COMMENTARY

Rosacea: 5 Things to Know

Graeme M. Lipper, MD

Disclosures

September 19, 2018

4. Red Skin, Red Eyes

Rosacea is associated with ocular involvement in up to 50% of cases, with up to 10 million cases of ocular rosacea in the United States alone.[27] Ocular rosacea may be asymptomatic at first, but usually progresses with pruritus and burning. The most common signs of ocular rosacea are blepharitis, meibomian gland dysfunction (eg, chalazion formation), and conjunctival redness.[28] If left untreated, ocular rosacea can lead to disfigurement and permanent morbidity.

Patients with signs or symptoms of ocular rosacea should be referred to an ophthalmologist for optimal management; this may require a combination of low-dose doxycycline, topical azithromycin, and/or cyclosporine.[29,30] Ocular rosacea is easier to manage when symptoms are mild, so early detection and intervention are critical. Of note, significant ocular rosacea may be present even with minimal cutaneous disease.[31]

5. Persistent Erythema? Don't Forget Lasers and Light

Chronic inflammation in rosacea leads to elevated expression of vascular endothelial growth factor and other angiogenic factors; this results in the characteristic telangiectatic mats of rosacea, which are concentrated centrofacially, in contrast to the lateral and diffuse telangiectasia of chronic photodamage.

Topical alpha-adrenergic receptor agonists can reduce background erythema, but have little effect on fixed telangiectatic mats. To treat these effectively, laser and intense pulsed-light devices are needed. Comparable good results can be obtained with a wide range of vascular (hemoglobin-targeting) lasers and intensed pulsed light, with protocols designed for both purpuragenic (bruising) and nonpurpuragenic settings.[32,33] Laser and pulsed-light treatments may also reduce background erythema and flushing.[34] To prevent blistering and postinflammatory hyper- or hypopigmentation, patients should avoid tanning before starting laser therapy.

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