In this podcast, Hilary Baldwin, MD, FAAD, and Jeffrey Fromowitz, MD, FAAD, discuss the burden of rosacea, management tips, available treatments, antibiotic stewardship, and more.

Managing Papulopustular Rosacea

Learn more about what treatments are on the rise for plaque psoriasis, the latest management advice and what trends are shaping the future of the disease. 

The changing treatment landscape of plaque psoriasis

®, has covered medical news for MJH Life Sciences, 

®’s parent company, since 2021. She has written for 

 and a variety of other lifestyle publications. She attended Emerson College, where she studied journalism and publishing. Antonia enjoys traveling, cooking, yoga and all things health and wellness. Follow her on Instagram @antonialdepace or email her at 

Tumor response to radiation may be affected by the gut microbiome health in patients with breast cancer or melanoma, according to results from a recent study.

“More than half of all (patients with cancer) will get radiation at some point during their treatment,” Dr. Stephen Shiao, an associate professor and director of basic science research in the department of radiation oncology and biomedical sciences at Cedars-Sinai Medical Center in Los Angeles, California, said in an interview with 

. “So it's very important in the global sense that we figured out that there are things in the microbiome that can enhance or inhibit the response to radiation.”

Shiao is also the co-leader of the translational oncology program at Cedars-Sinai Cancer Center and associate professor of Health Sciences in the department of medicine at the University of California, Los Angeles.

Previous studies have suggested that the gut microbiome may influence chemotherapy and immunotherapy in animals and humans, but not in radiation.

“Not all treatments work in all patients, right? And we don't understand some of the factors that are individual that drive that difference in response. … One of the things that's been very hot in cancer has been immunotherapy, and because we're particularly interested in the immune system, we were trying to figure out why it's so strange that some people have immune systems that respond well, and some do not. And, so, we started the study to try and understand what some of the factors (are) that drive that,” Shiao, who was the lead author on the study, added.

Researchers on the study found that fungi depleted by antibiotics enhanced responsiveness to radiation, while bacteria depleted by antibiotics reduced responsiveness due to the overgrowth of fungi. Shiao also observed an elevated amount of Dectin-1, a type of fungi that negatively affects survival in patients with breast cancer.

Shiao described the microbiota as “friendly symbiotes.” Under normal circumstances, the two don’t cause disease, and are important for overall health as they aid in digestion and help to strengthen the immune system by teaching it the difference between good and bad bacteria. Because of this, when bacteria is removed or depleted, it can actually weaken the immune system.

Shiao added, “We saw that one of the reasons that happened is because when you take out the bacteria, it seemed that it made a lot more space for the fungi. And so now it's almost like, you got rid of all these things in the neighborhood, and then now there's new houses built, and these new houses were primarily fungi. When we looked at them, we saw that there was this tremendous growth of lots of different kinds of fungi. And when we looked at what the implication of that (was), we realized that the fungi actually – in terms of shaping the cancer –gave a signal to tell the immune system to stop fighting the cancer.”

These findings highlight the possible importance of regulating the gut microbiome before and during cancer treatment in order to gain optimal results, as well as keeping a healthy gut microbiome by being cognizant about taking antibiotics and focusing on a health, balanced diet.

“It's really important to eat … a balance (of) complex carbohydrates, high fiber diet that supports a healthy kind of microbiota,” Shiao said.

“On the patient front, I think the next step is to really do some careful characterization of the bacteria fungi in patients in a lot of different settings,” he explained, adding that future studies would have to see which methods of antifungal depletion are safe for patients and what the implications could be.

This article was initially published by our sister publication 

Articles

The overgrowth of fungi could cause the immune system to stop fighting cancer, according to a study.

Gut Microbiome Can Affect Radiation Cancer Treatment

Keith A. Reynolds is contributing author for 

The American College of Physicians (ACP) is speaking out against the spread of COVID-19 misinformation.

, ACP President George M. Abraham, MD, FACP, FIDSA, discusses the concern caused by misinformation surrounding COVID-19 and the negative impact it has on public health.

The American College of Physicians (ACP), representing 161,000 internal medicine physicians (internists), related subspecialists, and medical students, is concerned about the spread of misinformation about the COVID-19 virus, vaccination and treatments, and its detrimental impact on public health. ACP strongly supports the use of science and scientific expertise, based on the best available evidence, in the fight against COVID-19. The spread of inaccurate and incorrect information about COVID-19 hinders our ability to mitigate the spread of the virus and combat the global public health crisis.

