{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzops2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzops2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/37\\\/26\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/37\\\/26\u0022}],\u0022ac\u0022:{\u0022spmdc;14\\\/37\\\/26\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;14\\\/37\\\/26\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ERosacea, a chronic inflammatory skin disease of unknown etiology, occurs mainly in red-haired, blue-eyed, fair-skinned individuals of Northern European and Celtic origin. This article discusses the association of rosacea with the Irish population, the clinical symptoms of rosacea, the management of red face symptoms, the diagnosis and management of red acne, as well as related clinical trial updates.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESkin Diseases\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDermatology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESkin Diseases\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ERosacea, a chronic inflammatory skin disease of unknown etiology, occurs mainly in red-haired, blue-eyed, fair-skinned individuals of Northern European and Celtic origin. Frank C. Powell, MD, University College Dublin, Dublin, Ireland, discussed the association of rosacea with the Irish population, 87% of whom have skin types 1 or 2 (pale-to-fair white).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe National Rosacea Society Expert Committee on the Classification and Staging of Rosacea defines 4 (sometimes overlapping) subtypes: erythematotelangiectatic rosacea (ETR; seen as flushing or persistent facial redness), papulopustular rosacea (PPR; characterized by bumps, pimples, and\/or raised red plaques in addition to persistent redness), phymatous rosacea (an often stigmatizing subtype in which the nose is enlarged), and ocular rosacea (swollen, watery, or bloodshot eyes accompanied by irritation, burning, or stinging) [Wilkin J et al. \u003Cem\u003EJ Am Acad Dermatol\u003C\/em\u003E. 2002].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ERecent molecular (gene array) and cellular findings of the different subtypes noted a differential regulation of genes with certain genes overlapping, suggesting a developmental progression from one subtype to another [Steinhoff M et al. \u003Cem\u003EJ Investig Dermatol Symp Proc\u003C\/em\u003E. 2011]. A rosacea gene has not been identified, however.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA 2010 study estimated the prevalence of PPR among Irish subjects to be about 2.7% [McAleer MA et al. \u003Cem\u003EJ Am Acad Dermatol\u003C\/em\u003E. 2010]. No association was noted with ultraviolet exposure, cutaneous photodamage, actinic keratoses, or cutaneous malignancy. This differs from ETR, which is significantly associated with photodamage (occurs in about 16.3% of Irish individuals with higher levels of sunlight exposure compared with 6.8% with lower levels; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .0001). It has been suggested that ETR and PPR may be different conditions rather than subtypes of the same disorder.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAccording to Christina Antoniou, MD, Athens University Sygros Hospital, Athens, Greece, having a \u201cred face\u201d is not always a sign of rosacea.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe clinical symptoms of rosacea include flushing of the central parts of the face and transient to persistent erythema [Powell FC. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2005]. It is characterized by telangiectasia and papulopustules and usually occurs in adults aged \u0026gt; 30 years old. These symptoms can be mimicked by other skin conditions such as seborrheic dermatitis (an inflammatory skin disorder affecting the scalp, face, and torso), acne vulgaris, perioral dermatitis, cortisone face, contact dermatitis, and polymorphous light eruption (PLE) after sun exposure. Demodicosis (a rare sensitivity to mites that manifests as facial papules and pustules) may also appear similar to rosacea, as can lupus erythematosus and ulerythema ophryogenes. Cutaneous B-cell neoplasms may present facial plaques or patches that mimic granulomatous rosacea or rhinophyma [Barzilai A et al. \u003Cem\u003EArch Dermatol\u003C\/em\u003E. 2012]. B-cell neoplasms may appear in the setting of preexisting rosacea or as a new eruption.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDiagnosis should include a close inspection of the face and a detailed medical history. Differential features of various conditions that present with some similarities to rosacea include, but are not limited to, acne, demodicosis, systemic lupus erythematosus, and PLE. Prof Antoniou suggests the use of a biopsy to confirm a diagnosis when encountering resistance to common therapy.