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  • Brady Barrows
    Case reports: new onset flushing due to unauthorized substitution of niacin for nicotinamide. Nicotinamide is the amide form of niacin and has
    Message 1 of 1 , Feb 1, 2008
      Case reports: new onset flushing due to unauthorized substitution of niacin for

      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.

      [Cathelicidin LL-37 : A central factor in the pathogenesis of inflammatory

      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.

      Granulomatous rosacea.

      Rosacea is classified into four clinical subtypes, namely
      papulopustular, phymatous, and ocular. There is also a granulomatous variant,
      which is recognized in the rosacea spectrum. The objective of this study is to
      a closer look at the different histopathologic patterns and cellular
      seen in granulomatous rosacea and their correlation to the clinical
      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
      clinical presentation. Four distinct histopathologic granulomatous patterns were
      identified, namely nodular, perifollicular, diffuse, and a combined
      and nodular patterns. The clinical presentation varied greatly among patients
      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.

      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),
      cheek (metophyma), eyelids (blepharophyma), or ears (otophyma). Herein, we
      the case of a 57-year-old man who developed unilateral enlargement of his left
      over 2 years. Biopsy revealed changes of rosaceous lymphedema associated with
      Demodex infestation. Corticosteroid and minocycline therapies resulted in
      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.

      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
      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
      a brief summary of the recent research in the area of tetracycline and its
      derivatives in control of pulmonary inflammation.



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