by over 95% within 8 weeks. 13-cis-retinoic acid acts as a potent anti-inflammatory and sebum-suppressive agent. Besides papulopustules, nodules, and hemorrhagic abscesses, the inflammatory plaques and facial edema, but to a lesser extent teleangiectasias and the chronic conjunctivitis disappeared. The severe seborrhea disappeared. Long-lasting remission, similar to patients with severe acne being treated with 13-cis-retinoic acid, can be expected, as the first patients are in full remission for over 12 months at the time of writing. Exfoliative cheilitis occurred in every patient. Serum lipids increased only slightly. For female patients a reliable contraception is mandatory as teratogenicity cannot be excluded in this drug (similar to all retinoids).

Topics: Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Isotretinoin; Male; Middle Aged; Rhinophyma; Rosacea; Skin; Tretinoin

Severe forms of rosacea are a new indication for the treatment with 13-cis retinoic acid. Results of therapy and duration of remission were in five patients, treated in this way, much better than compared to standard therapeutic measurements.

Topics: Adult; Chronic Disease; Humans; Isotretinoin; Middle Aged; Rosacea; Tretinoin

Sodium sulfacetamide, penetrating antibacterial, in combination with hydrocortisone and sulfur, has enjoyed twenty years of remarkable safety, with outstanding efficacy and patient acceptance, in the prescription treatment of pustular acne and severe, refractory seborrheic dermatitis. Recently, this combination has been reported to be highly effective concomitant therapy for perioral dermatitis. Almost paradoxically, it achieves these desired goals without the excessive erythema and discomforting irritation associated with retinoic acid and benzoyl peroxide.

Topics: Acne Vulgaris; Administration, Topical; Anti-Inflammatory Agents; Benzoyl Peroxide; Dermatitis, Seborrheic; Drug Combinations; Humans; Hydrocortisone; Rosacea; Sulfacetamide; Sulfur; Tretinoin