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ENoting the lack of sensitive tests to investigate red face sensitivity, Gabriella Fabbrocini, MD, University of Naples Federico II, Naples, Italy, urges dermatologists to perform multiple tests to assess sensitivity before prescribing treatments.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EPatients with sensitive skin syndrome (SSS) report exaggerated reactions on skin contact with substances not usually considered irritants that is worse after exposure to dry and cold climates [Berardesca E et al. \u003Cem\u003EInt J Cosmet Sci.\u003C\/em\u003E 2013]. SSS is classified as hyperreactive, hypersensitive, or hypersusceptible. Hyperreactors may have a thinner stratum corneum, alterations in vanilloid receptors, and changes in neuronal transmission.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EAlthough 45% of the population report having characteristics of SSS, there have been few studies with objective data. Most of the studies rely on self-diagnosis. The current hypothesis for SSS notes a correlation between sensitive skin and constitutional genetic abnormalities with occupational skin diseases and chronic exposure to irritants as possible triggers. Other hypotheses suggest thinner and\/or increased permeability of the stratum corneum, changes in vanilloid receptors, and changes in neuronal transmission as explanations.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EInflammatory conditions related to allergens should be ruled out with patch or photopatch tests before making a diagnosis of SSS. Irritant reactivity tests, bio-engineering tests, and sensory testing methods are just a few of the many available tests that can used, none of which are universally accepted. An automatic lesion-counting program is a useful tool for acne severity evaluation [Min S et al. \u003Cem\u003ESkin Res Technol\u003C\/em\u003E. 2013]. A common test is the stinging test, in which patients self-report the presence and intensity of a stinging sensation after topical application of lactic acid along the nasolabial fold. A smart phone app is also available to provide objective support for patient responses by measuring erythema photographically and calculating an index of erythema.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EFaced with the multiple causes of facial redness, it is often difficult to devise a treatment strategy. Martin Steinhoff, MD, University College of Dublin, Dublin, Ireland, discussed some of the approaches he uses to manage red face symptoms.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EYamasaki and colleagues [\u003Cem\u003EJ Invest Dermatol\u003C\/em\u003E. 2011; \u003Cem\u003EJ Invest Dermatol Proc\u003C\/em\u003E. 2011; \u003Cem\u003ENature Med.\u003C\/em\u003E 2007] published several animal studies showing that the activation of proteases leads to signs that resemble rosacea. Proteases are significantly enhanced in inflammatory skin diseases as well as in all subtypes of rosacea and may be an effective therapeutic target for its treatment [Seeliger S et al. \u003Cem\u003EFASEB J.\u003C\/em\u003E 2003]. Research also indicates that the ETR and PPR subtypes may be associated more with vasodilation than angiogenesis. The difficulty of treating rosacea is that vessel function in facial skin is regulated by multiple neural systems including sympathicus, parasympathicus, sensory nerves, and local inflammation.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EThe diagnosis of rosacea is hampered by the complex activation of the innate and adaptive immune systems, neurovascular dysregulation, and inflammation. A better understanding of the vasodilation mechanism induced by tachykinins released from nerve endings may lead to the next generation of neurokinin receptor antagonists for the treatment of rosacea [Steinhoff MS et al. \u003Cem\u003EPhysiol Rev.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EIt is now known that a significant inflammatory infiltrate is detectable in early rosacea.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EEarly rosacea is also characterized by increases in T cells, macrophages, and mast cells, indicating early activation [Schwab VD et al. \u003Cem\u003EJ Investig Dermatol Symp Proc\u003C\/em\u003E. 2011]. Early treatment is important because the psychological impact of rosacea is significant on many fronts, including frustration, embarrassment, and low self-esteem.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003ERed acne can be either common inflammatory acne or inflammatory acne plus diffuse erythema. Giuseppe Micali, MD, University of Catania, Catania, Italy, shared his thoughts regarding the diagnosis and management of this separate entity.