While ethical and responsible discussions of evidence and science to inform patient care and scientific and public policy are necessary and appropriate, clinicians—including physicians—must not contribute to spreading misinformation that can be harmful to patients. Physicians have an ethical obligation to put patient care and best interests above self-interest, and to provide patients and the public with accurate information about health care. We agree with the U.S. Surgeon General that health misinformation is a serious threat to public health. Contributing to the spread of misinformation that is not factual or based on the best available evidence puts the health of patients, families and communities at risk and thwarts the efforts of all physicians, health care workers, researchers, and others who are working tirelessly to fight COVID-19.

ACP calls on physicians, other health care professionals and patients to get vaccinated against COVID-19. We also urge the continued use of masks as part of a comprehensive public health strategy to help reduce the spread of COVID-19 and slow infection rates.

Physician organizations have been taking the offensive lately in the fight against COVID-19 information as the American Medical Association, American Pharmacists Association and American Society of Health-System Pharmacists spoke out 

 calling for an immediate end to prescribing, dispensing, and using ivermectin to prevent or treat COVID-19, other than in clinical trials.

The groups said they are “alarmed” by reports that outpatient prescribing for, and dispensing of, ivermectin are up 24-fold since the start of the pandemic and have “increased exponentially over the past few months.”

The groups also say they are urging doctors, pharmacists and other prescribers to warn patients against using ivermectin outside of FDA-approved indications and guidance or buying it from online stores, noting that in its veterinary forms the drug is highly concentrated for use in large animals and thus poses “a significant toxicity risk for humans.”

The FDA has approved the use of ivermectin for use by humans to treat infections caused by internal and external parasites, according to the release, but not to prevent or treat COVID-19. It cites a recent CDC Health Alert Network Advisory recommending that health care professionals counsel patients against using ivermectin as a treatment for COVID-19, and emphasize the “potentially toxic effects” of the drug, including nausea, vomiting, and diarrhea.

This article was initially published by our sister publication

The organization is also calling on everyone to be vaccinated against the disease.

ACP speaks out against COVID-19 misinformation


Courtney Marabella joined the MJH Life Sciences team in 2021 and is Senior Editor for 

. Prior to joining the company she worked as the Audience Development Editor for the Asbury Park Press, part of the USA Today Network. 

The topical HDAC inhibitor remetinostat demonstrated favorable tolerability and clinically significant efficacy in reducing disease burden in patients with basal cell carcinoma, according to results from a phase 2 trial (NCT03180528) published in 

Results from the study showed an overall response rate (ORR) of 69.7% (90% CI, 54%-82.5%), which was defined as the proportion of tumors that achieved a decrease in diameter of at least 30% from baseline to week 8. Additionally, 54.8% of tumors demonstrated complete resolution, and no systemic adverse effects (AEs) were reported.

“Although further research is needed, our results suggest that remetinostat could be a safe and promising alternative to surgical treatment of BCC due to the high rate of complete responses we observed,” Kavita Sarin, MD, PhD, senior author of the study and an associate professor of dermatology at Stanford University, stated in a press release.

Basal cell carcinoma is the most common cancer worldwide, and surgery continues to be the standard of care. Surgical procedures, however, are time consuming and costly, resulting in nearly $4 billion in annual healthcare costs in the United States alone; they have also been associated with cosmetic and functional morbidity. As such, there is an unmet need for non-surgical approaches for this patient population.

Remetinostat is an HDAC inhibitor that has been shown to retain potency within the skin, but also metabolize upon absorption and produce effective local activity in cutaneous lesions. Additionally, the agent has been previously studied in patients with cutaneous T-cell lymphoma with no treatment-related systemic AEs reported.

As such, investigators sought to examine the safety and efficacy of topical 1% remetinostat gel in patients with basal cell carcinoma.

Patients on the study were instructed to apply the remetinostat gel 3 times daily for 6 weeks. Measurements of tumor diameter were conducted at baseline, as well as after 8 weeks of treatment. Surgical excision of the remaining tumor was done at the end of the study period.

To be eligible for enrollment, patients had to have at least 1 cutaneous basal cell carcinoma that was 5 mm in diameter or larger and be amenable to surgical resection. Additionally, women enrolled to the study were required to show proof of a negative pregnancy test and use contraceptives while on the study. Those with lesions larger than 25 mm that were cosmetically sensitive, inoperable, locally advanced, or metastatic were excluded.

