Case reports: new onset flushing due to unauthorized substitution of niacin for
nicotinamide.

Nicotinamide is the amide form of niacin and has anti-inflammatory
properties that have led to its use in the treatment of several inflammatory
dermatologic conditions, such as rosacea. Niacin has established its role in
the prevention of coronary artery disease. Cutaneous flushing is a well-known
and often dose-limiting side effect of niacin therapy, which does not occur with
nicotinamide. We report a patient with rosacea who developed new onset flushing
due to unauthorized substitution of niacin for nicotinamide. The
anti-inflammatory mechanisms of nicotinamide and flushing mechanisms of niacin
are discussed.
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[Cathelicidin LL-37 : A central factor in the pathogenesis of inflammatory
dermatoses?]

Keratinocytes produce and secrete antimicrobial peptides which function as
endogenous antibiotics and as signaling molecules within the cutaneous innate
immune system. Recent studies demonstrate that the antimicrobial peptide
cathelicidin LL-37 plays an important role in the pathogenesis of atopic eczema,
rosacea and psoriasis. Whereas skin in atopic eczema shows decreased
cathelicidin expression which leads to increased susceptibility to
superinfection in those patients, overabundant expression of cathelicidin
peptide fragments causes inflammation in rosacea. Finally, in psoriasis
cathelicidin peptide
binds to self DNA which triggers an autoimmune response. These studies
demonstrate the role of cathelicidin as a central factor in the pathogenesis of
cutaneous inflammation. Therapies targeting cathelicidin expression and function
could lead to new treatments for these diseases.
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Granulomatous rosacea.

Rosacea is classified into four clinical subtypes, namely
erythematotelangiectatic,
papulopustular, phymatous, and ocular. There is also a granulomatous variant,
which is recognized in the rosacea spectrum. The objective of this study is to
take
a closer look at the different histopathologic patterns and cellular
compositions
seen in granulomatous rosacea and their correlation to the clinical
presentation.
Facial biopsies from patients previously identified with a clinical diagnosis
consistent with rosacea, and who demonstrated a granulomatous infiltrate upon
histopathologic examination, were reviewed and the results were correlated to
the
clinical presentation. Four distinct histopathologic granulomatous patterns were
identified, namely nodular, perifollicular, diffuse, and a combined
perifollicular
and nodular patterns. The clinical presentation varied greatly among patients
and
failed to correlate to the microscopic findings. The varied clinical features
seen in
our study favors the theory that granulomatous rosacea is not a clinical subtype
of rosacea per se, but a distinct histological variant, which can be found in
most of
its clinical spectrum.
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Otophyma: A Case Report and Review of the Literature of Lymphedema
(Elephantiasis) of
the Ear.

Phymas (swellings, masses, or bulbs) are considered the end-stage of rosacea and
mostly affect the nose (rhinophyma), and rarely involve the chin (gnatophyma),
the
cheek (metophyma), eyelids (blepharophyma), or ears (otophyma). Herein, we
report
the case of a 57-year-old man who developed unilateral enlargement of his left
ear
over 2 years. Biopsy revealed changes of rosaceous lymphedema associated with
Demodex infestation. Corticosteroid and minocycline therapies resulted in
partial
reduction of the ear enlargement. Literature review examining for cases of
lymphedema (elephantiasis) of the ear revealed that chronic inflammatory
disorders (rosacea (most frequent), psoriasis, eczema), bacterial cellulitis
(erysipelas), pediculosis, trauma, and primary (congenital) lymphedema can all
lead to localized, lymphedematous enlargement of the ear. Depending on the
severity, medical treatment directed at the inflammatory condition for mild,
diffuse enlargement to surgical debulking for extensive diffuse enlargement or
tumor formation can improve the signs and symptoms of otophyma. Decreased
immune surveillance secondary to rosaceous lymphedema may explain why
Demodex infestation is common in rosacea and support the suspicion that
phymatous skin is predisposed to skin cancer development.
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Tetracyclines and pulmonary inflammation

Tetracycline and its derivatives, such as chlortetracycline, oxytetracycline,
minocycline, doxycycline, methacycline and lymecycline, are naturally occurring
or semi-synthetic polyketide compounds that exhibit a well known
broad-spectrum antibacterial activity that interferes with prokaryotic protein s
ynthesis at the ribosome level. In addition to this well known antibacterial
activity these compounds also exhibit a variety of additional, less well known
properties. Among them are separate and distinct anti-inflammatory
properties. Tetracycline and related compounds have been shown to be
effective chemotherapeutic agents in a wide variety of chronic inflammatory
diseases and conditions. These include periodontitis, rosacea, acne,
auto-immune diseases such as rheumatoid arthritis and protection of the
central nervous system against trauma and neurodegenerative diseases
such as stroke, multiple sclerosis and Parkinson disease. Tetracycline and
related compounds appear to be beneficial for treatment of several chronic
inflammatory airway diseases. Among them are asthma, bronchiectasis, acute
respiratory distress syndrome, chemical induced lung damage and cystic fibrosis.
The clinical use of tetracycline-type drugs in treatment of chronic airway
inflammation is becoming a topic of intense interest. Recent findings in this
area
have led to an understanding of the myriad physiological, cellular and
molecular mechanisms of the inflammatory response and how this response
may be controlled to limit damage to host cells and tissues. This review
presents
a brief summary of the recent research in the area of tetracycline and its
derivatives in control of pulmonary inflammation.

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source:

http://members.rosacea-research-and-development-institute.org/index.php?
showforum=19