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Demodex mites are commensal inhabitants of the pilosebaceous unit that are typically absent or at low numbers in childhood. When they are present, they can cause a primary eruption or exacerbate an underlying facial dermatosis. Here we report five cases of demodicosis occurring in childhood, the clinical presentations, and responses to treatment. Papulopustular lesions predominate, prompting the advice "pustules on noses, think demodicosis!"

Background: Targeted chemotherapeutic drugs have led to a remarkable improvement in the survival of cancer patients but also have resulted in the increased incidence of uncommon but specific muco-cutaneous adverse effects. Aims: This study aimed to highlight the spectrum of such cutaneous adverse drug reactions and to derive a causal association. Materials and Methods: A hospital-based, descriptive study was carried out in the dermatology outpatient department between August 2016 and July 2018, on patients referred from the state cancer institute, who developed muco-cutaneous lesions after the initiation of targeted chemotherapeutic drugs. Results: A total of 80 patients, 59 (74%) males and 21 (26%) females of mean age 45.83 ± 16.37 years (range 4–70 years) developed one or more uncommon albeit specific muco-cutaneous adverse effects. Among them, papulopustular and acneiform eruptions were found in 21 patients (26.25%), and PRIDE complex was seen in 3 patients. Sixteen patients (20.00%) developed palmar-plantar erythrodysesthesia, 8 patients (10%) developed lichenoid drug eruption, and 5 patients (6.25%) developed flagellate dermatitis. Twenty-two (27.5%) patients showed nail changes, the most common, being melanonychia. Conclusion: There has been a paradigm shift in the management of both hematopoietic and solid cancers with the advent of targeted chemotherapeutic drugs leading to an increase in uncommon and specific drug reactions. Early recognition of these decreases morbidity, improves quality of life, and allows continuation of the life saving chemotherapy.

BACKGROUND: Rosacea is a common chronic cutaneous disorder which is characterized by flushing, erythema, papulopustules and telangiectasia. The pathogenesis of the disease is still unknown. A multifaceted approach is necessary to control the disease because of its tendency to relapse. New more effective treatment options are desirable to achieve a complete remission. Aminolevulinic acid–photodynamic therapy (ALA-PDT) is a well-established treatment for non-melanoma skin cancer and precancerous lesions. ALA-PDT can also be used for inflammatory disease, including acne vulgaris. However, little is known about the efficacy and safety of ALA-PDT for rosacea in Chinese patients with Fitzpatrick skin types III and IV. OBJECTIVES: To investigate the efficacy and safety of ALA-PDT in the treatment of rosacea classified as erythematotelangiectatic type or papulopustular type. METHODS: Twenty rosacea patients with either erythematotelangiectatic or papulopustular types were enrolled. 5% 5-Aminolevulinic acid in an oil-in-water emulsion was applied to the lesions under occlusion with plastic film for 2h, and the lesions were irradiated with 100 mW/cm(2), 80-90 J/cm(2), LED red light (635 ± 15 nm) over 15 minutes in each session with four sessions at 10-day intervals. Objective measures (severity of flushing, erythema and telangiectasia, number of inflammatory lesions, VISIA Red Complexion Analysis images), subjective symptoms (including itching, prickling, burning, etc.) were recorded at baseline and at 4, 12 and 24 weeks after the last treatment. Adverse effects were recorded at each treatment and follow-up visit. RESULTS: During the follow-up period, all patients showed gradual objective clinical improvement compared with baseline (P

Given the increasing use of novel targeted therapies, dermatologists are constantly confronted with novel cutaneous side effects of these agents. A rapid diagnosis and appropriate management of these side effects are crucial to prevent impairment of the patients' quality of life and interruptions of essential cancer treatments. Immune checkpoint and EGFR inhibitors are frequently used targeted therapies for various malignancies and are associated with a distinct spectrum of cutaneous adverse events. Exanthematous drug eruptions represent a particular diagnostic challenge in these patients. Immune checkpoint inhibitors can elicit a plethora of immune-related exanthemas, most commonly maculopapular, lichenoid, and psoriasiform eruptions. Additionally, autoimmune bullous dermatoses and exanthemas associated with connective tissue diseases may arise. In cases of severe, atypical or therapy-resistant presentations an extensive dermatological investigation including a skin biopsy is recommended. Topical and systemic steroids are the mainstay of treatment. Papulopustular eruptions represent the major cutaneous adverse effect of EGFR inhibitor therapy, occurring in up to 90 % of patients within the first two weeks of therapy, depending on the agent. Besides topical antibiotics and steroids, oral tetracyclines are the first choice in systemic treatment and can also be used as prophylaxis.

Rosacea is a common inflammatory facial skin condition affecting the adult population. Its papulopustular subtype is mainly treated pharmacologically by topical and oral antibiotics. For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective. However, no previous study has assessed the efficacy of once-weekly administered isotretinoin for papulopustular rosacea. For this purpose, a retrospective comparative study was conducted. For severe rosacea, 40mg/week isotretinoin (24 patients) was administered. For mild to moderate rosacea, once-weekly 20 mg/week isotretinoin (28 patients) was compared to 100 mg/day minocycline (24 patients). Treatment courses lasted 4 to 7 months. 40 mg/week isotretinoin was highly effective for severe rosacea, achieving complete response (over 90% improvement) in 62.5% of patients and partial response (50-90% improvement) in additional 29.2% of patients. 20 mg/week isotretinoin and 100 mg/day minocycline showed comparable efficacy for mild to moderate rosacea (complete response of 10.7% vs. 8.3% and partial response of 28.6% vs. 33.3%, respectively). This study demonstrates that that the use of a weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea, including among patients with severe disease. This article is protected by copyright. All rights reserved.

