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Die vorliegende aktualisierte und auf S2k-Niveau angehobene Leitlinie befasst sich mit der Diagnostik und der Therapie der Rosazea, bei welcher es sich um eine häufige, chronisch-entzündliche Hauterkrankung handelt, die meist das Gesicht betrifft. Der Verlauf der Rosazea ist initial durch rezidivierende Erytheme, Teleangiektasien sowie Flushing gekennzeichnet. Später überwiegt die entzündliche Komponente, wobei es zu persistierenden Erythemen mit follikulären Papeln, Papulopusteln und Pusteln kommt. Die Bildung von Phymen, die meist an den Akren auftreten, stellt dabei die schwerste Ausprägung der Erkrankung dar. Zur Behandlung empfiehlt die interdisziplinäre Leitlinienkommission, die aus Vertretern der Deutschen Dermatologischen Gesellschaft (DDG), des Berufsverbandes der Deutschen Dermatologen (BVDD), der Deutschen Ophthalmologischen Gesellschaft (DOG), der Gesellschaft für Dermopharmazie (GD), der Schweizerischen Gesellschaft für Dermatologie und Venerologie (SGDV) und der Deutschen Rosazea Hilfe e. V. besteht, neben der Meidung von Triggerfaktoren, die topische Anwendung der Wirkstoffe Metronidazol, Azelainsäure oder Ivermectin. Zur symptomatischen Behandlung persistierender zentrofazialer Erytheme können zudem die Vasokonstriktoren Brimonidin oder Oxymetazolin topisch angewandt werden. Bei therapieresistenten sowie bei schweren Formen der Rosacea papulopustulosa wird eine systemische Therapie empfohlen. Hierfür ist niedrigdosiertes Doxycyclin das Präparat der 1. Wahl. Alternativ kann niedrigdosiertes Isotretinoin empfohlen werden. Für die okulären Rosazea kann neben einer Lidrandhygiene die topische Behandlung mit Ciclosporin-haltigen Augentropfen, Azithromycin, Ivermectin oder Metronidazol empfohlen werden.

Dupilumab facial redness (DFR), or the development of an eczematous rash of the face and neck with dupilumab use, has been observed in recent case reports. It is estimated to impact between 4 and 43.8% of dupilumab users, including children and adults. Aside from reviewing the pathogenesis and clinical presentation, we present potential diagnostic steps (such as skin scraping, serologies, biopsy, and patch testing) and management options for DFR ranging from allergen avoidance to dupilumab interruption. It is hoped that this article will serve as a means for clinicians to familiarize themselves with DFR regarding the differential diagnosis, diagnostic tools, and treatment options associated with this phenomenon.

BACKGROUND The dermoscopic findings of papulopustular rosacea include tiny papules and pustules, follicular plugs and follicular dilatation. Demodex tails and Demodex follicular openings are dermoscopic indicators that are mainly found in primary demodicosis and, less frequently, in rosacea. AIM To describe the dermoscopic features of papulopustular rosacea and to investigate the differential dermoscopic features between patients with and without concomitant Demodex infestation. METHODS We conducted a prospective study of patients with almost-clear, mild or moderate papulopustular rosacea. For each patient, dermoscopic images were taken and a standardized skin surface biopsy was performed. RESULTS In this group of 60 patients, the most frequent dermoscopic findings were yellow dots, vascular polygons and follicular scales. Patients with moderate rosacea had more Demodex follicular openings compared with patients with mild rosacea (P = 0.02), while patients with mild rosacea had a higher frequency of follicular scales than did patients with almost-clear rosacea (P = 0.01). Patients with moderate rosacea had higher rates of Demodex follicular openings (P = 0.02), follicular scales (P

Subcutaneous fat necrosis of the newborn (SCFN) is a rare self-limiting panniculitis. It is thought to be associated with perinatal hypoxia and therapeutic hypothermia. It is characterised by firm subcutaneous nodules on the back, shoulder and arms. We present a rare facial presentation of SCFN in a 4-week-old infant with no history of therapeutic cooling. She presented with a discrete right cheek mass with no overlying skin changes. We present the diagnostic challenge and undertake a review of the literature. SCFN is an important differential diagnosis in a neonate with subcutaneous facial lesions. SCFN can be complicated by metabolic derangements including hypercalcaemia.

