Combination Rosacea Treatment Little data exists on the simultaneous treatment of different features of rosacea. Individually, ivermectin 1% (IVM) cream (Soolantra) and brimonidine (BR) 0.33% gel (Mirvaso) have demonstrated efficacy on inflammatory lesions and persistent erythema, respectively. A recent study evaluated the efficacy, safety, patient satisfaction, and optimal timing of administration of ivermectin 1% associated with brimonidine (IVM+BR) vs their vehicles in rosacea (Investigator’s Global Assessment [IGA] ≥3).
The multicenter, randomized, double-blind study included patients with rosacea characterized by moderate to severe persistent erythema and inflammatory lesions. The active treatment group included the IVM+BR/12 weeks subgroup (once-daily BR and once-daily IVM for 12 weeks), and the IVM+BR/8 weeks subgroup (once-daily BR vehicle for 4 weeks followed by once-daily BR for the remaining 8 weeks and once-daily IVM for 12 weeks). The vehicle group received once-daily BR vehicle and once-daily IVM vehicle for 12 weeks.
The association showed superior efficacy (IGA success [clear/almost clear]) for erythema and inflammatory lesions in the total active group (combined active subgroups) compared with vehicle (55.8% vs 36.8%; P=.007) at week 12. The success rate increased from 32.7% to 61.2% at hour 0 and hour 3, respectively, in the IVM+BR/12 weeks subgroup, and from 28.3% to 50% in the IVM+BR/8 weeks subgroup. Reductions in erythema and inflammatory lesion counts confirmed the additive effect of BR to IVM treatment. The patients reported greater improvement in the active subgroups than in the vehicle group, and similar rates for facial appearance satisfaction after the first 4 weeks of treatment in both active subgroups. All groups showed similar tolerability profiles.
“Concomitant administration of IVM cream with BR gel demonstrated good efficacy and safety, endorsing the comprehensive approach to this complex disease,” according to the researchers. “Early introduction of BR, along with a complete daily skin care regimen may accelerate treatment success without impairing tolerability,” they concluded.
Reference
Gold LS, Papp K, Lynde C, et al. Treatment of rosacea with concomitant use of topical ivermectin 1% cream and brimonidine 0.33% gel: A randomized, vehicle-controlled study. J Drugs Dermatol. 2017;16(9):909-916.
Chemical Peels in Men Increasing in Popularity
Chemical peels are a mainstay of aesthetic medicine and an increasingly popular cosmetic procedure performed in men. A recent review, published in Dermatologic Surgery, reviewed the indications for chemical peels with an emphasis on performing this procedure in men.
The study included a review of the English PubMed/MEDLINE literature and specialty texts in cosmetic dermatology, oculoplastic, and facial aesthetic surgery regarding sex-specific use of chemical peels in men. Results showed conditions treated successfully with chemical peels in men include acne vulgaris, acne scarring, rosacea, keratosis pilaris, melasma, actinic keratosis, photodamage, resurfacing of surgical reconstruction scars, and periorbital rejuvenation. Chemical peels are commonly combined with other nonsurgical cosmetic procedures to optimize results. Men may require a greater number of treatments or higher concentration of peeling agent due to increased sebaceous quality of skin and hair follicle density, the researchers noted.
Chemical peels are a cost-effective and reliable treatment for a variety of aesthetic and medical skin conditions. Given the increasing demand for noninvasive cosmetic procedures among men, dermatologists should be versed in chemical peel applications and techniques to address the concerns of male patients.
Reference
Reserva J, Champlain A, Soon SL, Tung R. Chemical peels: indications and special considerations for the male patient [published online September 4, 2017]. Dermatol Surg. doi:10.1097/DSS.0000000000001281
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Role of Demodex Mite Infestation in Rosacea The reported prevalence and degrees of Demodex mite infestation in rosacea vary widely. A recent study, published in the Journal of the American Academy of Dermatology, sought to conduct an evidence-based meta-analysis of the prevalence and degrees of Demodex mite infestation in patients with rosacea.
Systematic literature review and meta-analysis were conducted. Odds ratio (OR) for prevalence of infestation and standardized mean difference (SMD) for Demodex density in patients with rosacea were pooled. Subgroup analysis for type of rosacea, control group, and sampling and examination methods were also performed.
Twenty-three case-control studies included 1513 patients with rosacea. Compared with the control patients, patients with rosacea were more likely to be infested by Demodex mites (OR, 9.039; 95% CI, 4.827-16.925) and had significantly higher Demodex density (SMD, 1.617; 95% CI, 1.090-2.145). Both erythematotelangiectatic rosacea (SMD, 2.686; 95% CI, 1.256-4.116) and papulopustular rosacea (SMD, 2.804; 95% CI, 1.464-4.145) had significantly higher Demodex density than did healthy control patients.