Background Rosacea is a common chronic inflammatory dermatosis with uncertainty of etiology. Although clinical features and risk factors of the disease in Caucasians have been reported, this information in Chinese is largely unavailable. Aims To analyze the clinical features and associated risk factors of rosacea in Chinese. Methods A questionnaire was given to outpatients with rosacea who visited the dermatology department of the first affiliated hospital of Kunming Medical University from June 2018 to March 2019. Analyses included demographic characteristics of subjects, clinical characteristics, and risk factors of rosacea. Results A total of 254 outpatients completed the questionnaire. The ratio of female to male was 5.68:1.00. The mean age at onset was 31.18 ± 10.23 years. Erythematotelangiectatic subtype accounted for 51.60%, while 39% of the subjects were of papulopustular subtype. The rest were phymatous type (9.40%). Subjects with flushing, persistent facial erythema, and telangiectasia accounted for 91.73%, 90.55%, and 83.07%, respectively. One hundred and thirteen subjects (44.49%) had papules or pustules, and 24 subjects (9.40%) were with phymatous changes. The most commonly involved sites were the cheeks (93.31%), followed by the nose (82.68%), the perioral area (61.42%), and the forehead (51.97%). The clinical symptoms included burning (93.70%), dryness (90.55%), and itching (75.59%). The main risk factors were sun exposure (90.94%), temperature change (87.40%), etc. Fifty-one (20.08%) patients had comorbidities. Conclusions Rosacea mainly affects young females. The common signs and symptoms include flushing, persistent facial erythema, and burning. Sun exposure and temperature changes are the common risk factors. Patients can have comorbidities of systemic disorders.

Behçet's disease (BD) is a chronic, relapsing, systemic inflammatory disease with clinical features showing mucocutaneous lesions involving the ocular, articular, and further miscellaneous organs. Mucocutaneous manifestations, one of the most characteristic signs of BD, have been most commonly observed upon onset or at any disease stage and are exceptionally important in its diagnosis. Given the lack of specific diagnostic laboratory tests for BD, diagnosis has been based on clinical findings. All diagnostic criteria published have thus far relied heavily on mucocutaneous manifestations, particularly oral ulcers (OU), genital ulcers (GU), cutaneous lesions, and pathergy test positivity. Worldwide, OU, GU, cutaneous lesions, and ocular and articular manifestations have been the most common symptoms, with erythema nodosum (EN)-like lesions and papulopustular lesions being the most prevalent cutaneous manifestations. While majority of the patients worldwide have reported OU as the most frequent symptom upon disease onset, GU, and EN-like lesions have also been identified upon onset. Considering that mucocutaneous symptoms precede severe organ involvement in most patients, familiarity with such symptoms is imperative for early diagnosis and prevention of potentially serious organ involvement through appropriate management.

Gefitinib is a selective tyrosine kinase inhibitor of epidermal growth factor receptor (EGFR) used for the treatment of malignant neoplasms. The most frequent skin complication during gefitinib therapy is an acneiform papulopustular eruption, usually distributed in the seborrheic areas but occasionally widespread. We report a patient with erosive pustular dermatosis of the scalp, a neutrophil-mediated skin disease presenting with sterile pustules evolving into erosions and crusts on the scalp, during treatment with the EGFR inhibitor gefitinib for lung cancer. A literature review of the drug-induced cases of this rare entity is provided.

Epidermal Growth Factor Receptor inhibitors (EGFRi) are approved as therapeutic options in several solid tumors. Cutaneous papulopustular eruption is the most frequent cutaneous adverse-event (AE), usually treated with emollient or corticosteroids according to toxicity grade. Our study evaluated the efficacy and safety of a topical product containing polydatin, a glycosylated polyphenol, natural precursor of resveratrol showing anti-inflammatory and anti-oxidative activities, for the prevention and treatment of skin papulopustular rash in EGFRi-treated patients. Forty oncologic patients treated with EGFRi were enrolled in two groups: group-A, 20 patients with papulopustular AE, and group-B, 20 patients without cutaneous manifestations. The study consisted of twice-daily application of polydatin cream 1.5% (group-A) and 0.8% (group-B) for 6 months. In group-A patients, we observed at week 4 a remarkable improvement of skin manifestation and quality of life evaluated with National-Cancer-Institute-Common-Terminology-Criteria for Adverse-Events (NCI-CTCAE), Dermatology-Life-Quality-Index (DLQI) score and Visual-Analogue-Scale (VAS) pruritus, with a statistical significance of p &lt, 0.05. None of the patients of group-B developed skin AEs to EGFRi. No cutaneous AEs related to the polydatin product were reported in both groups. Polydatin can be a good topical aid for the prevention and management of papulopustular rash in cancer patients receiving EGFRi, also capable of improving cancer patients&rsquo, quality of life.

Rosacea is a common skin disease that is troublesome for both the patients and the dermatologists. Erythema, telangiectasia, papulopustular changes, and phymatous changes are the main problems faced by the patients and dermatologists in everyday practice. Due to the chronic and relapsing nature of the disease, patients are usually unsatisfied with conventional treatment methods. We report a case of a patient with rosacea, erythematotelangiectatic subtype with an eight-year history of progressive worsening and experience of combined therapy based on the broadband pulse light and topical 0.5% brimonidine tartrate gel. The effectiveness of the therapy was evaluated using multispectral skin imaging that enables to define morphological patterns of the pathological skin areas in a real-time mode as well as to create the map of hemoglobin distribution and to measure its concentration in the rosacea foci. In this case report, an efficacy and very good tolerability of the abovementioned treatment have been demonstrated.