Chromhidrosis is a rare disorder, which can have significant psychosocial consequences for patients, particularly when it affects the face, as it can be mistaken for scarring, dirt or erroneous make-up application. Chromhidrosis can be divided into apocrine, eccrine and pseudo subtypes. We present a case of apocrine chromhidrosis localized to the bilateral cheek area. Click https://www.wileyhealthlearning.com/#/online-courses/9c761d0a-20de-4709-a57d-36be93cf64e1 for the corresponding questions to this CME article.

Lupus miliaris disseminatus faciei (LMDF) is a chronic inflammatory dermatosis of unknown aetiology, most often seen in young adults. Although many treatments for LMDF exist, treatment guidelines have not been developed, and response to therapy is generally unpredictable. We present the results of transcriptomic analysis of LMDF lesional skin, which revealed a variety of differentially expressed genes linking LMDF to alterations in innate and adaptive T helper 1 immunity. Immunohistochemical analysis was also performed, identifying similar changes in T-cell immune responses. Given evidence for increased tumour necrosis factor (TNF) pathway activity, our patient, who had previously been refractory to multiple treatments, was initiated on TNF inhibitor therapy with excellent response. This characterization of the LMDF immune response may lead to improved treatment of this condition.

Parenteral gold has historically been used to treat several conditions, including rheumatoid arthritis. Gold administration leads to a variety of cutaneous reactions, including chrysiasis, which is a permanent blue-grey hyperpigmentation of the skin due to dermal gold deposition. In this report, we describe the case of a patient who received parenteral gold injections 22 years before the onset of her chrysiasis for the treatment of rheumatoid arthritis. Biopsy of the macules showed dermal gold deposits aggregating around a melanocytic nevus, as well as around preexisting osteoma cutis. To the authors' knowledge, this is the first report in the literature describing a case of chrysiasis with gold deposits concentrated around a melanocytic nevus and an area of osteoma cutis.

Background No long-term maintenance therapy has been tested in patients with seborrheic dermatitis (SD). Objective We sought to compare the efficacy and tolerance of tacrolimus 0.1% ointment versus ciclopiroxolamine 1% cream as maintenance therapy for severe SD. Methods This double-blind randomized controlled study was conducted from 2014 to 2017 in 5 Dermatology Departments and 15 dermatology practices in France. Consecutive patients with severe and chronic facial SD were included. Patients were initially treated with desonide 0.05% cream twice daily for 7 days. Patients cleared after this open phase were randomized to receive tacrolimus 0.1% or ciclopiroxolamine 1% cream 2 times a week 24 weeks. The primary endpoint was disease-free-duration, defined as the time from randomization to first relapse. Results One hundred fourteen patients were randomized (tacrolimus, n = 57; ciclopiroxolamine, n = 57). Twelve patients relapsed in the tacrolimus group after a median delay of 91.5 days (range 15-195 days) versus 23 patients in the ciclopiroxolamine group (median delay, 27 days [range 13-201 days]). Comparison of disease-free duration curves showed that patients in the tacrolimus group had a longer duration of complete remission than those in the ciclopiroxolamine group (P = .018), corresponding to a hazard ratio of relapse of 0.44 (95% confidence interval 0.22-0.89; P = .022). Limitations The theoretical sample size was not reached. Conclusion Tacrolimus 0.1% is more effective than ciclopiroxolamine 1% as maintenance therapy for patients with facial SD.

BACKGROUND: During the COVID-19 pandemic, wearing face masks is mandatory not only for health care workers (HCWs) but also for the general population in many countries around the globe. OBJECTIVES: The aim of the study was to investigate the onset of adverse facial skin reactions due to compulsory face masks during the COVID-19 pandemic in HCWs and non-HCWs, and draw awareness of this new dermatological condition and its preventive measures. MATERIALS & METHODS: A questionnaire was distributed to 550 patients and HCWs from the Department of Dermatology and Allergy of the University Hospital Munich (LMU), Germany. Participants were surveyed regarding mask type, duration of usage and adverse facial skin reactions. Information on symptoms and the use of skin care products and topical drugs were retrieved. RESULTS: The duration of wearing masks showed a significant impact on the prevalence of symptoms (p < 0.001). Type IV hypersensitivity was significantly more likely in participants with symptoms compared to those without symptoms (p = 0.001), whereas no increase in symptoms was observed in participants with atopic diathesis. HCWs used facial skin care products significantly more often than non-HCWs (p = 0.001). CONCLUSION: Preventive and therapeutic measures should be established in order to avoid "face mask dermatitis", especially for people with underlying risk factors.

