Combination of traditional Chinese medicine and standard biomedical treatment for rosacea: a systematic review and a meta-analysis.

Background: A combination of standard biomedical treatment and traditional Chinese medicine (TCM) has been suggested as a therapeutic approach for rosacea that may significantly lower the recurrence rate and clinical symptom scores. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the impact of this combination treatment on clinical symptom and TCM syndrome scores, as well as on the scores of the Dermatology Life Quality Index (DLQI), erythema index (EI), and interleukin 37 (IL-37) levels in patients with rosacea. Methods: The PROSPERO registration number for the study is CRD42023472737. We systematically searched the PubMed, Embase, Web of Science, China National Knowledge Infrastructure Wanfang Database, China Biomedical Medicine database (CBM), and the VIP information resource integration service platform (cqvip) databases for RCTs (published from the beginning to September 2023, regardless of the language used) that compared the traditional Chinese medicine and standard biomedical treatment combination treatment to conventional anti-rosacea treatments. Our primary outcomes comprised the clinical symptom and TCM syndrome scores, and the scores of Dermatology Life Quality Index, erythema index, and IL-37 levels. We used a random-effects model to evaluate the pooled data. Results: We identified 260 studies. Of these, 13 eligible studies were employed for analysis (N = 1,348 participants). Compared with other anti-rosacea treatments, the TCM and standard biomedical treatment combination treatment yielded an improved mean reduction in the clinical symptom score -2.24% [95% CI (-3.02 to -1.46), p < 0.00001], TCM syndrome score -4.42 [95% CI (-5.33 to -3.50), p < 0.00001], and the score of DLQI of -2.55 [95% CI (-3.73 to -1.36), p < 0.00001], EI of -151.97 [95% CI (-276.59 to -27.36), p < 0.00001], and IL-37 level -4.23 [95% CI (-4.95 to -3.51), p = 0.854], as well as in the overall effective rate risk ratio (RR) = 1.25 [95%CI (1.18, 1.32), p = 0.994] and the recurrence rate = 0.27 [95%CI (0.15, 0.46), p = 0.297]. Conclusion: The TCM and standard biomedical treatment combination treatment can provide a better outcome, including a reduction in the TCM syndrome and clinical symptom scores, and in the scores of DLQI, EI, and IL-37. Hence, this combination is a viable and more effective therapeutic approach for rosacea. However, these results should be considered cautiously because of uncertain evidence and the low quality of the study reports considered in this meta-analysis. Systematic Review Registration: website, identifier CRD42023472737.

Treatment of Common Dermatologic Conditions.

Dermatologic concerns are discussed in about a third of all primary care visits. This review discusses treatments for common dermatologic diagnoses addressed in primary care settings, with an emphasis on new and emerging treatments. Topical, oral, and injectable treatment of common forms of alopecia, facial rashes, atopic dermatitis, psoriasis, seborrheic dermatitis, and stasis dermatitis will be discussed to help increase comfort in prescribing and alert providers to common side effects or complications of more intensive treatments used by dermatologists.

Ocular Rosacea: Don't Forget Eyelids and Skin in the Assessment of This Stubborn Ocular Surface Disease.

Ocular rosacea, a subset of rosacea affecting the ocular surface, poses a diagnostic challenge due to its elusive presentation and overlapping symptoms with other ocular surface diseases (OSDs). This report emphasizes the critical role of a comprehensive evaluation, particularly focusing on eyelid and skin assessment, in diagnosing and effectively managing ocular rosacea-related ocular surface symptoms. The case study highlights a 69-year-old female initially diagnosed with common dry eye disease, subsequently identified with ocular rosacea following a meticulous examination revealing subtle ocular and skin manifestations. Treatment encompassed a tailored approach combining systemic and local therapies, emphasizing proper eyelid hygiene. Objective improvements were observed in ocular surface parameters and patient-reported symptom scores, showcasing the significance of an integrated approach addressing ocular and dermatological aspects in managing ocular rosacea. This report underscores the importance of heightened clinical suspicion, thorough assessments, and comprehensive management strategies in optimizing outcomes for patients with OSD, particularly ocular rosacea.