Background: Acne Vulgaris (AV) is one of the most common diseases in the field of dermatology and ranks as the eighth most prevalent disease worldwide. Early management of this potentially deforming skin disease may reduce the pathophysiological burden and improve the quality of life of patients. Purpose: This study aimed to determine the pharmacotherapy for new patients with AV. Methods: This cross-sectional study used new patients with AV of the Cosmetic Division of the Outpatient Skin and Venereal Health Unit, Regional Public Hospital (RSUD) Dr. Soetomo, from January to December 2013 that were descriptively presented. The variable was the pharmacotherapy given. This study used secondary data collection by looking at the patients’ medical records. The variables studied were acne lesions and pharmacotherapy regimens, including the administration route and the medicine used. Results: The number of samples that met the inclusion criteria was 951 patients. Comedonal acne was most commonly given topical tretinoin. Papulopustular acne was most commonly given a topical combination of clindamycin and tretinoin, while acne conglobata was most commonly given a combination of topical clindamycin and tretinoin with oral doxycycline. Conclusion: The new patients with comedonal acne were mostly prescribed topical tretinoin pharmacotherapy. A pharmacotherapy combination of topical clindamycin and tretinoin was given to most new patients with papulopustular acne, whereas new patients with conglobata acne were given a pharmacotherapy combination of topical tretinoin and clindamycin with oral doxycycline.

Inhibitors of the mitogen-activated protein kinase (MAPK) pathway are commonly used in clinical oncology. However, with the exception of BRAF inhibitors (BRAFi), MAPK pathway inhibitors such as epidermal growth factor receptor inhibitors (EGFRi) or MEK inhibitors (MEKi) are associated with dose-limiting papulopustular eruptions. Interestingly, patients treated with a combination of systemic BRAFi and MEKi experience less skin toxicities than patients on monotherapy BRAFi or MEKi. The reduction in cutaneous adverse events with combination therapy is thought to be due to a paradoxical activation of the MAPK pathway by BRAFi in keratinocytes carrying wildtype BRAF. Although treatment options for EGFRi- or MEKi-induced papulopustular eruptions exist, many patients still experience dose reduction, interruption, or discontinuation of EGFRi or MEKi. With the goal of activating MAPK signaling in the skin via BRAFi while minimizing systemic risks, we propose topical BRAFi therapy for the treatment and prevention of papulopustular eruptions due to MAPK pathway inhibitors. If effective, patients will be able to tolerate higher doses of MAPK pathway inhibitors, stay on treatment longer, and achieve better therapeutic outcomes overall.

Pediatric periorificial dermatitis is a papulopustular eruption found around the facial orifices in children. Although the treatment of the disease has been largely anecdotal and experience-based, studies have shown that topical calcineurin inhibitors, as well as other topical and oral antibiotics, such as metronidazole, can be effective treatment options. However, most of the studies with a sizable number of patients have been based on the Caucasian population. Herein, we evaluated the clinical efficacy of topical calcineurin inhibitors and topical/oral metronidazole in 24 Korean patients with pediatric periorificial dermatitis. The majority of the patients showed a complete response to treatment.

Chemo and targeted anticancer therapies present significant skin adverse reactions, which impair the patients’ quality of life. Cutaneous toxicities lead to poor treatment adherence, drug cessation, and psychosocial distress. This review aims to summarize the current knowledge concerning the prevention and management of skin toxicity arising from these therapies. A systematic literature search on online databases was conducted. The categorization of the main preventive and treatment measures was performed according to the level of evidence. Management of skin adverse reactions of oncology treatments is very heterogeneous, which can be explained by the lack of sound evidence-based treatments. The most studied adverse effects are papulopustular eruption, xerosis, and hand–foot syndrome. Prevention of xerosis stands out as the strategy most supported by level II studies. With respect to treatment, the use of antibiotics in papulopustular eruption resulting from anti-epidermal growth factor receptor agents is the most evidence-based approach. In general, the number of studies published in the literature classified with a level II of evidence (52%) is similar to the ones classified as level IV (33%), making clear the need of more randomized controlled trials regarding the effectiveness of preventive and treatment measures of skin adverse reactions of chemo and targeted anticancer therapies.

Chemical peels are widely used as therapeutic agents in dermatology and cosmetology. This study aims to explore the differences in the effectiveness of azelaic and pyruvic acid peels in the treatment of acne vulgaris. Eligibility criteria for participants were: female gender, 18–25 years of age, no dermatological treatment within the last 12 months and mild to moderate papulopustular acne. We treated 120 young women (with a mean age of 22 years old) with six peeling sessions at 2-week intervals. In the parallel clinical study design, one randomized group (n = 60, 50%) was treated using azelaic acid (AA), whereas the second group participated in pyruvic acid (PA) sessions. We evaluated the patients clinically twice (before and after treatment), using the Scale of Hellegren–Vincent Severity Symptoms to assess the acne diagnosis, and the Nati Analyzer to estimate the skin properties (oily skin, desquamation, porosity, and moisture). The clinical evaluation of the patients demonstrated a significant reduction of acne severity symptoms in both the AA and PA groups, after the peeling sessions. An effect was also found in terms of decreasing desquamation and the oiliness of the skin. PA showed a more significant reduction of greasy skin than AA. In conclusion, after the six peeling sessions using AA and PA, all patients showed better skin parameters in term of reduced oiliness and desquamation. Both AA and PA peelings are a safe and efficient treatment for mild acne, however, during the selection of one of the two acids, side effects, skin properties, and patients’ preferences should be taken into account. This study was registered in the ISRCTN registry (registration number ISRCTN79716614, 17/01/2020).

Purpose: Rosacea is one of the most common conditions affecting the ocular surface. The purpose of this review is to provide an update on the pathogenesis and treatment of rosacea based on the dermatology and ophthalmology literatures. Methods: Literature searches were conducted for rosacea and ocular rosacea. Preference was given to systematic reviews, meta-analysis, case-controlled studies, and documented case reports while excluding poorly documented case studies and commentaries. The data were examined and independently analyzed by more than two of the authors. Results: Rosacea is a complex inflammatory condition involving the pilosebaceous unit. Its underlying mechanism involves an interplay of the microbiome, innate immunity, adaptive immunity, environmental triggers, and neurovascular sensitivity. The latest classification of rosacea includes three dermatologic subgroups and a fourth subgroup, ocular rosacea. Ocular rosacea clinically displays many features that are analogous to the cutaneous disease, such as lid margin telangiectasia and phlyctenulosis. The role of environmental triggers in the exacerbation of ocular rosacea appears to be understudied. While lid hygiene and systemic treatment with tetracycline drugs remain the mainstay of treatment for ocular rosacea, newer dermatologic targets and therapies may have potential application for the eye disease. Conclusions: Ocular rosacea appears to embody many of the manifestation of the dermatologic disease. Hence, the basic pathophysiologic mechanisms of the ocular and cutaneous disease are likely to be shared. Better understanding of the ocular surface microbiome and the immunologic mechanisms, may lead to novel approaches in the management of ocular rosacea.

