Rosacea Research Articles

Management of 10 Children With Inflammatory Rosacea With Topical Ivermectin.

Rosacea diagnosis and treatment in children are challenging, due to its rarity and to the lack of approved pharmacological agents for its treatment in this age group. In this case series, response to treatment with once daily applications of ivermectin (IVM) 1% cream for 12 weeks in 10 children affected by mild to severe inflammatory rosacea was evaluated clinically by Investigator Erythema Severity Assessment (IESA), Investigator Global Assessment of Severity (IGA-S), Investigator Global Assessment score of Global Efficacy (IGA-GE), and instrumentally by dermoscopy and Erythema-Directed Digital Photography (EDDP). Clinical improvement was achieved at the end of treatment compared to baseline (IESA: 2.3 vs. 0.5; IGA-S: 2.1 vs. 0.3) and confirmed by IGA-GE (0 = 55%, 1 = 33%, 3 = 11%) and instrumental monitoring (EDDP: 2.7 vs. 0.6). Once daily IVM application may be an effective therapeutic option for children with rosacea.

Giant Facial Tumor in Rosacea: A Case Report

Introduction: Rosacea is a centrofacial dermatosis with numerous triggers, leading to neurovascular dysregulation. Phymatous rosacea results from sebaceous hyperplasia and fibrosis, clinically presenting as irregular hypertrophy of the affected area. Medical therapies, such as photoprotection, anti-inflammatory antibiotics, and retinoids, provide suboptimal benefits in cases of phymatous rosacea. This limitation necessitates the use of surgical modalities like ablative lasers, electrosurgery, or plastic reconstruction for effective treatment. Here, we report a case of phymatous rosacea with multiple phymas over the nose, eyelids, forehead, chin, ears, and cheeks, creating a lion-like facial appearance (leonine facies) due to diffuse facial nodularity. The condition was clinically confounded with leprosy, leishmaniasis, lymphoma, and scleromyxedema. Additionally, the zygophyma (cheek) presented as a giant pedunculated tumor, which is rarely reported. It was mistaken for a soft tissue tumor, posing a diagnostic challenge. Plastic surgical excision and reconstruction proved therapeutic, and microscopic examination played a pivotal role in solving the diagnostic enigma. Case Presentation: A young male farmer with recurrent photo-exacerbated centrofacial lesions, clinically diagnosed as rosacea, later developed diffuse facial nodularity resembling leonine facies. The appearance of a progressively enlarging, globose, pedunculated tumor on his right cheek further complicated the diagnosis. Although phymatous rosacea was the leading clinical suspicion, histological analysis was deemed necessary to distinguish the combination of leonine facies and the pendulous mass from other serious conditions. Leprosy, leishmaniasis, lymphoma, and scleromyxedema are among the many causes of leonine facies, while soft tissue tumors like lipoma, fibroma, and neurofibroma can present with pedunculated morphology. The pendulous mass was surgically excised and sent for microscopic analysis, which confirmed the diagnosis of granulomatous rosacea. Cold knife excision was preferred over lasers and radiosurgery to preserve tissue architecture for histological analysis. Continued medical therapy and photoprotection contributed to further clinical regression. Conclusions: Pedunculated phymatous rosacea, mimicking a soft tissue tumor, requires histopathological distinction from more serious conditions. Cold knife plastic surgery, which preserves tissue architecture for histopathological studies, should be the recommended surgical treatment in such cases. Additionally, avoiding triggers and adhering to medical therapy are essential for better aesthetic outcomes.

Prescriber Phenotypes: Variability in Topical Rosacea Treatment Patterns among United States Dermatologists

Background/Objectives: Aggregate prescribing behavior for inflammatory lesions of rosacea has been described, but individual physician behavior has not been characterized. This study aims to assess the modern state of topical rosacea drug selection by analyzing prescribing patterns among individual dermatologists. Methods: We assessed utilization patterns of four topical papulopustular rosacea agents in 2021 Medicare Part-D data. K-means cluster analysis identified prescriber phenotypes based on the proportion of claims for each drug by physician. Results: Cluster analysis identified four prescriber phenotypes for topical rosacea agents, with the majority favoring metronidazole. In each of the other clusters, metronidazole was co-prescribed alongside the primary agent. Significant predictors of phenotype included patient ages, patient risk scores, and a group practice setting. Conclusions: The study reveals nonuniform prescribing patterns for topical papulopustular rosacea treatments among U.S. dermatologists. While aggregate data indicate diverse drug utilization, cluster analysis suggests that individual prescribers tend to use a limited selection of agents.