Variation in skin pigmentation can be affected by both environmental factors and intrinsic factors such as age, gender, and genetic variation. Recent GWASs revealed that genetic variants of genes functionally related to a pigmentation pathway were associated with skin pigmentary traits. However, these GWASs focused on populations with European ancestry, and only a few studies have been performed on Asian populations, limiting our understanding of the genetic basis of skin pigmentary traits in Asians. To evaluate the genetic variants associated with facial pigmented spots, we conducted a GWAS analysis of objectively measured facial pigmented spots in 17,019 Korean women. This large-scale GWAS identified several genomic loci that were significantly associated with facial pigmented spots (five previously reported loci and two previously unreported loci, to our knowledge), which were detected by UV light: BNC2 at 9p22 (rs16935073; P-value = 2.11 × 10−46), PPARGC1B at 5q32 (rs32579; P-value = 9.04 × 10−42), 10q26 (rs11198112; P-value = 9.66 × 10−38), MC1R at 16q24 (rs2228479; P-value = 6.62 × 10−21), lnc01877 at 2q33 (rs12693889; P-value = 1.59 × 10−11), CDKN2B-AS1 at 9p21 (rs643319; P-value = 7.76 × 10−9), and MFSD12 at 19p13 (rs2240751; P-value = 9.70 × 10−9). Further functional characterization of the candidate genes needs to be done to fully evaluate their contribution to facial pigmented spots.

A 32-year-old man presented with multiple reddish and skin-colored asymptomatic skin lesions over his face and ears present for a year. These lesions appeared in crops at variable intervals, healing with scarring over the next few months. He had received doxycycline and azithromycin for about 6 months without any relief. No history of flushing, worsening of lesions on sun exposure, or eating spicy food, was reported. He had no chronic illness or prolonged usage of any medication. The patient neither had abdominal pain, respiratory distress, or uveitis to suggest sarcoidosis nor accounted any personal or family history of tuberculosis. (

The use of masks for infection control was common in the COVID-19 pandemic. As numerous cross-sectional studies have suggested a link between the use of such masks and various facial dermatoses, a systematic review and meta-analysis of published studies was conducted to evaluate this association, as well as potential risk factors for the development of such facial dermatoses. Observational studies were searched for in MEDLINE, EMBASE and the Cochrane Central Register. Thirty-seven observational studies with a total of 29 557 study participants were identified. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist and quality was assessed via the Newcastle-Ottawa Quality Assessment Scale., Overall prevalence of facial dermatoses was 55%. Individually, acne, facial dermatitis, itch and pressure injuries were consistently reported as facial dermatoses, with a pooled prevalence of 31%, 24%, 30% and 31%, respectively. Duration of mask-wear was the most significant risk factor for the development of facial dermatoses (95% CI: 1.31-1.54, p 0.001). Overall, facial dermatoses associated with mask wear are common, and consist of distinct entities. They are related to duration of use. Appropriate and tailored treatment is important to improve the outcomes for these affected patients.

Jane Austen died 200 years ago at the age of 41 and authors have attributed her premature death to a wide variety of causes, which include Addison’s disease and lymphoma. We have reviewed all of her available letters and extricated relevant medical information which reveal rheumatism, facial skin lesions, fever and marked fluctuation of these symptoms. The severity of these symptoms increased, leading to her death within a year. This range of clinical features fulfils the most recent classification criteria for systemic lupus erythematosus.

BACKGROUND Skin care regimens with multiple active ingredients offer a multimodal approach to anti-aging treatments. OBJECTIVE The objective of this research was to investigate the efficacy of a multimodal skincare regimen on facial skin appearance after 12 weeks of twice daily use as compared to baseline. METHOD 35 healthy female subjects 35–65 years of age of Fitzpatrick skin types I–III with mild to moderate facial photoaging characterized by hyperpigmentation were enrolled. Subjects were seen at baseline, week 6, and week 12, and underwent subject and investigator assessments along with noninvasive evaluations (elasticity, corneometry, dermaspectrophotometer) and photography. RESULTS Most notable at week 12 was a 60% improvement in smoothness, 82% improvement in dryness, 30% improvement in fine lines, and 24% improvement in crow’s feet. There was an 8% reduction in macule hyperpigmentation (P