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EThe diffuse erythema seen in some cases of red acne may have several possible causes, including enhanced intrinsic inflammation, side effects from drugs or cosmetics, or other underlying\/superimposed \u201cred face\u201d conditions. Recent data suggest that inflammation plays a pivotal role in both the development and severity of acne lesions [Contassot E, French LE. \u003Cem\u003EJ Invest Dermatol\u003C\/em\u003E. 2014]. Acne products like benzoyl peroxide and retinoids or keratolytic-based cosmetics can also cause diffuse skin irritation and redness, as can discontinuation of inappropriate steroids used to manage acne (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Gollnick HP, Zouboulis CC. \u003Cem\u003EDtsch Arztebl Int.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12125\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12125\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12125\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003ESide Effects From Topical Acne Products\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-26\u0022\u003EThe presence of an underlying chronic \u201cred face\u201d condition such as rosacea, perioral dermatitis, atopic dermatitis, seborrheic dermatitis, and rarely psoriasis may lead to increased diffuse redness in patients with acne. Acute causes of red face such as sunburn, eczema flare, and flushing can also lead to increased redness. Some patients with acne who are prone to flushing and blushing may develop rosacea later in life as well as other \u201cred face\u201d conditions. Acne generally peaks in adolescence but an increased prevalence in adults is observed.\u003C\/p\u003E\u003Cp id=\u0022p-27\u0022\u003EProper management of \u201cred acne\u201d should include an accurate investigation on the possible causative factors. The use of anti-inflammatory drugs along with a short course of oral steroids (oral prednisolone) followed by oral isotretinoin is suggested in case of diffuse erythema with no apparent causes. In the other cases, avoidance of triggering factors as well as correction of the concomitant \u201cred face\u201d conditions are recommended. Use of mild cleansers, moisturizers, and anti-inflammatory creams may be helpful. Finally, camouflage with specific makeup products is able to minimize redness with positive results.\u003C\/p\u003E\u003Cp id=\u0022p-28\u0022\u003EEster van Zuuren, MD, Leiden University Medical Centre, Leiden, The Netherlands, presented preliminary results of an updated Cochrane review of 106 randomized controlled trials in adults with rosacea and any type of intervention. Most studies were conducted in participants with PPR; the mean study duration was 2 to 3 months.\u003C\/p\u003E\u003Cp id=\u0022p-29\u0022\u003EAmong patients with subtype 1, once-daily brimonidine tartrate gel 0.5% reduces moderate to severe erythema over 12 hours (peak effect at 4 to 6 hours) [Fowler J Jr et al. \u003Cem\u003EJ Drugs Dermatol\u003C\/em\u003E. 2013]. Eight studies addressed laser- and light-based therapies, which appeared to be effective but limited data were provided. The data for metronidazole, azelaic acid, doxycycline, and other laser and\/or light therapies were insufficient to draw any conclusions.\u003C\/p\u003E\u003Cp id=\u0022p-30\u0022\u003EFor subtype 2, 9 studies noted efficacy with metronidazole; 4 studies noted similar findings for azelaic acid. Ivermectin 1% cream achieved significant (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) patient- and physician-assessed improvement and quality-of-life outcomes [Stein L et al. \u003Cem\u003EJ Drugs Dermatol\u003C\/em\u003E. 2014]. Ivermectin was superior to metronidazole, and patients reported higher satisfaction [Taieb A et al. \u003Cem\u003EBr J Dermatol\u003C\/em\u003E. 2014]. Three studies showed effectiveness for the use of oral doxycycline 40 mg with no differences in adverse events vs placebo [Del Rosso JQ et al. \u003Cem\u003EJ Am Acad Dermatol\u003C\/em\u003E. 2007; Fowler JF Jr. \u003Cem\u003EJ Drugs Dermatol\u003C\/em\u003E. 2007; Sanchez J et al. \u003Cem\u003EJ Am Acad Dermatol\u003C\/em\u003E. 2005]. Oral isotretinoin (0.3 mg\/kg) is an effective and well-tolerated therapy option as well [Gollnick H et al. \u003Cem\u003EJ Dtsch Dermatol Ges.\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-31\u0022\u003ERandomized controlled trial evidence is lacking for pharmacologic treatment of subtype 3; both laser treatment and surgery show good cosmetic results. There is limited evidence for topical cyclosporine 0.05% ophthalmic emulsion over artificial tears for subtype 4.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/37\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzops2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzops2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}