Skin surface lipid composition in rosacea

Lipid Alterations and Metabolism Disturbances in Selected Inflammatory Skin Diseases

Lipidomics is a term used to define the field that analyzes the structure, functions, and interactions of lipids. Inflammatory dermatoses and lipid disturbances are interrelated, especially due to chronic inflammatory conditions. This review discusses lipidomics in selected inflammatory skin diseases: psoriasis, lichen planus, and atopic dermatitis, as well as the less commonly mentioned hidradenitis suppurativa, rosacea, and acne vulgaris. Lipid homeostasis disorders are common; they are especially well-documented in psoriasis, lichen planus, and atopic dermatitis. Future studies are required for better insight into this issue, particularly on the skin lipidome. Understanding lipidomics, in particular skin diseases, increases our knowledge about their pathogenesis, and may become useful in adjusting tailored management for each patient as well establishing prognosis. Noteworthily, it seems advisable to alert doctors to the need to analyze lipid parameters and the complications of abnormal lipid metabolism in dermatological patients, which could decrease their comorbidities and improve the life quality and health condition of dermatological patients.

Revealing the Correlation between Altered Skin Lipids Composition and Skin Disorders

Human skin layers serve as a barrier between the body and the environment, by preventing water loss and blocking the entry of chemicals, allergens, and microbes. Recent data showed that skin lipids are vital ‘key players’ of several functions and mechanisms performing in the skin, such as, barrier function and microbiome composition. Abnormalities in lipid composition have been observed in inflammatory cutaneous diseases with a disrupted skin barrier. This review aims to demonstrate the fundamental role of keratinocytes, sebocytes, and microbiome-derived lipids in the maintenance of the skin barrier. Furthermore, it would reveal the correlation between altered skin lipids’ composition, microbiome, and the occurrence of certain dermatological disorders such as acne vulgaris, atopic dermatitis, psoriasis, and rosacea.

Rosacea: I. Etiology, pathogenesis, and subtype classification

Rosacea is one of the most common conditions dermatologists treat. Rosacea is most often characterized by transient or persistent central facial erythema, visible blood vessels, and often papules and pustules. Based on patterns of physical findings, rosacea can be classified into 4 broad subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. The cause of rosacea remains somewhat of a mystery. Several hypotheses have been documented in the literature and include potential roles for vascular abnormalities, dermal matrix degeneration, environmental factors, and microorganisms such as Demodex folliculorum and Helicobacter pylori. This article reviews the current literature on rosacea with emphasis placed on the new classification system and the main pathogenic theories. Learning objective At the conclusion of this learning activity, participants should be acquainted with rosacea's defining characteristics, the new subtype classification system, and the main theories on pathogenesis.

Meibomian gland dysfunction

Blepharitis is probably the most common disease entity seen in the general ophthalmologist's office. A significant proportion of these cases are secondary to meibomian gland disease. This review outlines our knowledge of the histopathology, lipid abnormalities and role of microorganisms in meibomian gland dysfunction. We will also review the physiology of meibomian gland secretion and present models of meibomian gland dysfunction which have enhanced our knowledge of this condition. The importance of diagnosing associated conditions such as aqueous tear deficiency, contact lens intolerance, rosacea, and seborrheic dermatitis is emphasized. Although this condition causes significant morbidity in the population, there are effective treatments available and these will be discussed.

Lipid synthesis in vitro by rabbit Meibomian gland tissue and its inhibition by tetracycline

Rabbit Meibomian gland tissue was incubated with radioactive acetate, propionate, valine, leucine or isoleucine. The time-course of incorporation of radioactivity into total lipids from acetate and isoleucine was studied in Hanks' or Krebs medium. Incorporation of acetate or isoleucine into lipid classes was followed by TLC, and of acetate label into individual fatty acids and alcohols by GLC with radioactivity detection. Radioactivity was highest in the minor acid components C16:1 and C18:1. Levels in branched fatty acids fell with chain length, reflecting the time-course of successive chain elongations. Use of amino acids or propionate as precursors suggested that molecules containing a specific branched structure were preferentially incorporated; this indicates a binding preference at the level of the fatty acid synthase which might explain the very high proportion of anteiso-branched structures in the rabbit secretion. Incorporation of label into total lipids was significantly reduced by tetracycline in the medium, with 50% reduction at about 1.5 mg/ml for acetate and 0.7 mg/ml for isoleucine.

Ocular rosacea

The demographic, clinical, and histopathologic characteristics of ocular rosacea are reviewed, with emphasis on examination of the skin in patients with external ocular disease. Since no single clinical or pathological hallmark of rosacea exists, a proposed point system for diagnosis is presented. Studies of pathogenesis reveal that no single unifying hypothesis accounts for all the expressions of ocular rosacea. Reports of treatment with tetracycline and other antibiotics demonstrate efficacy, although the mechanisms of action of these drugs are not known. More recently, other classes of drugs, including isotretinoin and hexachlorocyclohexane, have proven to be effective in dermatologic manifestations of rosacea, but effects on ocular manifestations are unknown.

Ocular rosacea

Ocular rosacea was diagnosed in 49 patients. The most common signs and symptoms were foreign body sensation, burning, superficial punctate erosions, chalazia, and belpharitis. Less common but dangerous to the vision was corneal thinning, vascularization, and infiltrates. Three new associated symptoms were found. These were mapdot subepithelial opacities, recurrent erosions, and moderately severe foreign body sensation, pain or burning with minimal associated signs. Of the 49 patients, 37 were treated with 250 mg of oral tetracycline four times a day, which resulted in improvement in almost all patients from four to 17 days after initiation of therapy. Most of the patients have been able to taper, or taper and stop therapy without recurrence of their symptoms. Those patients with foreign body sensation, burning, and pain required the most prolonged therapy in order to taper or stop treatment with tetracycline.