Rosacea

A chronic inflammatory dermatosis characterized by facial erythema, telangiectasia, and inflammatory lesions.

Pathophysiology

The exact etiology is multi-factorial, involving dysregulation of the innate immune system (elevated cathelicidin LL-37), neurovascular hyper-reactivity, and potential microbiome alterations (e.g., Demodex folliculorum proliferation).

Clinical Subtypes

Erythematotelangiectatic (ETR)

Persistent erythema with transient flushing. Prominent telangiectasias. Skin is often highly sensitive and stings upon application of topical products.

Papulopustular (PPR)

Persistent central facial erythema with transient, central facial papules or pustules. Can resemble acne but lacks comedones.

Phymatous

Thickening skin, irregular surface nodularities, most commonly on the nose (rhinophyma).

Ocular

Watery or bloodshot appearance, foreign body sensation, burning or stinging.

Management Protocols

First-line defense involves barrier repair and strict avoidance of triggers (UV radiation, heat, spicy foods, alcohol).

Pharmacological Interventions

  • Azelaic Acid (15-20%): Reduces inflammation and reactive oxygen species. First-line for PPR.
  • Metronidazole (0.75-1%): Anti-inflammatory effects.
  • Ivermectin (1%): Anti-inflammatory and anti-parasitic (targets Demodex).
  • Brimonidine / Oxymetazoline: Alpha-adrenergic agonists for temporary vasoconstriction of ETR.