Childhood Rosacea

Rosacea usually occurs in adults and rarely has been noted in children. We recently observed three children with rosacea, all of whom responded dramatically to systemic and topical antibiotics. Rosacea in childhood must be distinguished from other erythematous facial disorders, most commonly acne, granulomatous perioral dermatitis, and sarcoidosis. The distribution of facial lesions; the presence of telangiectasias, flushing, and pustules; and the appearance of lesional biopsy sections and the ocular lesions, if present, allow differentiation of rosacea from other facial eruptions.     

Is rosacea a systemic disease?

Rosacea is a chronic inflammatory facial disease occurring world-wide. The incidence of rosacea is increasing with age, with the clinical course being characterized by relapses. The pathogenesis of rosacea is not completely understood, but neurovascular and immunologic mechanisms are involved. Rosacea has a number of known extrinsic triggers that should be avoided, such as sun exposure, heat and cold, alcoholic beverages, and spicy food. Of greater importance is the observation that rosacea may develop as a manifestation of systemic diseases with a significant morbidity and even mortality. Obesity, Helicobacter pylori infection, smoking, and inflammatory bowel disease bear a significant risk for the development of rosacea. Metabolic, psychiatric, and neurologic disorders and certain types of cancer show a significant association with rosacea. The possible link to cardiovascular events is debatable. There are extrafacial and extracutaneous manifestations of rosacea, such as the red scalp syndrome, ocular rosacea, and migraine. Rosacea should be considered a systemic disease.     

Rosacea: an update

Rosacea is a common chronic cutaneous disorder of unknown etiology which occurs most commonly in middle-aged individuals. Cutaneous manifestations include transient or persistent facial erythema, telangiectasia, edema, papules and pustules that are usually confined to the central portion of the face. The National Rosacea Society's Expert Committee on the Classification and Staging of Rosacea identified four subtypes of rosacea: erythematotelangiectatic, papulopustular, phymatous and ocular. Recently, a standard grading system for assessing gradations of the severity of rosacea has been reported. Little is known about the cause of rosacea. Genetic, environmental, vascular, inflammatory factors and microorganisms such as Demodex folliculorum and Helicobacter pylori have been considered. Topical metronidazole and azelaic acid have been demonstrated to be effective treatments for rosacea. Severer or persistent cases may be treated with oral metronidazole, tetracyclines or isotretinoin.     

Gnatophyma: a rare variant of phyma

We report a case of a 44-year-old woman with an 8-year history of gnatophyma. Rosacea is a facial dermatosis that may present as flushing, erythema, telangiectases, papules, pustules and phyma. Phyma is considered the final evolution stage of rosacea and is a rare variant. Treatment of phyma with atypical localization may be a challenge for dermatologists in clinical practice.     

酒渣鼻的激光和光动力疗法

酒渣鼻是一种常见的慢性炎症性皮肤疾病,其临床特点为面部红斑伴丘疹脓疱或毛细血管扩张,病情发展晚期可有鼻赘形成.酒渣鼻分为4种亚型,针对不同亚型临床特点可采用相应的激光和光化学疗法,主要包括脉冲染料激光、强脉冲光疗法、光动力疗法及二氧化碳激光磨削.概述上述疗法在酒渣鼻治疗中的机制,疗效和不良反应发生.

Abstract：

Rosacea is a common chronic inflammatory disease of the skin.It is characterized by erythematous changes of the facial skin accompanied by papules,pustules or telangiectasias,and eventually,it may progress into rhinophyma.Rosacea can be categorized into four subtypes.To get a satisfactory outcome,appropriate lasers and photochemotherapies should be selected from pulsed dye laser,intense pulsed laser,photodynamic therapy and carbon dioxide laser according to the subtype of rosacea.This review states the mechanisms,efficacy,side effects as well as targeting subtypes of these phototherapies for rosacea.     

Pediatric rosacea

Rosacea is a condition most commonly associated with adults; however, various forms exist in the pediatric population and need to be considered when a child presents with a facial rash. Acne rosacea, steroid rosacea, granulomatous periorificial dermatitis, and other variants of rosacea are presented here and are distinguished from their numerous mimickers. Various topical and systemic therapeutic options exist for the treatment of rosacea with several adjustments and considerations that must be taken into account when treating a child.     

