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according to the authors of a retrospective study.
Currently, there is a lack of consensus among physicians and health care organizations on how Demodex mites affect the development of rosacea. Many experts separate rosacea into two camps: PPR not caused by Demodex and rosacea-like demodicosis caused by Demodex.
During each evaluation session, each patient underwent two consecutive standardized skin surface biopsies (SSSBs), a small 1 square centimeter sample of the horny skin layer and the follicular content, on each cheek. The first sample, SSSB1, was a superficial sample, and SSSB2, the second sample, was a deep sample. The sum of the two samples, SSSB1+2, also was noted.
During the same session, patients had Demodex densities (Dds) measured. To avoid any confounding factors that could affect facial skin symptoms, Dr. Forton and Dr. de Maertelaer evaluated a subgroup of 132 patients who had not been treated in the previous 3 months and had no other facial dermatoses, such as acne vulgaris and seborrheic dermatitis.
The study revealed that, among the 242 patients in the primary analysis group, those with persistent erythema had higher Dds than did those without and the differences were statistically significant when comparing SSSB2 (208 D/cm2 vs. 130 D/cm2; P = 0.031) and SSB1+2 (298 D/cm2 vs. 191 D/cm2; P = 0.025), respectively.
This pattern of greater Dds density among patients with persistent erythema, compared with patients without, also held true among the subgroup of 132 patients who had not received any recent dermatological treatments, but the difference was not statistically significant. Nonetheless, patients with follicular scales did have greater SSSBs than did those without follicular scales.
As part of the study, Dr. Forton and Dr. de Maertelaer analyzed the findings of a case report of a 19-year-old woman who had a facial papulopustular eruption that had been present for 1 year. She had two SSSBs taken on each cheek: the right had follicular scales and papulopustules, and the left was clinically normal. This revealed that she had much higher Dds on the affected cheek than on the clinically normal one (108 and 216 D/cm2 vs. 12 and 20 D/cm2). She was subsequently diagnosed with rosacea-like demodicosis.
After treating the areas with acaricidal ointment, the symptoms improved. But 27 months after stopping maintenance treatments, the facial eruptions reappeared, and the papulopustules were larger than during her original consultation, leading to the diagnosis of PPR. This time, the Dds was high on both cheeks but responded to acaricidal treatment, which indicates that her eruptions were caused Demodex mites.
“All our observations, therefore, highlight the nosological confusion that persists between PPR and rosacea-like demodicosis and the need to update the consensus concerning the definition and classification of rosacea. Moreover, they suggest that PPR and rosacea-like demodicosis may be phenotypes of the same disease,” wrote Dr. Forton and Dr. de Maertelaer. “This concept is supported by our case report, with many features indicating that the second presentation was an evolution of the first.”
They cautioned that their research is not definitive but should provide strong evidence that PPR and rosacea-like demodicosis are the same disease.
“While our observations do not prove a causative role of Demodex in rosacea, they nevertheless support the idea that PPR and rosacea-like demodicosis should no longer be considered as two separate entities but, rather, as two phenotypes of the same disease,” they wrote. “As such, the definition of rosacea subtype II (PPR) should be reconsidered and simplified to include all patients with central face papulopustules – with or without persistent erythema – and thus also patients with ‘rosacea-like demodicosis,’ which is a term that should therefore disappear.”
This study received no external funding. Dr. Forton works for Galderma as a consultant. Dr. de Maertelaer had no conflicts of interest to declare.
SOURCE: Forton F et al. J Eur Acad Dermatol Venereol. 2018 Feb 25. doi: 10.1111/jdv.14885.
according to the authors of a retrospective study.
Currently, there is a lack of consensus among physicians and health care organizations on how Demodex mites affect the development of rosacea. Many experts separate rosacea into two camps: PPR not caused by Demodex and rosacea-like demodicosis caused by Demodex.
During each evaluation session, each patient underwent two consecutive standardized skin surface biopsies (SSSBs), a small 1 square centimeter sample of the horny skin layer and the follicular content, on each cheek. The first sample, SSSB1, was a superficial sample, and SSSB2, the second sample, was a deep sample. The sum of the two samples, SSSB1+2, also was noted.
During the same session, patients had Demodex densities (Dds) measured. To avoid any confounding factors that could affect facial skin symptoms, Dr. Forton and Dr. de Maertelaer evaluated a subgroup of 132 patients who had not been treated in the previous 3 months and had no other facial dermatoses, such as acne vulgaris and seborrheic dermatitis.
The study revealed that, among the 242 patients in the primary analysis group, those with persistent erythema had higher Dds than did those without and the differences were statistically significant when comparing SSSB2 (208 D/cm2 vs. 130 D/cm2; P = 0.031) and SSB1+2 (298 D/cm2 vs. 191 D/cm2; P = 0.025), respectively.
This pattern of greater Dds density among patients with persistent erythema, compared with patients without, also held true among the subgroup of 132 patients who had not received any recent dermatological treatments, but the difference was not statistically significant. Nonetheless, patients with follicular scales did have greater SSSBs than did those without follicular scales.
As part of the study, Dr. Forton and Dr. de Maertelaer analyzed the findings of a case report of a 19-year-old woman who had a facial papulopustular eruption that had been present for 1 year. She had two SSSBs taken on each cheek: the right had follicular scales and papulopustules, and the left was clinically normal. This revealed that she had much higher Dds on the affected cheek than on the clinically normal one (108 and 216 D/cm2 vs. 12 and 20 D/cm2). She was subsequently diagnosed with rosacea-like demodicosis.
