Severe Papulopustular Rosacea with Demodicosis in a 47-year-old Filipino female: A case report

Introduction@# Rosacea is a chronic relapsing inflammatory facial dermatosis often characterized by flare-ups and remissions exclusively affecting the centrofacial skin.@*Case report@#This is a case of multiple symmetric intensely erythematous papules, pustules, and plaques over both cheeks in a 47-year-old Filipino female. Dermoscopy showed brown-yellowish structureless areas, straight vessels in a polygonal pattern, dilated follicles, follicular plugs, ill-defined white rosettes, and non-specific scales. Skin punch biopsy showed spongiosis of the epidermis and demodex folliculorum within the follicular infundibulum. The dermis revealed telangiectasia of blood vessels and dense inflammatory infiltrates. Hypertrophy of sebaceous lobules was also seen. The patient was initially treated with oral lymecycline 300mg twice a day for 2 weeks without improvement. Due to the persistence of centrofacial erythema, papules and pustules, the patient was given prednisone 10mg once a day for 1 month and low dose isotretinoin 10mg once a day for 8 months which resulted in significant decrease in erythema and number of existing lesions. To further decrease the inflammation con- tributed by demodex mites, permethrin 5% cream twice a day for 1 month was applied. Long-pulsed Neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064 nm laser for a total of 10 sessions together with Isotretinoin 10 mg every other day effectively maintained remission for 1 year and 5 months. Gentle skin care measures, sunscreen, metronidazole 0.75% cream once a day, and desonide 0.05% cream twice a day for 1 week in cases of acute flares were maintained during the treatment course.@*Conclusion@#An armamentarium of topical and oral antibiotics, corticosteroids, isotretinoin and non-ablative long-pulsed Nd:YAG 1064 nm laser showed significant improvement in the inflammatory papules, pustules, and centrofacial erythema of rosa- cea and proves to be beneficial in the maintenance of its long-term remission.

A double-blind randomized controlled trial on the efficacy and safety of metformin as an adjunct to lymecycline and topical adapalene plus benzoyl peroxide gel in the treatment of moderate to severe acne vulgaris

@#INTRODUCTION: Acne vulgaris has multifactorial causes. Prolonged systemic antibiotics are often necessary because relapse of lesions occurs upon its discontinuation. Currently, antimicrobial resistance is a growing concern. Androgen inhibitors like metformin may decrease need for antibiotics and maintain adequate control of the disease. OBJECTIVE: To determine the efficacy and safety of metformin versus placebo as an adjunct to lymecycline and adapalene+benzoyl peroxide gel in the treatment of moderate to severe acne vulgaris METHODS: Patients with moderate to severe acne vulgaris received either metformin or placebo tablets, together with lymecycline and adapalene+benzoyl peroxide gel. Lymecycline was taken for six weeks. The rest were given for 18 weeks. Evaluation was done biweekly using the mean reduction rates of non-inflammatory, inflammatory and total lesion count, modified global severity score, subjective self-assessment score, Dermatology life quality index (DLQI) score, and cutaneous and systemic adverse events. RESULTS: Forty patients were selected for the trial. Mean reduction rates of the non-inflammatory lesion counts of the two groups were comparable (p>0.05). Mean reduction rates of the inflammatory and total lesion count in the metformin group were higher than the placebo group (p<0.05). The mean modified global severity score of the metformin group was lower than the placebo group (p=0.034). Mean DLQI scores decreased in both groups (p<0.0001). Subjective self-assessment scores improved in both groups with comparable results. Cutaneous adverse events (erythema, pain, scaling, and dryness) were tolerable. Systemic adverse events (diarrhea, flatulence, headache, and epigastric pain) were self-limited CONCLUSION: Metformin is an effective and safe adjunct in the treatment of moderate to severe acne vulgaris.

Treatment of Mycobacterium marinum with lymecycline: new therapeutic alternative?

Skin infections by Mycobacterium marinum are quite rare in our environment and, therefore, little studied. The majority of the lesions appear three weeks after traumas in aquariums, beaches and fish tanks. Lymph node drainage and systematization of the disease are rare and most lesions disappear in about three years. This case aims to show the effectiveness of the treatment used (lymecycline 150 mg/orally/day). This medication may be a new therapeutic option for the treatment of Mycobacterium marinum.

Uso da limeciclina associada com o peróxido de benzoíla no tratamento da hipomelanose macular progressiva: um estudo prospectivo / The use of lymecycline and benzoyl peroxide for the treatment of progressive macular hypomelanosis: a prospective study

A hipomelanose macular progressiva é uma dermatose de etiopatogenia pouco conhecida. A participação do Propionibacterium acnes e a resposta ao tratamento com medicamentos com atividade para essa bactéria têm sido sugeridas. Relata-se uma série de casos de 13 pacientes com hipomelanose macular progressiva tratados com limeciclina e peróxido de benzoíla durante três meses, que apresentaram excelente resposta ao tratamento e nele se mantêm durante o período de seguimento do estudo.

Progressive macular hypomelanosis is a dermatosis of uncertain etiology. The participation of Propionibacterium acnes has been suggested in view of the response achieved following therapy with drugs that are active against this bacterium. This report describes a series of thirteen patients with progressive macular hypomelanosis who were treated with an association of lymecycline and benzoyl peroxide over a three-month period. Response to treatment was excellent and the positive results were maintained during the entire follow up period.