Klinik und Klassifikation der Rosazea

Rosacea is a frequent chronic dermatological disorder mainly affecting the face. Since it affects the appearance, it can be very distressing for the patient leading to psychosocial disturbances. Rosacea occurs in adults, peaking between 40 and 50 years of age. The course of rosacea is quite variable and the disease may stop at any stage. Generally, three main stages are differentiated: erythemato-teleangiectatic rosacea (rosacea stage I), papulopustular rosacea (rosacea stage II), hyperglandular-hypertrophic rosacea (rosacea stage III). Besides these main manifestations numerous special forms exist, which often lead to difficulties in the differential diagnoses and require specific therapeutic strategies. These include rosacea conglobata, rosacea fulminans, granulomatous rosacea, persisting edema, (Morbihan disease), gram negative rosacea, ocular rosacea, and steroid rosacea. Recently increasing numbers of patients have been observed, whose rosacea was were induced by inhibitors of epidermal growth factors (cetuximab, geftinib) used as chemotherapy in patients with different malignancies. These side effects have been described as acneiform eruptions but at least some of the described patients have a rosacea-like appearance; therefore, this form can be classified as a subset of drug induced rosacea.     

Aktuelles Verständnis der Pathophysiologie der Rosazea

Rosacea is a chronic inflammatory skin disease mainly affecting the face. Four major clinical subtypes of rosacea can be identified: erythemato-telangiectatic, papulopustular, phymatous and ocular rosacea. Still, it is currently unclear whether these subtypes develop consecutively or if any subtypes may occur individually as part of a syndrome. Rosacea is characterized by facial flushing, erythema, chronic inflammation, edema and fibrosis. Several trigger factors can worsen the disease or cause recurring episodes of inflammation. Although some aspects in the pathophysiology of rosacea have been characterized in more detail during the past years, the precise interplay of the various dysregulated systems is still poorly understood. In early disease manifestations and milder stages, dysfunction of neurovascular regulation and the innate immune system seem to be driving forces in rosacea pathophysiology. A disturbed chemokine and cytokine network further contributes to disease progression. This current review highlights some of the recent findings in rosacea pathophysiology and points out novel targets for therapeutic intervention.     

Etiopathogenesis, classification, and current trends in treatment of rosacea

Rosacea is a common chronic dermatosis characterized by varying degrees of flushing, erythema, telangiectasia, edema, papules, pustules, ocular lesions, and phymas. Etiology and pathogenesis of rosacea are still unknown. Many possible causes have been described as inducing the disease or contributing to its manifestation, such as genetic predisposition, abnormal vascular reactivity, changes in vascular mediating mechanisms, Helicobacter pylori infection, Demodex folliculorum infestation, seborrhea, sunlight, hypertension, and psychogenic factors. However, none of these factors has been proved. Rosacea shows a wide spectrum of clinical presentations, which vary over time and with age. Successful management of rosacea requires careful patient evaluation and individualized therapy with appropriate variations and modifications, as the severity of the disorder fluctuates. In mild cases of rosacea, patients are instructed to avoid sun, to apply sun-protective creams, and to avoid facial irritants and other triggers that provoke symptoms. At later stage, drug therapy is often necessary. The disease commonly requires long-term treatment with topical or oral medicaments. Surgical correction may be required for rhinophyma and telangiectasia. We reviewed the current literature on the aspects of the pathogenesis, diagnostic criteria, and treatment options for rosacea.     

Ocular rosacea and treatment of symptomatic Helicobacter pylori infection: a case series

Rosacea is a chronic inflammatory skin disease characterized by recurrent episodes of facial flushing, erythema, papules, pustules, and telangiectasia. More than half of all rosacea patients may have ocular symptoms. Rosacea is associated with certain digestive diseases, such as gastritis, hypochlorhydria, or a number of jejunal mucosal abnormalities, and many patients have Helicobacter pylori infection. The role of Helicobacter pylori has often been a subject of investigation; these studies show conflicting results. Here we present results of the effects of treatment given for H. pylori eradication in seven patients with ocular rosacea that, at the same time, had clinical and serological evidence of H. pylori infection. Six weeks after completion of the treatment, all patients experienced improvement of their rosacea symptoms. Ocular disease responded better than cutaneous rosacea.     

