Rosacea – chronic inflammatory skin disease that focuses on sebaceous hair follicles and includes at least one of the following features: centrofacial erythema with telangiectatic changes; inflammatory lesions (papules, pustules, cysts); phymatous changes (skin hypertrophy and fibrosis), usually affecting the nose; ophthalmic inflammation (conjunctivitis, blepharitis, chalazion).
The main symptoms of rosacea on the face are burning and itching. In the article estet-portal.com you can get acquainted in detail with the main little-known facts associated with this pathology.
Fact #1: Rosacea – it's not just a skin disease
Rosacea is associated with an overreactive innate immune system that protects epithelial barriers against infection and chemical or physical factors (eg, ultraviolet radiation, extreme heat or cold). This non-specific inflammatory response is caused by a number of environmental, diet, hormone, and lifestyle factors. In this broader context, rosacea may just be the superficial tip of an inflammatory iceberg.
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Women with rosacea are more susceptible to autoimmune disorders with increased odds ratios (ORs) of 2.59 for type 1 diabetes, 2.03 for celiac disease, 1.65 for multiple sclerosis, and 2.14 for rheumatoid arthritis; intriguingly, this study showed a striking gender difference: rosacea in men only increased the prevalence of rheumatoid arthritis (NR 2.05).
Epidemiological studies have linked rosacea to comorbid conditions affecting almost every organ system:
1. Immune (dietary and air allergies);2. Digestive (ulcerative colitis, Crohn's disease, Helicobacter pylori infection, gastroesophageal reflux disease, celiac disease);
3. Cardiovascular (hypertension, coronary artery disease, dyslipidemia);
4. Endocrine (diabetes mellitus type 1 and 2);
5. Musculoskeletal (rheumatoid arthritis);
6. Nervous (migraine, dementia, Parkinson's disease);
7. Mental (depression, anxiety, alcoholism).
Fact #2: Treatment of razocea with antibiotics is not etiotropic
Low dose dosicycline (40 mg once daily) is the only U.S. Food and Drug Administration (FDA)-approved treatment for rosacea, although systemic therapy also allows other antibiotics (minocycline, azithromycin), oral ivermectin, and isotretinoin.
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But rosacea is not an infectious process. A growing body of evidence points to another etiology: an overactive cutaneous innate immune system.The critical components of this pathway are the Toll-like receptor, nucleotide-binding domain, and leucine-rich repeat families; when activated, they increase the expression of pro-inflammatory cytokines, proteases, and antimicrobial peptides (eg, cathelicidin) in the skin.
In rosacea, inflamed skin shows elevated levels of cathelicidin and proteases. In a 12-week study, doxycycline (40 mg/day) reduced inflammatory lesions compared to placebo.
Clinical improvement correlates with a decrease in cathelicidin and protease activity, supporting the idea that doxycycline combats rosacea through anti-inflammatory rather than antimicrobial mechanisms.
Similar anti-inflammatory effects have been demonstrated for topical metronidazole, azelaic acid and ivermectin.
Fact #3: There is no single approach to treating rosacea
As mentioned above, rosacea has several variants, each of which may occur in the same patient with overlapping clinical forms or at different times. There are also rare pediatric granulomatous and pyodermic (rosacea fulminans) variants.
Proper cosmetic management of patients with facial rosacea
All rosacea patients should be educated about skin care and the need to avoid triggers such as intense UV exposure, acidic or alkaline cleansers, facial cosmetics, and dietary triggers (eg, alcohol, spicy foods).Daily use of sunscreen and avoidance of mechanical irritants such as facial scrubs should also be encouraged.
Fact #4: Is facial rosacea always associated with red eyes
Rosacea is associated with ocular involvement in up to 50% of cases, with up to 10 million cases of ocular rosacea in the United States. Ocular rosacea may be asymptomatic at first, but usually progresses with itching and burning. The most common signs of ocular rosacea are blepharitis, meibomic gland dysfunction (eg, chalazion formation), and conjunctival redness.
It should be noted that significant ocular rosacea may be present even with minimal cutaneous manifestation of the disease.
Fact #5: Persistent erythema can be treated with lasers
Chronic inflammation in rosacea leads to increased expression of vascular endothelial growth factor and other angiogenic factors; this leads to the characteristic telangiectatic changes of rosacea, which are concentrated centrofacially, in contrast to the lateral and diffuse telangiectasia of chronic exposure to UV exposure.
Alpha-adrenergic receptor agonists may reduce erythema but have little effect on fixed telangiectatic changes in rosacea.
They require laser and intense flash lamps to be used effectively. Comparable good results can be obtained using a wide range of (hemoglobin-targeted) lasers and intense pulsed light.
To prevent blistering and post-inflammatory hyper- or hypopigmentation, patients should avoid sun exposure before starting laser therapy.
The information provided will help in the selection of a comprehensive treatment for patients with rosacea. The appointment of drug therapy, the introduction of laser technologies, the correction of lifestyle and habits will improve the clinical condition of a patient with this pathology of the immune pro-inflammatory system.
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Adapted from Medscape
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