Limitations of the study included that the interstudy variability was high, and a causal relationship could not be established by case-control studies.
“Patients with rosacea had significantly higher prevalence and degrees of Demodex mite infestation than did control patients. Demodex mites may play a role in both erythematotelangiectatic rosacea and papulopustular rosacea,” the researchers concluded.
Reference
Chang YS, Huang YC. Role of Demodex mite infestation in rosacea: A systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(3):441-447.e6.
Rosacea Patients With Clear (IGA 0) Experience a Delayed Time to RelapseThe results of a pooled analysis of 4 Galderma-sponsored studies evaluating the use of topical therapies for the treatment of inflammatory papules and pustules of rosacea were presented at the 26th European Academy of Dermatology and Venereology Congress in Geneva, Switzerland.
The success of rosacea treatment is usually defined as a score of 1 (almost clear) or 0 (clear) on the 5-point Investigator’s Global Assessment (IGA) scale. The new analysis reports that patients with rosacea who achieve clear (IGA 0) not only experience a more complete reduction in inflammatory lesions compared with patients who achieve almost clear (IGA 1), but also an extended time to relapse that is associated with improved quality of life.
The analysis is the first of its kind to report on the differences in patient-reported outcomes, quality of life, and time to relapse associated with clear (IGA 0) and almost clear (IGA 1) patients.
“Rosacea is a chronic dermatological disease with remissions and exacerbations. Improving treatment options with earlier effective treatment and longer remission times may not only control symptoms, but also delay progression of the disease,” said study author Guy Webster, MD, in practice in Hockessin, DE, and affiliated with Thomas Jefferson University in Philadelphia, PA. “This first-of-its-kind analysis shows that both remission time and quality of life are improved if patients achieve an endpoint of ‘clear’ (IGA 0) compared with patients who achieve ‘almost clear’ (IGA 1).”
In the analysis, patients who achieved clear (IGA 0) were associated with a delayed time to relapse of more than 5 months compared with patients who achieved almost clear (IGA 1). At 8-month follow-up, twice as many patients who had achieved clear (IGA 0) remained free of treatment compared with patients who had achieved almost clear (IGA 1) (54% vs 23%). “This delayed time to relapse may contribute to improved quality of life and satisfaction with treatment, both in the short term and over the long term,” he reported.
Additionally, one-third more clear (IGA 0) patients than almost clear (IGA 1) patients (59% vs 44%) reported a clinically meaningful difference (≥4 points) in Dermatology Life Quality Index score.
Reference
Tan J. Defining treatment success in rosacea as ‘clear’ may provide multiple patient benefits: results of a pooled analysis by Guy Webster et al. Presented at: The European Academy of Dermatology and Venereology Congress 2017; September 16, 2017; Geneva, Switzerland. Abstract 1685.
Combination Rosacea Treatment
Little data exists on the simultaneous treatment of different features of rosacea. Individually, ivermectin 1% (IVM) cream (Soolantra) and brimonidine (BR) 0.33% gel (Mirvaso) have demonstrated efficacy on inflammatory lesions and persistent erythema, respectively. A recent study evaluated the efficacy, safety, patient satisfaction, and optimal timing of administration of ivermectin 1% associated with brimonidine (IVM+BR) vs their vehicles in rosacea (Investigator’s Global Assessment [IGA] ≥3).
The multicenter, randomized, double-blind study included patients with rosacea characterized by moderate to severe persistent erythema and inflammatory lesions. The active treatment group included the IVM+BR/12 weeks subgroup (once-daily BR and once-daily IVM for 12 weeks), and the IVM+BR/8 weeks subgroup (once-daily BR vehicle for 4 weeks followed by once-daily BR for the remaining 8 weeks and once-daily IVM for 12 weeks). The vehicle group received once-daily BR vehicle and once-daily IVM vehicle for 12 weeks.
The association showed superior efficacy (IGA success [clear/almost clear]) for erythema and inflammatory lesions in the total active group (combined active subgroups) compared with vehicle (55.8% vs 36.8%; P=.007) at week 12. The success rate increased from 32.7% to 61.2% at hour 0 and hour 3, respectively, in the IVM+BR/12 weeks subgroup, and from 28.3% to 50% in the IVM+BR/8 weeks subgroup. Reductions in erythema and inflammatory lesion counts confirmed the additive effect of BR to IVM treatment. The patients reported greater improvement in the active subgroups than in the vehicle group, and similar rates for facial appearance satisfaction after the first 4 weeks of treatment in both active subgroups. All groups showed similar tolerability profiles.
