S2k guideline: Rosacea Clanner‐Engelshofen, Benjamin M.; Bernhard, Dominik; Dargatz, Sonja ...
Journal der Deutschen Dermatologischen Gesellschaft,
August 2022, 2022-08-00, 20220801, Letnik:
20, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Summary
This updated and upgraded S2k guideline deals with the diagnosis and treatment of rosacea, which is a common, chronic inflammatory skin disease mostly affecting the face. Initially, rosacea ...is characterized by recurrent erythema, telangiectasia and flushing. Later, the inflammatory component predominates, with persistent erythema with follicular papules, papulopustules and pustules. The development of phyma, which usually occurs on the acral localizations, is the most severe manifestation. For the treatment of rosacea, the interdisciplinary guideline committee, with representatives of the German Dermatological Society (DDG), the Professional Association of German Dermatologists (BVDD), the German Opthalmological Society (DOG), the Society for Dermopharmacy (GD), the Swiss Society for Dermatology and Venereology (SGDV) and the German Rosacea Aid e. V., recommends the avoidance of trigger factors and topical applications of metronidazole, azelaic acid or ivermectin. For symptomatic treatment of persistent centrofacial erythema, the topical vasoconstrictors brimonidine or oxymetazoline can also be used. Systemic therapy is recommended for therapy‐resistant and severe forms of rosacea papulopustulosa. The drug of choice is low‐dose doxycycline. Alternatively, low‐dose isotretinoin can be recommended. Ocular rosacea should be treated with lid margin hygiene. For topical treatment, ciclosporin eye drops, azithromycin, ivermectin or metronidazole are suggested.
S2k‐Leitlinie: Rosazea Clanner‐Engelshofen, Benjamin M.; Bernhard, Dominik; Dargatz, Sonja ...
Journal der Deutschen Dermatologischen Gesellschaft,
August 2022, 2022-08-00, 20220801, Letnik:
20, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Zusammenfassung
Die vorliegende aktualisierte und auf S2k‐Niveau angehobene Leitlinie befasst sich mit der Diagnostik und der Therapie der Rosazea, bei welcher es sich um eine häufige, ...chronisch‐entzündliche Hauterkrankung handelt, die meist das Gesicht betrifft. Der Verlauf der Rosazea ist initial durch rezidivierende Erytheme, Teleangiektasien sowie Flushing gekennzeichnet. Später überwiegt die entzündliche Komponente, wobei es zu persistierenden Erythemen mit follikulären Papeln, Papulopusteln und Pusteln kommt. Die Bildung von Phymen, die meist an den Akren auftreten, stellt dabei die schwerste Ausprägung der Erkrankung dar. Zur Behandlung empfiehlt die interdisziplinäre Leitlinienkommission, die aus Vertretern der Deutschen Dermatologischen Gesellschaft (DDG), des Berufsverbandes der Deutschen Dermatologen (BVDD), der Deutschen Ophthalmologischen Gesellschaft (DOG), der Gesellschaft für Dermopharmazie (GD), der Schweizerischen Gesellschaft für Dermatologie und Venerologie (SGDV) und der Deutschen Rosazea Hilfe e. V. besteht, neben der Meidung von Triggerfaktoren, die topische Anwendung der Wirkstoffe Metronidazol, Azelainsäure oder Ivermectin. Zur symptomatischen Behandlung persistierender zentrofazialer Erytheme können zudem die Vasokonstriktoren Brimonidin oder Oxymetazolin topisch angewandt werden. Bei therapieresistenten sowie bei schweren Formen der Rosacea papulopustulosa wird eine systemische Therapie empfohlen. Hierfür ist niedrigdosiertes Doxycyclin das Präparat der 1. Wahl. Alternativ kann niedrigdosiertes Isotretinoin empfohlen werden. Für die okulären Rosazea kann neben einer Lidrandhygiene die topische Behandlung mit Ciclosporin‐haltigen Augentropfen, Azithromycin, Ivermectin oder Metronidazol empfohlen werden.
BACKGROUND
Photodynamic therapy (PDT) is an effective treatment for actinic keratoses (AKs). Light‐emitting diodes (LEDs) offer practical advantages when treating multiple lesions.
OBJECTIVE
To ...evaluate the efficacy and tolerability of PDT using a LED and topical methyl aminolevulinate (MAL) for treatment of multiple AKs.
METHODS AND MATERIALS
One hundred thirty‐one patients with four to 10 non‐pigmented, previously untreated thin or moderately thick AKs on the face or scalp were enrolled in this multicenter, double‐blind, randomized, placebo‐controlled study. MAL or matching placebo cream was applied to the débrided lesion surface for 3 hours before illumination with noncoherent red light (630 nm, light dose 37 J/cm2). Treatment was repeated 1 week later.
RESULTS
Efficacy was evaluated in 57 patients with 418 lesions treated with MAL PDT and 58 with 414 lesions treated with placebo PDT. Sixteen patients were excluded as protocol violators (not randomized). MAL PDT was superior (p<.001) to placebo PDT in lesion complete response rates (83.3%, 95% confidence interval (CI)=79.3–86.7%, vs 28.7%, 95% CI=24.4–33.4%) and patient complete response rates (all lesions showing complete response; 68.4%, 95% CI=54.8–80.1% vs 6.9%, 95% CI=1.9–16.7%).
CONCLUSIONS
Topical MAL PDT using a LED is an effective treatment for multiple AKs.
Background. A variety of lasers have been used in an attempt to treat leg vein telangiectasia
Objective. To evaluate the feasibility of a new 940 nm diode laser for the treatment of leg vein ...telangiectasia.
Methods. Thirty‐one patients with leg vein telangiectasia were treated with a diode laser; 26 of these with 940 nm, 300–350 J/cm2, 40–70 msec, 1.0 mm handpiece, one pass, and 5 of these with 940 nm, 815 J/cm2, 50 msec, 0.5 mm handpiece, one pass. Each subject had three treatments of the same site at 4‐week intervals. Photographs taken before and 4 weeks after the last treatment were evaluated by two independent observers for vessel clearance.
Results. In those 26 patients treated with a fluence of 300–350 J/cm2, a vessel clearance of greater than 50% was achieved in 20 patients (76%), 12 of these patients had clearance rates greater than 75%. A clearance rate of less than 50% was obtained in six patients, with three of these patients showing responses of less than 25%. In five patients treated with a fluence of 815 J/cm2 a clearance rate of more than 75% was observed.
Conclusions. In this preliminary study a 940 nm diode laser was shown to be safe and effective for the treatment of leg vein telangiectasia.
background. Short‐term results obtained with a 940 nm diode laser indicate that this laser is effective in the treatment of leg vein telangiectasia. Long‐term studies are needed to evaluate the ...definitive clinical end results.
objective. To evaluate long‐term results in the treatment of leg vein telangiectasia with a 940 nm diode laser and to compare these with short‐term results.
methods. Twenty patients were treated with 940 nm diode laser, 300–350 J/cm2, 40–70 msec, 1 mm spot, single pass. Photographs for evaluation of clearance were taken before treatment and 4 weeks and 12 months after the last treatment.
results. At 12 months follow‐up, clearing rates were greater than 75% in 15 patients (75%) and 50–75% in 5 patients. In 7 patients (35%) the clearing rate had improved considerably during follow‐up.
conclusion. Definitive results with the 940 nm laser occur only after prolonged follow‐up. They are considerably better than the short‐term results.
