Rosacea

It is a chronic dermatosis that almost always affects only the skin of the face.

Once called “acne rosacea” for the presence in some cases of papulo-pustular lesions similar to those of common acne, it is now simply called “rosacea” because acne differs both for the pathogenetic mechanism and, consequently, for the clinical aspects and for the treatment. Onset typically occurs in adulthood, between 30 and 60 years of age, and affects women more frequently.

Causes

The etiology of rosacea is still unknown.

Several hypotheses have been advanced on its origin that call into question factors of various kinds: predisposing genetic factors, as it is observed more frequently in some populations (typically among the Irish and the English), in light-skinned individuals and is often recurrent in the same family; infectious factors, as it has sometimes been associated with high concentrations of particular bacteria typical of the cutaneous microbial flora (such as Demodex folliculorum) and sometimes with the presence of Helicobacter pylori at gastric level; immunological factors as the clinical manifestations seem to be linked to an excessive reactivity of the skin.

It is possible that the disease is actually caused by several concomitant factors and that different factors prevail in different individuals. The pathogenesis of the disease, i.e. the mechanism underlying its clinical manifestations, is however inflammatory and mainly affects the blood vessels of the superficial cutaneous microcirculation.

Symptoms

The symptoms of the disease are almost always only cutaneous, localized exclusively to the central areas of the face (chin, nose, forehead, cheeks), although in some cases they are accompanied by involvement of the ocular tissues. The manifestations depend on the evolution of the disease that can configure four different clinical aspects:

• erythematous rosacea, characterized by crises of generalized redness (erythema) and visible dilations of the capillaries (telangiectasias) that can be triggered by various events (sun exposure, temperature changes, emotional stress, meals);
• edematous rosacea, characterized by persistence of redness and telangiectasias and diffuse swelling of the skin in the same areas;
• papulo-pustular rosacea, characterized by the appearance in the reddened areas of lesions reminiscent of the papules and pustules of common acne;
• Hypertrophic rosacea, characterized by the formation in the affected areas of irregular thickening, caused by hyperplasia of the connective tissue and sebaceous glands, resulting in deformation of the skin surface.

In cases with concomitant eye involvement, inflammation of the conjunctiva, cornea, eyelids and periocular skin (ophthalmic rosacea) may occur.

In cases with deforming hypertrophic evolution the most frequently affected area is the nose (rhinophyma), more rarely are the chin, forehead, eyelids. The disease can occur with varying severity in individuals and does not necessarily evolve from one stage to another.

In general, although it affects women more often, it tends to take the most complicated clinical forms in men (in which, for example, the hypertrophic form with rhinophyma appears almost exclusively).

Since the cause of rosacea remains unknown, some factors are well known that in individuals can act as triggers or aggravating factors: exposure to the sun, washing with too hot or too cold water, application of oil-based creams, application of corticosteroids, intake of spicy foods or alcohol, emotional stress.

Treatment

Since rosacea is a chronic disease, for which there is currently no cure, its treatment is aimed at controlling and alleviating symptoms and is therefore different depending on the clinical form.

In general, it uses topical drugs (metronidazole, azelaic acid) and in the most serious cases also oral antibiotics (belonging to the macrolide and tetracycline families) and a vitamin A derivative (isotretinoin).

In hypertrophic forms, the use of surgical correction treatments with dermatological laser or pulsed light may be indicated. Among the natural remedies so far considered good results has given in moderate forms the topical use of extracts of Chrysanthellum indicum.

Other phytotherapeutics and other synthetic molecules are currently being studied.

Any treatment, whether local or systemic, should only be undertaken on the basis of a medical prescription.

A fundamental rule in the management of rosacea is, of course, to avoid exposure to factors that appear to have a triggering or aggravating effect of symptoms.