BACKGROUND:Assisted reproductive technologies (ARTs) are considered to be physically and mentally stressful. During their treatment trajectory, couples express high information and communication needs. They appreciate using the internet to obtain fertility-related information. In a previous study, we developed myFertiCare, an eHealth tool providing personalized information and interactive functionalities for infertile couples in order to improve patient-centered care. The app has already been successful in qualitative evaluations of usability. OBJECTIVE:The aim of the current study is to quantitatively evaluate the implementation of myFertiCare by using the human, organizational, and technology-fit (HOT-fit) framework and to study the effects of using myFertiCare on couples' knowledge about infertility, their experience of the burden of infertility, and their experience of patient-centered care. With these results, implementation can be further improved, and patient-centered care can be enhanced. METHODS:A quantitative study was performed based on the HOT-fit framework using validated questionnaires focusing on the human, organizational, and technology domains. Questions were added on the effect of using myFertiCare on couples' knowledge about infertility and treatment. Questions regarding the burden of infertility, the burden of infertility treatment, and the experience of patient-centeredness were based on the main items of the validated fertility quality of life (FertiQoL) and Patient-Centredness Questionnaire-Infertility questionnaires, respectively. Also, nonusers of the app were included to explore motivations for not using the app and identify opportunities for improvement. Finally, user data were analyzed to provide insight into multiple variables concerning app use. RESULTS:In the human and technology domains, myFertiCare showed good system usability, high user satisfaction, and high information and interface quality. In the organizational domain, implementation was considered to be sufficient by both patients and staff. Use of the app increased knowledge about the treatment, improved coping with the treatment, and enhanced the experience of patient-centeredness. User data showed that women were the main app users and that use of the app gradually declined during the treatment trajectory. CONCLUSIONS:A multi-faceted online app, myFertiCare, has been successfully evaluated quantitatively for implementation by using the HOT-fit framework. Use of the app increased knowledge about the treatment, improved coping with the treatment, and enhanced the experience of patient-centeredness. App use could be improved by creating more publicity. By providing myFertiCare, professionals in fertility care are supported in guiding patients through their treatment trajectory and in delivering patient-centered care.

Background Stratum corneum hydration (SCH) and transepidermal water loss (TEWL) provide useful information about skin barrier function. This study aimed to determine the value of GPSkin Pro, a new handheld device determining both SCH and TEWL, to measure skin barrier impairment and to monitor barrier function in rosacea in daily practice. Materials and Methods Two pilots were performed.Pilot 1: in 27 healthy participants, GPSkin SCH and TEWL were compared to Aquaflux(R)and Epsilon(R)values at the forearm before and after skin barrier perturbation via tapestripping. Moreover, GPSkin values were measured at both cheeks without intervention.Pilot 2: in 16 rosacea patients, GPSkin measurements were performed at the forearm, and at both cheeks before and during anti-inflammatory treatment. They were compared to clinical symptoms and to GPSkin values from pilot 1. Results Pilot 1:after merging data from before and after tapestripping, a strong correlation was observed between GPSkin TEWL and Aquaflux(R)(R-s = 0.9256), and GPSkin SCH and Epsilon(R)(R-s = 0.8798).Pilot 2:SCH was significantly lower at the cheeks of rosacea patients compared to controls, with a normalizing trend during successful treatment. TEWL was comparable among patients and controls and did not change during treatment at all locations. Conclusion The GPSkin determines TEWL and SCH accurately in healthy and impaired skin barrier state and can monitor skin barrier function in rosacea during treatment. The GPSkin device is much more practical compared to previous skin barrier tools when used in clinical practice. Its further validation in other inflammatory skin diseases is recommended.

Rosacea is a chronic inflammatory skin disease of unknown etiology. We noticed a series of patients who were diagnosed with rosacea as well as obstructive sleep apnea syndrome (OSAS), for which they used a continuous positive airway pressure (CPAP) mask. This case series aims to give insight in the possible relationship between rosacea and the use of a CPAP mask for OSAS. We present five patients with OSAS who developed or worsened rosacea symptoms after use of a CPAP mask covering nose and mouth. Two patients showed centrofacial symptoms consistent with the shape of the CPAP mask; three patients had nasal cutaneous symptoms. It is postulated that the occlusive effect of the CPAP mask, increasing skin humidity and temperature, can induce primary symptoms in patients with an underlying sensibility for rosacea. This could have implications for choice of CPAP mask type and topical therapeutic options for rosacea.

