Rosacea
Rosacea, a chronic, inflammatory skin condition, is estimated to affect ten million Americans [1]. Characterized by a centrofacial distribution of acneiform papules and pustules, diffuse erythema, and frequently but not always telangiectases [2], rosacea
- PDF / 211,714 Bytes
- 8 Pages / 439.37 x 666.14 pts Page_size
- 77 Downloads / 221 Views
Rosacea Joseph Bikowski
43.1
Introduction
Rosacea, a chronic, inflammatory skin condition, is estimated to affect ten million Americans [1]. Characterized by a centrofacial distribution of acneiform papules and pustules, diffuse erythema, and frequently but not always telangiectases [2], rosacea is a highly visible disease that has been associated with negative influences on affected individuals’ quality of life [3, 4]. Although the disease is generally thought to be of primarily cosmetic consequence, patients have reported stinging and pain associated with rosacea [5], and functional impairments may result from severe rhinophyma [6]. A number of treatment options are available—both topical and systemic—for the management of rosacea in its various presentations. With a proper diagnosis, a rational therapeutic strategy, and supportive skin care and patient education, control of rosacea is possible.
43.2
Background
Rosacea is generally considered a disease that affects individuals in middle age; the incidence is shown to increase with age and peak in those over age 65 [7]. While the majority of individuals with rosacea are women (69 %), men may be prone to more severe presentations [8]. The vast majority of rosacea patients (96 %) are Caucasian [8].
J. Bikowski, M.D. (*) Director, Bikowski Skin Care Center, 500 Chadwick Street, Sewickley, PA, USA e-mail: [email protected]
J.A. Zeichner (ed.), Acneiform Eruptions in Dermatology: A Differential Diagnosis, DOI 10.1007/978-1-4614-8344-1_43, © Springer Science+Business Media New York 2014
309
310
J. Bikowski
The pathophysiology of rosacea is not well elucidated, although the clinical features of the disease are well documented. Based on recent molecular studies, current understanding holds that vascular and inflammatory manifestations of the disease are mediated by an altered innate immune response [1, 9]. Recently, the antimicrobial peptide cathelicidin and its activator kallikrein-5 have been found to contribute to the exacerbated immune response in rosacea [10]. Neutrophils have also been shown to induce inflammation associated with rosacea and are thought to promote the release of reactive oxygen species [11]. Other inflammatory mediators implicated in the development of rosacea include histamine, serotonin, bradykinin, or prostaglandins [1]. Chronic UV exposure has been suggested to play a role in the pathophysiology of rosacea, causing damage to dermal connective tissues, which facilitates and exacerbates the effects of vasodilation and vascular pooling [12]. A recent study involving 1,000 patients, however, failed to demonstrate an association between UV exposure and papulopustular rosacea [13]. Environmental trigger factors may be associated with exacerbation of rosacea and may initiate the flushing and blushing response in susceptible individuals. The degree to which any individual is affected, if at all, by a given trigger is variable. Commonly cited triggers include thermally hot beverages or foods, alcoholic drinks, and/or spicy foods [14].
43.3
Data Loading...