Secondary outcomes included change in tumor cross-sectional area, pathologic resolution of the tumor at time of excision, participant compliance, relative change in GLI1 mRNA expression, and the incidence, nature, and severity of AEs.

A total of 30 participants with 49 basal cell carcinoma tumors were enrolled to the study between May 2018 and June 2020. Of those participants, 25 patients with 33 tumors were included in the per-protocol analysis.

The median age of patients enrolled to the study was 59 years (range, 38-86), and the majority were male (63%) and White (90%). Additionally, 47% of patients had a prior history of skin cance were enrolled with just 1 basal cell carcinoma tumor. Moreover, most tumors were either nodular (35%) or superficial (14%) in histology.

Additional data showed that from baseline to week 8, 6 partial responses (PRs) were reported with the approach, along with 17 complete responses in the tumor longest diameter. Moreover, the average change in the longest tumor diameter was a 62.3% decrease. Of the 33 tumors examined in the per-protocol analysis, 2 did not change in diameter and 8 decreased in size but less than the 30% threshold for a PR. Notably, no tumors increased in diameter.

Based on histology, those with superficial basal cell carcinoma tumors responded the best to treatment, with an ORR of 100%. Moreover, those with nodular tumors experienced an ORR of 68.2%, and those with infiltrative tumors reported an ORR of 66.7%. The micronodular subtype did not respond to treatment.

Additionally, age under 60 years, male gender, and a history of prior skin cancer were all linked with small, non-significant increases in ORR. Tumor location on a sun-exposed site and higher grade of cutaneous drug reaction were both linked with larger ORRs, although these increases were still not determined to be of statistical significance. The ORR in those with sun-exposed sites was 81.8% vs 63.6% in those with nonexposed sites. In those with grade 2 to 3 cutaneous drug reaction, the ORR was 73.9% vs 60.0% in those with grade 1 or no reaction.

Moreover, the average change in tumor area was a decrease of 71.5%.

Ninety percent of patients experienced at least 1 AE. The most frequently reported AE was an eczematous reaction localized to the site of drug application. A total of 27 discrete episodes were reported, with a mean duration of 64.4 days. Most of these cases were grade 2 in severity (n = 21), 5 were grade 1, and 1 was grade 3. Additionally, 4 patients had to suspend treatment due to an eczematous reaction, and 3 patients stopped treatment permanently because of this toxicity.

A less frequently reported AE was pain at the site of drug application, and 6 episodes were reported; 4 of these episodes were grade 1 and 2 were grade 2. Two participants had to temporarily suspend treatment.

“Given the tolerability and clinical and pathologic response rates demonstrated in this trial across several histological subtypes, HDAC inhibitors could be a realistic new class of topical agents for basal cell carcinoma,” the study authors wrote. “In patients suffering from recurrent disease, an effective topical treatment could have a revolutionary impact on patient outcomes, morbidity and quality of life, and for this reason, further trials are warranted, particularly to assess the durability of treatment response following HDAC inhibitor therapy.”

Kilgour JM, Shah A, Urman NM, et al. Phase II open-label, single-arm trial to investigate the efficacy and safety of topical remetinostat gel in patients with basal cell carcinoma. 

. Published online August 6, 2021. doi:10.1158/1078-0432.CCR-21-0560

First-in-class histone deacetylase inhibitor gel shows promise for the treatment of patients with basal cell carcinoma. News release. AACR. August 6, 2021. Accessed August 25, 2021. 

The topical HDAC inhibitor remetinostat demonstrated favorable tolerability and clinically significant efficacy in reducing disease burden in patients with basal cell carcinoma, according to results from a phase 2 trial.

Topical Remetinostat Effective, Tolerable in Basal Cell Carcinoma

Telehealth has been a lifesaver for practices hammered by the COVID-19 pandemic, but new data shows that its use is declining.

 from healthcare data firm FAIR Health, national telehealth utilization dropped 10 percent from May to June. It decreased from 5 percent of medical claim lines in May to 4.5 percent in June. Telehealth utilization is measured as a percentage of all medical claim lines.

This came after utilization rose 2 percent nationally from April to May and a decrease each month from February to April, the release says.

Telehealth claim lines fell across all four U.S. census regions, with the sharpest decline being seen in the northeast which saw an 11.9 percent drop from May to June, according to the release.

The period from May to June also saw changes to the top-five diagnoses given over telehealth. Joint/soft tissue diseases and issues saw a rise in the rankings nationally (from number four in May to number three in June) and in all regions except for the west. Acute respiratory diseases and infections also rose from third to second in the same period. Meanwhile mental health conditions remained at the top nationally and in every region, the release says.