Diagnostic Challenges of Ocular Rosacea.

OBJECTIVE: This study aims to address the issues surrounding the diagnosis of ocular rosacea and to evaluate the development of the patients' condition after treatment, as well as to distinguish between healthy and diseased patients using a glycomic analysis of tears. METHODOLOGY: A prospective study was conducted to assess a total of 68 eyes in 34 patients over a six-week period. These patients were diagnosed with ocular rosacea based on subjective symptoms and clinical examination. The study monitored the development of objective and subjective values. The difference between patients with the pathology and healthy controls was established by means of analysis of glycans in tears. RESULTS: Skin lesions were diagnosed in 94% of patients with ocular rosacea, with the most commonly observed phenotype being erythematotelangiectatic (68.8%). The mean duration of symptoms was 29.3 months (range 0.5­126 months) with a median of 12 months. Throughout the study, an improvement in all monitored parameters was observed, including Meibomian gland dysfunction, bulbar conjunctival hyperemia, telangiectasia of the eyelid margin, anterior blepharitis, uneven and reddened eyelid margins, and corneal neovascularization. The study also observed improvements in subjective manifestations of the disease, such as foreign body sensation, burning, dryness, lachrymation, itching eyes, photophobia, and morning discomfort. The analysis of glycans in tears partially separated tear samples based on their origin, which allowed for the differentiation of patients with rosacea from healthy controls. In the first sample, the pathology was determined in a total of 63 eyes (98.4%) of 32 patients, with further samples showing a change in the glycomic profile of patients' tears during treatment. CONCLUSION: The study demonstrated objective and subjective improvements in all the patients. Tear sampling and analysis could provide a means of timely diagnosis of ocular rosacea.

Minocycline-Induced Hyperpigmentation of Nails.

Minocycline is an antibiotic used for several dermatologic conditions, including rosacea. The development of skin, scleral, and nail hyperpigmentation may occur with long-term use of minocycline, and this is associated with no adverse effect on function. We present a case of a 66-year-old male who developed blue-gray hyperpigmentation of his nail beds after treating rosacea with systemic minocycline for over 20 years. The remainder of the physical exam was unremarkable for hyperpigmentation elsewhere. The patient was informed that this was likely an adverse effect of his chronic minocycline use. He insisted upon the continuation of minocycline, so he was counseled on the adverse effects of the medication and scheduled for follow-up.

Common ocular findings in patients with acne rosacea.

PURPOSE: To evaluate ocular surface manifestations in patients with acne rosecea (AR) and to find out main features indicating a propensity toward an association with disease diagnosis. METHODS: Right eyes of consecutive 76 AR patients and 113 age-gender matched healthy subjects were enrolled. Ophthalmologic examinations including tear break-up time (t-BUT) and Schirmer-2 tests to analyze tear film insufficiency, optical coherence tomography (OCT)-assisted infrared meibography to analyze meibomian gland drop-out, and Ocular Surface Disease Index (OSDI) questionnaire were performed in all participants. RESULTS: No statistically differences were found in visual acuity, intraocular pressure, central corneal thickness, and axial length assessments between the study and control eyes. Study eyes had more foreign body sensation, itching, dryness, hyperemia, conjunctival telangiectasia, and meibomitis (p ≤ 0.005, for all). Significantly higher t-BUT and Schirmer-2 tests; lower-eyelid and total OCT meibography; and OSDI scores were found in AR patients (p < 0.05, for all). Among all, only conjunctival telangiectasia (p = 0.001; OR:0.070, 95% CI:0.015-0.330) was found to be major independent predictor for AR diagnosis. CONCLUSION: Detailed slit-lamp examination to detect any conjunctival telangiectasia seems to be crucial in recalcitrant dry eye cases, not to miss underlying AR. Especially, lower-eyelid OCT meibography score may be sensitively used for disease staging.

Measurement of the serum zonulin levels in patients with acne rosacea.