Background Facial erythema is a common symptom in rosacea. To overcome subjectivity in scoring erythema severity, objective redness quantification is desirable. This study evaluated an image-based erythema quantification tool to monitor facial erythema in rosacea patients during treatment and compared these values to clinical scores. Materials and Methods Twenty-one rosacea patients were treated with topical ivermectin for 16 weeks. Clinical erythema scores and clinical photographs were taken at week 0, 6, 16 and 28. Using ImageJ, RGB images were split into red, green and blue channels to measure the green/red ratio of lesional skin compared with a green sticker. With CIELAB colour space, a* (indicating colour from green to red) of a lesional and non-lesional facial site was measured, calculating increment a*. Interobserver concordance and correlation between quantitative and clinical erythema values were determined. Results Treatment resulted in reduction of clinical erythema scores. No significant changes in red/green ratios were measured. Lesional a* and increment a* significantly decreased from baseline to week 16 and 28 (P < .05). A weak correlation existed between clinical scores and lesional a* (R-s = 0.37), and between clinical scores and increment a* (R-s = 0.30), with a clear trend towards higher a* and increment a* for higher clinical scores. Interobserver correlation was high (R-2 = 0.82). Conclusion ImageJ is a simple, rapid, objective and reproducible tool to monitor erythema in rosacea patients during treatment. The photographs allow retrospective analysis, evaluation of large and small lesions, and discrimination of subtle redness differences. We recommend using lesional a* to monitor erythema of inflammatory dermatoses in clinical practice.

Background: Flushing and erythema are frequent skin symptoms in rosacea. Because their adequate treatment remains a clinical challenge, new treatment options are explored, such as oral beta-blockers. Objectives: To evaluate the efficacy of oral beta-blockers for rosacea-associated facial flushing and erythema. Methods: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched, including studies providing original data on the efficacy of oral beta-blockers in rosacea patients with facial flushing and/or persistent erythema. Risk of bias was assessed using the Cochrane Risk of Bias tool, Newcastle-Ottawa scale, and Quality in Prognosis Studies tool. Results: Nine studies evaluating the use of carvedilol, propranolol, nadolol, and beta-blockers in general were included. Articles studying carvedilol and propranolol showed a large reduction of erythema and flushing during treatment with a rapid onset of symptom control. Bradycardia and hypotension were the most commonly described adverse events. Limitations: Most studies had a retrospective design with a small sample size, and outcome measurement was often subjective. Conclusions: Oral beta-blockers could be an effective treatment option for patients with rosacea with facial erythema and flushing that does not respond to conventional therapy. Larger prospective trials with objective outcome assessment are needed to validate the promising results of these studies.

Background Flushing and erythema are frequent skin symptoms in rosacea. Because their adequate treatment remains a clinical challenge, new treatment options are explored, such as oral β-blockers. Objectives To evaluate the efficacy of oral β-blockers for rosacea-associated facial flushing and erythema. Methods PubMed, Embase, Web of Science, and Cochrane Library were systematically searched, including studies providing original data on the efficacy of oral β-blockers in rosacea patients with facial flushing and/or persistent erythema. Risk of bias was assessed using the Cochrane Risk of Bias tool, Newcastle-Ottawa scale, and Quality in Prognosis Studies tool. Results Nine studies evaluating the use of carvedilol, propranolol, nadolol, and β-blockers in general were included. Articles studying carvedilol and propranolol showed a large reduction of erythema and flushing during treatment with a rapid onset of symptom control. Bradycardia and hypotension were the most commonly described adverse events. Limitations Most studies had a retrospective design with a small sample size, and outcome measurement was often subjective. Conclusions Oral β-blockers could be an effective treatment option for patients with rosacea with facial erythema and flushing that does not respond to conventional therapy. Larger prospective trials with objective outcome assessment are needed to validate the promising results of these studies.

