Rosacea

WEDNESDAY, Sept. 3, 2025 (HealthDay News) -- A holistic approach is needed for treatment of <a href="/conditions/rosacea" target="_blank" rel="noopener noreferrer">rosacea</a> during pregnancy due to emotional distress experienced by patients and possible physical harm to their babies, according to a review published in the July issue of SKIN.Emily Garelick, from the Philadelphia College of Osteopathic Medicine, and colleagues conducted a systematic review to examine rosacea treatment during pregnancy. Twenty studies with 230 patients who presented with rosacea fulminans or rosacea-associated edema were included in the review.The researchers found that antibiotics, steroids, topical antiseptic, wet compresses, and osteopathic manipulative treatment (OMT) were included as treatment options. Complications among pregnant patients included ocular perforation, corneal transplant, fetal arrhythmia, oligohydramnios, and intrauterine death. Due to rosacea-related anxiety and depression, some patients elected for termination of pregnancy."This systematic review supports the use of a multifaceted treatment approach, combining pregnancy-safe medications with holistic strategies such as OMT," the authors write. "While many pharmaceutical agents offer therapeutic benefits, the potential for fetal risk requires caution."<a target="_blank" rel="noopener noreferrer" href="https://skin.dermsquared.com/skin/article/view/3167">Abstract/Full Text</a>

Patients face emotional distress and their babies may have physical harm from treatment

Holistic Approach Recommended for Rosacea in Pregnancy

TUESDAY, Nov. 12, 2024 (HealthDay News) -- The U.S. Food and Drug Administration has approved Emrosi (minocycline hydrochloride) for the treatment of inflammatory rosacea in adults.The extended-release capsules (40 mg) will be available late in the first quarter or early in the second quarter of 2025.The approval was based on positive results from two 16-week phase 3 clinical trials, during which Emrosi met all coprimary and secondary end points and showed significant superiority over both the current standard-of-care treatment (Oracea) and placebo for Investigator’s Global Assessment treatment success as well as reduction in total inflammatory lesion count. Additionally, participants experienced no significant safety issues."Rosacea is a difficult to treat skin condition, and based on the favorable results from our phase 3 clinical trials, Emrosi has potential to become the best-in-class oral medication to treat the condition," Claude Maraoui, the cofounder, president, and CEO of Journey Medical, said in a statement. "Our seasoned dermatology-focused sales force is now preparing for a successful launch and to establish Emrosi as a new standard of care in the treatment of rosacea."The approval of Emrosi was granted to Journey Medical.<a target="_blank" rel="noopener noreferrer" href="https://ir.journeymedicalcorp.com/new-events/press-releases/detail/75/journey-medical-corporation-announces-u-s-fda-approval-of">More Information</a>

Phase 3 trials show significant reduction in total lesion count versus Oracea and placebo

FDA Approves Emrosi for Rosacea in Adults

<div class="raw-html-embed"> <mux-player playback-id="6QM4ivz01OmW01mnfoLryOAoxvb7VFV51I5VPTNDCV4YE" env-key="ENV_KEY" metadata-video-title="Launch Alert: FDA Approves Emrosi for Inflammatory Lesions of Rosacea " controls=""></mux-player>
</div>James Del Rosso, DO, provides an overview of Emrosi for inflammatory lesions of rosacea, including clinical trial outcomes, safety, dosing, and more.&nbsp;Journey Medical Corporation has announced US FDA has approval of Emrosi (Minocycline Hydrochloride Extended Release Capsules, 40 mg, previously known as DFD-29, for the treatment of inflammatory lesions (papules and pustules) of rosacea in adults. The approval marks the first oral formulation of minocycline for the treatment of rosacea.&nbsp;Clinical trial insights&nbsp;The approval follows positive results from two pivotal Phase 3 clinical trials, MVOR-1 (NCT05296629) and MVOR-2 (NCT05343455). Both trials were designed as double-blind, placebo-controlled studies evaluating low-dose minocycline in comparison to low-dose modified-release doxycycline and placebo over a 16-week period. Participants presented with 15 to 60 inflammatory lesions at baseline.&nbsp;The trials assessed the following coprimary endpoints:&nbsp;<ul><li>Investigator’s Global Assessment (IGA) success, with patients achieving a clear or almost clear status with at least a 2-grade improvement over placebo&nbsp;</li><li>Total inflammatory lesion count reduction compared to placebo&nbsp;</li></ul>Secondary endpoints encompassed:&nbsp;<ul><li>Percentage change in total inflammatory lesion count compared to placebo&nbsp;</li><li>IGA treatment success in comparison to modified-release doxycycline&nbsp;</li><li>Reduction in total inflammatory lesion count relative to doxycycline&nbsp;</li><li>Clinician’s Erythema Assessment compared to placebo&nbsp;</li><li>Dermatology Quality of Life Index score changes from baseline versus placebo&nbsp;</li></ul>Both trials met all coprimary and secondary endpoints, with patients in the Emrosi group demonstrating statistically significant superiority over both modified-release doxycycline and placebo with no significant safety issues.&nbsp;Safety profile&nbsp;The most common adverse reaction reported by ≥1% of patients treated with Emrosi, at a greater frequency than those receiving placebo, was dyspepsia. Emrosi is contraindicated for patients who have a history of hypersensitivity to any of the tetracyclines.&nbsp;Future outlook&nbsp;Journey Medical is finalizing the manufacturing process for Emrosi in the US, with an anticipated product launch and initial supply availability projected for late in the first quarter or early in the second quarter of 2025.

