What is the pathophysiology of ocular rosacea?

Updated: Mar 03, 2020
  • Author: Jitander Dudee, MD, MA(Cantab), FACS, FRCOphth; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Answer

The precise pathophysiology of rosacea remains unclear [8, 9] but is comprised of both vascular dysregulation and altered immune system responses and inflammatory changes. [10] Recent research has shown an upregulation of proinflammatory and vasoregulatory genes in rosacea patients. Alterations in the innate immune system responses include an overabundance of cathelicidin (an antimicrobial peptide), along with kallikrein-5, an enzyme involved in processing cathelicidin. Moreover, toll-like receptor 2 activity in the innate immune system is increased in patients with rosacea. [5]

A variety of rosacea triggers have been described including skin colonization with Demodex mites (along with bacteria in their gut) [11] and Staphyloccocus epidermidis. [12] Eradication of Helicobacter pylori has been shown to improve rosacea in some patients, and the organism may play a role in the pathogenesis of inflammation of inflammation in rosacea.

Four distinct rosacea subtypes have been described: erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea.


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