In the south, urinary tract infections rose to fifth among telehealth diagnoses in June after not appearing on the regional or national lists since the beginning of the pandemic. It had been common prior to COVID-19, according to the release.

The same period also saw changes to the top five telehealth procedure codes by utilization, specifically CPT 99214, established patient outpatient visit, total time 30-39 minutes, rose from third to second place, while CPT 99213, established patient outpatient visit, total time 20-29 minutes, fell from second to third place, the release says.

While June seemed bleak for telehealth, the service remains a key tool in the arsenal of physicians treating those most at risk during the pandemic.

 prepared by survey and market research firm SSRS on behalf the Bipartisan Policy Center, while 31 percent of the general population of U.S. had a telehealth visit for themselves or a dependent an even greater share of adults over the age of 65 have taken advantage of the service. Among Medicare beneficiaries, 44 percent reported having a telehealth visit within the last year.

The service is also proving to be effective as eight out of 10 adults said that their primary health issue was resolved by a telehealth visit. This isn’t surprising as 63 percent of telehealth visits were for a preventive service, routine visits for chronic illness, or for prescription refills. In these cases, audio-only visits were as likely to resolve patient issues as video visits.

Rural residents and older adults have reported technology-related barriers to accessing telehealth as 42 percent of older adults and 35 percent of rural residents reported that access to high-speed internet or broadband was an obstacle. Overall 45 percent of respondents reported some type of technical issue has been an obstacle to their taking advantage of telehealth visits.

The drop in use was starkest in the northeast.

Telehealth saw dip in June

Insomnia is highly prevalent in patients with 

, with most iterations of the sleep disorder being caused by vitiligo itself, according to a new study.

In new case-control study data from China, a team of investigators reported that approximately half of all observed patients with vitiligo surveyed via online questionnaire also suffered from insomnia. The findings emphasize the need for wellbeing assessments conducted by dermatologists, as well as care plans that emphasize individual burdens beyond the skin condition.

The team, led by Jia-Wei Liu of the Department of Dermatology at Peking Union Medical College Hospital, conducted the trial to evaluate prevalence, severity, and risk factors of insomnia in patients with diagnosed vitiligo.

As they noted, the disfiguration-causing skin condition has been commonly associated with impaired social function and physiological disorders including depression, stress, and insomnia.

“In the meantime, various autoimmune diseases are associated with sleep disorders,” they wrote. “Patients with sleep disorders may suffer the potential risk for vitiligo. Therefore, a bidirectional relationship exists between vitiligo and sleep disorders.”

Vitiligo onset may be a causal trigger for sleeping disorders, Liu and colleagues noted, or sleeping disorders may induce or worsen cases of vitiligo.

Their telesurvey case-control assessment was conducted in March 2021, via an online questionnaire sent to 762 adult patients with vitiligo. The questionnaire included a survey on patient baseline information, as well as a 45-item sleep-related instrument.

Vitiligo activity was evaluated via 6-point Vitiligo Disease Activity (VIDA) score assessment. The sleep-related instrument helped define insomnia by diagnosis; Insomnia Severity Index (ISI) score; specific insomnia type; instruments and history requisition to exclude other sleep disorders; and specific disturbance faces.

Liu and colleagues included 409 total patients with vitiligo. Mean patient age was 30.0 years old, with 56.0% being female. Nearly half (48.7%) of observed patients had vitiligo for ≥3 years.

A total of 204 (49.9%) patients had experienced insomnia, with 114 (55.9%) of those patients experiencing a form of the adjustment sleep disorder caused by their vitiligo. Another 81 (71.1%) reported development, aggravation, or recurrence of vitiligo as the first reason for their insomnia.

Investigators observed significant differences in age among vitiligo patients with insomnia and those without (32.1 vs 27.9, respectively; 

< .001). Patients with vitiligo and insomnia were more likely to be female (62.8%; 

 = .017), experience vitiligo in their face and neck (67.2%; 

 <.001). Patients with both conditions were also more likely to receive oral corticosteroids for their vitiligo and suffer from depression than those with lone vitiligo.

In adjusting for baseline demographics, investigators observed face and neck vitiligo (OR, 2.62; 

 = .032), vitiligo progression (OR, 2.50; 

= .002), and oral corticosteroid use (OR, 2.71; 

 = .021) to be significant risk factors for insomnia in patients with vitiligo.

