Treatment of rosacea.

A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40 mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole.

Updates on the pathophysiology and management of acne rosacea.

There are many options for the treatment of acne rosacea, including topical and systemic therapies, laser and light-based therapies, and surgical procedures. A classification system for rosacea identifies 4 subtypes (ie, erythematotelangiectatic, papulopustular, phymatous, and ocular), which may help guide therapeutic decision making. Until recently, the pathophysiology of acne rosacea has been poorly understood and limited to descriptions of factors that exacerbate or improve this disorder. Recent molecular studies suggest that an altered innate immune response is involved in the pathogenesis of the vascular and inflammatory disease seen in patients with rosacea. These findings may help explain the benefits of current treatments and suggest new therapeutic strategies helpful for alleviating this disease. The goals of therapy include reduction of papules, pustules, erythema, physical discomfort, and an improvement in quality of life. Standard topical treatment agents include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Second-line therapies include benzoyl peroxide, clindamycin, calcineurin inhibitors, and permethrin. There are also various systemic therapy options.

The treatment of rosacea.

The roundtable discussion encompassed many topics-from seminal research by Ronald Marks to the latest National Rosacea Society-funded studies on the pathophysiology of rosacea. All participants commented on the value of the new National Rosacea Society classification system for subtypes of rosacea, designed to direct future research and help physicians better diagnose and manage these subtypes. A lively discussion centered on treatment options for the various subtypes of rosacea ensued.

Topical bactrim versus trimethoprim and sulfonamide against nocardia keratitis.

PURPOSE: The conventional treatment of Nocardia keratitis is with topical sulfonamides. Recently, topical trimethoprim and sulfamethoxazole (Bactrim) has been suggested as treatment. This study compares the in vitro efficacy against Nocardia asteroides of Bactrim and various ratios of trimethoprim and a sulfonamide. METHODS: Antibiotic disks were soaked with various ratios of trimethoprim and sulfacetamide sodium. They contained trimethoprim alone, sulfacetamide sodium alone, and both trimethoprim and sulfacetamide sodium at ratios of 1:40, 1:20, and 1:5. Disks containing Bactrim were also prepared. Each disk was placed on blood agar plates streaked with N. asteroides. The plates were incubated at 37 degrees C for 72 hours and then examined. RESULTS: Trimethoprim alone showed minimal effect. Sulfacetamide sodium alone had a clearance zone of 12 mm. The plates of trimethoprim and sulfacetamide sodium at ratios of 1:40, 1:20, and 1:5 had clearance zones of 14 mm, 17 mm, and 27 mm, respectively. Bactrim had a clearance zone of 70 mm. CONCLUSION: Trimethoprim or sulfacetamide sodium alone is not as effective as both drugs together. As the ratio of the two drugs was changed, potency differed against Nocardia organisms. Bactrim was the most effective antibiotic against Nocardia organisms. It should be the recommended agent for the treatment of Nocardia keratitis.

Berberine, a potential drug for trachoma.

The clinical serological response to topical treatment of trachoma with Berberine an indigenous drug has been studied in 32 microbiologically confirmed cases. Efficacy of Berberine 0.2% when compared to sulfacetamide 20% was found to be superior in both the clinical course of trachoma and in achieving a fall in the serum antibody titers (P < 0.05) against chlamydia trachomatis in the treated patients.

[A new pyrimidine-series preparation in the treatment of experimental chemical eye burns]. / Novyi preparat pirimidinovogo riada v lechenii khimicheskikh ozhogov glaz v éksperimente.

The effectiveness of a substance of a group of pyrimidine derivatives LUS-3 has been studied in 87 rabbits (174 eyes) with chemical burns of the cornea of degree III. In parallel series of experiments, its action was compared with one of traditional methods of treatment of eye burns using sodium sulfacetamide in combination with subconjunctival injections of autologous blood with penicillin as well as with a pyrimidine derivative--methyluracil. The assessment of the effectiveness of the preparations was made by the picture of the clinical course as well as by data of histologic investigations. The results obtained have shown a pronounced effectiveness of the preparation LUS-3: it accelerated regenerative processes, prevented development of secondary infection, and, as a result, conditioned formation of low-intensive opacifications of the cornea.

Clinical evaluation of trimethoprim-containing ophthalmic solutions in humans.

We studied trimethoprim in combination with sulfacetamide and polymyxin B and also in combination with polymyxin B alone (without the sulfacetamide) to determine the efficacy and safety of these new antibiotic combinations in the eyes of patients with bacterial conjunctivitis or blepharitis. Patients were selected for the study if they showed at least three of the following criteria: (1) symptoms of a surface ocular infection; (2) a purulent discharge; (3) a polymorphonuclear neutrophilic response on Giemsa stain; (4) a history of recent exposure to an infected individual; (5) a history of an inadequately treated surface bacterial infection. Trimethoprim-sulfacetamide-polymyxin B and polymyxin B-neomycin-gramicidin (Neosporin, the control) eliminated bacteria from the eyes of patients with conjunctivitis or blepharitis with equal effectiveness. There was no loss of effectiveness when trimethoprim-polymyxin B was compared with trimethoprim-sulfacetamide-polymyxin B, suggesting that the sulfacetamide was not a necessary component. The combination antibiotic containing trimethoprim and polymyxin B appears to be an effective topical antibiotic solution for the treatment of ocular surface infections.

Trachoma in Punjab: a study of the prevalence and of mass treatment.

During the years 1971-1974 the prevalence of trachoma in the state of Punjab/Northwest-India was investigated among 11,172 persons of all age-groups. The overall prevalence came to 71,07%. Active and progressive stages (WHO stages I and II) were most common among children and adolescents, whereas complicated cases (WHO stage IV) were found predominantly beyond 45 years of age. Regressive cases (WHO stage III) were equally distributed throughout all ages. To our opinion bacterial conjunctivitis is an important factor preceding the infection with the TRIC-agent. Bacterial conjunctivitis is favoured by adverse climatic conditions (duststorms). A masstreatment using local sulfacetamide was started among 4500 children with trachoma, 1966 children could be seen after 6 months. The incidence of trachoma had dropped to 30%. For mass-treatment in a developing country topical application of antibiotics or sulfas seems advisable. Still more important is health-education, which at the moment is lacking everywhere.