OBJECTIVE: Although the etiopathogenesis of acne rosacea has not yet been clearly elucidated, it has been discussed over the years that autoimmunity may play a role. Genetic and environmental factors are known to have combined effects in the background of autoimmunity, but it has recently been emphasized that an impaired intestinal barrier system is also involved in the development of the disease. Zonulin is a protein that reversibly increases intestinal permeability. This study aimed to evaluate the zonulin levels in acne rosacea. METHODS: A total of 61 individuals, 30 diagnosed with acne rosacea and 31 healthy controls, were included in this study. There was no difference between the two groups in terms of age, gender, and body mass index. Zonulin was studied using the enzyme-linked immunosorbent assay. RESULTS: The serum zonulin levels were found to be significantly higher in the patient group than in the control group (18.5 ± 2.9 ng/ml and 13.2 ± 2.7 ng/ml, respectively; p < .001). CONCLUSION: This is the first study in the literature to demonstrate that the serum zonulin levels are increased in patients with acne rosacea.

Development of a skin microbiome diagnostic method to assess skin condition in healthy individuals: Application of research on skin microbiomes and skin condition.

OBJECTIVE: Skin microbiomes vary across individuals. They are known to play essential roles in maintaining homeostasis and preventing infectious pathogens. In recent years, cosmetic product development has begun to focus on the relationship between skin microbiomes and skin conditions. However, the statistical methods used in many studies include the standard t-test and small-scale correlation analysis, which do not take into account the internal correlation structure in data on skin microbiomes and skin features. In this study, we aimed to understand the relationship between skin microbiomes and skin features by analysing complex microbiomes and skin data. METHODS: We obtained data on 19 skin characteristics and skin microbiomes based on 16s ribosomal RNA (16S rRNA) gene analysis of 276 healthy Japanese women. We then performed the principal component analysis (PCA), a method that takes into account the internal correlation structure, on 234 panels of them that did not contain outliers or missing values. We confirmed the relationship between skin microbiomes and skin features with principal component regression analysis and hierarchical clustering analysis (HCA). RESULTS: The principal component regression analysis showed strong relationships between skin microbiomes and sebum-related skin characteristics and skin pH. In the HCA, the female panel was classified into two major groups based on the skin microbiome. Furthermore, there were significant differences in sebum-related skin characteristics and the way skin condition changes with ageing between those groups, suggesting the possibility of measuring skin condition and age-related skin risk based on microbiome data. In addition, sebum-related characteristics differed significantly among middle-aged participants, suggesting a strong relationship between skin microbiomes and sebum-related characteristics. CONCLUSION: Analysis of skin condition and skin microbiome in Japanese women, taking into account the correlation between variables, showed that skin microbiome was significantly related to the number of pores and the amount of sebum. Furthermore, it was suggested that the skin condition and the way the skin condition changes with ageing may differ depending on the type of skin microbiome. The finding of a relationship between skin condition and skin microbiome suggests the possibility of proposing a new beauty method focusing on the skin microbiome in the future.