Rosacea: I. Etiology, pathogenesis, and subtype classification

Rosacea is one of the most common conditions dermatologists treat. Rosacea is most often characterized by transient or persistent central facial erythema, visible blood vessels, and often papules and pustules. Based on patterns of physical findings, rosacea can be classified into 4 broad subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. The cause of rosacea remains somewhat of a mystery. Several hypotheses have been documented in the literature and include potential roles for vascular abnormalities, dermal matrix degeneration, environmental factors, and microorganisms such as Demodex folliculorum and Helicobacter pylori. This article reviews the current literature on rosacea with emphasis placed on the new classification system and the main pathogenic theories. Learning objective At the conclusion of this learning activity, participants should be acquainted with rosacea's defining characteristics, the new subtype classification system, and the main theories on pathogenesis.     

Rosacea and rhinophyma in the elderly

Rosacea is a chronic inflammatory disease with a predominance of facial manifestations. The prevalence is increasing with age, peaking in the group aged older than 65 years. In 1997, one in eight Americans was aged 65 years and older. By 2030, more than 70 million individuals will be in this age group. This contribution reviews the current understanding of pathogenesis, aggravating factors, classification, comorbidities, and treatment options. Rosacea is a manageable disease that negatively affects quality of life. Rosacea increases the risk of depression and shows a significant proportion of extracutaneous manifestations, in particular ocular rosacea.     

The effect of azithromycin on reactive oxygen species in rosacea

BACKGROUND: Recent evidence suggests that inflammation in rosacea is associated with generation of reactive oxygen species (ROS) that are released by inflammatory cells. The efficacy of current therapeutic agents for rosacea such as tetracyclines and metronidazole has also been attributed to their antioxidant properties. Recently, a macrolide antibiotic, azithromycin, has been found to be an effective alternative in the treatment of rosacea. AIM: We planned a study to evaluate the antioxidant effects of azithromycin on ROS in rosacea. We compared basal ROS concentrations measured in the facial skin of patients with rosacea with the post-treatment levels and with those of healthy controls. METHODS: Facial skin biopsies of 17 papulopustular patients with rosacea and 25 healthy controls were taken. Rosacea patients were assigned to receive oral azithromycin 500 mg on three consecutive days each week for 4 weeks. The total number of inflammatory lesions (the sum of papules and pustules) on the face of each patient with rosacea was counted at each visit. The luminol- and lucigenin-enhanced chemiluminescence (CL) levels of patients with rosacea were measured before and after 4 weeks of treatment and compared with those of healthy controls. RESULTS: Rosacea patients had higher ROS levels than healthy controls (P < 0.001). A statistically significant decrease of both luminol- and lucigenin-enhanced CL levels were observed in patients with rosacea after treatment with azithromycin (t = 4.602, P < 0.001; vs. t = 4.634, P < 0.001, respectively). CONCLUSION: Rosacea patients have higher ROS levels than healthy controls. The results of our study support the antioxidant properties of azithromycin in rosacea.     

微生物在玫瑰痤疮中致病机制的研究进展

玫瑰痤疮是一种好发于面中部的慢性炎症性皮肤病,以面部阵发性潮红、持久性红斑、丘疹脓疱等为主要表现,其病因及发病机制尚不清楚.关于微生物在玫瑰痤疮中的致病作用存在争议.微生物一般通过破坏皮肤屏障、诱发炎症反应、分泌生物活性因子及毒素等方式介导玫瑰痤疮的发生.本文总结国内外近年关于微生物与玫瑰痤疮发病的相关研究,进一步揭示...     

Incidental control of rosacea by somatostatin

BACKGROUND: The precise pathomechanism of rosacea remains elusive. The disease commonly requires long-term treatments using topical or oral therapies. OBJECTIVE: This report presents incidental findings about the possible modulatory role of somatostatin in the outcome of rosacea. METHOD: Four patients presenting long-standing recalcitrant facial rosacea were treated with octreotide for diabetic retinopathy. RESULTS: Rosacea improved rapidly and even cleared without any recurrence in 3 of the patients. CONCLUSION: The beneficial effect might be attributed to inhibitory actions on the sebaceous gland, the neovascularization and/or on the inflammatory process.     