Background Prolonged wear of facial protective equipment can lead to occupational dermatoses. Objective To identify important causes of occupational dermatoses from facial protective equipment. Methods A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks or N95 respirators, or both. Results We identified 344 articles, and 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in health care workers. Allergic contact dermatitis to the elastic straps, glue, and formaldehyde released from the mask fabric was reported. Irritant contact dermatitis was common on the cheeks and nasal bridge due to pressure and friction. Irritant dermatitis was associated with personal history of atopic dermatitis and prolonged mask wear (>6 hours). Acneiform eruption was reported due to prolonged wear and occlusion. Contact urticaria was rare. Limitations Only publications listed in PubMed or Embase were included. Most publications were case reports and retrospective studies. Conclusion This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment, including potential offending allergens. This work may help in the diagnosis and treatment of health care workers with facial occupational dermatitis.

The COVID-19 pandemic emerged when India was already facing an epidemic-like situation of superficial dermatophytosis (tinea). The prevalence of tinea in India is currently 27.6%, with tinea faciei accounting for 1.8% cases.1 The use of face masks although necessary, has the potential to aggravate a worrisome situation in India.

We herein report a rare case of lupus miliaris disseminatus faciei on the chin and neck in a patient with systemic lupus erythematosus and Sjögren's syndrome. Histopathological features showed focal aggregates of epithelioid granulomas accompanied by mononuclear cell infiltration in the upper dermis. Immunohistological examination showed enhanced expression of CD68 and CD163. Recent findings have implicated a key role of innate immunity in the pathogenesis of systemic lupus erythematosus, and alteration in M1 and M2 macrophage profile has been suggested. Increased expression of CD163 in the affected skin and other organs, and elevated serum levels of soluble CD163, are reported in systemic lupus erythematosus. Our results may suggest that activated M2 macrophages participated in the induction of lupus miliaris disseminatus faciei in a patient with systemic lupus erythematosus and Sjögren's syndrome.

As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications. J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259.

Cutaneous tuberculosis occurs in 1-2% of world cases of tuberculosis and more common in tropical countries. It presents with different clinical forms. Unusual clinical presentations are not uncommon and awareness of these will help in suspecting and managing these patients successfully. Lupus pernio like lupus vulgaris, tuberculosis of glans penis and lichen scrofulosorum on the distal parts of limbs are presented here because of their unusual clinical presentation.

Antibiotics and retinoids have been used for acne vulgaris for decades. Though effective, each has its own drawbacks. Chemical peels have been used for treatment of acne vulgaris with inadequate clinical evidence. We sought to determine the efficacy and safety of Jessner's solution (JS) in comparison with salicylic acid (SA) 30% in the management of acne vulgaris and postacne hyperpigmentation in patients with colored skin.A total of 36 subjects (94.5% Fitzpatick Type IV-V) were recruited in this randomized double-blinded, split-face, controlled trial. Each side of the face was randomly assigned for treatment with either JS or SA. Subjects were treated once fortnightly for a total of three sessions. Lesion counting, Michaelsson acne score (MAS), photographs, and postacne hyperpigmentation index (PAHPI) were used to objectively assess the improvement. Complications were assessed during each visit. Statistical analysis was conducted using SPSS v22.0. Significance was set at P = 0.05.At the end of therapy, significant reduction in inflammatory, noninflammatory lesions, MAS, and PAHPI scores (P 0.001, respectively) were noted in comparison to baseline. Mixed model analysis revealed no significant outcome difference between the two groups. Patients who reported good and very good outcome were 76.4% (JS) and 85.3% (SA). Burning, stinging sensation, and exfoliation were the common complications reported. Postinflammatory hyperpigmentation was reported only once in the JS arm.Both JS and SA were equally effective in the treatment of acne vulgaris and reducing postacne hyperpigmentation in patients with colored skin.