Liu and colleagues observed that the present study demonstrated the very prevalent risk of insomnia in their vitiligo patient population.

“Seemingly, this sleep problem affected their quality of life by a psychopathological condition such as depression and stress,” they wrote. “Therefore, it may be significant for dermatologists to have general identification of these conditions in vitiligo patients, both psychological and physical, and offer individualized therapy.”

Though no previous relevant research has observed insomnia treatment’s association with vitiligo disease control, the investigators theorized that improved sleep quality may positively influence their patients’ skin condition.

“Of note, different patients with vitiligo have specific worries about this disease and problems,” they concluded. “Dermatologists should identify them carefully, especially humanistic factors in social life, and perform individualized ‘non-drug’ treatment.”

Location, Spreading and Oral Corticosteroids are Associated with Insomnia in Vitiligo Patients: A Case–Control Study

Clinical, Cosmetic and Investigational Dermatology.

A new study showed about half of all vitiligo patients from a care system were burdened with the sleeping disorder.

Vitiligo Linked to Insomnia Risk

Armand Butera is the assistant editor for 

. He attended Fairleigh Dickinson University and graduated with a degree in communications with a concentration in journalism. Prior to graduating, Armand worked as the editor-in-chief of his college newspaper and a radio host for WFDU. He went on to work as a copywriter, freelancer, and human resources assistant before joining 

. In his spare time, he enjoys reading, writing, traveling with his companion and spinning vinyl records. Email him at 

Research from the Postgraduate Institute of Medical Education and Research in India found that serial assessment of vitiligo patches on patients post-non-cultured epidermal cell suspension (NCES) resulted in early recognition of unstable patches.

Additionally, the appearance of normal pigment network at 8 weeks by dermatoscopy was a predictor of excellent repigmentation.

The study, led by Keshavamurthy Vinay, MD, DNB, asserted the role of dermatoscopy in assessing disease stability and predicting repigmentation rates in vitiligo patients undergoing NCES.

Stability in vitiligo was considered a dynamic process by the investigators, with lesion stability of at least 12 months being essential for treatment success in patients undergoing autologous NCES.

However, surgically treated vitiligo patches could develop instability anytime during follow-up, which could adversely affect repigmentation rates and pigment retention.

In their study, Vinay and colleagues evaluated the role of serial dermatoscopic monitoring in assessing disease stability and predicting repigmentation rates in vitiligo patients undergoing NCES.

Participants in the study were recruited from the patients who attended the pigmentary and dermatosurgery clinic of department of Dermatology, Venereology and Lueprology, Postgraduate Institute of Medical Education and Research in Chandigarh, India.

The team performed NCES on 2 patches each for 26 patients of vitiligo, which totaled 56 patches that were all clinically stable for at least 1 year (VIDA 0)

Repigmentation was assessed at follow-up visits with clinical and photographic assessments.

Successful repigmentation was defined as repigmentation greater than 75% and excellent repigmentation as greater than 90%.

The investigators performed dermatoscopic assessments of target lesions at baseline and post-procedure at weeks 4, 8, 12, 16 and 24.

The dermatoscopic features of target lesions that showed clinical signs of disease activity anytime during the follow-up period were compared to those who maintained clinical stability throughout.

A Fischer exact test was done to explore the difference in the dermoscopic parameters between the 2 groups.

All 26 patients (17 females, 9 males) completed the study and were included in the final analysis.

Vinay and investigators found that 19 (73%) participants had a VIDA of -1 at baseline and 7 (27%) had a VIDA of 0 at baseline.

Additionally, 18 patients (69.2%) had non-segmental vitiligo and 8 patients (30.8%) had segmental type of vitiligo. Baseline dermatoscopic features included absent pigment network (96%) and sharp margins (100%) suggestive of stable vitiligo.

In a follow-up, investigators recorded 6 patches that showed signs of instabililty, with 2 of them showing focal loss of pigmentation after initial repigmentation following NCES and 1 with complete loss of pigment.

By 24 weeks, 2 of the patches (33.33%) showed focal loss of pigment network while a single patch completely depigmented. Normal pigment network at 24 weeks was seen in only 3 (50%) patches in the unstable group, whereas 37 (80%) patches in the stable group showed normal reticular pigment network.

Excellent repigmentation (>90%) was achieved in 29 out of 52 patches, and it was noted that appearance of normal reticular pigment network at 8 weeks was a positive predictor of excellent response (OR=10.5, confidence intervals 1.2 – 89.7).