Tetracyclines revisited: tetracyclines in the field of dermatology.

Tetracyclines are a class of broad-spectrum antibiotics favored by dermatologists. Over the last decade, the clinical efficacy of tetracyclines has expanded into various dermatoses. This review tries to encompass the possible indications of tetracycline in the field of dermatology and possible mechanisms of action. This comprehensive review encompasses all possible indications of tetracyclines besides acne vulgaris and rosacea: hidradenitis suppurativa, autoimmune bullous dermatoses, vitiligo, alopecia, prurigo pigmentosa, granulomatous dermatoses, Kaposi sarcoma, cold urticaria, atopic dermatitis, scrub typhus, scarring, and miscellaneous dermatoses. We also focus on the recently approved sarecycline, a third generation narrow-spectrum tetracycline, and its clinical efficacy and potential impact on the microbiome. Our review provides a better understanding of this extremely familiar drug class and encourages its use in a wider spectrum of dermatologic diseases and symptoms.

Ferulic Acid in the Treatment of Papulopustular Rosacea: A Randomized Controlled Study.

Rosacea is a chronic inflammatory skin disease characterized by flushing, erythema, papules, and pustules on the central face. It affects patient appearance and is noted for its chronicity, recurrence, and resistance to treatment. Effective rosacea treatment requires repairing the skin barrier, reducing inflammation, and promoting vasoconstriction. This study aims to evaluate the efficacy of topical ferulic acid in treating papulopustular rosacea and its impact on skin barrier function. Sixty patients with mild to moderate papulopustular rosacea were selected from the Department of Dermatology at the Affiliated Hospital of Shandong Second Medical University between January 2023 and December 2023. Patients were randomly assigned to either a control group or an observation group, with 30 patients in each group. The observation group applied ferulic acid solution to the affected areas, while the control group used normal saline, both twice daily for 6 weeks. Both groups also received 0.1 g doxycycline hydrochloride tablets orally once daily. Skin lesions and skin barrier function were assessed using VISIA imaging and self-rating scales before and during treatment, and adverse reactions were recorded. After 6 weeks, both skin lesion assessments and self-assessment scores improved significantly from baseline, with greater improvement in the observation group compared to the control group (p < 0.05). Indicators of skin barrier function and VISIA imaging results demonstrated the efficacy of ferulic acid in treating rosacea. The total effective rate was significantly higher in the observation group (80.00%) compared to the control group (63.33%) (p < 0.05). In the observation group, nine patients (30.00%) experienced a greasy sensation initially, one patient (3.33%) reported tingling and itching, and no serious adverse reactions were observed. Ferulic acid is effective as an adjuvant treatment for papulopustular rosacea, significantly improving skin lesions and repairing skin barrier function with minimal adverse reactions.

Single-cell transcriptomics reveals aberrant skin-resident cell populations and identifies fibroblasts as a determinant in rosacea

Rosacea is a chronic inflammatory skin disorder, whose underlying cellular and molecular mechanisms remain obscure. Here, we generate a single-cell atlas of facial skin from female rosacea patients and healthy individuals. Among keratinocytes, a subpopulation characterized by IFNγ-mediated barrier function damage is found to be unique to rosacea lesions. Blocking IFNγ signaling alleviates rosacea-like phenotypes and skin barrier damage in mice. The papulopustular rosacea is featured by expansion of pro-inflammatory fibroblasts, Schwann, endothelial and macrophage/dendritic cells. The frequencies of type 1/17 and skin-resident memory T cells are increased, and vascular mural cells are characterized by activation of inflammatory pathways and impaired muscle contraction function in rosacea. Most importantly, fibroblasts are identified as the leading cell type producing pro-inflammatory and vasodilative signals in rosacea. Depletion of fibroblasts or knockdown of PTGDS, a gene specifically upregulated in fibroblasts, blocks rosacea development in mice. Our study provides a comprehensive understanding of the aberrant alterations of skin-resident cell populations and identifies fibroblasts as a key determinant in rosacea development.

Differences in the Clinical Characteristics of Male Patients With Different Ages of Rosacea: A Retrospective Study of 215 Male Outpatients.