Rosacea and rhinophyma

Rosacea is a common and chronic inflammatory cutaneous disease with unknown etiology. The pathophysiology of rosacea is still poorly understood. Epidemiological studies indicate a genetic component, but a rosacea gene has not been detected yet. Recent molecular studies propose that an altered innate immune response is involved in the pathogenesis of the rosacea disease. Signs of rosacea are indicated by the presence of characteristic facial or ocular inflammation involving both the vascular and tissue stroma. A wide range of drug options is available for the treatment of rosacea, including several topical ones (metronidazole, antibiotics, azelaic acid, benzoyl peroxide, sulfacetamide/sulfur, retinoids) and oral ones (mainly tetracyclines, metronidazole, macrolides, isotretinoin). This review highlights the recent clinical and pathophysiological developments concerning rosacea.     

Rosacea under the microscope: characteristic histological findings

Rosacea is a common facial dermatosis that is seldom biopsied; thus, histological aspects have not been well described. Biopsies are generally performed in the presence of atypical symptoms (e.g. granulomas). Differential diagnosis with sarcoidosis, lupus miliaris or lupus erythematosus is another indication for biopsy. There are few published studies addressing the microscopic aspects of rosacea and describing the histological and immunohistochemical features of this disease. While some textbooks consider the microscopic signs of rosacea to be non‐diagnostic, experienced dermatopathologists are generally able to make the diagnosis via histology. This article discusses the specific combinations of histological features that are highly suggestive of rosacea.     

Sensitive skin and rosacea: nosologic framework

Flushing due to rosacea may be mistaken for sensitive skin, which can manifest as abnormal sensations during fairly acute reactions to a variety of triggers, many of which are shared by rosacea and sensitive skin. Nevertheless, the two conditions are clearly different. Rosacea is a vascular disease, worsens gradually over time, manifests as flares triggered chiefly by systemic factors, is largely confined to the facial and/or ocular regions, and responds to specific treatments. Sensitive skin, in contrast, is an epidermal cosmetic problem that runs a variable course, with diffuse skin involvement and flares triggered mainly by contact factors. The flares respond to specific cosmetics and are usually worsened by treatments for rosacea.     

Erythematotelangiectatic rosacea may be associated with a subclinical stage of demodicosis: a case–control study

Demodex mites are small parasites that live in the skin pores of all adult humans, mainly on the face, and feed on human cells. Demodicosis is a facial skin condition that occurs when the mites proliferate (multiply) abnormally. Demodicosis shows as scales on the skin surface and, when the mites cause inflammation, by redness and/or red or weeping spots. Rosacea is another frequent skin condition affecting more than 10% of the population and characterised by facial redness. Sometimes spots develop and the condition is then called papulopustular rosacea (PPR). The cause of rosacea is still controversial, but it has been suggested that Demodex mites may be involved, because patients with PPR have a high density of mites on the facial skin, similar to patients with demodicosis. In this study, from Belgium, the density of Demodex mites was measured by two successive skin biopsies in patients in the early stage of a condition called erythematotelangiectatic rosacea (ETR), where patients have only redness without spots. The mean densities were lower than the densities in patients with PPR and patients with demodicosis but higher than in patients with healthy skin and patients with other skin conditions. The authors suggest that ETR may favour Demodex proliferation and may represent an early phase of demodicosis, with mites beginning to proliferate but not yet clinically visible. As such, dermatologists should look for Demodex mites in patients with ETR, so that appropriate treatment can be offered if densities are high.     

Remission of rosacea induced by reduction of gut transit time

Rosacea is a chronic disorder characterized by hypersensitivity of the facial vasculature, presenting with intense flushing eventually leading to chronic erythema and telangiectasia. Although the precise aetiology of rosacea is not known, numerous associations with inflammatory gastrointestinal tract disorders have been reported. Furthermore, substance P-immunoreactive neurones occur in considerably greater numbers in tissue surrounding affected blood vessels suggesting involvement of neurogenic inflammation and moreover plasma kallikrein-kinin activation is consistently found in patients. In this report, a patient without digestive tract disease is described, who experienced complete remission of rosacea symptoms following ingestion of a material intended to sweep through the digestive tract and reduce transit time below 30 h. It is possible that intestinal bacteria are capable of plasma kallikrein-kinin activation and that flushing symptoms and the development of other characteristic features of rosacea result from frequent episodes of neurogenic inflammation caused by bradykinin-induced hypersensitization of facial afferent neurones. The possible relevance of this hypothesis to other conditions featuring afferent hypersensitivity, such as fibromyalgia, is considered.