Epidermal growth factor receptor inhibitors (EGFRIs) frequently cause cutaneous adverse effects such as papulopustular eruptions. However, the mechanism of the reactions remains unclear. To assess the pathological mechanism of cutaneous adverse reactions caused by EGFRIs, we investigated whether EGFRIs have an influence on the innate immune response of the skin. Levels of human β-defensins (hBDs), which serve as the first line of defence against infection by pathogenic microorganisms, in the stratum corneum samples of patients treated with EGFR. monoclonal antibodies were measured before and after starting therapy. There were no obvious trends in hBD production in patients without eruptions, whereas a significant decrease in hBD1 and hBD3 production and a nonsignficant decrease in hBD2 production were observed in patients who developed papulopustular eruptions. Our results suggest that a reduction in hBD contributes to the increased incidence of papulopustular eruptions.

Papulopustular rosacea (PPR) is a chronic inflammatory skin disease with limited treatment options. Although multiple pathways have been described to be upregulated in PPR, a mechanistic understanding of the key drivers and interaction between pathways in PPR pathology is lacking. In this study, we utilized PPR skin biopsy explants to integrate both differentially expressed genes and differentially expressed proteins in paired nonlesional and lesional PPR tissue (n = 5 patients). The results of this study identified 92 differentially expressed genes and 20 differentially expressed proteins between paired PPR lesional and nonlesional explants. MAPK and TNF signaling pathways were the most significantly upregulated pathways in PPR lesional tissue and aligned with differently expressed proteins identified in this study. Both MAPK and TNF signaling pathways highlighted IL-1β as a potential central mediator for PPR pathogenesis. In support of this, stimulation of nonlesional explants with IL-1β resulted in transcriptomic and proteomic profiles similar to those of lesional PPR. In this integrative transcriptomic and quantitative protein analysis, we identified several inflammatory genes, proteins, and pathways, which may be contributing to PPR, as well as highlighted a potential role of IL-1β in driving inflammation in PPR.

Background Few large studies have assessed spironolactone treatment of adult female acne. Objectives To explore the role of spironolactone in the treatment of adult female acne. Methods We performed a retrospective case series assessing the efficacy of spironolactone treatment of a cohort of women evaluated at Mayo Clinic in Rochester, Minnesota, from 2007 through 2017. Results In total, 395 patients (median age, 32 years) received a median spironolactone dose of 100 mg daily. Approximately two-thirds of patients (66.1%) had a complete response; 85.1% had a complete response or a partial response greater than 50%. Median times to initial response and maximum response were 3 and 5 months. Efficacy was observed across all severity subtypes of acne, including those with papulopustular and nodulocystic acne. Patients received long-term treatment with spironolactone (median duration, 13 months) and had few adverse effects. Conclusions Spironolactone is a safe and effective treatment of acne for women.

Non-pigmented rapidly growing mycobacteria are nontuberculous mycobacteria (NTM) capable of producing disease. We report a case of tattoo-associated NTM infection with a novel species: Mycobacterium mageritense. A 48-year-old man presented with a two-week history of a papulopustular eruption on the shaded areas of a tattoo that had been placed five weeks prior while in the Philippines. Histopathology from punch biopsies revealed suppurative granulomatous dermatitis with acid fast bacilli present. Subsequent matrix assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometer identified the bacteria as Mycobacterium margeritense. After consultation with infectious disease specialists and culture susceptibilities, the patient was treated with three months of dual antibiotic therapy with minocycline and moxifloxacin. The patient experienced a slow but complete resolution of clinical skin findings after the course of treatment. Since discovery in 1997, M. mageritense infection has been demonstrated in a wide spectrum of disease, predominantly skin and soft tissue infections. The species has not been previously implicated in tattoo-associated NTM infections. M. mageritense should be considered as a specific type of mycobacteria in the differential diagnosis for tattoo-associated NTM infections owing to differences in antibiotic susceptibilities compared to other NTM species.

Rosacea is a syndrome and not a pathogenically defined disease. Currently, there is no well-established basic mechanism of disease established for rosacea. The classification of rosacea began with the distinction from acne, and by the last half of the twentieth century, the classifications of experts in different countries had become aligned around the notion of rosacea having four or more phenotypic subtypes with some versions allowing for possible, but not obligatory, progression of these phenotypic subtypes as “stages.” While these classifications from different authors consistently recognized similar phenotypic subtypes, there were differences in their precise definitions. In 2002 a consensus committee of the National Rosacea Society (NRS) sought to develop definitions which would provide for a more standardized classification system. These four classic phenotypic subtypes of rosacea have important utilities, including the increased awareness that use of products demonstrated to improve only papulopustular rosacea may lead to disappointment in physicians and their patients with only erythematotelangiectatic rosacea.

Background Prevalence of rosacea has been estimated around the world in the range of 0-22%. In Colombia, the prevalence of rosacea remains unknown. The aim of this study was to determine the prevalence of rosacea and the frequencies of its subtypes in Colombia. Methods This cross-sectional, multicenter study was conducted in six outpatient dermatology clinics across Colombia. A total of 33 dermatologists conducted a comprehensive medical history and physical examination for all rosacea patients seen at their offices over the course of 2 months. All patients who accepted to participate were encouraged to answer a survey about the history of their illness. Results Of 10,204 outpatients evaluated for rosacea between July and August 2014, 291 rosacea patients were included in this study. The prevalence of rosacea subtypes in this cohort was: 45.3% erythematotelangiectatic (ETR) (n = 132), 48.7% papulopustular (PPR) (n = 142), 4.8% phymatous (n = 14), and 1% ocular (n = 3). Conclusions Overall, the prevalence in Colombia was 2.85%. Our data represent an important first step to understanding the current state of rosacea in Colombia. The prevalence of rosacea in Colombia is the highest in Latin America among a few reports published, which might be explained by geographic features. However, contrary to our expectations, the prevalence is lower than that in some European countries. We postulate that this finding may be due to methodological differences.