Overall, the study proved the effectiveness of routine patch assessment via dermatoscopy and similar methods.

“Serial assessment of the vitiligo patches post NCES for dermoscopic markers of instability can help in early recognition of unstable patches and initiation of appropriate medical treatment (including topical corticosteroids and tacrolimus) or targeted phototherapy to retain stability and augment repigmentation,” the team wrote.

“Dermoscopic assessment of treatment response in patients undergoing autologous non cultured epidermal cell suspension for the treatment of stable vitiligo: a prospective study,”

was published online in Dermatologic Therapy.

Investigators write that methods such as dermatoscopy can result in early recognition of unstable patches and lead to appropriate medical treatment for patients with vitiligo.

Serial Assessment of Vitiligo Patches Results in Early Recognition

and joined the MJH Life Sciences team in April 2021. She graduated from Kent State University in 2018 with a bachelor's degree in journalism and a minor in sociology. Linda used to work as a creative writer for 

 and was a technical writer/regulatory specialist/purchasing agent at GM Industrial before coming on to the team. She enjoys reading, traveling, and learning new perspectives. You can reach her at 

POLL: How often do you treat hidradenitis suppurativa?

Dermavant has announced it has dosed the first patient in its phase 3 trial evaluating tapinarof cream for the treatment of moderate to severe atopic dermatitis.

Although JAK inhibitors have shown efficacy in treating challenging conditions, federal regulators continue their safety reviews.

Study: 730 nm Picosecond Laser for Treatment of Lentigines

A recent study delved into how well the 730 nm picosecond-domain laser could treat facial and non-facial lentigines in patients.

Image-Guided Superficial Radiotherapy for BCC and SCC

New study data shows positive data for Image-Guided Superficial Radiotherapy (IGSRT) in treating basal cell carcinoma and squamous cell carcinoma.

The organization is also calling on everyone to be vaccinated against the disease

Derm-Biome Announces Positive Preclinical Data in AD trials

Derm-Biome’s topical compounds have positive results in preclinical trial.

Jill Weibel, MD, discusses her recommendations on how to treat keloids and scaring using lasers in her presentation at the Skin of Color Update 2021.

The National Rosacea Society has recently released recommendations based on a group discussion regarding updates in rosacea.

ICYMI, some of this week’s featured content includes FDA warnings about JAK inhibitors, and articles about laser treatment for lentigines,  Image-Guided Superficial Radiotherapy for BCC and SCC, the risk of insomnia in vitiligo patients, plus more.

Weekly Roundup: September 13-17

 has offered new recommendations for physicians to pay closer attention to erythema in rosacea.

The article was based on a National Rosacea Society (NRS) discussion about this key symptom came up after the recently updated standard classification system, standard management options, new burden-of-illness study results, and significant advances in care. 

The discussion was led by Richard Gallo, MD, PhD, chair of dermatology at the University of California-San Diego, in San Diego, California, and included Hilary Baldwin, MD, associate professor of dermatology at Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Julie Harper, MD, president and owner of the Dermatology and Skin Care Center of Birmingham, Vestavia Hills, Alabama; and Linda Stein Gold, MD, director of dermatology clinical research at the Henry Ford Health System, Detroit, Michigan.

“Based on current scientific knowledge and clinical experience, rosacea is now classified as a single disorder with many potential phenotypes (signs and symptoms) that may occur in various combinations, with persistent facial erythema as the primary diagnostic sign,” said Gallo. “Combined with study results showing the substantial psychological and social impact of facial erythema alone, these important findings have clarified our understanding of how and why all signs and symptoms of rosacea should be effectively managed for optimal patient outcomes.”

If any of the two phenotypes are present (i.e. erythema, skin thickening, papules, pustules, flushing, telangiectasia, and certain ocular manifestations) they may be considered diagnostic, according to the article. The secondary phenotypes include burning, stinging, edema, and dryness.

According to the article, research has suggested that rosacea’s initial redness is likely because of inflammation, which can cause other issues, and medication to treat inflammation may be useful for treatment. Data collected in NRS surveys as well as in burden-of-illness studies showed that persistent facial redness, though often dismissed by physicians as a less serious phenotype, has a significant impact on sufferers’ quality of life, often comparable to the impact of eczema, atopic dermatitis and psoriasis.

, out of 1,675 patients diagnosed with rosacea, 82% of those who suffered from erythema reported the condition had a negative impact on their general outlook on life and it was 90% for those with moderate to severe redness.