Background Rosacea assessment and therapy monitoring can be challenging to standardize, as most clinical evaluation systems are prone to interobserver variability and not always validated. Therefore, objective, reliable and preferably noninvasive measurement tools are needed. Objectives To give insight into available noninvasive imaging techniques and biophysical methods in rosacea by performing a systematic review. Methods PubMed, Embase, Cochrane and Web of Science databases were searched until 1 September 2018 in accordance with PRISMA guidelines, to identify studies providing original data about objective noninvasive imaging and/or biophysical skin measurement techniques for diagnosis, assessing severity or therapy monitoring of adult patients with cutaneous facial rosacea. Risk of bias of included articles was assessed with the Cochrane Risk of Bias tool, Quality in Prognosis Studies tool, and the Newcastle-Ottawa Scale. Results A total of 78 studies were included, describing 14 imaging and biophysical methods. Widespread information about (sub)surface cutaneous morphology and functionality was obtained. Methodological study quality was relatively low and interstudy outcome variability was large. Several tools show promising value in research settings: for treatment follow-up Demodex mites are countable with reflectance confocal microscopy, spectrometry can quantify erythema, and rosacea severity could be objectified with skin hydration- and transepidermal water loss measurements. Conclusions This systematic review describes the spectrum of noninvasive imaging and biophysical methods in rosacea assessment, giving multifaceted information about structure and properties of rosacea skin, especially useful for research purposes. Larger studies with good methodological quality are needed to create validated protocols for further implementation into research. What's already known about this topic? Rosacea is a chronic inflammatory skin disease with a variety of clinical manifestations. Most clinical evaluation systems are subjective, not always validated, and subsurface skin processes remain unnoticed. Currently, different types of noninvasive measurement tools are available for rosacea assessment and therapy monitoring, but a comprehensive overview is lacking. What does this study add? Seventy-eight publications were included, describing 14 imaging and biophysical tools, providing a wide range of information about rosacea skin morphology and functionality. Reflectance confocal microscopy and spectrometry are especially promising in therapy monitoring and skin barrier measurements for rosacea severity assessment. Larger studies with better methodological quality are needed to create validated protocols for implementation into research.

酒渣鼻是一种麻烦的成人皮肤问题, 导致发红、肿块和小疮, 主要是在脸部。其中一个病因是一种称作蠕形螨的微小螨虫。酒渣鼻在女性中更常见, 通常可使用抗生素进行改善, 但可能持续很久。 为了找到更好的治疗, 研究人员需要一种可靠的方法来衡量患者病况的严重程度及其对治疗的应答。这很困难, 因为酒渣鼻在不同人群中的外观和表现不同, 并且外观有许多描述方式。 荷兰的这个团队搜索了医学文献, 查看了已使用的研究。他们分析了 78 项已发表的研究, 这些研究以无创方式(不影响皮肤)评估了皮肤的外观和功能。 很难比较结果, 这是因为研究人员以多种方式表达了这些结果。试验的设计和报告存在缺陷而且结果不一致。已使用许多技术和设备:放大皮肤血管和其他功能的显微镜和皮肤镜; 分析皮肤颜色的计算机程序;检查皮肤不规则性的超声波; 皮肤含水量的电记录; 表面油和酸度的测量; 皮肤血流的激光评估; 测量温度的各种器械。这些技术中的一些只能用于研究, 但某些也可在诊所中使用(如皮肤镜检查)。 其中几个测量显示与酒渣鼻严重程度无明显关系。最有前途的技术包括蠕形螨计数的表面显微镜和用于测量皮肤发红、含水量和水分流失的技术。 This summary relates to the study: 酒渣鼻评估的无创客观皮肤测量方法:一项系统回顾。

Rosacea is a troublesome adult skin problem causing redness, lumps and pimples, mainly on the face. One of the causes is a tiny mite called demodex. Rosacea is commoner in women and usually improves with antibiotics but can be very persistent. In order to find better treatments, researchers need a reliable way to measure the severity of a person's condition, and its response to therapy. This is difficult because rosacea looks and behaves differently in different people and there are many ways to describe the appearance. This team from Holland searched the medical literature to see what investigations have been used. They examined 78 published studies which assessed skin appearance and function non-invasively (without disrupting the skin). It was difficult to compare the results because researchers expressed them in a variety of ways. There were weaknesses in the design and reporting of experiments as well as inconsistencies in the findings. Many techniques and devices have been used: microscopes and dermatoscopes to magnify skin blood vessels and other features; computer programmes to analyse skin colour; ultrasound to examine skin irregularities; electrical recording of skin water content; measurement of surface oils and acidity; laser assessment of skin blood flow; various devices to measure temperature. Some of these techniques would only be used in research but others, such as dermoscopy, could be used in the clinic. Several of these measurements showed no clear relationship to rosacea severity. The most promising techniques included a surface microscope to count demodex mites and techniques for measuring skin redness, water content and water loss. This summary relates to the study: Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

Reflectance confocal microscopy (RCM) enables noninvasive Demodex mite detection in rosacea. Objective scoring of rosacea severity is currently lacking.To determine the value of RCM for monitoring Demodex, inflammation and vascular parameters in rosacea during treatment.In 20 rosacea patients, clinical and RCM examination were performed before, during, and 12 weeks after a 16-week treatment course with topical ivermectin. Using RCM, number of mites and inflammatory cells, epidermal thickness, and vascular density and diameter were measured. RCM features were correlated with clinical assessment.Treatment resulted in clinical reduction of inflammatory lesions. Mites were detected in 80% of patients at baseline, 30% at week 16, and 63% at week 28. The number of mites reduced significantly during treatment, but no changes in inflammatory cells, epidermal thickness or vascular parameters were observed. Correlation between number of inflammatory lesions and mites was low. None of the RCM variables were significant predictors for clinical success.RCM enables anti-inflammatory effect monitoring of topical ivermectin by determining mite presence. Quantifying exact mite number, and inflammatory and vascular characteristics is challenging due to device limitations. In its current form, RCM seems of limited value for noninvasive follow-up of rosacea in clinical practice.