After treating the areas with acaricidal ointment, the symptoms improved. But 27 months after stopping maintenance treatments, the facial eruptions reappeared, and the papulopustules were larger than during her original consultation, leading to the diagnosis of PPR. This time, the Dds was high on both cheeks but responded to acaricidal treatment, which indicates that her eruptions were caused Demodex mites.
“All our observations, therefore, highlight the nosological confusion that persists between PPR and rosacea-like demodicosis and the need to update the consensus concerning the definition and classification of rosacea. Moreover, they suggest that PPR and rosacea-like demodicosis may be phenotypes of the same disease,” wrote Dr. Forton and Dr. de Maertelaer. “This concept is supported by our case report, with many features indicating that the second presentation was an evolution of the first.”
They cautioned that their research is not definitive but should provide strong evidence that PPR and rosacea-like demodicosis are the same disease.
“While our observations do not prove a causative role of Demodex in rosacea, they nevertheless support the idea that PPR and rosacea-like demodicosis should no longer be considered as two separate entities but, rather, as two phenotypes of the same disease,” they wrote. “As such, the definition of rosacea subtype II (PPR) should be reconsidered and simplified to include all patients with central face papulopustules – with or without persistent erythema – and thus also patients with ‘rosacea-like demodicosis,’ which is a term that should therefore disappear.”
This study received no external funding. Dr. Forton works for Galderma as a consultant. Dr. de Maertelaer had no conflicts of interest to declare.
SOURCE: Forton F et al. J Eur Acad Dermatol Venereol. 2018 Feb 25. doi: 10.1111/jdv.14885.
according to the authors of a retrospective study.
Currently, there is a lack of consensus among physicians and health care organizations on how Demodex mites affect the development of rosacea. Many experts separate rosacea into two camps: PPR not caused by Demodex and rosacea-like demodicosis caused by Demodex.
During each evaluation session, each patient underwent two consecutive standardized skin surface biopsies (SSSBs), a small 1 square centimeter sample of the horny skin layer and the follicular content, on each cheek. The first sample, SSSB1, was a superficial sample, and SSSB2, the second sample, was a deep sample. The sum of the two samples, SSSB1+2, also was noted.
During the same session, patients had Demodex densities (Dds) measured. To avoid any confounding factors that could affect facial skin symptoms, Dr. Forton and Dr. de Maertelaer evaluated a subgroup of 132 patients who had not been treated in the previous 3 months and had no other facial dermatoses, such as acne vulgaris and seborrheic dermatitis.
The study revealed that, among the 242 patients in the primary analysis group, those with persistent erythema had higher Dds than did those without and the differences were statistically significant when comparing SSSB2 (208 D/cm2 vs. 130 D/cm2; P = 0.031) and SSB1+2 (298 D/cm2 vs. 191 D/cm2; P = 0.025), respectively.
This pattern of greater Dds density among patients with persistent erythema, compared with patients without, also held true among the subgroup of 132 patients who had not received any recent dermatological treatments, but the difference was not statistically significant. Nonetheless, patients with follicular scales did have greater SSSBs than did those without follicular scales.
As part of the study, Dr. Forton and Dr. de Maertelaer analyzed the findings of a case report of a 19-year-old woman who had a facial papulopustular eruption that had been present for 1 year. She had two SSSBs taken on each cheek: the right had follicular scales and papulopustules, and the left was clinically normal. This revealed that she had much higher Dds on the affected cheek than on the clinically normal one (108 and 216 D/cm2 vs. 12 and 20 D/cm2). She was subsequently diagnosed with rosacea-like demodicosis.
After treating the areas with acaricidal ointment, the symptoms improved. But 27 months after stopping maintenance treatments, the facial eruptions reappeared, and the papulopustules were larger than during her original consultation, leading to the diagnosis of PPR. This time, the Dds was high on both cheeks but responded to acaricidal treatment, which indicates that her eruptions were caused Demodex mites.
“All our observations, therefore, highlight the nosological confusion that persists between PPR and rosacea-like demodicosis and the need to update the consensus concerning the definition and classification of rosacea. Moreover, they suggest that PPR and rosacea-like demodicosis may be phenotypes of the same disease,” wrote Dr. Forton and Dr. de Maertelaer. “This concept is supported by our case report, with many features indicating that the second presentation was an evolution of the first.”
They cautioned that their research is not definitive but should provide strong evidence that PPR and rosacea-like demodicosis are the same disease.
“While our observations do not prove a causative role of Demodex in rosacea, they nevertheless support the idea that PPR and rosacea-like demodicosis should no longer be considered as two separate entities but, rather, as two phenotypes of the same disease,” they wrote. “As such, the definition of rosacea subtype II (PPR) should be reconsidered and simplified to include all patients with central face papulopustules – with or without persistent erythema – and thus also patients with ‘rosacea-like demodicosis,’ which is a term that should therefore disappear.”
This study received no external funding. Dr. Forton works for Galderma as a consultant. Dr. de Maertelaer had no conflicts of interest to declare.
SOURCE: Forton F et al. J Eur Acad Dermatol Venereol. 2018 Feb 25. doi: 10.1111/jdv.14885.
FROM THE JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY
Key clinical point: Demodex densities were greater in patients with persistent erythema than in those without.
Major finding: Deep tissue samples showed higher mite densities in patients with persistent erythema than in those without (SSSB2: 208 D/cm2 and 130 D/cm2; P = 0.031).
Study details: A retrospective, observational, case-control study of 242 patients with central face papulopustules.
Disclosures: This study received no external funding. Dr. Forton works for Galderma as a consultant. Dr. de Maertelaer has no conflicts of interest to declare.
Source: Forton F et al. J Eur Acad Dermatol Venereol. 2018 Feb 25. doi: 10.1111/jdv.14885.