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FA L L C L I N I C A L D E R M AT O L O G Y C O N F E R E N C E P R O C E E D I N G S
FIGURE 1. DEMODEX DERMATITIS: AT BASELINE (LEFT) AND AFTER 2 WEEKS OF TREATMENT WITH PER-
METHRIN TWICE DAILY (RIGHT).
BASELINE
AFTER 2 WEEKS
U S U A L THERAPIES FOR ROSACEA
van Zuuren et al 1 conducted a literature review of 71 randomized,
controlled studies of rosacea therapy. Of the 71
studies, 29 met their inclusion criteria, but the quality in general
of these studies was not considered very good. The
conclusions were that topical metronidazole and azelaic acid
a re effective therapies for rosacea. There was some evidence
that oral metronidazole and tetracycline including
doxycycline and minocycline are effective, but the take-away
message was that there is a great need for randomized, cont
rolled trials examining the efficacy of present medications for
the treatment of ro s a c e a .
Del Rosso et al 2 conducted two such randomized, Phase
III clinical trials evaluating the anti-inflammatory doxycycline
40 mg a day administered once daily for the treatment of
rosacea. They concluded that once-daily anti-inflammatory
dose doxycycline appears to be effective and safe for the
t reatment of ro s a c e a .
U N U S U A L T R E ATMENTS FOR ROSACEA
Skin care. The skin of the rosacea patient can be either oily
or dry. Certainly, it can be extremely sensitive in some cases.
There can be altered cutaneous vascular reactivity and, most
importantly, skin barrier dysfunction, which is defined as
increased transepidermal water loss, increased susceptibility
to irritants, allergens and pathogens, and increased skin
inflammation through cytokine-mediated lipogenesis.
Skin barrier dysfunction exists in most inflammatory diseases,
including atopic dermatitis, psoriasis, acne and aged,
actinicly damaged skin. The stratum corneum is a “bricks” and
“mortar” structure. Corneocytes are the bricks, and sitting
between the corneocytes is the mortar, the lipid matrix, which
has a certain constitution that needs to be re s t o red. Ceramides
a re most important, constituting about 40% to 50% of the lipid
matrix. In addition to the ceramides, the lipid matrix contains
f ree sterols and free fatty acid. There are also lipid bilayers,
which become a moisture barrier for the stratum corn e u m .
S U P P L E M E N T T O S K I N & A G I N G • M A R C H 2 0 0 8 • 9