The approval marks the first oral minocycline formulation for the papules and pustules characteristic of the condition

Launch Alert: FDA Approves Emrosi for Inflammatory Lesions of Rosacea 

WEDNESDAY, April 17, 2024 (HealthDay News) -- The anticalcitonin gene-related peptide-receptor monoclonal antibody erenumab is effective and safe for treatment of rosacea-associated erythema and flushing, according to a study published online April 17 in JAMA Dermatology.Nita K.F. Wienholtz, M.D., Ph.D., from Copenhagen University Hospital-Rigshospitalet in Denmark, and colleagues examined the effectiveness, tolerability, and safety of erenumab for treatment of rosacea-associated erythema and flushing in a single-center, nonrandomized trial involving adults with rosacea with at least 15 days of moderate-to-severe erythema and/or moderate-to-extreme flushing. Participants received 140 mg erenumab subcutaneously every four weeks for a period of 12 weeks; safety was assessed at week 20.Thirty participants were included; 27 completed the study. The researchers observed a reduction of −6.9 days in the mean number of days with moderate-to-extreme flushing, from 23.6 days at baseline. For moderate-to-severe erythema, the mean number of days was reduced by −8.1 from 15.2 at baseline. Adverse events included transient mild-to-moderate constipation, transient worsening of flushing, bloating, and upper respiratory tract infection (33, 13, 10, and 10 percent, respectively). One participant discontinued the study due to a serious adverse event, deemed unrelated to the study, and two withdrew consent due to time constraints."The results also suggest that erenumab is generally well tolerated, with mild and/or transient adverse effects," the authors write. "Larger randomized, controlled, double-blind studies are necessary to confirm these findings and to investigate the long-term effects of erenumab treatment."Several authors disclosed ties to pharmaceutical companies, including Novartis Pharma, which funded the study.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2817738">Abstract/Full Text (subscription or payment may be required)</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2817742">Editor's Note (subscription or payment may be required)</a>

Reduction seen in mean number of days with moderate-to-extreme flushing, moderate-to-severe erythema

Erenumab Effective, Safe for Rosacea-Linked Erythema, Flushing

WEDNESDAY, May 17, 2023 -- For patients with persistent facial erythema of rosacea, oxymetazoline is effective, according to research published online May 2 in the Journal of Cosmetic Dermatology.Fei Liu, from the Jinhua People's Hospital in China, and colleagues conducted a meta-analysis to examine the efficacy and safety of oxymetazoline. Seven studies with 3,934 patients randomly assigned to receive oxymetazoline or vehicle were included in the meta-analysis.The researchers found that the three-, six-, nine-, and 12-hour Clinician Erythema Assessment success rates (relative risk [RR], 1.76, 1.71, 1.63, and 1.41, respectively) and three-, six-, nine-, and 12-hour Subject Self-Assessment for rosacea facial redness success rates (RR, 1.65, 1.75, 1.63, and 1.78, respectively) were significantly higher after oxymetazoline treatment versus vehicle in the pooled results. In addition, the incidence of treatment-emergent adverse events was significantly higher after treatment with oxymetazoline versus vehicle in pooled results (RR, 1.34). In an analysis of specific adverse events, only the incidence of application-site dermatitis was significantly higher in the oxymetazoline versus vehicle group (RR, 8.91), while no significant difference was seen in the incidence of other adverse events."These findings demonstrate that the efficacy of oxymetazoline is reproducible, suggesting that dermatologists may perceive greater improvement with treatment of persistent facial erythema of rosacea," the authors write.

Clinician Erythema Assessment success rate significantly higher after oxymetazoline treatment versus vehicle

Is Oxymetazoline Effective for Persistent Facial Erythema of Rosacea?