The FDA has approved 2 therapies specifically for erythema caused by neurovascular dysregulation in rosacea, brimonidine and oxymetazoline, which are both alpha agonists. 

, while brimonidine does work relatively fast, within 30 minutes, some patients complain of over-whitening of the skin, and it has been noted that exacerbations of redness can occur. While on the other hand, oxymetazoline has a peak reduction of erythema at 3 hours, lasting through a 24-hour period then returning to baseline and the exacerbation of erythema was not reported.

A combination of therapies can be used to treat the different symptoms, such as anti-inflammatory treatments for redness around papules and pustules or light devices in removing telangiectasia and reducing erythema. The roundtable agreed that treatment the present phenotypes with target therapies would achieve the best outcome instead of using a singular method. They also emphasized educating the patient on compliance as avoiding triggers, regular treatment use, and lifestyle changes may be needed to properly treat the rosacea.

The roundtable was made possible by an educational grant from EPI Health.

1. New publication updates physicians on facial redness in rosacea. Rosacea.org. Published August 23, 2021. Accessed September 13, 2021. 

https://www.rosacea.org/blog/2021/august/new-publication-updates-physicians-on-facial-erythema-in-rosacea

2. New rosacea survey shows emotional toll of facial redness equals impact of bumps, pimples | rosacea. Org. Published January 15, 2015. Accessed September 14, 2021. 

https://www.rosacea.org/press/2014/january/new-rosacea-survey-shows-emotional-toll-of-facial-redness-equals-impact-of-bumps-pimples

3. Gallo RL, Baldwin HE, Stein Gold L, Harper JC. Update on Facial Erythema in Rosacea. J Drugs Dermatol 2021 Aug 1;20(8). Published online July 19, 2021. Accessed September 14, 2021. DOI:10.36849/JDD.6062

The National Rosacea Society has recently released recommendations based on a group discussion regarding updates in rosacea.  

New NRS Recommendations for Rosacea

Jill Weibel, MD, presented at the Skin of Color Update, held virtual September 10-12 on lasers and their uses for both scar and keloid treatment.1 Weibel is medical director and owner, Miami Dermatology and Laser Institute, subsection chief of dermatology, Baptist Hospital, medical director, Multidisciplinary Skin Cancer Clinic, Miami Cancer Institute, all in Miami Florida and 

She explained that scar formation is affected by the level of wound trauma, personal genetics, and location of scar. Keloids tend to form in the same location multiple times due to tension; however, Weibel said that the issue could be deeper than what it seems.

Although it is usually used for wrinkles, ablative fraction laser (AFL), according to Weibel, was the laser that changed the treatment world for scars. She says combination treatment is needed when choosing an approach, but the scar type determines the different combination therapies to use.

“The one thing that I almost always do with every scar patient I treat and every keloid patient I treat is laser assisted drug delivery,” Weibel said. She expanded on this, noting that when using a fractional ablative laser, columns open on the skin and these holes are open for about 48 hours. She said, most research suggests a physicians can inject FDA approved medication into a scar. Previously when she treated triplets, Weibel injected 1 of the triplets, resulting in the 1 patient healing 60% better than her other 2 sisters.

When treating hyperpigmentation, Weibel uses 1927 nm laser and AFL for treatment. For hypopigmentation, which she said is tough to treat, she said she can use a multitude of solutions, like a nonAFL (NAFL), AFL, AFL and bimatoprost, and CelluTome (KCI). When she uses bimatoprost, which is FDA approved to treat glaucoma, she injects immediately after the laser treatment then twice a day for a week, which repigments the skin.

For atrophic scars, the dermal depressions occur after a loss of dermal collagen and can represent a reconstruction challenge. Weibel’s solution is AFL with an after topical treatment of poly-L-lactic acid (PLLA) for both deep atrophic and thin skin atrophic scars. She reminds her patients that it does take 3 to 6 months for collagen remodeling.

For post inflammatory erythema (PIE) and post inflammatory hyperpigmentation (PIH), which she stated comes from acne which must be treated first. She treated a patient with a pulse dye laser, and while some inflammation remained, it stopped the spread.

When it comes to excessive scaring such as those created after surgery, the etiologies include location, hormones, genetics, chronic inflammation (acne), tension wound borders, and delayed epithelization. Weibel believes if a scar is less than 6 months old, it can be prevented, and they have to be treated gently and she tends to only use NAFL, and it works on all skin types.