Rosacea is thought to be associated with factors involved in metabolic syndrome (MetS). Muscle mass has a beneficial role in preventing MetS, but its link to rosacea remains unknown. We sought to investigate the association between rosacea severity and relative skeletal muscle mass. A cross-sectional study was conducted on subjects who attended a skin check-up program at the Kangbuk Samsung Hospital Health Screening Center between 2014 and 2016. Polarized light photographs of the face were taken and evaluated by two dermatologists. Skeletal muscle mass index (SMI, [%] = total skeletal muscle mass [kg] / bodyweight [kg] × 100) was estimated using a bioelectrical impedance analyzer. A logistic regression model was used to evaluate an association between SMI and rosacea. Of 110 rosacea subjects who were finally enrolled, 17 (15.5%) and 93 (84.5%) were classified as having papulopustular and erythematotelangiectatic rosacea, respectively. Categories of SMI comprised the following tertiles: 22.86-38.40%, 38.41-43.44% and 43.45-80.65%. In severity, compared with mild rosacea (75.5%), moderate rosacea (24.5%) incrementally increased as SMI decreased (Ptrend < 0.01). Severe rosacea was not observed. After adjustment for age and sex, odds ratios (95% confidence intervals) for moderate rosacea comparing SMI tertiles 1 and 2 to the highest tertile (reference) were 5.66 (1.22-26.20) and 4.43 (1.12-17.55), respectively (Ptrend = 0.03). This association was present in women with marginal significance (Ptrend = 0.06), but not in men. Relative muscle mass is negatively associated with an increased risk of more severe rosacea, suggesting that skeletal muscle can have a protective effect on rosacea exacerbation.

There are two therapeutic options for patients with cancer: radiotherapy and chemotherapy. The latter is subdivided into conventional chemotherapy and targeted chemotherapy. Both categories of chemotherapy treatment induce side effects, although these are more frequent with conventional chemotherapy than with targeted chemotherapy. These side effects are frequently affecting the skin, hair and nails. In this review, all categories of chemotherapeutical drugs are considered and the adverse events related with each drug are described. The most severe events are hypersensitivity reactions, which can endanger the patient’s life. Besides, the most common cutaneous reactions will be maculopustular or papulopustular rashes, hand and foot skin syndrome, edema, erythema, hyperpigmentation disorders or photosensitivity reactions. Stomatitis is also frequent on oral mucosa. Regarding hair, anagen effluvium and alopecia are frequently observed, whilst the nails are also affected by many of these treatments. This review describes these side effects and their symptoms and diagnosis, giving tips for prevention and treatment of the same.

New topical therapies have demonstrated efficacy in patients with moderate or severe acne who might otherwise have required therapy with systemic antibiotics or isotretinoin. Increasing knowledge about the pathogenesis of acne has facilitated the development of therapies with novel modes of action. New and investigational therapies also are available or in development for the treatment of both the papulopustular and erythematous manifestations of rosacea. Semin Cutan Med Surg 37(supp3):S63-S66 © 2018 published by Frontline Medical Communications.

Introduction:Panitumumab (VECTIBIX®) is a monoclonal antibody used alone or in combination with a chemotherapy for management of metastatic colorectal cancer.Observation:A patient treated with this protocol manifested skin lesions; the etiological diagnosis was difficult. The lesions, namely a papulopustular rash at the lower third of the face, and the medical history allowed to diagnose an acute skin toxicity case due to this monoclonal antibody.Commentary:Many side effects are related to the panitumumab, among which dermatologic adverse events having already been the subject of some publications. Nevertheless, several studies conclude that the therapeutic benefit of this epidermal growth factor receptor inhibitor makes acceptable these complications.Conclusion:Stop treatment and corticosteroids allowed a whole and quick disappearance of skin lesions. Alongside dermatologists and infectious diseases specialists, the opinion of an oral surgeon was useful to provide an answer to these symptoms.

Monoclonal antibody inhibitors of the epidermal growth factor receptor (EGFR) have been shown to improve outcomes for patients with metastatic colorectal cancer (mCRC) without RAS gene mutations. However, treatment with anti-EGFR agents can be associated with toxicities of the skin, nails, hair, and eyes. Because these dermatologic toxicities can result in treatment discontinuation and affect patient quality of life, their management is an important focus when administering anti-EGFR monoclonal antibodies. The present systematic review describes the current data reporting the nature and incidence of, and management and treatment options for, dermatologic toxicities occurring during anti-EGFR treatment of mCRC. A search of the National Library of Medicine PubMed database from January 1, 2009, to August 18, 2016, identified relevant reports discussing dermatologic toxicity management among patients with mCRC receiving anti-EGFR therapy. The studies were grouped by type and rated by level of evidence using the GRADE approach developed by the Agency for Healthcare Research and Quality. Overall, 269 reports were reviewed (nonrandomized trials, n = 120; randomized trials, n = 31; retrospective studies, n = 15; reviews, n = 39). Dermatologic toxicity of any grade occurs in most patients who receive anti-EGFR therapy; approximately 10% to 20% of patients experienced grade 3/4 toxicity. The most common dermatologic toxicities include papulopustular/acneiform rash, xerosis, and pruritus; however, nail changes, hair abnormalities, and ocular conditions also occur. Guidance for managing these toxicities includes the use of inexpensive emollient ointments and moisturizers, avoidance of sun exposure, avoidance of irritants, and the use of short showers. Several studies also found that preemptive treatment was more effective than reactive treatment at limiting the incidence and severity of skin toxicity. With appropriate treatment, the dermatologic toxicities associated with anti-EGFR monoclonal antibody therapy can be managed, minimizing patient discomfort and the need for therapy interruption and/or discontinuation. Additionally, preemptive treatment can reduce dermatologic toxicity severity, ultimately yielding better quality of life.