For women with rosacea, clinical characteristics, influencing factors, and systemic diseases differ with age of diagnosis, according to a study published online Oct. 13 in the
 
 Journal of
 
 
 Cosmetic Dermatology
 
 .




 Fengjuan Yang, from West China Hospital at Sichuan University in Chengdu, China, and colleagues examined and compared the clinical characteristics of female patients with rosacea in different age groups in a retrospective study of 840 patients. Patients were categorized according to age at diagnosis: 30 years or younger, 31 to 44 years, and 45 years or older.




 The researchers found that common symptoms among the cohort included telangiectasia, persistent erythema, burning/stinging sensation, dry sensation, and pruritus (82.6, 82.0, 89.3, 74.0, and 41.9 percent, respectively). Common aggravating factors included hot temperature, emotional changes, spicy food, and sun exposure (89.9, 67.3, 55.6, and 50.7 percent, respectively). Overall, 20.4 percent of the patients had comorbidities of systemic disorders. A total of 48.8 and 35.2 percent of patients presented with anxiety and depression, respectively. Among the different age groups, the clinical characteristics differed significantly. The likelihood of having more serious persistent erythema and telangiectasia was increased for middle-aged and older patients (aged 45 years or older), and they were less affected by some influencing factors. These patients also had more systemic diseases of the digestive system, endocrine metabolic system, and cardiovascular system.




 "The clinical characteristics of rosacea are more complex and more difficult to treat in females over the age of 45," the authors write. "Personalized comprehensive therapy should be given according to the clinical characteristics of the different age groups."




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Patients aged 45 years or older at diagnosis more likely to have serious persistent erythema and telangiectasia

Do Clinical Characteristics of Rosacea in Women Differ With Age?

A 12-week topical treatment regimen for facial redness and sensitive skin calms inflamed skin and is well-tolerated, according to a study published online May 31 in the Journal of Cosmetic Dermatology.

 Ellen O. Turner, M.D., from the Dermatology Office in Dallas, conducted a 12-week, open-label clinical trial to examine the efficacy and tolerability of a topical facial regimen for treating facial redness and sensitive skin. Healthy men and women, aged 25 to 60 years, with Fitzpatrick skin types I to VI, who were seeking treatment for moderate or severe facial redness were enrolled. Products were provided that were applied each morning and evening.

 Turner found that at weeks eight and 12, the mean Overall Redness Scale Score improved by 34 and 25 percent, respectively. Mild or moderate improvement was seen in Global Improvement Scale scores starting in week two; by week 12, more than 50 percent achieved marked improvement. All subjects agreed or strongly agreed that by week 12 their facial redness was less noticeable, their skin seemed less inflamed, there was improvement in overall skin appearance, and their skin looked and felt healthier. The treatment regimen was well tolerated.




 "The results of this 12-week study indicated a treatment regimen designed to neutralize skin redness, calm inflamed skin, and provide sunscreen protection was well-tolerated and improved the visible and physical symptoms of sensitive skin," Turner writes.




 The research was funded by Colorescience, the manufacturer of the products used in the study.




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Skin seemed less inflamed, improvement seen in overall skin appearance, and skin looked and felt healthier

Twelve-Week Treatment Regimen Reduces Facial Redness

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Dallas/Fort Worth–based dermatologist Todd Plott, MD, for an in-depth discussion on the first extended-release formulation of minocycline approved for rosacea.The conversation begins with a historical look at tetracyclines, tracing back to tetracycline in 1953, doxycycline in 1968, and minocycline in 1971. While traditionally used as broad-spectrum antibiotics, these agents have shown efficacy in rosacea primarily due to their anti-inflammatory activity rather than antimicrobial effects.They review head-to-head clinical data showing that extended-release minocycline, commercially available as Emrosi, significantly reduced inflammatory lesions and improved Investigator Global Assessment scores in patients with moderate-to-severe rosacea, outperforming both modified-release doxycycline and placebo. The trial population averaged 25 papules per patient, demonstrating the robust improvement required for trial success.A key point of discussion is minocycline’s narrow therapeutic window. While higher doses have raised concerns about adverse effects such as hyperpigmentation and lupus-like drug reactions, pharmacokinetic data show that extended-release dosing achieves lower systemic exposure with fewer safety issues compared to immediate-release formulations. Dr. Plott contextualizes this by noting that dermatology indications require far lower doses than in infectious disease, which helps explain the rationale for the extended-release formulation in rosacea.Tune in to the full episode to learn more about how extended-release minocycline and anti-inflammatory dosing fit into current rosacea treatment options, what the latest evidence shows about its efficacy and safety, and how clinicians can gain refreshed perspectives on this long-standing therapy.