Estudo das mudanças quali e quantitativas da participação de ácidos graxos no sebo de pacientes com acne inflamatória, graus II ou III, em uso sistêmico de limeciclina e/ou suplementação oral à base de ácidos linoleico, gamalinolênico / Study of qualitative and quantitative changes of fatty acids in the sebum of patients with inflammatory acne, grade II or III, under systemic use of lymecycline and/or oral supplementation based on linoleic, gamma-linolenic, and oleic acids using gas

Introdução: Acne é uma dermatose que apresenta o padrão do sebo alterado, tanto quali, quanto quantitativamente. Objetivos: Estudar as possíveis alterações quali e quantitativas dos ácidos graxos encontrados no sebo de portadores de acne vulgar graus II ou III mediante ao uso diário de limeciclina e/ou suplemento oral a base de ácidos linoleico, gamalinolênico e oleico. Métodos: Quarenta e cinco sujeitos de pesquisa masculinos, de 12 a 40 anos de idade, portadores de acne vulgar graus II ou III, submeteram-se a 90 dias de uso de: Grupo A, 300mg/dia de limeciclina; Grupo B, 540mg de ácidos gamalinolênico, 1.200mg linoleico e 510mg oleico/dia; Grupo C: Grupos A+B. A cada 30 dias, eles tinham amostra de sebo da fronte coletada para análise cromatográfica dos ácidos graxos nele presentes. Resultados: Quarenta sujeitos de pesquisa (88,9 por cento) concluíram o estudo, os quais ingeriram todas as doses dos produtos, sem apresentarem eventos adversos em qualquer dos Grupos. O número de comedões, pústulas e cistos reduziu com o tempo (p<0,001, para todos), nos três Grupos. Com relação ao número total de lesões, houve uma maior quantidade de lesões em pacientes do Grupo B, quando comparados aos do Grupo A (p=0,033) e aos do Grupo C (p=0,030). Sete ácidos graxos apresentaram mudanças de seu padrão durante o estudo. De um modo geral, as mudanças que se tornaram mais evidentes foram: 1) a concentração de esqualeno no SB não reduziu em qualquer Grupo de estudo; 2) C12:0, C14:0 e C16:1 tiveram suas respectivas concentrações aumentadas nos três Grupos com o tempo de terapêuticas; 3) há indicativo de aumento de C18:1n9c+C18:1n9t na associação das duas classes terapêuticas estudadas; 4) limeciclina e/ou ingestão de ácido linoleico não aumentaram a participação do ácido linoleico no sebo; 5) ácido -linolênico teve sua concentração aumentada e, depois diminuída com o uso de LM e/ou com sua própria suplementação oral...

Introduction: Acne is a dermatosis that presents an altered sebum pattern, quantitatively and qualitatively. Objectives: To study the possible quantitative and qualitative changes of fatty acids found in the sebum of patients with acne vulgaris grade II or III, through the daily use of lymecycline and/or oral supplementation based on linoleic, gamma-linolenic, and oleic acids. Methods: Fortyfive male research subjects, ages 12 to 40, presenting acne vulgaris grade II or III, were submitted to a 90-day use of: Group 1, 300mg of lymecycline per day; Group 2, 540mg of gamma-linolenic acid, 1,200mg of linoleic acid, and e 510mg of oleic acid per day; Group 3: Groups A+B. Every 30 days, a sample of the sebum of their forehead was collected for chromatographic analysis of the fatty acids contained therein. Results: Forty research subjects (88.9 percent ) concluded the study. They ingested all dosages of the products, without presenting side effects in any of the Groups. The number of comedones, pustules, and cysts reduced with time (p<0.001, for all), in all the 3 Groups. With respect to the total number of lesions, Group B´s patients presented a larger quantity of lesions, as compared to those of Group A (p=0.033) and Group C (p=0.030). Seven fatty acids presented pattern changes during the study. In general, the changes that became more evident were: 1) the squalene concentration in the sebum did not diminish in any Group under study; 2) C12:0, C14:0, and C16:1 had their respective concentrations increased in the 3 Groups over the time of the treatments; 3) there is an indication for increasing of C18:1n9t+C18:1n9c when both of therapies are associated; 4) lymecycline and/or the ingestion of linoleic acid did not increase the participation of linoleic acid in the sebum; and 5) gama-linolenic acid had its concentration increased during the first 60-day and diminished during the last 30-day therapies period using lymecycline and/or with its own oral supplementation...

Acné: nuevas tendencias / Acne: new tendencies

La acné es una enfermedad muy frecuente que aparece alrededor de la pubertad y se caracteriza por su polimorfismo lesional y su cronicidad. Se la divide en grados de severidad y según los mismos se determina la terapéutica adecuada. Tiene un alto impacto psicosocial en quienes la padecen por lo cual es muy importante el vínculo que se establece entre el paciente y su médico, lo cual redundará en una buena aceptación del tratamiento y una mejor respuesta por parte del paciente. En los últimos años se ha avanzado en el conocimiento de su etiopatogenia, lo cual permitió un entendimiento más profundo de la enfermedad. La tendencia actual es la de combinar diferentes drogas que tengan influencia sobre diferentes etiopatogénicos de la acné. Se ha comprobado que de este modo la respuesta es más rápida y el tratamiento menos tóxico