BACKGROUND Hair care products (HCPs) may cause both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). OBJECTIVES The aims of the study were to determine the prevalence of HCP-associated ICD/ACD and to characterize relevant allergens. METHODS This study is a retrospective analysis of North American Contact Dermatitis Group (NACDG) patch test data, 2001-2016. RESULTS Of 38,775 patients tested, 3481 (9.0%) had positive patch test reactions associated with HCPs. The HCP-positive patients were significantly more likely to be female (79.9% vs 66.0%) and/or have primary sites of dermatitis on the face (32.0% vs 27.8%) or scalp (15.4% vs 2.2%) compared with the HCP-negative patients (P < 0.0001). Of 4908 HCP-associated positive patch test reactions, 86.9% (n = 4263) were due to allergens on the NACDG screening series; p-phenylenediamine (35.8%), methylisothiazolinone (9.7%), methylchloroisothiazolinone/methylisothiazolinone (8.7%), and cocamidopropyl betaine (5.9%) were the most frequent. Most reactions (87.7%, 3736/4263) were currently clinically relevant. The most common job associated with 366 occupationally related NACDG HCP-associated allergens was hairdresser/cosmetologist (71.9%). Two hundred eighty-two patients (0.7%) had ICD associated with HCPs. Shampoo/conditioners were the most frequent source of NACDG HCP-associated reactions (47.3%) and HCP-associated ICD (45.0%). CONCLUSIONS Of the HCP-positive patients, 18.5% had HCP reactions to allergens not on the NACDG screening series, underscoring the importance of patch testing to expanded series in patients suspected of HCP allergy.

Background: Occupational contact dermatitis (OCD) is frequent in the workplace. Objectives: To provide recent data on the epidemiology of OCD in Italy. Methods: This multicenter retrospective study, conducted from 1996 to 2016, included patients with suspected allergic contact dermatitis (ACD) patch tested in the departments comprising the North-East Italy Contact Dermatitis Group. Results: We studied 18 859 workers with a diagnosis of contact dermatitis (CD), of which 10.4% were recognized as being of professional origin. OCD declined from 1996 to 2011–2013 and increased in 2014–2016. The overall prevalence of both CD and OCD was higher in women compared to men, but the share of OCD of the total CD was greater for men compared to women. A history of atopic dermatitis was less frequent in workers with OCD than in non-OCD patients (5.8% vs 8.6%). Hairdressers were the youngest profession (27.1 ± 11.7 years). Hands were the primary site of involvement in patients with OCD (76.6%). The five highest risk occupations for OCD were hairdressers, cooks, metalworkers, chemical industry workers, and construction workers. Conclusions: OCDs have a relevant impact in our region, mainly for five job categories, and the increase in the last 3 years suggests the need to improve preventive measures.

FMX101 4% topical minocycline foam has been shown to be an effective and safe treatment for acne vulgaris (AV).To further evaluate the efficacy and safety of FMX101 4% in treating moderate to severe acne vulgaris.A 12-week, multicenter, randomized (1:1), double-blind, vehicle-controlled study was conducted. Coprimary end points were the absolute change in inflammatory lesion count from baseline and the rate of treatment success (Investigator's Global Assessment score of 0 or 1 with a ≥2-grade improvement).There were 1488 participants in the intent-to-treat population. The FMX101 4% group had significantly greater reductions in the number of inflammatory lesions from baseline (P .0001) and a greater rate of treatment success based on Investigator's Global Assessment (P .0001) versus the foam vehicle group at week 12. FMX101 4% was generally safe and well tolerated.The efficacy and safety of FMX101 4% were not characterized in participants with mild AV.FMX101 4% topical minocycline foam was effective and safe for the treatment of moderate to severe AV.

BACKGROUND: Blue light photodynamic therapy (PDT) is effective for actinic keratosis, but many patients experience stinging pain during illumination. OBJECTIVE: To compare a conventional regimen (1 hour of 5-aminolevulinic acid [ALA] preincubation, followed by blue light) versus a new modified regimen in which blue light is started immediately after ALA application. METHODS: A clinical trial with a bilaterally controlled, intrapatient study design was conducted with 23 patients. Topical 20% ALA was applied to the entire face and/or scalp. On 1 side of the body, blue light was started immediately and continued for either 30, 45, or 60 minutes (simultaneous PDT). On the contralateral side, the blue light began 1 hour after ALA application and lasted 1000 seconds (conventional PDT). Pain was evaluated on a scale from 0 to 10. Actinic keratosis lesion counts were determined by clinical examination and photography. RESULTS: All patients experienced significantly less pain during simultaneous illumination than during the conventional regimen. At 3 months after treatment, lesion clearance was nearly identical on the 2 sides, as determined by statistical testing of noninferiority ± 15% margin. LIMITATIONS: Although bilaterally controlled, the study was relatively small. Additional studies are recommended. CONCLUSION: The modified PDT regimen is essentially painless, yet it provides treatment efficacy similar to a conventional regimen. (J Am Acad Dermatol https://doi.org/10.1016/j.jaad.2019.09.010.)