“Concomitant administration of IVM cream with BR gel demonstrated good efficacy and safety, endorsing the comprehensive approach to this complex disease,” according to the researchers. “Early introduction of BR, along with a complete daily skin care regimen may accelerate treatment success without impairing tolerability,” they concluded.
Reference
Gold LS, Papp K, Lynde C, et al. Treatment of rosacea with concomitant use of topical ivermectin 1% cream and brimonidine 0.33% gel: A randomized, vehicle-controlled study. J Drugs Dermatol. 2017;16(9):909-916.
Chemical Peels in Men Increasing in Popularity
Chemical peels are a mainstay of aesthetic medicine and an increasingly popular cosmetic procedure performed in men. A recent review, published in Dermatologic Surgery, reviewed the indications for chemical peels with an emphasis on performing this procedure in men.
The study included a review of the English PubMed/MEDLINE literature and specialty texts in cosmetic dermatology, oculoplastic, and facial aesthetic surgery regarding sex-specific use of chemical peels in men. Results showed conditions treated successfully with chemical peels in men include acne vulgaris, acne scarring, rosacea, keratosis pilaris, melasma, actinic keratosis, photodamage, resurfacing of surgical reconstruction scars, and periorbital rejuvenation. Chemical peels are commonly combined with other nonsurgical cosmetic procedures to optimize results. Men may require a greater number of treatments or higher concentration of peeling agent due to increased sebaceous quality of skin and hair follicle density, the researchers noted.
Chemical peels are a cost-effective and reliable treatment for a variety of aesthetic and medical skin conditions. Given the increasing demand for noninvasive cosmetic procedures among men, dermatologists should be versed in chemical peel applications and techniques to address the concerns of male patients.
Reference
Reserva J, Champlain A, Soon SL, Tung R. Chemical peels: indications and special considerations for the male patient [published online September 4, 2017]. Dermatol Surg. doi:10.1097/DSS.0000000000001281
{{pagebreak}}
Role of Demodex Mite Infestation in Rosacea
The reported prevalence and degrees of Demodex mite infestation in rosacea vary widely. A recent study, published in the Journal of the American Academy of Dermatology, sought to conduct an evidence-based meta-analysis of the prevalence and degrees of Demodex mite infestation in patients with rosacea.
Systematic literature review and meta-analysis were conducted. Odds ratio (OR) for prevalence of infestation and standardized mean difference (SMD) for Demodex density in patients with rosacea were pooled. Subgroup analysis for type of rosacea, control group, and sampling and examination methods were also performed.
Twenty-three case-control studies included 1513 patients with rosacea. Compared with the control patients, patients with rosacea were more likely to be infested by Demodex mites (OR, 9.039; 95% CI, 4.827-16.925) and had significantly higher Demodex density (SMD, 1.617; 95% CI, 1.090-2.145). Both erythematotelangiectatic rosacea (SMD, 2.686; 95% CI, 1.256-4.116) and papulopustular rosacea (SMD, 2.804; 95% CI, 1.464-4.145) had significantly higher Demodex density than did healthy control patients.
Limitations of the study included that the interstudy variability was high, and a causal relationship could not be established by case-control studies.
“Patients with rosacea had significantly higher prevalence and degrees of Demodex mite infestation than did control patients. Demodex mites may play a role in both erythematotelangiectatic rosacea and papulopustular rosacea,” the researchers concluded.
Reference
Chang YS, Huang YC. Role of Demodex mite infestation in rosacea: A systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(3):441-447.e6.
Rosacea Patients With Clear (IGA 0) Experience a Delayed Time to Relapse
The results of a pooled analysis of 4 Galderma-sponsored studies evaluating the use of topical therapies for the treatment of inflammatory papules and pustules of rosacea were presented at the 26th European Academy of Dermatology and Venereology Congress in Geneva, Switzerland.
The success of rosacea treatment is usually defined as a score of 1 (almost clear) or 0 (clear) on the 5-point Investigator’s Global Assessment (IGA) scale. The new analysis reports that patients with rosacea who achieve clear (IGA 0) not only experience a more complete reduction in inflammatory lesions compared with patients who achieve almost clear (IGA 1), but also an extended time to relapse that is associated with improved quality of life.
The analysis is the first of its kind to report on the differences in patient-reported outcomes, quality of life, and time to relapse associated with clear (IGA 0) and almost clear (IGA 1) patients.
