Systemic Therapy for Rosacea

H. E. Baldwin, MD


Skin Therapy Letter. 2007;12(2) 

In This Article

Pathophysiology of Rosacea

Our lack of understanding with regard to the pathogenesis of rosacea hampers our therapeutic efforts. Still unclear at this time is the fundamental issue of whether or not the papules and pustules are based in the follicle. There is a growing consensus that bacterial infection does not play a role in rosacea etiology. The neurologic or hormonal mechanisms that may generate the flushing reaction and phyma formation are similarly unknown. It is also unclear if accumulated sun damage, which bears many biochemical and clinical similarities to vascular rosacea, is involved in its pathogenesis.

What is known is that inflammation plays an important role in lesion formation. Inflammatory cells release proinflammatory cytokines and degradative enzymes that induce angiogenesis and damage dermal constituents.[4]

The outcome of our poor understanding of its pathogenesis is that treatment has been traditionally based on disease endpoints rather than targeting the underlying anomalies. Inflammation is treated with anti-inflammatory agents, flushing with vasoconstrictors, and telangiectasias with laser and light therapy. Until recently, papules and pustules were treated with antibiotics and no target organism.


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