A case of Scalp Rosacea treated with low dose doxycycline and probiotic therapy and literature review on therapeutic options

Fortuna, Maria Caterina; Garelli, Valentina; Pranteda, Guglielmo; Romaniello, Federico; Cardone, Michele; Carlesimo, Marta; Rossi, Alfredo

doi:10.1111/dth.12355

Cited by 31 publications

(28 citation statements)

References 10 publications

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“…The high prevalence of scalp involvement was an unexpected finding of this study. Because scalp involvement has rarely been reported in demodicosis (37)(38)(39)(40)(41)(42), and even more rarely in rosacea (43)(44)(45)(46), its presence was not specifically looked for when the study started, which explains why most of the patients with scalp involvement were identified in the later phase of the study.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Indicators of Rosacea and Demodicosis

Forton

Maertelaer²

2018

Acta Derm Venerol

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Papulopustular rosacea and demodicosis are characterized by non-specific symptoms, which can make clinical diagnosis difficult. This retrospective study of 844 patients assessed the diagnostic importance of clinical signs and symptoms that are poorly recognized as being associated with these conditions. In addition to well-known signs (vascular signs (present in 80% of patients), papules (39%), pustules (22%) and ocular involvement (21%)), other signs and symptoms (discreet follicular scales (93%), scalp symptoms (pruritus, dandruff or folliculitis; 38%) and pruritus (15%)) may also suggest a diagnosis not only of demodicosis, but also of papulopustular rosacea. Facial Demodex densities (measured by 2 consecutive standardized skin biopsies) were higher when ocular or scalp involvement was present, suggesting more advanced disease, but further investigations are needed to confirm this hypothesis. Recognition of these clinical signs and symptoms should encourage dermatologists to perform a Demodex density test, thus enabling appropriate diagnosis to be made.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Indicators of Rosacea and Demodicosis

Forton

Maertelaer²

2018

Acta Derm Venerol

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“…There are also great interpersonal differences in the human microbiota, a problem that can only be overcome by conducting studies using paired samples from the same patient [22]. Although data are scarce, the reports of successful rosacea treatment with oral probiotics combined with conventional therapy are promising [35,36] and provide evidence for the role of the gut microbiota in rosacea pathogenesis. In acne, several clinical trials reported positive results with oral or topical probiotics used alone or in combination.…”

Section: Discussionmentioning

confidence: 99%

“…In a randomized, controlled, non-blinded trial, patients with papulopustular exanthema (including 36% with rosacea) who received the bacteria Escherichia coli Nissle 1917 as an oral probiotic as well as a standard topical therapy had a better outcome than patients who only received the standard treatment (P < 0.01) [35]. Fortuna et al [36] also reported a case of rosacea with scalp involvement that was successfully treated with low-dose doxycycline (40 mg/ day) combined with oral probiotics (Bifidobacterium breve BR03 and Lactobacillus salivarius LS01) for 8 weeks, followed by probiotics alone. No relapse or flare-up of disease was observed during 6 months of follow-up [36].…”

Section: Does the Gut Microbiota Play A Role In Rosacea?mentioning

confidence: 99%

“…Fortuna et al [36] also reported a case of rosacea with scalp involvement that was successfully treated with low-dose doxycycline (40 mg/ day) combined with oral probiotics (Bifidobacterium breve BR03 and Lactobacillus salivarius LS01) for 8 weeks, followed by probiotics alone. No relapse or flare-up of disease was observed during 6 months of follow-up [36]. However, [9,12].…”

Section: Does the Gut Microbiota Play A Role In Rosacea?mentioning

confidence: 99%

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Microbiota in Rosacea

Kim

2020

Am J Clin Dermatol

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Rosacea is a complex facial skin condition associated with abnormal inflammation and vascular dysfunction. Next to the known trigger factors, the role of microbiota in the development and aggravation of rosacea continues to raise interest. Demodex folliculorum mites, Helicobacter pylori, Staphylococcus epidermidis, Chlamydia pneumoniae, and the Demodexassociated bacterium, Bacillus oleronius are microbes that have been linked with rosacea. However, the results of studies which assessed their involvement in the disease have been inconsistent and inconclusive. Microbiological research in many different disciplines exploded in recent years as methods to analyze complex microbial communities at the taxonomic and phylogenetic levels became available. Here, we provide an update on the microorganisms implicated in rosacea and review the potential pathogenic role of microbes in the development of rosacea. Key Points Microbes have long been suspected to play a role in rosacea. Better understanding of the microbiota and its role in rosacea pathophysiology may help determine the impact of microbial dysbiosis and host reactivity in rosacea populations. Deeper knowledge of microbe-host interactions in rosacea will allow targeted patient care and aid the development of innovative therapies.

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“…Rosacea has been associated with altered concentrations of Helicobacter pylori , S epidermidis , Chlamydia pneumonia , Bacillus olenorium and the Demodex mite and recent studies suggest a relationship between small intestinal bacterial overgrowth and rosacea . There has only been one case report of scalp and ocular rosacea that was treated successfully with a combination of doxycycline and oral probiotic therapy . This mechanism of success could be through targeting pathogenic bacteria with doxycycline while promoting commensal bacteria through probiotic therapy.…”

Section: Addressing the Skin Microflora To Combat Disease Statesmentioning

confidence: 99%

The role of topical probiotics in skin conditions: A systematic review of animal and human studies and implications for future therapies

Knackstedt

Gatherwright

2019

Experimental Dermatology

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There is increasing evidence that the intestinal microbiome plays an important role in modulating systemic inflammation and disease. Oral probiotics can modulate the intestinal microbiome and have demonstrated to be efficacious in treating topical skin conditions, such as atopic dermatitis, acne and rosacea. By proxy, exogenous application to the skin of probiotics should also promote a positive bacterial balance to mitigate or potentially eliminate pathologic conditions. The goal of this article was to provide a systematic review of studies that have investigated the role of topical probiotics in mitigating skin conditions. Additionally, skin conditions where dysbiosis has been identified but topical probiotics have not been investigated are discussed. We hope this review both analyses the evidence for the role that topical probiotics could play in topical skin conditions and highlights additional areas in need of research and exploration.

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A case of Scalp Rosacea treated with low dose doxycycline and probiotic therapy and literature review on therapeutic options

Cited by 31 publications

References 10 publications

Diagnostic Indicators of Rosacea and Demodicosis

Diagnostic Indicators of Rosacea and Demodicosis

Microbiota in Rosacea

The role of topical probiotics in skin conditions: A systematic review of animal and human studies and implications for future therapies

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