Antecedentes: La foliculitis por Malassezia spp. (fm) es una infección del folículo piloso causada principalmente por M. furfur. Afecta a adolescentes y adultos y se caracteriza por la presencia de pápulas y pústulas foliculares pruriginosas localizadas en el tronco.Objetivo: Describir las características epidemiológicas y clínicas de los pacientes con fm diagnosticados por examen directo (emd) en el Centro Dermatológico de Yucatán (cdy).Métodos: Se realizó un estudio transversal, descriptivo y retrospectivo en el que se revisaron los registros de los Emds realizados en el Laboratorio de Micología del cdy durante enero 2009 - diciembre 2015.Resultados y conclusiones: Se documentaron 56 casos, el 78.6% fueron hombres. La edad promedio fue de 21.4 años. La topografía más frecuente fue el tronco (94.6%), seguido de cara (16.1%), cuello (12.5%), extremidades superiores (10.7%) e inferiores (3.6%). Durante el 2015 se documentaron 22 casos (39.3%) de los cuales el 86.3% se presentaron en junio-septiembre. Seis casos (27.7%) utilizaron previamente esteroides tópicos y 3 casos (13.6%) antibióticos sistémicos. Todos los casos fueron diagnosticados mediante EMD con azul de metileno, el cual es una técnica rápida y no invasiva que permite iniciar un tratamiento temprano.

Rosacea is a polyethiological disease at the base of it progress is pathologically changed innervation of vessels of the skin of face - angioneurosis and it undergoes several stages of development. Initially, against the background of permanent extension, the vascular wall loses elasticity and the blood plasma penetrates it. Microcirculation disorders lead to hypostasis of tissues. This process leads to change of a biota of the face skin - to the uncontrollable growth of number of a Demodex tick, which is one of the ethyopathogenetics factor of promotion from erythemoteleangiectatic form to papulopustular. Etiological reasonable approach for therapy of papulopustular rosacea is a combination of external and physiotherapeutic methods of therapy. As medicamentous therapy for suppression of excess activity of a Demodex tick and its uncontrollable growth in our research we have taken the cream with 1% of Ivermektin. As a physiotherapeutic influence - the submilisecond Nd:YAG-laser radiation (1064 nm). This radiation influences at expanded vessels, sanifies pustules, moderate temperature increase in a derma to 41-42оС, leads to elimination of puffiness and stage-by-stage restructuring of collagen fibers.

The lack of validated rosacea assessment tools is a hurdle in assessing rosacea severity. This article discusses a valid and reliable rosacea severity self-assessment tool (RSAT) to measure rosacea severity. To determine test-retest validity, participants completed the self-assessment twice. A blinded physician graded the participant's disease severity with the Investigator Global Severity (IGS) score. Pearson correlations were used to assess the relationship between the self-assessment measure and the IGS. Test-retest RSAT measurements were correlated. The RSAT represents a valid and reliable tool. This tool may facilitate determination of rosacea severity in survey research studies.

The recalcitrance of rosacea to many treatment options may prompt patients to spend exorbitant amounts of money on unsubstantiated treatment regimens in an effort to achieve relief. The authors examine the relationship between disease severity and treatment cost across several demographic and socioeconomic strata. Familiarization of evidence-based clinical recommendations and consensus guidelines may equip physicians to educate patients about the most efficacious and cost-effective treatment options to assist patients in making cost-conscious decisions in the management of their rosacea.

Demodicosis is an ectoparasitic cutaneous infestation of pilosebaceous unit caused by Demodex mites. Demodex spp. are considered to be pathogenic when they increase in number and infect dermis.They can be the cause of diseases such as pityriasis folliculorum, papulopustular rosacea, granulomatous rosacea, inflammatory papule, acne vulgaris, perioral dermatitis, blepharitis and folliculitis. These mites can be found in most mammals including human. Canine and feline demodicosis is a well-known example of severe dermatitis caused by the proliferation of Demodex mites. Dogs are one of the most popular pets worldwide with well-being feeling to their owners. However, they may cause a health risk to humans due to their zoonotic diseases potential. Demodicosis is a severe and prevalent dermatologic disease in dogs. In this case report, a Demodex case thought to be related with a dog infestation was presented. A twenty-year-old girl student who feeds a Miniature Pinscher crossbred dog in her house for a while noticed common itchy papulopustular lesions, incrustation and some alopecic loci in her dog and admitted to Selçuk University Faculty of Veterinary Medicine, Department of Parasitology. Itchy papules and pustules were also observed in dog's owner face and arm about three or four weeks later. Skin scrapings and hair samples were taken from the patient and the dog and examined with light microscope. Adult and egg forms of Demodex spp. were detected in both patient and dog specimens in microscopic examination. Ivermectin treatment was recommended as 0.2 mg/kg for the dog. The owner of the dog was sent to a dermatology clinic and topical permethrin was recommended for the treatment. At the end of the first month the dog was controlled again, a whole clinical and microscopic improvement was observed and all of the lesions were disappeared for both the dog and its owner. This demodicosis case, thought to originate from a dog, is a rare condition because of Demodex mites are known to be highly host specific and not a zoonotic parasite. Although host specific cross infections between humans and animals have been rarely reported, D. canis was determined to be more transmissible across species than the other Demodex mites as indicated in the literature. As a result, it is necessary and important to keep in mind about Demodex spp. infestation in patients with skin complaints and pet feeding.