Background/Objectives: Treatment options for the correction of age-related changes in skin include the use of energy-based devices and dermal fillers. In this study, we evaluate the clinical efficacy and tolerability of microfocused ultrasound with visualization (MFU-V) and injectable calcium hydroxylapatite (CaHA) filler diluted with normal saline, for the correction of age-related changes and to assess patients' satisfaction with this combination therapy. Methods: This was a randomized, split-face, comparative clinical study and immunohistochemical analysis in 20 subjects with indications for lower face, neck and décolleté lifting. Over five visits, CaHA diluted with normal saline (1:2) was injected subdermally in the lower third of the face, neck and décolleté, and lower abdominal quadrant. MFU-V was performed on the lower third of the face, neck, and décolleté, and the right lower abdominal quadrant. Results: Upon baseline examination, the age-related changes were quantified as follows: marionette lines score 2.47 ± 0.8, jawline contour score 2.2 ± 0.7 and neck score 2.1 ± 0.7 points; and after 15 months, they changed to 1.8 ± 0.7 (P≤0.00003), 1.89 ± 0.56 (P≤0.005), and 1.7 ± 0.6 (P≤0.005) points, respectively. The procedures were well tolerated, and subject satisfaction was high. Conclusions: The injections of CaHA in combination with MFU-V treatment stimulated neoangiogenesis, led to the increased synthetic activity of cells, a marked increase in collagen and elastin fibers, and remodeling of both the superficial and deep layers of the dermis. An improvement in the severity of age-related changes was observed in all areas studied. J Drugs Dermatol. 2020;19(4):405-411. doi:10.36849/JDD.2020.4625.

Background: Thread lifting procedure was developed to reverse the aging process and restore youthful appearance by retightening and lifting the skin. Different models of absorbable and non-absorbable threads are universally available and promise quick results with minimum downtime. Objectives: To evaluate the efficacy, safety, and cost effectiveness of the commonly used threads for facial lifting and rejuvenation using an evidence-based review. Methods: A comprehensive search of the literature was done using numerous databases (including Cochrane Collaboration, PubMed, Ovid, and Google Scholar). Thread lift for non-aesthetic purpose, open surgical procedure, animals or cadaver studies were excluded. 16 relevant studies were included. The extracted data included significant details related to the review question. Results: Several types of threads with different designs and properties are available for facial rejuvenation, provided by many companies all over the world. Higher quality evidence was found for Contour thread (III). Available studies for the other various threads were level IV. Thread lifting procedure was found to be safe and effective, with minor and mostly self-limited complications. The longevity of results varied from months to years, with more focus related to the technique and patient selection rather than the type of thread. Conclusion: Comparatively high quality long-term multicentre standardized studies are required to help aesthetic doctors to choose the appropriate thread type based on optimum aesthetic outcomes. J Drugs Dermatol. 2020;19(4):413-417. doi:10.36849/JDD.2020.3646.

During the SARS-COV-2 pandemic, using face masks became mandatory in many countries. Although evidence suggests that masks can exacerbate several inflammatory skin diseases, few studies focus on their real impact on eczema localized to the face in atopic dermatitis (AD) patients. The aim of this study is to evaluate facial eczema prevalence during pandemic and its psychological impact in AD patients pre-assessed for systemic treatment and/or in therapy with dupilumab. This study includes 71 patients affected by moderate-severe AD, treated with dupilumab at SCDU of Dermatology in Novara, Italy. We calculated the number of subjects with facial involvement in pre- and post-pandemic periods and the related localization trend. We evaluated, in the two groups, clinical and psychological indicators recorded at each visit and the score modifications during the observational period. No statistically significant differences were observed in facial eczema prevalence, between pre- and post-pandemic periods (p = 0.7618) and in facial eczema remission among the two groups (p = 0.1903). In post-pandemic period, psychological scores were significantly lower (DLQI and HADS respectively with p 0.0001 and p = 0.0025) and the reduction in EASI score during observational period was significantly greater (p = 0.0001). Our analysis revealed a potential protective effect of masks on face eczema, suggesting that they could enhance dupilumab efficacy. Face masks, covering sensitive areas, can positively contribute to mental distress in patients with facial eczema, and being associated with a lower allergic diseases incidence may sustain dupilumab in reducing AD severity.