The epidermal barrier function is disrupted in various inflammatory skin diseases. Accurate methods to measure skin barrier function are needed to assess the effect of therapeutic agents. Therefore, we developed a noninvasive multiparametric approach to measure four different parameters regarding the skin barrier. In the current pilot study, we evaluate this method in 14 healthy volunteers. We assessed erythema, transepidermal water loss (TEWL), water content, and epidermal thickness at both cheeks before and 30 min after application of Lanette and Vaseline-Lanette cream. For this, we used spectrophotometry, the Aquaflux device, the Epsilon device, and reflection confocal microscopy, respectively. Stratum corneum (SC) thickness was significantly increased after application of both creams (p < 0.05), and this increase was larger after Lanette cream compared to after Vaseline-Lanette cream (p = 0.035). Erythema, TEWL, and water content did not significantly change after cream application. Our multiparametric approach is promising and offers a feasible and practical way to quickly obtain multifaceted information about skin barrier function. Further exploration of this approach after prolonged use of cream and in conditions of disrupted skin barrier are recommended areas for future research.

Background This pilot study aimed to investigate the anatomical site variation of water content of the stratum corneum (SC) on the body by measuring skin capacitance with the Epsilon, a new generation corneometer with multiple sensors. Secondly, values of the Epsilon were compared to values measured by conventional single sensor corneometers. Methods The hydration status of SC was measured in 15 healthy Caucasian volunteers with the Epsilon at five body sites (cheek, lower forearm, mid-calf, lower back and abdomen). Transepidermal water loss (TEWL) was measured with the Aquaflux to get more insight into the condition of the skin barrier. A literature search was performed to compare Epsilon values with conventional corneometers. Results The tested anatomical locations showed significant differences in water content (P < 0.001) with large interindividual variations; highest values were found in the cheek (11.64 epsilon) and lowest values in the mid-calf (4.43 epsilon). No correlation between water content and TEWL was found. In general, Epsilon values were lower compared to values of conventional corneometers, with a similar trend. Conclusion This pilot study showed significant variations in water content at different skin locations measured by the Epsilon. Moreover, the Epsilon measured consistent lower values compared to single sensor corneometers. Further validation of the device is recommended.

In a multiple-dose-ranging trial, we previously evaluated higher doses of rifampin in patients for 2 weeks. The objectives of the current study were to administer higher doses of rifampin for a longer period to compare the pharmacokinetics, safety/tolerability, and bacteriological activity of such regimens. In a double-blind, randomized, placebo-controlled, phase II clinical trial, 150 Tanzanian patients with tuberculosis (TB) were randomized to receive either 600 mg (approximately 10 mg/kg of body weight), 900 mg, or 1,200 mg rifampin combined with standard doses of isoniazid, pyrazinamide, and ethambutol administered daily for 2 months. Intensive pharmacokinetic sampling occurred in 63 patients after 6 weeks of treatment, and safety/tolerability was assessed. The bacteriological response was assessed by culture conversion in liquid and solid media. Geometric mean total exposures (area under the concentration-versus-time curve up to 24 h after the dose) were 24.6, 50.8, and 76.1 mg · h/liter in the 600-mg, 900-mg, and 1,200-mg groups, respectively, reflecting a nonlinear increase in exposure with the dose (P < 0.001). Grade 3 adverse events occurred in only 2 patients in the 600-mg arm, 4 patients in the 900-mg arm, and 5 patients in the 1,200-mg arm. No significant differences in the bacteriological response were observed. Higher daily doses of rifampin (900 and 1,200 mg) resulted in a more than proportional increase in rifampin exposure in plasma and were safe and well tolerated when combined with other first-line anti-TB drugs for 2 months, but they did not result in improved bacteriological responses in patients with pulmonary TB. These findings have warranted evaluation of even higher doses of rifampin in follow-up trials. (This study has been registered at ClinicalTrials.gov under identifier NCT00760149.).