Rosacea is a common inflammatory skin disorder that can seriously impair quality of life. Treatment starts with general measures which include gentle skin cleansing, photoprotection and avoidance of exacerbating factors such as changes in temperature, ultraviolet light, stress, alcohol and some foods. For patients with the erythematotelangiectatic form, specific topical treatments include metronidazole, azelaic acid, and brimonidine as monotherapy or in combination. Laser therapies may also be beneficial. For the papulopustular form, consider a combination of topical therapies and oral antibiotics. Antibiotics are primarily used for their anti-inflammatory effects. For severe or refractory forms, referral to a dermatologist should be considered. Additional treatment options may include oral isotretinoin, laser therapies or surgery. Patients should be checked after the first 6–8 weeks of treatment to assess effectiveness and potential adverse effects.

Non Small Cell Lung Cancer(NSCLC) is the most common type of Lung Cancer. It is characterized by multiple mutations, the commonest being the EGFR and KRAS. Afatinib is an immaculate drug used in Non-Small Cell Lung Cancer, with EGFR mutations. Here we are presenting a case of a 70 year old male, with Non-Small Cell Lung Carcinoma, started on Afatinib, who subsequently developed multiple raised skin lesions over the face, neck and the upper chest. On examination, multiple crusted papules and pustules over the face and anterior chest were present. A diagnosis of Photo distributed Acneiform Eruption secondary to Afatinib was made. Patient was treated appropriately and lesions subsided with post inflammatory hyperpigmentation.This article highlights the characteristic Afatinib induced papulo – pustular eruptions, which eventually responded to treatment.

Heterozygous STAT1 gain-of-function (GOF) mutations result in a combined form of immunodeficiency which is the most common genetic cause of chronic mucocutaneous candidiasis (CMC). We present a pedigree with a GOF mutation in STAT1, manifesting with chronic demodicosis in the form of a facial papulopustular eruption, blepharitis, and chalazion. So far, demodicosis has been described in only one family with STAT1-GOF mutation. We suggest that chronic demodicosis is an under-recognized feature of the immune dysregulation disorder caused by STAT1 gain-of-function mutations.

Demodex folliculorum is a parasitic mite that is found in pilosebaceous units. Demodicosis, or an overgrowth of the mites, have been implicated in diseases such as blepharitis, scalp folliculitis, and nonspecific diffuse, pruritic papulopustular eruptions of the face and neck areas.1, 2, 3 Here we present a case of localized Demodex folliculitis mimicking perioral dermatitis in a pregnant woman and highlight the rapid onset of action of systemic ivermectin therapy.

Papulopustulozni rosacea je středně těžka forma oblicejove dermatozy. Je charakterizovana vznikem papul a papulopustul na trvale zarudle kůži. Kožni morfy se nachazi v centralni casti obliceje. Existuje vice patofyziologických modelů vzniku rosacey. V lokalni terapii se uplatňuje řada extern zaměřených na zmirněni zanětlivých projevů. V posledni době se stava u tohoto subtypu růžovky lekem volby ivermektin 1% krem, přicemž je využivan jeho protizanětlivý a antiparazitický ucinek. Vzhledem k soucasne přitomnosti trvaleho erytemu využivame i doporucovane kombinace ivermektinu s antagonistou alfa 2 adrenergniho receptoru brimonidinu, který zmirňuje erytem konstrikci svalů krevnich cev. Důležitou soucasti lecby je i edukace pacienta o spravne dermato‑kosmetice, o rizikových faktorech a nutnosti fotoprotekce. Významnou roli hraje i psychosomatický přistup.

(1) Background: The epidermal growth factor inhibitors (EGFRIs)/tyrosine kinase inhibitors (TKIs) are effective for cancer target therapy, but acneiform rashes or so-called inflammatory papulopustular exanthemas are common (50% to 90%). The conventional therapy for EGFRIs/TKIs-induced skin toxicity is steroids and antibacterial drugs, but it is still ineffective for some patients, and EGFRIs/TKIs dose reduction/interruption may be needed. In this study, a modified Chinese herbal medicine, Huang-Lian-Jie-Du decoction cream with Yin-Cold (YC) medicine characteristic, was investigated for the effect on patients suffering EGFRIs/TKIs-induced skin toxicity. (2) Methods: The modified Huang-Lian-Jie-Du (mHLJD) decoction cream was made from 10 herbal medicines, including 4 major medicines (Huanglian, Huangqin, Huangbo, and Zhizi) in traditional HLJD decoction. Patients with EGFRIs/TKIs-induced skin toxicity were enrolled. Patients were excluded if they also used other cream for skin toxicity. Skin conditions were monitored by follow up every 2 weeks. The patients’ characteristics, the skin toxicities, treatment response, and adverse events were recorded and analyzed until skin problems resolved or the study ended. (3) Results: The mHLJD decoction cream and its sub-packages were stored at 4 °C before use. Thirty-four patients who had grade 1–3 skin toxicities after receiving EGFRIs/TKIs were enrolled. Seven patients withdrew or were excluded. Finally, data from 27 patients were analyzed. The mean grade of rash acneiform was significantly decreased from 2.19 (ranged 1 to 3) to 0.88 (ranged 0 to 2) after mHLJD decoction cream treatment for 4 weeks and to 0.55 (ranged 0 to 2) after mHLJD decoction cream treatment for 8 weeks. Additionally, the mean grade of dry skin was also significantly decreased from 1.57 (ranged 1 to 2) to 0.71 (ranged 0 to 1) after mHLJD decoction cream treatment for 4 weeks. The changes of skin toxicity were significant, with no obvious adverse events. (4) Conclusions: In summary, the mHLJD decoction cream provides benefits for alleviation of EGFRIs/TKIs-induced skin rash acneiform and dry skin. Additionally, no obvious side effects were found in patients using mHLJD decoction cream.