Rosacea is more common in women and Caucasians, leading to little research on rosacea in Asian men. Additionally, there is limited research on the patients across different age groups. The aim of this study is to analyze and compare the characteristics of male patients of rosacea among different age groups. A retrospective analysis was conducted on 215 male patients with rosacea, investigating their characteristics, clinical symptoms, exacerbating factors, complications, psychological status, and treatment, as well as exploring factors influencing the early onset of male rosacea. The patients were divided into three age groups (≤ 30 years, 31-44 years, and ≥ 45 years), with the study revealing an average age of 38.59 ± 13.13 years among the patients. The most common subtype of rosacea in men was erythematotelangiectatic rosacea (ETR), followed by phymatous rosacea (PhR). The main reported features included persistent erythema (87.4%) and telangiectasia (71.2%), predominantly affecting the nose (58.6%) and cheeks (56.3%). Twenty-six percent of patients reported concurrent skin diseases, with 14.0% reporting systemic diseases. Significant differences were observed among different age groups regarding family history, clinical features, lesion distribution, symptom severity, aggravating factors, presence of systemic diseases, and treatment preferences. Subjective skin typing, Fitzpatrick phototype, and positive family history were identified as factors influencing the age of onset of rosacea in men. Male patients with rosacea exhibit distinct clinical characteristics, with a greater prevalence of nasal involvement and nasal lesions among male patients. Clinical features vary among different age groups, with patients aged ≥ 45 experiencing more complex and severe symptoms. Patients aged ≤ 30 may be more influenced by genetic factors and have higher treatment expectations.

Azelaic Acid: Mechanisms of Action and Clinical Applications.

AZA is a non-phenolic, saturated dicarboxylic acid with nine carbon atoms, naturally produced by the yeast Malassezia. It has diverse physiological activities, including antibacterial, anti-keratinizing, antimelanogenic, antioxidant and anti-inflammatory effects. AZA is widely used in dermatology and is FDA-approved for treating papulopustular rosacea. It also shows significant efficacy in acne vulgaris and melasma. This review summarizes the mechanisms of action and clinical applications of AZA, aiming to provide theoretical support for its clinical and cosmetic use and to facilitate further research.

The Clinical Efficacy of Lapachol in Facial Redness Reduction.

Facial erythema from acne, vascular rosacea, or photoaging is a common difficult-to-treat dermatologic challenge. The objective of this study was to examine the role of lapachol in alleviating facial erythema associated with a variety of common dermatologic conditions. Twenty-five healthy female and male subjects 35-65 years of age of Fitzpatrick skin types I-II with mild-to-moderate stable facial erythema from acne, rosacea or photoaging were enrolled in a single-site monadic study. Subjects received the study cream for twice daily application and were assessed at baseline, Week 4, and Week 8. The dermatologist investigator and subjects assessed efficacy and tolerability and facial photographic images were taken of all subjects at each visit. Noninvasive erythema assessments of the face were conducted using a colorimeter at baseline, Week 4, and Week 8 to document improvement in facial erythema. Twenty-five out of 25 subjects successfully completed the study without tolerability issues including 12 subjects with rosacea, 6 subjects with photoaging and 7 subjects with acne. After 8 weeks of use, the investigator rated a 44% decrease in facial erythema while the subjects rated a 40% decrease. Facial erythema was also noninvasively assessed with a colorimeter and dermaspectrophotometer (DSP). There was a 26% decrease in skin redness at Week 4 and a 31% decrease in skin redness at Week 8 on the colorimeter L*a*b* scale. This finding was collaborated by the DSP which registered a 29% decrease on the erythema scale at Week 8. Lapachol in a moisturizer formulation was found to be effective in reducing facial erythema from acne, rosacea, and photoaging.

Evaluation of Skin of Color Curricular Content for Physician Assistant Education.

Physician assistants (PAs) are often members of dermatologic care teams. Adequate knowledge of dermatologic conditions in skin of color (SOC) is crucial to proper diagnosis, treatment, and patient satisfaction. The objective of this study was to increase PA students' objective knowledge of and comfort level with evaluating dermatologic conditions in SOC. Eligible participants included 36 PA students at a major metropolitan medical center during the 2022 to 2023 academic year. A preintervention survey, immediate postintervention survey, and 7-month follow-up postintervention survey were administered before and after a SOC lecture. The surveys concluded with a 10-question, image-based, multiple-choice examination. There was a significant increase in accurate diagnoses of acne scarring, eczema, psoriasis, rosacea, and seborrheic dermatitis in SOC (59.4% preintervention to 76.9% postintervention, P = .029). Student confidence, as rated on a scale of 1 (minimally confident) to 5 (extremely confident), in diagnosing these conditions increased from 2.97 to 3.52 (P = .036). Implementation of a SOC-specific dermatology lecture significantly increased the accuracy and confidence with which PA students diagnosed dermatologic conditions.

