Rosacea: Choosing Among the Topical and Systemic Therapeutic Options
نویسنده
چکیده
Heat, sun exposure, environmental factors and specific foods can trigger flares in rosacea. The exact etiology of rosacea remains unknown, but is likely multifactorial. Infectious agents, such as Demodex, have been hypothesized as causative agents. In one recent study, staphylococcus epidermidis was felt to play a role in pustular and ocular rosacea. Vascular instability and pilosebaceous unit abnormalities may also be contributing factors. The role of inflammation in rosacea has recently been given greater attention. Cathelicidins, which are antimicrobial peptides, are an important component of the innate immune system. Cathelicidins and related peptides trigger inflammation and promote angiogenesis. They have been noted to be increased in rosacea. One of the active inflammatory components of cathelicidin is LL-37, which is cleaved off a precursor molecule by serine proteases. Patients with rosacea produce an excessive serine protease, kallikrein 5, which generates increased LL-37. This may increase inflammation and angiogenesis. Rosacea can be classified into four subtypes. These include erythematotelangiectatic, papulopustular, phymatous, and ocular variants. Proper classification of the rosacea subtype can make the management of rosacea more specific and focused. Erythematotelangiectatic and Papulopustular Rosacea The erythematotelangiectatic rosacea (ETR) subtype is challenging to manage. Patients report flushing episodes lasting more than 10 minutes, often accompanied by a burning or stinging sensation. Over time, the flushing becomes more longlasting and eventually permanent. Telangiectasias become prominent, especially with cumulative photodamage. Few to no inflammatory lesions are noted. Topical management is often unsuccessful, and patients report a lower threshold for irritation from topically applied substances. Dysesthesia of the skin can become prominent and a significant component of disability. Rosacea: Choosing Among the Topical and Systemic Therapeutic Options
منابع مشابه
Rosacea and its topical management.
Many options exist for the treatment of rosacea, including topical and systemic therapies, laser and light-based therapies, and surgical procedures. A classification system for rosacea identifies 4 subtypes (i.e., erythematotelangiectatic, papulopustular, phymatous, and ocular), which may help guide therapeutic decision-making. The goals of therapy include reduction of papules, pustules, erythe...
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