For keloids, as the knowledge is still growing on how to treat them, Weibel explained that she never tells a patient it won’t come back after treatment. When treating keloids, she shaves off the keloid and then uses a laser, but never sutures as, in her experience, it makes the keloid come back worse than before. She uses is fractional laser and if the patient has not had surgery in that area before, she applies triamcinolone acetonide 10 mg. Weibel does not use a higher dose as it runs a risk of hyperpigmentation.

For burn and trauma scars, she can use multiple lasers. For a burn patient Weibel had, she used a 1550 nm laser and a 1927 nm NAFL and within 2 sessions the scarring looked more even. When doing these treatments, she works closely with reconstructive surgeons as they can work together to create the best treatment for the patient.

Not only cosmetic improvement can be made, but motion improvement can also be made according to Weibel and to keep in mind symptoms are sometimes what brings a patient in. She also learned that scars may be deeper than expected and have different depths are different levels.

“We have seen that the sooner you treat scars, and this is all scars, they melt away,” Weibel said. She stated laser treatments have a major role in trauma rehabilitation and give the physician power to heal patients and help alleviate suffering.

Jill Weibel, MD, has done clinical trials for AbbVie, ArgenX, Cytrellis, Eli Lilly and Company, Lumenis, Lutronics, Michelson Diagnostics, Novartis, Pfizer, RegenX, Sciton, Syneron/Candela, and UCB. She has been on advisory boards for Cytrellis, Dominion Aesthetic Technologies, Sciton. A speaker for Eli Lilly and Company, Loreal, Novartis, and Syneron/Candela. Equipment from Michelson Diagnostics. She also discusses FDA off label uses.

1. Weibel. J. Lasers As First Line of Therapy for Keloids and Other Scars - Pearls from the Expert. Presented at the: Skin of Color Update; September 10, 2021; Virtual.

Jill Weibel, MD, discusses her recommendations on how to treat keloids and scaring using lasers in her presentation at the Skin of Color Update 2021.  

Laser Therapy for Scars and Keloids

Derm-Biome Pharmaceuticals, Inc, a Vancouver-based biopharmaceutical company, today announced 2 of its topical treatments for atopic dermatitis (AD) had a great inhibitory effect in a well-established mouse model of the disease.

“Atopic dermatitis is an intensely itchy inflammatory skin disease that causes physical and psychological suffering in millions of people worldwide,” said Youwen Zhou, MD, PhD, professor of dermatology at the University of British Columbia, and directory of skin research program, Vancouver Coastal Health Research Institute, Canada. “The currently available therapies, including the most recent FDA approved drug, crisaborole, are unsatisfactory due to limitations in effectiveness or tolerability. Therefore, it is exciting to discover that several of Derm-Biome’s newly developed compounds far outperformed crisaborole in blocking the development of skin inflammation in a mouse model of atopic dermatitis. If confirmed in further experimental testing, these compounds hold strong potential to become the next generation of therapies for the treatment of atopic dermatitis.”

The Derm-Biome’s compounds were submitted for a US patent application titled COMPOSITIONS AND METHODS FOR TREATMENT OF INFLAMMATORY SKIN CONDITIONS that was filed on June 14, 2021, according to the release. 

CEO of Derm-Biome, Gordon Eberwin, Vancouver, Canada, said the company was excited over the results for the trial as they had decided to develop a new generation of novel derivatives to create more effective treatments. He stated that the company believes they have a commercially viable drug candidate.

“We are absolutely thrilled with the recent findings that our compounds are highly efficacious in a very well-established mouse model of atopic dermatitis,” said CSO of Bio-Derm, Poul Sorensen, MD, PhD, Vancouver, Canada. “As a biomedical researcher with a long-standing interest in molecular therapeutics, I can unequivocally say that these types of dramatic in vivo results are exceedingly rare.”

A Clinical Trial Application (CTA) is expected to be submitted to Health Canada by the first quarter of 2022. 

1. Derm-Biome Pharmaceuticals, Inc. reports positive results from a preclinical study in atopic dermatitis: its new generation of compounds are significantly more effective than FDA-approved topical AD drug crisaborole. BioSpace. Press release. Published September 16, 2021. Accessed September 16, 2021. 

https://www.biospace.com/article/derm-biome-pharmaceuticals-inc-reports-positive-results-from-a-preclinical-study-in-atopic-dermatitis-its-new-generation-of-compounds-are-significantly-more-effective-than-fda-approved-topical-ad-drug-crisaborole/

Derm-Biome’s topical compounds have positive results in preclinical trial. 