Comparative analysis of selected gene expression profiles in peripheral blood mononuclear cells in patients with rosacea and healthy volunteers

Introduction. Rosacea is a chronic skin disease with about 10% prevalence in the global population. The pathogenesis of the disease is multifactorial and is not yet fully understood. The dermatosis affects the facial skin and is characterized by persistent erythema, the formation of telangiectasias, papules, pustules, and can also be complicated by ophthalmic lesions.The disease is rooted in impaired neurovascular regulation and changes in the innate immune systems. It is known that the expression of vascular endothelial growth factors (VEGF) in the skin are increased in rosacea and the level of myeloperoxidase, a lymphocyte lysosomal enzyme, is increased in the inflammatory processes occurring in the arteries.Aim. To study the level of these gene expression in blood lymphocytes in the acute stage of the disease.Materials and methods. A total of 10 patients with erythematous rosacea, 10 patients with papulopustular rosacea and 10 healthy volunteers were included in the study. The peripheral blood samples were collected from the subjects for further isolation of lymphocytes. The level of gene expression was determined by real-time polymerase chain reaction.Results. Investigators observed a 3.7-fold increase in the activity of myeloperoxidase expression in immune blood cells compared to the values of healthy volunteers. Also, the level of relative VEGFA expression increased by 6.5 times, the level of VEGFС increased by 11 times in mononuclear lymphocytes of patients compared to the values of healthy subjects. A comparative analysis in the groups of patients with erythematous and papulopustular rosacea showed a multidirectional expression pattern of vascular growth factors VEGFA and VEGFС. An increase in VEGFA expression is observed in the papulopustular rosacea, while VEGFС is higher in the erythematous form of the pathology.Conclusion. The obtained results demonstrate that a significant increase in the gene expression levels associated with vascular activity and angiogenesis in rosacea occurs not only in the skin, but also in the peripheral blood mononuclear lymphocytes of the patients. The detected differences in the expression of vascular growth factors in different forms of the disease indicate the need for differentiated treatments.

Causal roles of skin and gut microbiota in skin appendage disorders suggested by genetic study.

There is evidence from observational studies that human microbiota is linked to skin appendage Disorders (SADs). Nevertheless, the causal association between microbiota and SADs is yet to be fully clarified. A comprehensive two-sample Mendelian randomization (MR) was first performed to determine the causal effect of skin and gut microbiota on SADs. A total of 294 skin taxa and 211 gut taxa based on phylum, class, order, family, genus, and ASV level information were identified. Summary data of SADs and eight subtypes (acne vulgaris, hidradenitis suppurativa, alopecia areata, rogenic alopecia, rosacea, rhinophyma, seborrhoeic dermatitis, and pilonidal cyst) were obtained from the FinnGen consortium. We performed bidirectional MR to determine whether the skin and gut microbiota are causally associated with multiple SADs. Furthermore, sensitivity analysis was conducted to examine horizontal pleiotropy and heterogeneity. A total of 65 and 161 causal relationships between genetic liability in the skin and gut microbiota with SADs were identified, respectively. Among these, we separately found 5 and 11 strong causal associations that passed Bonferroni correction in the skin and gut microbiota with SADs. Several skin bacteria, such as Staphylococcus, Streptococcus, and Propionibacterium, were considered associated with multiple SADs. As gut probiotics, Bifidobacteria and Lactobacilli were associated with a protective effect on SAD risk. There was no significant heterogeneity in instrumental variables or horizontal pleiotropy. Our MR analysis unveiled bidirectional causal relationships between SADs and the gut and skin microbiota, and had the potential to offer novel perspectives on the mechanistic of microbiota-facilitated dermatosis.

Off-Label Uses of Abrocitinib: Review of Emerging Therapeutic Applications beyond Atopic Dermatitis.

Abrocitinib, an oral small-molecule Janus Kinase 1 (JAK1) inhibitor, is primarily approved for treating moderate-to-severe atopic dermatitis (AD) in adults and adolescents aged 12 and older. This review examines the emerging off-label uses of Abrocitinib. We identified 37 papers reporting on the use of Abrocitinib in various conditions other than AD. The most commonly reported uses were for vitiligo, prurigo nodularis, and hand eczema, with 12 cases each. There were also 10 cases of lichen sclerosus and chronic pruritus of unknown origin and 5 cases each of pityriasis rubra pilaris alopecia areata. Additionally, erythematotelangiectatic rosacea and steroid-induced rosacea were reported in four cases each. Other conditions treated with Abrocitinib were noted, but these mostly had only one or two reported cases. Interestingly, out of the 103 patients reviewed, all studies reported favorable clinical outcomes and satisfactory results, with the exception of one isolated case where Abrocitinib was used to treat erythematotelangiectatic rosacea.