Derms and Conditions Podcast

Oral Tetracyclines for Rosacea: Previous and Newer Therapies

In episode 61 of Derms and Conditions, our host, James Q. Del Rosso, DO, presents a self-made episode where he clarifies key points on many therapies relevant to everyday clinical practice. First, he discusses topical alpha-agonist therapy for persistent facial erythema (PFE) of rosacea. Long-term data shows that daily use of either topical oxymetazoline or brimonidine appears to “reset” (lower) the baseline level of PFE in patients with rosacea.

In episode 61 of Derms and Conditions, our host, James Q. Del Rosso, DO, presents a self-made episode where he clarifies key points on many therapies relevant to everyday clinical practice. First, he discusses topical alpha-agonist therapy for persistent facial erythema (PFE) of rosacea. Long-term data shows that daily use of either topical oxymetazoline or brimonidine appears to “reset” (lower) the baseline level of PFE in patients with rosacea.Next, he talks about subantibiotic dosing of doxycycline and how its anti-inflammatory properties, including support of the dermal matrix, can be used for the treatment of rosacea. He notes that studies have demonstrated reduced antibiotic selection pressure with decreased emergence of antibiotic-resistant bacterial strains with this therapeutic approach. Additionally, monotherapy with subantibiotic dose doxycycline used as maintenance treatment has been shown to be effective in reducing relapse of papulopustular rosacea (PPR), an approach that is appealing to those patients who do not prefer or are not compliant with topical therapy. Dr Del Rosso then mentions sarecycline, a narrow-spectrum tetracycline FDA approved for the treatment of acne in patients &gt;9 years of age, which has also been shown in a large pilot study to be effective for PPR. Microbiological data demonstrates that the narrow antibiotic spectrum of sarecycline spares activity against many strains of bacteria, especially gram-negative organisms that inhabit the GI tract.He then transitions to hidradenitis suppurativa (HS) and the welcome emergence of IL-17 inhibitors for HS, which are very effective based on study results to date. Dr Del Rosso stresses the importance of early consideration of biologic therapies (such as anti-IL agents) for HS, as this disease progresses below the skin surface with eventual development of sinus tracts and scarring. If we wait until we “see” these consequences, it is too late as they have already occurred. FDA approvals and published guidelines typically depend on visibly seeing the clinical manifestation before a specific therapy is recommended, which is not early enough in many cases.He finishes with a discussion on dupilumab for the treatment of atopic dermatitis, which is often remarkably effective but at times may be limited by partial efficacy or side effects such as conjunctivitis and facial erythema. Dr Del Rosso discusses practical use of JAK inhibitors such as abrocitinib and upadacitinib for AD in dupilumab “nonresponders” and also case reports with tralokinumab, a monoclonal antibody targeting IL-13. Tune in to this episode to learn more!