OBJECTIF: Les microbiomes de la peau varient selon les individus. Ils sont connus pour jouer des rôles essentiels dans le maintien de l'homéostasie et la prévention des agents pathogènes infectieux. Ces dernières années, le développement de produits cosmétiques a commencé à se concentrer sur la relation entre les microbiomes cutanés et les conditions de la peau. Cependant, les méthodes statistiques utilisées dans de nombreuses études comprennent le t-test standard et l'analyse de corrélation à petite échelle, qui ne tiennent pas compte de la structure de corrélation interne dans les données sur les microbiomes cutanés et les caractéristiques de la peau. Dans cette étude, nous avons cherché à comprendre la relation entre les microbiomes cutanés et les caractéristiques de la peau en analysant des données complexes sur les microbiomes et la peau. MÉTHODES: Nous avons obtenu des données sur 19 caractéristiques de la peau et sur les microbiomes cutanés à partir de l'analyse du gène de l'ARNr 16S (16S rRNA) de 276 femmes japonaises en bonne santé. Nous avons ensuite effectué l'analyse en composantes principales (PCA: principal component analysis), une méthode qui prend en compte la structure de corrélation interne, sur 234 d'entre elles qui ne contenaient pas de valeurs aberrantes ou manquantes. Nous avons confirmé la relation entre les microbiomes cutanés et les caractéristiques de la peau à l'aide d'une analyse de régression en composantes principales et d'une analyse de regroupement hiérarchique (HCA: hierarchical clustering analysis). RÉSULTATS: L'analyse de régression en composantes principales a montré des relations fortes entre les microbiomes cutanés et les caractéristiques de la peau liées au sébum et au pH de la peau. Dans l'étude HCA, le panel de femmes a été classé en deux grands groupes sur la base du microbiome cutané. En outre, il y avait des différences significatives dans les caractéristiques de la peau liées au sébum et dans la façon dont l'état de la peau change avec l'âge entre ces groupes, ce qui suggère la possibilité de mesurer l'état de la peau et le risque cutané lié à l'âge à partir des données du microbiome. En outre, les caractéristiques liées au sébum différaient de manière significative chez les participants d'âge moyen, ce qui suggère une forte relation entre les microbiomes cutanés et les caractéristiques liées au sébum. CONCLUSION: L'analyse de l'état de la peau et du microbiome cutané chez les femmes japonaises, en tenant compte de la corrélation entre les variables, a montré que le microbiome cutané était significativement lié au nombre de pores et à la quantité de sébum. En outre, il a été suggéré que l'état de la peau et la façon dont l'état de la peau évolue avec le vieillissement peuvent différer en fonction du type de microbiome cutané. La découverte d'une relation entre l'état de la peau et le microbiome cutané suggère la possibilité de proposer à l'avenir une nouvelle méthode de beauté axée sur le microbiome cutané.

Complex Decongestive Therapy in the Physical Therapist Management of Rosacea-Related Edema (Morbus Morbihan Syndrome): A Case Report With a New Approach.

OBJECTIVE: The aim of this case report was to describe the use of complete decongestive therapy (CDT) with a new approach in the management of a male with facial edema related to Morbus Morbihan Syndrome (MMS). METHODS: An 18-year-old male with MMS after acne treatment was the subject of this case report. Volume assessment was performed with distance measurements of the facial area using standard reference points, the overflow method, and the measurement of the percentage of subdermal fluid. Participant-reported symptoms of lymphedema (feeling of swelling and tightness) and body image perception were evaluated with the visual analogue scale, and the severity of anxiety was evaluated with the State and Trait Anxiety Inventory. In addition, the participant's perception of improvement was determined using a Likert-type scale. Evaluations were performed at baseline, week 4 (during the treatment), and week 8 (immediately after treatment). CDT was applied to the participant in a total of 24 sessions, 3 d/wk for 8 weeks. RESULTS: Compared with the baseline measurement, the facial distances (tragus-mental cavity, tragus-mouth corner, mandibula-nasal canal, mandibula-internal orbita, mandibula-external orbita, mental cavity-internal orbita, mental cavity-mandibula, right-left tragus, and hairline in the forehead-mental cavity), the volume, and the percentage of subdermal fluid of facial area were decreased at the week 4 and 8 measurements. The anxiety score, participant reports of feelings of swelling and tightness, and body image perception improved after the 8 weeks of treatment compared with baseline. CONCLUSION: This case report described the use of CDT in treating edema and participant symptoms in an individual with facial lymphedema related to MMS. Body image and level of anxiety improved.

Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life.

Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.

Pediatric Ocular Acne Rosacea: Clinical Features and Long Term Follow-Up of Sixteen Cases.

Purpose: To report the clinical characteristics, treatment modalities and long term follow-up of 16 pediatric ocular acne rosacea patients.Methods: The medical records of pediatric ocular acne rosacea patients were reviewed.Results: There were 16 patients with a mean age of 7.7 ± 5 (1-16) years. The mean follow-up period was 52.8 ± 52 (3-150) months. Eight patients had skin involvement. The mean duration of delay for diagnosis was 16.2 ± 5.1 (4-48) months. Nine patients had a delayed diagnosis. Meibomitis, blepharitis, lid telangiectasia, and conjunctival hyperemia were present in all cases. Systemic antibiotics were prescribed in 12 patients. The mean delay in diagnosis was longer in patients with conjunctival/corneal involvement (p = .001) and these patients required longer systemic treatment (p = .001). Complete remission was achieved in 87.5% of cases.Conclusion: Children presenting with a long history of ocular irritation, meibomian gland disease, recurrent chalazia and peripheral corneal infiltrates should alert ophthalmologists to consider the diagnosis of ocular acne rosacea even in the absence of skin changes.

