Rosacea used to be called ‘acne rosacea’ but it is quite different from acne. There are red spots (papules) and sometimes pustules in both conditions, but in rosacea they are dome-shaped rather than pointed and there are no blackheads, whiteheads, deep cysts, or lumps. It mainly manifests itself as centrofacial erythematous macules with dilated capillaries with episodes of flushing due to vendodilation and inflammation. With chronicity edema will ensue as a result of vascular leakage and perivascular inflammation.
Rosacea may also result in reddened skin, scaling and swelling of affected areas. Pustules are larger in appearance, inflammatory and may contain pus. Acne inflammation may have a bacterial component to their makeup and are also mainly localized in and around the hair follicles.
Although it may first appear as early as the teen years, rosacea most frequently begins when sufferers enter their 30s, 40s or 50s affecting up to 10% of the population, as a flushing or transient redness on the cheeks or nose, and in some cases the chin or forehead. In this earliest stage, some patients may report stinging or burning sensations, including the feeling of dry or tight skin as opposed to acne patients who frequently complain of cutaneous oils.
The cause of rosacea is unknown but there are several theories regarding the origin of overactive facial blood vessels, inflammation and neural. There may be a genetic component. Hair follicle mites (Demodex folliculorum) may be involved in at least some cases, as these are found in greater numbers within rosacea papules. An increased incidence of rosacea has been reported in those who carry the stomach bacterium, Helicobacter pylori, but is not known how they may be related. Continuous steroid use, topical or systemic, may also explains rosacea in some cases with macular erythema and telengectasia which warrants discontinuation of glucocorticosteroids.
In rosacea, the stratum corneum and its functionality as skin barrier is impaired, evidenced by a decrease in various major skin mantle proteins, organization of desomosomes and antimicrobial peptides. Disruption of permeability barrier leads to proliferation of inflammatory markers, namely, IL-1, IL-6 and TNF-alpha and cutaneous inflammation, symptomatically, presents itself as stinging or itching. Overproduction of toll-like receptors and antimicrobial peptides has also been suggested as underlying mechanisms in pahogenesis of rosacea. Moreover, enhanced activity of cathlicidin, an antimicrobial peptide, augemented response of kallikreint-5, a serine protease, and neurovascular abnormalities have been proposed as pathophysiology of rosacea.
Treatment options for rosacea, are quite distinct from treatment modalities for acne vulgaris, vary from non-pharmacological options to pharmacological ones based on severity and extent of the disease. Topical metronidazole has been found effective and routinely used as first line while azelaic acid has been demonstrated to be equally beneficial by restraining ROS generation and curbing pro-inflammatory cytokines implicated in rosacea.
A double-blind placebo control study randomized 31 rosacea patients to 320mg/day GLA, gamma linolenic acid, plus 100mg/day minocycline or placebo for 12 weeks assessed for erythema index and transepidermal water loss and stratum conrneum hydration and lipid concentration demonstrated significant superiority of GLA with p=0.033 and P=0.003. Another open label study of fourty four rosacea patients showed efficacy of 15% azalaic acid in a rosacea skin care routine with 1% dihydroavenanthramide D by a meaningful decline in investigator global assessment score and inflammatory lesions count. Tretinoids has been shown with equivocal results in various studies.
Various plant extracts have been studies for their anti inflammatory and vasoconstrictive effect, among them Potentilla erecta (L.) Raeusch is noteworthy for its tannins content and its inflammation-curbing impact as well as nitric oxide inhibitory effect comparable with those of corticoids.
Disruption of the skin barrier is known as one of the fundamental culprits in pathogenesis of rosacea, which robustly suggest use of rosacea skin care in mild to medoerate cases and as maintenacne treatment is severe disease. Specifically formulated for this chronic condition to enhance barrier function by mitigating inflammatory component, kallikrein 5 mediated, of rosacea as well as diminishing contact with environmental irritants. A skin care routine, aimed to restore the stratum corneum and temper inflammation and vasodialation, of cleansing, moisturizing and sun protection is advocated by medical research.