Once Is Not Enough: Round 2 on Therapeutic Insights

You're listening to the Derms and Conditions podcast. So I'm Dr. Jim Dolasso, a dermatologist in Las Vegas, Nevada. And one of my wishes is that all of you find the Derms and Condition podcast that we've been doing. Now, we're into our third season, a third year, that you're finding them beneficial, and that's really important to me and to the team that puts them together. So we hope that they have been, we hear that they are, and we hope that that continues today. I'm going to be bringing you an episode where I'm flying solo periodically. I do that after hearing a lot of information from different people at meetings, reading, talking to people on these podcasts. A lot of things come to mind, and I really want to focus on some therapies that I think there's some information that's important that you may or may not be familiar with. And one of these is the use of alpha agonists. Topical alpha agonists. We have two. We have topical bromonidine and topical oximetazoline. There are some differences between the two of them in terms of the subalpha receptors that they interact with, but the bottom line is they're designed to reduce the persistent facial erythema that's due to the dilated vasculature, right. Not related specifically to the redness from papules and pustules. But there's an important aspect to the use of alpha agonists, which are applied each day and over a period of time. Usually, they'll kick in within an hour to a couple of hours, and you'll have the decrease in the persistent facial erythema that will usually go for a good 1012 hours or longer, but then it comes back and you have to apply the medication the next day. Both of these agents were studied being applied once a day. An important factor that really wasn't a primary endpoint, but was something that was observed over a year's use with either agent, topical vermontidine, or topical oximetazzoline, and the solutions that are designed for use on the skin. The solution of the cream designed for use on the skin is that if you look at the baseline erythema, that diffuse persistent facial erythema in the very beginning, before the start of the study, and you look at it on the last day, after 52 weeks, the baseline before they treated on that last day, overall, the magnitude, the severity of that baseline erythema goes down across the group that's treated in the study. So there's some sense that you're resetting with the continued use of the topical alpha agonists every day and that vasoconstriction that you're allowing to occur with their use, that you reset the baseline of the amount of erythema they have each morning when they wake up before they utilize the medication. And that's a very important concept because hopefully we're resetting or we're having influence on the disease progression because a lot of people will use these agents. Prn only when I'm going out and I don't want to look as red, but I think it's really important if you're really trying to treat all the different manifestations of rosacea, that component of it, to utilize an alpha agonist every day and hopefully see over time that that baseline redness diminishes. Another area that I think is important to differentiate when we talk about antibiotic use and we hear about antibiotic stewardship and antibiotic resistance, and to some dermatologists it's like, I don't really know that it's something that I see or that I'm that concerned with. Others understand it when we have a patient use a topical antibiotic or a systemic, usually we're using an oral antibiotic, you're going to have a selection of agents of bacteria that are responsive because they're more sensitive to that antibiotic. So ones that are less sensitive are going to emerge and you have selection pressure leading to the emergence of resistant strains. And then you can have some other mechanisms whereby continued exposure can select out some resistant organisms. So there are two concepts that have been discussed. One is anti inflammatory dose doxycycline was what it was initially called, but now we call it sub antibiotic dose doxycycline, which is FDA approved for papules and puffels of rosacea. And initially it was a 20 milligram twice a day of an immediate release doxycycline and then eventually the modified release to 40 milligrams once a day became FDA approved specifically for rosacea, papules and pustules of rosacea. Keeping in mind that this therapy was initially developed, the original brand product was called periostat because it was for periodontal disease. We know that when you give tetracyclines and certainly with doxycycline, you have some antiinflammatory effects that are unrelated to their antibiotic effect. And one of those effects is to inhibit collagen breakdown. And that was noted in the gum tissue, the gingiva of individuals. And it was developed to try to assist in preventing breakdown of collagen of the gingiva. Right. And that's where it started. And then noticed by some individuals that people that had rosacea, papules and pustules, that improved. So this therapy eventually got into dermatology. So now, looking at the sub antibiotic dosing, there were a variety of studies done out of stony Brook by Dr. Gollop, where he looked at several different analyses to look at the anti inflammatory effects and found a breakpoint with doxycycline that he wasn't able to find effectively with the other tetracyclines. Right. And there's a dose below which you're not getting what's felt to be significant antibiotic activity. It's not necessarily zero, but you don't see the progressive emergence of several different, in this case, doxycycline resistant strains, but you do see the antiinflammatory effect being sustained. And that has been proven for papillopustular rosacea, with particularly that 40 milligram modified release doxycycline. Studies that were done over a prolonged period of time showed that there was no what was believed to be relevant or any significant emergence of resistant bacteria. Right. That were tested in the mouth, tested in the GI tract, tested in the vaginal flora, on the skin. So that's where the idea of giving something that can help reduce papules and pustules of rosacea and get around selection of resistant bacteria came to light. And I still think that is very important. And there is data on long term treatment, of utilizing only that particular therapy to try to maintain control of papillopusteurization without a topical agent. Now, that sounds like heresy, but there are some people that do better with taking one capsule a day, for example, than necessarily utilizing a topical agent regularly. So you do have that option, and I think you can feel comfortable that you are obviating the emergence of resistant bacteria to a significant degree. Now, there's also a concept, and there's a lot of data to support that, quite frankly, several references. There's also the concept of narrow spectrum tetracyclines with the development of saracycline. And that's really the only new agent that we've had come to light was FDA approved on a weight based dosing with saracycline, oral saracycline patients with acne vulgaris down to the age of nine. Right, nine years of age. And looking at it from a microbiologic perspective, it's narrow spectrum as compared to doxycycline and minocycline, which are approved as antibiotics for the treatment of a variety of different infections. Right. And so these are agents that have a broad spectrum of antibiotic activity. They're certainly used for acne and sometimes for rosacea outside of the FDA approved minocycline, which is an extended release minocycline, or the sub antibiotic dose doxycycline. Other than that, they are grandparented in for acne. They never receive formal approval based on large scale studies and phase three studies, but they're so widespread in their use and they're accepted as a standard care. But when you give someone immediate release doxycycline at an antibiotic dose, which is typically thought of as more than 50 milligrams a day, or minocycline in a formulation that's not one of the extended release formulations, you are going to get emergence of resistant bacteria. And it's not necessarily selective. It doesn't spare a lot of gram negatives or gram positives. It's very broad spectrum. Saracycline is narrow spectrum. It's still antibiotic, but its activity is primarily against gram positive organisms. So that would be the c acnes, which used to be p acnes that were targeting in acne. Because it's only approved for acne, it's not approved as an antibiotic. It was only evaluated for acne, just like extended release minocycline was. Right. But it spares gram negatives significantly. And that's based on mic evaluations and some other studies that were done looking at microbiologic profiles, where if you give serocycline, it spares gram negatives, it spares also several different anaerobes. Right. And so the GI tract microbiome is felt to be spared with saracycline, at least based on the mics, which is something that's important because we don't want to disturb any microbiome, especially the GI tract. Now, there are data with other antibiotics like quinolones, extended activity, penicillins, minocycline, et cetera, where when you give these antibiotics and you get resistant organisms in the GI tract, they can persist after the antibiotic is stopped, even azithromycin. This has been shown in some