Optimizing Management of Otophyma: A Case Series Highlighting the Role of Surgical and Retinoid Therapy.

Otophyma is a rare condition that can result in conductive hearing loss. Current otophyma literature does not examine validated treatment outcomes for patients. Utilizing a medical and surgical approach to maintain a patent canal can lead to significant objective improvements. The aim of this case series is to describe a combined successful approach in 3 cases from an academic, multidisciplinary center. The main outcomes analyzed were pre and post air-bone gap audiogram analysis and disimpaction frequency. The results showed that post-management, patient 1 had substantial improvement in hearing, recovering 49 dB in his right ear and 25 dB in his left ear, demonstrating near complete air-bone gap closure. Patient 2 showed a similar dermatologic and functional improvement, although objective audiometric assessment related to otophyma could not be performed due to coexisting chronic otitis media and cholesteatoma. Patient 3, in the 12 months prior to comanagement, had 8 bilateral disimpactions, and following comanagement had 2 disimpactions in 23 months. All 3 patients were pleased with the resultant functional and physical appearance following comanagement. By presenting this approach and objective measures of treatment, we hope to improve future clinical decision-making in a rare condition.

Assessment of Tear Functions in Patients with Acne Rosacea without Meibomian Gland Dysfunction.

Purpose: To evaluate the results of tear functions in acne rosacea. Methods: This prospective study includes 64 eyes of 32 acne rosacea patients without blepharitis and meibomian gland dysfunction and 90 eyes of 45 patients as control group. Tear functions of all were evaluated with ocular surface disease index (OSDI) questionnaire, and measurements of tear osmolarity were performed by using TearLab, Schirmer I tests without anesthesia and fluorescein tear break-up time (TBUT). Results: The mean Schirmer test result was 12.53 ± 6.54 in study group and 16.21 + 7.52 mm/5 min in control group (p = 0.28). The mean TBUT in study group was 8.21 ± 4.01 and in control group was 18.03 ± 6.45 s (p = 0.02). Mean tear osmolarity in study group was 304.77 ± 15.59and in control group was 275.23 + 28.52 mOsms/L (p = 0.03). Mean OSDI score in study group was 27.51 ± 16.73 and was 18.15 ± 7.05 in control group (p = 0.38). Conclusions: Our study demonstrated lower dry eye tests before the appearance of clinical signs of meibomian gland disease in acne rosacea.

Body odour aldehyde reduction by acetic acid bacterial extract including enzymes: alcohol dehydrogenase and aldehyde dehydrogenase.

OBJECTIVE: The major causes of unpleasant human body odour are aldehydes produced by axillary-resident bacteria. There are many methods of body odour prevention; however, they all carry risks of destroying indigenous dermal bacteria that are necessary for the maintenance of the normal physical function of the skin. Furthermore, some methods cannot directly reduce the concentrations of substances that cause body odour. Therefore, a novel method of reducing body odour more safely and effectively is required. We focused on acetic acid bacterial enzymes, which can convert aldehydes into carboxylic acids, and investigated their effect on aldehydes and body odour. METHODS: Subjects with strong body odour were recruited using screening questionnaires. Acetic acid bacterial extract including enzymes was applied to subjects' skin, and their effects were evaluated by trained panellists and by quantitative aldehyde analysis using thermal detector gas chromatography/mass spectrometry. RESULTS: Acetic acid bacterial extract including enzymes decreased the ratio of dilution to threshold and the concentration of body odour-producing aldehydes dropped by up to 98.7%. CONCLUSION: These results indicate that simply applying acetic acid bacterial enzymes on the skin can reduce the concentration of aldehydes that cause unpleasant body odour by directly converting them into carboxylic acids. Therefore, acetic acid bacterial enzymes can potentially be developed into new products that do not destroy indigenous bacteria and yet can effectively reduce unpleasant body odour.