Epidermal growth factor receptor inhibitors (EGFRIs) are increasingly being used for malignancies of epithelial origin. Though these therapies are better tolerated than conventional chemotherapy, they have unique side-effect profiles that are related to their mechanism of action. Given the function of the epidermal growth factor receptor in the skin, nails, and hair, dermatologic side effects are commonly seen with the use of EGFRIs. This review includes a practical approach to recognizing and treating the most common dermatologic side effects seen with EGFRIs, including papulopustular eruptions, nail changes, xerosis and pruritus, hair changes, mucositis, and radiation dermatitis exacerbations.

Gerald Staedtler,1 Kaweh Shakery,2 Jan Endrikat,3,4 Richard Nkulikiyinka,2 Christoph Gerlinger1,4 1Bayer AG, Pharmaceutical Statistics, 2Bayer AG, Dermatology & Anti-infectives 2, 3Bayer AG, Radiology, Berlin, 4Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany Objective: The aim of this study was to empirically generate a responder definition for the treatment of papulopustular rosacea.Methods: A total of 8 multicenter clinical studies on patients with papulopustular facial rosacea were analyzed. All patients were treated with azelaic acid and/or comparator treatments. The severity of rosacea was described by the Investigator Global Assessment (IGA) and the number of lesions. Patients with the IGA score of “clear/minimal” were considered as responders, and those staying in the range of IGA “mild to severe” as nonresponders. The respective number of lesions was determined.Results: A total of 2,748 patients providing 12,410 measurements were included. After treatment, responders showed 2.23±2.48 lesions (median 2 lesions [0–3]), and nonresponders showed 13.74±10.40 lesions (median 12 lesions [6–18]). The optimal cutoff point between both groups was 5.69 lesions.Conclusion: The calculated cutoff point of 5.69 lesions allows discrimination of responders (5 or less remaining lesions) and nonresponders (6 or more remaining lesions) of therapeutic interventions in rosacea. Keywords: rosacea, Investigator Global Assessment, facial lesions, responder

Behcet's syndrome (BS) is a multisystem vasculitis that presents with a variety of mucocutaneous manifestations such as oral and genital ulcers, papulopustular lesions and erythema nodosum as well as ocular, vascular, gastrointestinal and nervous system involvement. Although it occurs worldwide, it is especially prevalent in the Far East and around the Mediterranean Sea. Male gender and younger age at disease onset are associated with a more severe disease course. The management of BS depends on the severity of symptoms. If untreated, morbidity and mortality are considerably high in patients with major organ involvement. Multidisciplinary patient care is essential for the management of BS, as it is for other multisystem diseases. Rheumatologists, dermatologists, ophthalmologists, neurologists, cardiovascular surgeons and gastroenterologists are members of the multidisciplinary team. In this study, we reviewed the epidemiology, etiology, diagnostic criteria sets, clinical findings and treatment of BS and highlighted the importance of the multidisciplinary team in the management of BS.

Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and several treatment algorithms are currently applied: no consensus on a common scale or treatment guidelines has been reached. A group of Spanish experts therefore met to identify a scale the majority could accept as the most appropriate for classifying severity and treating accordingly. The group chose the following classifications: comedonal acne, mild or moderate papulopustular acne, severe papulopustular acne, moderate nodular acne, and nodular-cystic acne (or acne tending to leave scars). Consensus was reached on first- and second-choice treatments for each type and on maintenance treatment. The experts also issued specific recommendations on antibiotic use (starting with mild or moderate papulopustular acne), always in combination with retinoids and/or benzoyl peroxide. The use of isotretinoin (starting at severe papulopustular or moderate nodular acne) was also covered.

Background Congenital cutaneous candidiasis (CCC) is a challenging diagnosis due to various rash presentations. Inadequate early treatment is associated with high rates of dissemination and death. The effects of early diagnosis, dermatologic presentation, and antifungal treatment on outcomes are lacking. Methods CCC cases were reviewed from 2 academic neonatal intensive care units (NICUs) from 2004 to 2015. We defined CCC as a diffuse rash involving the body, extremities, face or scalp, and/or funisitis, presenting in the first week (≤7 days), with identification of Candida species from skin or mucous membrane cultures, and/or by culture or staining of the placenta or umbilical cord. Results CCC occurred in 0.1% of all NICU admissions (21 of 19 303) and 0.6% of infants

Rosacea is a common, chronic inflammatory skin condition with a significant psychosocial impact. Photodynamic therapy (PDT) has been found to both selectively destroy sebaceous glands and have an immunomodulatory effect on the skin. Therefore, this modality is being increasingly used in the treatment of inflammatory dermatoses. PDT is simple to perform, using equipment that is often already available in aesthetic clinics. This review summarises the evidence base for the use of PDT in the papulopustular subtype of rosacea, common treatment protocols and the management of potential side effects.

Introduction: While epidermal growth factor receptor (EGFR) inhibitors have improved progression-free survival in patients with non-small cell lung cancer (NSCLC), one of the most common adverse effects is papulopustular skin eruption, which is frequently severe enough to be treated with oral minocycline or doxycycline. Case: We present a case of an 87-year-old man who developed a severe papulopustular skin eruption secondary to erlotinib therapy for NSCLC. Control of the eruption with 100 mg of minocycline twice daily for 8 months eventually led to blue-gray skin hyperpigmentation. After 30 months, this side effect was recognized as minocycline drug deposition, which was confirmed with skin biopsy. Discussion: Compliance with EGFR inhibitor therapy in NSCLC is often challenging due to common side effects, most notably cutaneous skin eruptions. Treatment of cutaneous toxicities is important to preserve patient compliance with targeted cancer therapy. Use of minocycline to treat the most common cutaneous side effect (papulopustular eruption) can in turn cause blue-black skin, eye, or tooth discoloration that can nullify its benefits, resulting in suboptimal patient adherence to cancer therapy. Although this adverse effect is well known in dermatology literature as a risk when using minocycline to treat acne, rosacea, or blistering disorders, it is less well documented in oncology literature. We present this case to highlight the need for greater consideration of unique patient characteristics in selecting an oral antibiotic as a treatment modality for EGFR inhibitor skin toxicities.