compartments. You have those resistant organisms persisting for several months to even years. So that's the basis of saracycline being a narrow spectrum tetracycline agent. So that is a differentiating feature and something to consider though we do need more data, we do need longitudinal data. The other thing I want to discuss is hydratinitis separativa is a disease that, for years, when I saw it, except when there were milder cases that tended not to seemingly be progressing and becoming more severe. And I can control them with intralesional triumphsinolone injection and chronic antibiotic therapy, et cetera. When patients came in and they had any significant disease, it was heartbreaking. And the struggle was, I was having difficulty really helping these people. They're in pain. They get scarred down in areas. It's in the axilla, it's in the groin. Sometimes it's on below the breasts. Right. And it could even be more diffuse, and it's very, very difficult to treat. It was heartbreaking, and a lot of times I felt like I really wasn't helping patients very much with the advent of anti tnf agents, like we've had out of limumab, but now we have anti IL 17 agents that are knocking at the door for approval, FDA approval, that, based on the data, to me, look very significantly effective for hydratinitis separativa. But my concern is with any of these agents, that we get FDA approval and we understand their use overall. They're very, very safe. They have some considerations. They are expensive treatments. They clearly are so much better than anything we've had before in really improving the disease and significantly suppressing the disease. Now, my concern is the way guidelines are written, and if you look with hydratinitis, when they're talking about Hurley stages, Hurley stage two of the three stages, you're already seeing scar formation, and with hydratinitis, you're looking at the skin. It could look normal at the surface, or you may see some older lesions that have resolved, some pigmentation, et cetera. You don't know what's going on under the surface until the volcano erupts. And at that point, it's likely too late. They already have some scar formation and some sinus tract formation, and you can certainly see that in some cases, especially if they've had the disease over a period of time. My concern is that guidelines, typically for diseases, typically wait until you see the problem before you initiate the patient. When you have a disease like hydratinitis suprativa, that causes sinus tracts and scarring, I don't want to wait till I see that problem, because the horse is already out of the barn and running way in the distance away from when you can close that door. So I think we're going to have to pay a lot of attention, especially as more agents come along, like we have with the anti IL 17s. Right. That we really need to be looking at initiating therapy earlier so we can look at suppressing the disease to get it under control and sustaining the control of the disease, much like we're doing now with biologics for psoriasis and even atopic dermatitis. We're not only treating that peak of the roller coaster ride, we're treating that disease that's really there every day. It may be what lies beneath or what is less active, but it's something that they have every day of their life. So we're not only controlling flares, we're actually treating the disease itself. My concern is still a lot of these patients are going to get the therapy too late because the guidelines are going to be written in that way, or the FDA approved prescribing information is going to be written that way, and there's going to be pushback on earlier prescribing. So that is a concern I have, I think especially hedridinitis, because it does scar, it does lead to a lot of pain, does lead to sinus tracts. Early treatment is even more important, I think, with that particular disease. So I do want to end with a discussion of a topic that we hear a lot about. We hear a lot about atopic dermatitis, for example. And if patients are not adequately controlled with topical therapies, prescription topical therapies, or previously used agents that they may have used even if they were some of the older immunosuppressive agents, like cyclosporin, methotrexate or corticosteroids, intermittently, that it's time to think about utilizing a monoclonal antibody. Right. One of the ones we have, like topiliumab, now we have trollachinumab, leprechiziamab is knocking on the door, or one of the Janus kinase inhibitors that we have, like abracitinib or upaticitinib. Right? And here we have agents that really have dramatically improved the quality of life of these patients that have very severe itching, extensive disease. Been on that roller coaster, that frustrating roller coaster, getting to the point of utilizing too much systemic corticosteroid or just can't use enough topical corticosteroid. Right. Because of limitations on how long you can prescribe it over to wide body surface areas. Even newer non steroidal agents that we have going to be limited to some extent by the body surface area that they can cover. Right. So now we're going to these systemic agents. But we often hear about with depiliumab because it's been around for six years, right. And we've had it. And it significantly helps many of the patients approve down to six months of age. Right. So it has a tremendously successful track record of success and overall very good safety. But we do have some patients that occasionally may have problems with it. Maybe they get some form of diffuse erythema or the red face that we do see some cases of that that become difficult or conjunctivitis that isn't mild or doesn't diminish with time or is difficult to adequately control, fortunately uncommon. But we see these situations, cutaneous eruptions or they're just not responding adequately based on the clinician or the patient's complaint about the symptoms that they have, moving them on to something else. And that's where the Janus kinase inhibitors have really become a part of the conversation. Now, they can certainly be used, those agents can be used in patients that didn't necessarily previously utilize a biologic, that's based on individual assessment and discussion with the patient of the benefits of those drugs, working very fast, having what looks like the highest efficacy data, with the higher doses of those agents especially. So they certainly have a definitive place and they do shut down itching very, very rapidly and successfully. There are data with both upaticitinib and abracitinib that in patients that had been treated with depiliumab, that if they have had an incomplete response or some other difficulty and they're switched to one of the Janus kinase inhibitors, that they'll get an incremental improvement in their response. So there's certainly data to support that. However, what's not talked about is if you have a patient, let's say that's using depiliumab and one of those situations comes up, can you switch that patient now to trallicinumab? Now trallicinumab is an anti IL 13, where dupiliumab is anti Il four and antio 13. And that does seem to correlate with some differences, maybe sometimes the efficacy, but even sometimes some of the reactions that patients may have right now, anti IL 13 is certainly effective in atopic dermatitis. And we now have a collection of case reports that appearing in the literature in patients that for whatever reason depiliumab was no longer being used, or some cases where they develop problematic conjunctivitis, where when they were switched to trallicinumab, they were successfully treated in terms of efficacy and did not have the conjunctivitis that they had with depiliumab. Now trallicinumab, in the studies there can be conjunctivitis, but it's not necessarily going to be those same patients. There are a collection of case reports that show that. So that gives us another option that we need to look at more. Even if they started in trolicinumab and they didn't have an adequate response, switching them, or if they got conjunctivitis, switching them to depiliumab, and I've not seen cases of that reported, but that may be a potential option or the option of Janus kinase inhibitors. So my take home point is we really have to have an open mind because we're going to run into patients that have a variety of different scenarios with any of these drugs, and we have other options that may be very helpful and successful in these patients. So stay tuned. We really have to look at this in more detail and hopefully get more studies and even good case report selections and reports that help us. There was even one patient that had difficulty with depiliumab with some erytheminous eruption was changed to upaticitinib, and they had difficulty with cutaneous eruption, and they responded to trolley kinumab. One case, an n of one. But we have to have an open mind in going in all these different directions. So I hope that helps you in thinking about some of the therapies that we use. And I hope you continue to tune in to derms and conditions because I will have my usual sequence of tremendous speakers. You're not just going to be stuck with Jim Delrasso, thank you very much. Thank you for listening to this episode of Derms and Conditions. If you have any questions, please email us at podcast@dermsquared.com that's podcast at D-E-R-M-S-Q-U-A-R-E D.com. Podcast@dermsquared.com you it.