Accuracy and reliability of a hand-held in vivo skin indentation device to assess skin elasticity.

OBJECTIVE: The aim of this study was to evaluate the performance of a hand-held indentation device for fast and reliable determination of skin stiffness. METHODS: Device accuracy to indentation depths of 0.6 and 1.3 mm was first evaluated on plastic foam materials with mechanical properties verified by a laboratory material testing device. Subsequently, the device's sensitivity to detect age-related changes in skin stiffness was evaluated among 46 healthy women (18-79 years). Finally, the reproducibility of the method was tested with six healthy subjects. RESULTS: High correlation was detected between indentation stiffness of reference material and Young's modulus determined with mechanical testing device (0.6 mm indenter: r = 0.97, P = 0.05; 1.3 mm indenter: r = 0.98, P = 0.04). Age-related decrease of 38% in skin stiffness was observed in healthy volunteers (P < 0.05). The coefficient of variation for 0.6 and 1.3 mm indenters was 7.4% and 8.5%, respectively. No trend related to hysteresis effect was observed from repeated measurements. CONCLUSIONS: The presented indentation technique was accurate against the laboratory material testing device. Furthermore, skin changes related to ageing could be detected with the indentation technique. The new device was found to be feasible for monitoring skin stiffness in cosmetics and clinical conditions.

Ocular acne rosacea in tertiary eye center in Saudi Arabia.

PURPOSE: To report the most common presenting signs and symptoms of ocular rosacea for timely diagnosis and management. METHODS: A retrospective chart review of 23 patients with a diagnosis of acne rosacea or a non-specific diagnosis was performed at a tertiary eye hospital. Patients with lid changes such as recurrent blepharitis; meibomianitis; recurrent chalazia; facial skin change such as papules, telangiectatic blood vessels, and/or rhinophyma were included. Data were collected on patient demographics, presenting symptoms, visual acuity, dermatologic findings and treatment. RESULTS: There were 23 patients documented with acne rosacea with dermatologic facial findings associated with lid and/or corneal findings of peripheral thinning and vascularization. Two cases had a serious spontaneous peripheral corneal perforation. Most of the patients had no clinically significant change in visual acuity. CONCLUSION: The diagnosis of ocular acne rosacea was straightforward despite non-specific findings. Diagnostic delay can result in serious complications.

Reinforcement of barrier function and scalp homeostasis by Senkyunolide A to fight against dandruff.

OBJECTIVE: Senkyunolide-A (SENKY) can be isolated from Apium graveolens seed oil obtained using supercritical CO2 extraction. SENKY and its parent compounds, the N-butyl phthalides, have been demonstrated to protect cells from CO poisoning, to prevent diabetes mellitus and to decrease cancer cell proliferation. This study was undertaken to evaluate in vitro and in vivo the effect of SENKY on epidermal function improvement, Malassezia effect control, scalp soothing and dandruff reduction via skin protection-related pathways. METHODS: DNA-array and proteomic studies were performed on human keratinocytes, sebocytes and skin explants to demonstrate SENKY activities. Two clinical evaluations were performed under dermatologist control on 106 volunteers, with greasy or dry scalp, experiencing dandruff, itching and redness. Volunteers tested a shampoo followed, or not, by a leave-on, containing SENKY, or their placebos. Dandruff severity and redness were scored on the scalp. Moisturization and sebum release were recorded using relevant measuring apparatus. Itching and scratching evaluations came from volunteers' self-declarations. RESULTS: DNA-array studies on keratinocytes showed a clear regulation of skin barrier functions and epidermis defence pathways. Upregulation of epidermal differentiation complex genes was observed. These preliminary observations were reinforced by immunocytochemistry and immunohistochemistry studies showing a significant increase of involucrin, filaggrin, loricrin, SPRR, LC3B and ceramide 2 productions. Tight-junctions and corneodesmosomes were significantly reinforced both in keratinocyte cultures (corneodesmosin, claudin, ZO-1) and in skin explants (desmoglein). DNA-array studies also demonstrated upregulation of genes involved in detoxification and anti-inflammation pathways. Proteomic studies revealed that hBD2 production was increased in keratinocytes in contact with SENKY, whereas IL-8, PGE-2 and TLR-9 releases were repressed as well as sebocyte lipid production. Clinical evaluations confirmed that after 3 weeks, SENKY significantly reduced dandruff intensity, redness, itching and scalp histamine content compared to placebo and beginning of treatment. CONCLUSION: For the first time, SENKY has been shown to promote scalp homoeostasis by reinforcing barrier and defence functions at both gene and protein levels. It reduces irritation and redness in promoting detoxification and anti-inflammation pathways while controlling the niche of Malassezia. Applied on scalp, SENKY significantly reduces the formation of dandruff and soothes the scalp.