The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in the use of personal protective equipment (PPE). However, the increased use of PPEs may lead to facial skin complaints.This survey study aims to evaluate the effect of the COVID-19 pandemic on facial dermatoses and complaints.A total of 1017 volunteers (age 18-60 years), consisting of healthcare workers, participated in the study. In the present study, healthcare professionals were screened for facial dermatoses and complaints between 1 and 15 April 2021 with an online survey.The vast majority of the survey were women (82.4%) and between 26 and 35 years old (49.2%). The most new-onset facial complaints were acne (25.3%) and lip dryness (29.2%). Along with the pandemic, 50.9% of patients with seborrheic dermatitis had an increase in lesions. Another remarkable result was a 60.5% increase in acne complaints. Moreover, the rate of exacerbations of rosacea, melasma, and lip dryness was increased after the COVID-19 pandemic (39.1%, 22.0%, and 42.7%, respectively). Exacerbations of seborrheic dermatitis, acne, and lip dryness have occurred more frequently in females when compared to males (p 0.001).The current pandemic has had serious impacts on facial dermatoses which had to be managed carefully. Compared to the pre-pandemic period, there was a significant increase in the frequency and severity of complaints in facial dermatoses related to PPE. If the complaints that may develop due to PPE are known in advance, their development can be prevented by taking precautions against them.

Rosacea is a facial chronic inflammatory skin disease with almost 5.5% prevalence. Although there are various scales of rosacea, they are objective and discordant among different dermatologists. Noninvasive objective measurements such as VISIA system might play essential roles in the diagnosis and evaluation of rosacea. Here, we intended to reveal the effectiveness of VISIA system in rosacea.A number of 563 participants diagnosed with facial rosacea were enrolled in study. They all received both full-face image-shoot by VISIA system with quantitative analysis software and physician's assessment via five different scales, including investigator global assessment (IGA), clinician erythema assessment (CEA), numerical score, the National Rosacea Society (NRS) grading system and telangiectasis.Absolute score and percentile of red area had significant correlations with IGA and CEA, whereas red area had no significant correlation with numerical score, NRS and telangiectasis. Red area in erythematotelangiectatic rosacea patients demonstrated the highest correlation with IGA and CEA, especially in those aged between 51 and 60. Besides red area, pigmentation parameters in VISIA system (brown spot) also showed significant correlation with IGA and CEA.VISIA system might be an effective measurement in the assessment of rosacea severity.

The rarity of Melkersson-Rosenthal syndrome, or orofacial granulomatosis, can present with persistent midface bogginess. The management for previous reported cases has included corticosteroid injections, antihistamines, and antibiotics. In the current reported case, the patient was treated with 5-fluorouracil and has been responding positively. Additionally, the patient has not shown signs of steroid atrophy.

We sought to determine the incidence of RFDD in patients receiving dupilumab and the rate of resolution of RFDD after expanded series patch testing (ESPT) and allergen avoidance.This is a retrospective chart review of 80 patients with atopic dermatitis who were evaluated for RFDD after treatment with dupilumab. Expanded series patch testing findings and response to allergen avoidance were assessed in the subset of patients with RFDD who subsequently underwent ESPT while continuing to receive dupilumab.Forty-nine patients (61.3%) experienced facial dermatitis before initiating dupilumab. Thirty-five patients (43.8%) experienced RFDD after starting dupilumab. Of the 14 patients with RFDD who received ESPT, 92.9% had 1 or more relevant positive patch test results, with 50% of such patients being mostly to completely clear of facial dermatitis after allergen avoidance. Importantly, 50.6% of the positive reactions to allergens were not included on the North American Contact Dermatitis Group Core 80.Many patients with RFDD benefit from patch testing and subsequent allergen avoidance. Expanded series patch testing should be offered to patients who experience RFDD after beginning dupilumab therapy to ensure that such patients have eliminated any exogenous component of their dermatitis, such as concomitant allergic contact dermatitis.

Hypertrophic and acneiform forms are very rare variants of discoid lupus erythematosus (DLE), which can suppose a diagnostic and therapeutic challenge. We present a South American woman with facial disfiguring lesions of 7 years of evolution with clinical and histopathological characteristic of both hypertrophic and acneiform DLE. No criteria for systemic lupus erythematosus were present in the patient. To the best of our knowledge, no patients with concomitant hypertrophic and acneiform DLE have been previously reported in the literature.