The Proposed Inflammatory Pathophysiology of Rosacea: Implications for Treatment

Larry Millikan, MD


Skinmed. 2003;2(1) 

In This Article

Abstract and Introduction

The pathophysiology of the vascular and inflammatory stages of facial rosacea and proposes an underlying cause is reviewed. It can be argued that all the stigmata of rosacea are manifestations of an inflammatory process: neutrophilic dermatosis. For this reason, treatments that block neutrophil involvement in the development of rosacea, such as topical metronidazole and systemic antibodies, should be considered first-line therapy for all stages of the disease.

Rosacea is a dermatologic condition commonly seen in clinical practice. A number of theories regarding its pathogenesis have been proposed. Rosacea has been viewed as a disorder provoked by various environmental stimuli, a disorder based on lability of the vasculature, or a disorder predicated on derangements of the immune system. Treatment regimens that have been shown to be effective are those that interfere with inflammatory processes. Thus, the recommended treatment for rosacea involves an initial regimen of an oral antibiotic with anti-inflammatory properties, such as tetracycline or doxycycline, in combination with topical metronidazole, an antimicrobial also exhibiting anti-inflammatory actions. Once remission is achieved, the oral antibiotic is tapered off and treatment with topical metronidazole is continued in order to maintain remission.[1,2,3,4]


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