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Figure 1. Mean steady-state plasma concentrations (ng/ml) of anti-inflammatory dose doxycycline (40 mg/day) and doxycycline 50 mg/day in 16 healthy adult volunteers (mean weight 75 kg; measured at 7 days). Data from [46].
(Figure omitted. See article PDF.)
Figure 2. Mean change from baseline in total inflammatory lesion count through week 16 in CollaGenex Pharmaceuticals, Inc. Study 301. Data from [47].
(Figure omitted. See article PDF.)
Figure 3. Mean change from baseline in total inflammatory lesion count through week 16 in CollaGenex Pharmaceuticals, Inc. Study 302. Data from [47].
(Figure omitted. See article PDF.)
Rosacea is a chronic dermatological condition that most frequently affects the central face, including the cheeks, nose, chin and forehead [1]. Rosacea is currently viewed as an inflammatory disorder of unknown etiology [2,3]. In the absence of treatment, the course of rosacea may be marked by progressive worsening, most often punctuated by remissions and exacerbations. Rosacea can have a substantial negative impact on patients'quality of life, causing embarrassment and distress and interfering with social and work activities [4,5,101].
The primary features of rosacea are flushing (transient erythema), nontransient erythema, telangiectasia and papules/pustules [1]. Secondary signs and symptoms may include burning or stinging, edematous plaques, ocular manifestations and phymatous changes. Most patients do not present with all of these features, but instead exhibit various combinations [1]. An expert committee has divided rosacea into four subtypes based on clinical characteristics: erythematotelangiectatic, papulopustular, phymatous and ocular; and one variant: granulomatous. Patients may simultaneously or sequentially exhibit characteristics of multiple subtypes.
Approximately 14 million Americans have rosacea, although the condition goes undiagnosed and untreated in many [102]. Rosacea usually begins between the ages of 30 and 50 years [6] and affects nearly three times more women than men [7]. Patients are often characterized as fair-skinned individuals of northern European descent, but the condition may occur in persons of any race or ethnic background [8].
Etiology & pathophysiology
Although the etiology of rosacea is unknown, both basic and clinical research suggests that it is an inflammatory condition. Upregulation of proinflammatory cytokines in affected skin promotes leukocyte chemotaxis and activation [3]. Neutrophil-expressed compounds, such as reactive oxygen species (ROS) [9] and matrix metalloproteinases (MMPs) [10], contribute to chronic vasodilation and ongoing dermal matrix degradation. Infiltrating leukocytes...