Development and clinical validation of a novel photography-based skin erythema evaluation system: a comparison with the calculated consensus of dermatologists.

OBJECTIVE: Erythema is the most common presenting sign in patients with skin diseases, and various methods to treat erythema symptoms have become common. To evaluate changes in erythema, a reliable device that can support objective diagnosis is required. We developed a novel photography-based system for erythema diagnosis that provides a high-resolution three-view photograph taken in a consistent photography environment with a curved surface light source and can be integrated with optimized image processing algorithms. METHODS: A new diagnostic algorithm was applied to photographs from 32 patients to determine areas of erythema automatically. To assess the performance in comparison to dermatologists' evaluations, five dermatologists independently evaluate the areas of erythema, and we defined an area called the clinical consensus area of erythema (CCAE), which is based on the majority opinion of dermatologists during evaluation. The CCAE values obtained were compared with the erythema areas determined by the system's diagnostic algorithm. RESULTS: Forty-one photographs with areas of erythema were evaluated by the proposed system and by dermatologists. The results obtained with the proposed system had a mean accuracy of 93.18% with a standard deviation of 3.52% when compared with the CCAE results. The results also showed that the proposed system could detect erythema areas without any pigmentation. In contrast to assessments by individual dermatologists, use of the CCAE reduced the amount of error that occurred owing to bias or subjectivity. CONCLUSION: A new erythema evaluation system was developed and validated through CCAE, suggesting that the system can support dermatologists' objective diagnoses of erythema.

A robust sebum, oil, and particulate pollution model for assessing cleansing efficacy of human skin.

With increasing concerns over the rise of atmospheric particulate pollution globally and its impact on systemic health and skin ageing, we have developed a pollution model to mimic particulate matter trapped in sebum and oils creating a robust (difficult to remove) surrogate for dirty, polluted skin. OBJECTIVE: To evaluate the cleansing efficacy/protective effect of a sonic brush vs. manual cleansing against particulate pollution (trapped in grease/oil typical of human sebum). METHODS: The pollution model (Sebollution; sebum pollution model; SPM) consists of atmospheric particulate matter/pollution combined with grease/oils typical of human sebum. Twenty subjects between the ages of 18-65 were enrolled in a single-centre, cleansing study comparisons between the sonic cleansing brush (normal speed) compared to manual cleansing. Equal amount of SPM was applied to the centre of each cheek (left and right). Method of cleansing (sonic vs. manual) was randomized to the side of the face (left or right) for each subject. Each side was cleansed for five-seconds using the sonic cleansing device with sensitive brush head or manually, using equal amounts of water and a gel cleanser. Photographs (VISIA-CR, Canfield Imaging, NJ, USA) were taken at baseline (before application of the SPM), after application of SPM (pre-cleansing), and following cleansing. Image analysis (ImageJ, NIH, Bethesda, MD, USA) was used to quantify colour intensity (amount of particulate pollutants on the skin) using a scale of 0 to 255 (0 = all black pixels; 255 = all white pixels). Differences between the baseline and post-cleansing values (pixels) are reported as the amount of SPM remaining following each method of cleansing. RESULTS: Using a robust cleansing protocol to assess removal of pollutants (SPM; atmospheric particulate matter trapped in grease/oil), the sonic brush removed significantly more SPM than manual cleansing (P < 0.001). While extreme in colour, this pollution method easily allows assessment of efficacy through image analysis.