In episode 18 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, speaks with Jacqueline Fisher, DO, a board-certified dermatologist and CEO/owner of <a target="_blank" rel="noopener noreferrer" href="https://www.cincyskin.com/">CincySkin Medical &amp; Cosmetic Dermatology</a> in Cincinnati, OH.&nbsp;

In episode 18 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, speaks with Jacqueline Fisher, DO, a board-certified dermatologist and CEO/owner of <a target="_blank" rel="noopener noreferrer" href="https://www.cincyskin.com/">CincySkin Medical &amp; Cosmetic Dermatology</a> in Cincinnati, OH.&nbsp;The episode begins with board review on rosacea. Dr Brownstone discusses key facts on rosacea and reviews the important rosacea subtypes. Dr Fischer then reviews rosacea variants along with the details mostly likely to show up on board exams. Dr Fischer also shares her method on how to best counsel patients on a diagnosis of rosacea in the clinic.&nbsp;In the main part of the episode, Dr Fischer discusses how to build a brand as a dermatologist. She highlights the importance of branding, the definition of branding, and how it differs from marketing. She gives some tips on how to develop a brand identity, a brand message, and what constitutes a brand. She ends the discussion with some of the pearls and pitfalls she discovered when building her dermatology brand along with her thoughts on hiring a professional branding firm.&nbsp;Whether you are about to begin practice or have been practicing for many years and desire to create or improve your brand, you can’t miss the episode!Introducing Cutaneous Miscellaneous Boards Booster!In this new feature, we’ll put your knowledge to the test with high-yield board review questions written by dermatology residents and fellows and sourced from key resources like Bolognia’s Dermatology, Andrews’ Dermatology, and Alikhan’s Review of Dermatology. These quiz questions will test your skills on the board review topic that’s discussed in each episode. <a target="_blank" rel="noopener noreferrer" href="https://www.research.net/r/JDMJL69">Click here to answer this month's question</a>.