“Rosacea is a chronic dermatological disease with remissions and exacerbations. Improving treatment options with earlier effective treatment and longer remission times may not only control symptoms, but also delay progression of the disease,” said study author Guy Webster, MD, in practice in Hockessin, DE, and affiliated with Thomas Jefferson University in Philadelphia, PA. “This first-of-its-kind analysis shows that both remission time and quality of life are improved if patients achieve an endpoint of ‘clear’ (IGA 0) compared with patients who achieve ‘almost clear’ (IGA 1).”
In the analysis, patients who achieved clear (IGA 0) were associated with a delayed time to relapse of more than 5 months compared with patients who achieved almost clear (IGA 1). At 8-month follow-up, twice as many patients who had achieved clear (IGA 0) remained free of treatment compared with patients who had achieved almost clear (IGA 1) (54% vs 23%). “This delayed time to relapse may contribute to improved quality of life and satisfaction with treatment, both in the short term and over the long term,” he reported.
Additionally, one-third more clear (IGA 0) patients than almost clear (IGA 1) patients (59% vs 44%) reported a clinically meaningful difference (≥4 points) in Dermatology Life Quality Index score.
Reference
Tan J. Defining treatment success in rosacea as ‘clear’ may provide multiple patient benefits: results of a pooled analysis by Guy Webster et al. Presented at: The European Academy of Dermatology and Venereology Congress 2017; September 16, 2017; Geneva, Switzerland. Abstract 1685.
Combination Rosacea Treatment
Little data exists on the simultaneous treatment of different features of rosacea. Individually, ivermectin 1% (IVM) cream (Soolantra) and brimonidine (BR) 0.33% gel (Mirvaso) have demonstrated efficacy on inflammatory lesions and persistent erythema, respectively. A recent study evaluated the efficacy, safety, patient satisfaction, and optimal timing of administration of ivermectin 1% associated with brimonidine (IVM+BR) vs their vehicles in rosacea (Investigator’s Global Assessment [IGA] ≥3).
The multicenter, randomized, double-blind study included patients with rosacea characterized by moderate to severe persistent erythema and inflammatory lesions. The active treatment group included the IVM+BR/12 weeks subgroup (once-daily BR and once-daily IVM for 12 weeks), and the IVM+BR/8 weeks subgroup (once-daily BR vehicle for 4 weeks followed by once-daily BR for the remaining 8 weeks and once-daily IVM for 12 weeks). The vehicle group received once-daily BR vehicle and once-daily IVM vehicle for 12 weeks.
The association showed superior efficacy (IGA success [clear/almost clear]) for erythema and inflammatory lesions in the total active group (combined active subgroups) compared with vehicle (55.8% vs 36.8%; P=.007) at week 12. The success rate increased from 32.7% to 61.2% at hour 0 and hour 3, respectively, in the IVM+BR/12 weeks subgroup, and from 28.3% to 50% in the IVM+BR/8 weeks subgroup. Reductions in erythema and inflammatory lesion counts confirmed the additive effect of BR to IVM treatment. The patients reported greater improvement in the active subgroups than in the vehicle group, and similar rates for facial appearance satisfaction after the first 4 weeks of treatment in both active subgroups. All groups showed similar tolerability profiles.
“Concomitant administration of IVM cream with BR gel demonstrated good efficacy and safety, endorsing the comprehensive approach to this complex disease,” according to the researchers. “Early introduction of BR, along with a complete daily skin care regimen may accelerate treatment success without impairing tolerability,” they concluded.
Reference
Gold LS, Papp K, Lynde C, et al. Treatment of rosacea with concomitant use of topical ivermectin 1% cream and brimonidine 0.33% gel: A randomized, vehicle-controlled study. J Drugs Dermatol. 2017;16(9):909-916.
Chemical Peels in Men Increasing in Popularity
Chemical peels are a mainstay of aesthetic medicine and an increasingly popular cosmetic procedure performed in men. A recent review, published in Dermatologic Surgery, reviewed the indications for chemical peels with an emphasis on performing this procedure in men.
The study included a review of the English PubMed/MEDLINE literature and specialty texts in cosmetic dermatology, oculoplastic, and facial aesthetic surgery regarding sex-specific use of chemical peels in men. Results showed conditions treated successfully with chemical peels in men include acne vulgaris, acne scarring, rosacea, keratosis pilaris, melasma, actinic keratosis, photodamage, resurfacing of surgical reconstruction scars, and periorbital rejuvenation. Chemical peels are commonly combined with other nonsurgical cosmetic procedures to optimize results. Men may require a greater number of treatments or higher concentration of peeling agent due to increased sebaceous quality of skin and hair follicle density, the researchers noted.
