Objectives: - the general concept of the Butterfly Effect,
- the implications of the inflammatory character of acne and rosacea in the approach of the patients,
- the impact on the quality of life of acne and rosacea.
- the holistic and integrative approach to chronic inflammatory skin diseases.

Introduction: The butterfly effect represents the sensitive dependence on initial conditions. That is, a very small change in one state of a deterministic nonlinear system is associated with significant differences in a later state.

Edward Lorenz coined the term, and was derived from the metaphorical example in which the details of a tornado were influenced by minor perturbations such as the flapping of the wings of a distant butterfly. Lorenz discovered the effect when he observed that runs of his weather model with a minimal change in initial conditions had created a significantly different outcome.

Materials / method: Acne, characterized by androgen-induced increased sebum production, follicular hyperkeratinisation, inflammation and altered adaptive immune response, is a chronic inflammatory disease of the pilosebaceous unit with a critical negative impact on the quality of life.
Acne is characterized by a prolonged course, a pattern of recurrence or relapse, manifestation as acute outbreaks or slow onset, and a psychological and social impact that affects the individual’s quality of life, and now acne is considered to be a ”chronic disease”.

Results: Rosacea is a chronic and common skin condition characterized by specific signs and symptoms located mainly on the convex areas of the face, such as facial erythema, dilated vessels, inflammatory lesions (papules and pustules), hypertrophic lesions named phyma, sometimes accompanied by ocular irritation, with a potential important impact on the individual’s emotional wellbeing.
The pathophysiology of rosacea continues to remain unclear, and genetic factors, immune system dysregulation, abnormal neurovascular signaling and dysbiosis of commensal skin organisms may be the key promoters of rosacea

Conclusion: From the authors’ point of view, “the butterfly effect” associated with Acne and Rosacea is represented by education about these chronic inflammatory skin diseases, with emphasis on myths and skin care, because the power of false myths keep patients away from medical care; also, correct and individualized skin care is associated with a better adherence to treatment and results.
Dermatologists have the great opportunity to introduce dietary and metabolic interventions in acne so as to prevent more serious mTORC1-driven diseases of civilization like obesity, diabetes, and cancer.

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Objectives: Assesing the safety and efficacy of thermal decomposition of the stratum corneum using a novel non-laser thermomechanical system to increase skin permeability for Botulinum toxin in the treatment of facial flushing of rosacea.

Introduction: Rosacea is a common, chronic facial skin disease that affects the quality of life. Treatment of facial erythema with intradermal botulinum toxin injection has previously been reported. Thermo-mechanical fractional injury (TMFI) therapy is an innovative technology with drug delivery enhancement features.

Materials / method: A retrospective review of16 patients aged 23 to 45 years with Fitzpatrick Skin Types II to IV and facial erythematotelangiectatic rosacea treated by Tixel followed by topical application of 100 units of abobotulinumtoxin. A standardized high-definition digital camera photographed the patients at baseline and 1, 3, and 6 months after the last treatment. Objective and subjective assessments of the patients were done via Mexameter, the Clinicians Erythema Assessment (CEA) and Patients self-assessment (PSA) scores and the dermatology life quality index (DLQI) validated instrument.

Results: The average Maxameter, CEA, and PSA scores at 1, 3, and 6 months were significantly improved compared with baseline (all had a p-value < .001). DLQI scores significantly improved with an average score of 18.6 at baseline at 6 months after treatment (P<0.001). Self-rated patient satisfaction was high. There were no motor function side-effects or drooping.

Conclusion: Thermal breakage of the stratum corneum using the device to increase skin permeability for botulinum toxin type A in the treatment of facial flushing of rosacea seems both effective and safe.

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请注明名称（个人，公司，学会等等）: Lutronic, Candela, Sinclair, Cynosure, Galderma

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