 Jacqueline Fisher, DO

Cutaneous Miscellaneous Podcast

Building Your Brand as a Dermatologist

In Episode 24 of Derms and Conditions, our host James Q. Del Rosso, DO talks with Julie C. Harper, MD who is in private practice in Birmingham, AL and is a recent past-President of the American Acne and Rosacea Society. Dr. Del Rosso and Dr. Harper spend the episode discussing important considerations in the diagnosis and treatment of rosacea.

In Episode 24 of Derms and Conditions, our host James Q. Del Rosso, DO talks with Julie C. Harper, MD who is in private practice in Birmingham, AL and is a recent past-President of the American Acne and Rosacea Society. Dr. Del Rosso and Dr. Harper spend the episode discussing important considerations in the diagnosis and treatment of rosacea. Emphasis is placed on noting the sources of facial redness in rosacea so that treatment selection can be optimized. Dr. Harper includes practical tips for treating a rosacea patient who presents with both persistent facial erythema and papules/pustules and concludes the episodes presenting her "STOP" mnemonic when seeing a rosacea patient in the office.&nbsp; &nbsp; Financial Disclosures: JAMES DEL ROSSO, DO:&nbsp; CONSULTANT/ADVISOR&nbsp; Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo)&nbsp; SPEAKER BUREAU&nbsp; Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo)&nbsp; RESEARCH INVESTIGATOR&nbsp; Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo).&nbsp; JULIE C. HARPER, MD&nbsp; Grant/Research Support:&nbsp; Almirall&nbsp; Consultant:&nbsp; Almirall, Cutera, EPI, Galderma, LaRoche Posay, Ortho, Sun, Vyne&nbsp; Speakers&rsquo; Bureau or Honoraria:&nbsp; Almirall, EPI, Galderma, Journey, Ortho, Sun, Vyne

How Can You Stop Seeing Red When Facing Up To Rosacea?

If you treat a rosacea patient with a laser do you stop other concomitant rosacea treatments?

You. So when I'm treating patients with rosacea, I'm typically using the pulse dye laser to improve their erythema and telangtasia. There's two questions that often come up related to this. I'll have other practitioners ask me do I need to stop doxycycline because they're getting a laser treatment? Do I need to worry about photosensitivity with doxycycline? The answer is no, you do not need to stop doxycycline or any of the other photosensitive tetracyclines while they're getting pulse dylaser. The pulse dye laser operates at 585 nanometer wavelength, and doxycycline and some of the other tetracyclines only have photosensitivity, really within the ultraviolet a spectrum, which is between 340. So you do not need to have your patients stop any of the oral antibiotics, even if typically, you'd be very concerned about them going out in the sun on those medications. Now, in regards to topical agents, the only topical therapeutics that I will have my patients stop prior to doing pulse dilaser are the alpha agonists like bromonidine and oxymetazoline. Because these medications work by constricting the blood vessels and lessening erythema. To get the optimal result from your pulse dilaser, you want to have that target chromophore present as much as possible. You don't want vasoconstriction at the time of pulse dilaser treatment. So if I'm going to do pulse dilaser treatment, I will have my patients stop their alpha agonists a few days prior to the pulse dilaser treatment. Usually about three days prior will do it.

What effect does COVID-19 have on rosacea?

You. So the coronavirus itself does not impact rosacea per se. There are some vascular permeability issues that could occur during an active infection, as well as increasing of flushing. But the real issue comes actually from wearing the mask. And what we found is that the occlusion of the mask, change of the humidity under the skin from the mask, as well as some of the friction, can be a very sensitive sizing issue for a lot of rosacea patients. And we've heard a lot about mask knee, if you will, with the aggravate of acne with the mask, so goes rosacea, becoming a little bit more inflamed and aggravated with the mask. So I think the COVID pandemic, as well as the activity of the coronavirus on rosacea, comes more from our prevention strategies and treatment, because the patients also find that using their medications becomes a little more difficult when they're having to wear a mask. Also,

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