Chemical peels are a cost-effective and reliable treatment for a variety of aesthetic and medical skin conditions. Given the increasing demand for noninvasive cosmetic procedures among men, dermatologists should be versed in chemical peel applications and techniques to address the concerns of male patients.
Reference
Reserva J, Champlain A, Soon SL, Tung R. Chemical peels: indications and special considerations for the male patient [published online September 4, 2017]. Dermatol Surg. doi:10.1097/DSS.0000000000001281
{{pagebreak}}
Role of Demodex Mite Infestation in Rosacea
The reported prevalence and degrees of Demodex mite infestation in rosacea vary widely. A recent study, published in the Journal of the American Academy of Dermatology, sought to conduct an evidence-based meta-analysis of the prevalence and degrees of Demodex mite infestation in patients with rosacea.
Systematic literature review and meta-analysis were conducted. Odds ratio (OR) for prevalence of infestation and standardized mean difference (SMD) for Demodex density in patients with rosacea were pooled. Subgroup analysis for type of rosacea, control group, and sampling and examination methods were also performed.
Twenty-three case-control studies included 1513 patients with rosacea. Compared with the control patients, patients with rosacea were more likely to be infested by Demodex mites (OR, 9.039; 95% CI, 4.827-16.925) and had significantly higher Demodex density (SMD, 1.617; 95% CI, 1.090-2.145). Both erythematotelangiectatic rosacea (SMD, 2.686; 95% CI, 1.256-4.116) and papulopustular rosacea (SMD, 2.804; 95% CI, 1.464-4.145) had significantly higher Demodex density than did healthy control patients.
Limitations of the study included that the interstudy variability was high, and a causal relationship could not be established by case-control studies.
“Patients with rosacea had significantly higher prevalence and degrees of Demodex mite infestation than did control patients. Demodex mites may play a role in both erythematotelangiectatic rosacea and papulopustular rosacea,” the researchers concluded.
Reference
Chang YS, Huang YC. Role of Demodex mite infestation in rosacea: A systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(3):441-447.e6.
Rosacea Patients With Clear (IGA 0) Experience a Delayed Time to Relapse
The results of a pooled analysis of 4 Galderma-sponsored studies evaluating the use of topical therapies for the treatment of inflammatory papules and pustules of rosacea were presented at the 26th European Academy of Dermatology and Venereology Congress in Geneva, Switzerland.
The success of rosacea treatment is usually defined as a score of 1 (almost clear) or 0 (clear) on the 5-point Investigator’s Global Assessment (IGA) scale. The new analysis reports that patients with rosacea who achieve clear (IGA 0) not only experience a more complete reduction in inflammatory lesions compared with patients who achieve almost clear (IGA 1), but also an extended time to relapse that is associated with improved quality of life.
The analysis is the first of its kind to report on the differences in patient-reported outcomes, quality of life, and time to relapse associated with clear (IGA 0) and almost clear (IGA 1) patients.
“Rosacea is a chronic dermatological disease with remissions and exacerbations. Improving treatment options with earlier effective treatment and longer remission times may not only control symptoms, but also delay progression of the disease,” said study author Guy Webster, MD, in practice in Hockessin, DE, and affiliated with Thomas Jefferson University in Philadelphia, PA. “This first-of-its-kind analysis shows that both remission time and quality of life are improved if patients achieve an endpoint of ‘clear’ (IGA 0) compared with patients who achieve ‘almost clear’ (IGA 1).”
In the analysis, patients who achieved clear (IGA 0) were associated with a delayed time to relapse of more than 5 months compared with patients who achieved almost clear (IGA 1). At 8-month follow-up, twice as many patients who had achieved clear (IGA 0) remained free of treatment compared with patients who had achieved almost clear (IGA 1) (54% vs 23%). “This delayed time to relapse may contribute to improved quality of life and satisfaction with treatment, both in the short term and over the long term,” he reported.
Additionally, one-third more clear (IGA 0) patients than almost clear (IGA 1) patients (59% vs 44%) reported a clinically meaningful difference (≥4 points) in Dermatology Life Quality Index score.
Reference
Tan J. Defining treatment success in rosacea as ‘clear’ may provide multiple patient benefits: results of a pooled analysis by Guy Webster et al. Presented at: The European Academy of Dermatology and Venereology Congress 2017; September 16, 2017; Geneva, Switzerland. Abstract 1685.