Plant Phenolics in the Prevention and Therapy of Acne: A Comprehensive Review.

Plants are a rich source of secondary metabolites, among which phenolics are the most abundant. To date, over 8000 various polyphenolic compounds have been identified in plant species, among which phenolic acids, flavonoids, coumarins, stilbenes and lignans are the most important ones. Acne is one of the most commonly treated dermatological diseases, among which acne vulgaris and rosacea are the most frequently diagnosed. In the scientific literature, there is a lack of a detailed scientific presentation and discussion on the importance of plant phenolics in the treatment of the most common specific skin diseases, e.g., acne. Therefore, the aim of this review is to gather, present and discuss the current state of knowledge on the activity of various plant phenolics towards the prevention and treatment of acne, including in vitro, in vivo and human studies. It was revealed that because of their significant antibacterial, anti-inflammatory and antioxidant activities, phenolic compounds may be used in the treatment of various types of acne, individually as well as in combination with commonly used drugs like clindamycin and benzoyl peroxide. Among the various phenolics that have been tested, EGCG, quercetin and nobiletin seem to be the most promising ones; however, more studies, especially clinical trials, are needed to fully evaluate their efficacy in treating acne.

53678 Comparative randomized split face clinical study to assess the efficacy and tolerance of a serum containing Angiopausin and Avène Thermal Spring water in adult women with erythematotelangiectatic rosacea

53678 Comparative randomized split face clinical study to assess the efficacy and tolerance of a serum containing Angiopausin and Avène Thermal Spring water in adult women with erythematotelangiectatic rosacea

Efficacyof fractional radiofrequency in the treatment of erythematous capillary rosacea: A split-face study.

To assess the effectiveness and safety of treating erythematotelangiectatic rosacea using fractional radiofrequency (FRF). Twenty patients with a confirmed diagnosis of erythema capillaris rosacea were selected, and one side of each patient's face was randomly assigned to receive FRF treatments for three to six times, with an interval of 2 weeks between each treatment. VISIA, dermoscopy, and the Clinician's Erythema Evaluation Scale (CEA) were applied to evaluate the efficacy of the treatment before and after the treatment, to record the VAS scores and adverse reactions, and to conduct a patient satisfaction survey. The characteristic counts and scores of red zone and porphyrin as assessed by VISIA test were significantly decreased, and the difference between the treated side and the pretreatment side was statistically significant (p < 0.05), and the efficacy of the treatment was statistically insignificant compared with the control side, except for the red zone and porphyrin which were statistically significant before and after the treatment (p > 0.05). By CEA score, the difference between the treated side after treatment and the control side was statistically significant (p < 0.05), and the difference between the treated side before and after treatment was statistically significant (p < 0.05); the difference between the control side before and after treatment was not statistically significant (p > 0.05). Dermatoscopic observation showed reduction in pore size, reduction of yellowish-white and black horn plugs within the pores, lightening of the red background and thinning and blurring of the capillary structure on the treated side of the skin compared to the control side, and the skin on the treated side showed the above mentioned changes before and after the treatment as well. The mean pain score of the subjects was obtained by VAS score 3.67 ± 0.90. Adverse effects included mild edema, erythema, and microscopic crusting; no long-term adverse effects were seen in all patients. The efficacy of FRF treatment was evaluated 1 month after the final treatment, and 85% of the subjects rated it as satisfactory, very satisfactory, and very satisfactory. FRF for the treatment of erythematous capillary dilatation rosacea is effective, safe, and suitable for clinical promotion.

The treatment of Tofacitinib for rosacea through the inhibition of the JAK/STAT signaling pathway.

Rosacea is a chronic inflammatory skin disease characterized by facial erythema and telangiectasia. Despite ongoing research, the pathogenesis of rosacea remains incompletely understood, and current therapies are not entirely satisfactory. The JAK/STAT signaling pathway plays an essential role in immunoregulation, inflammation, and neurovascular regulation. Inhibition of the JAK/STAT pathway appears to hold promise as a potential therapy for rosacea. This study aimed to investigate the effects of the JAK inhibitor tofacitinib on rosacea and to preliminarily explore its therapeutic mechanism. To this end, a rosacea-like mouse model was induced using LL37 and treated with a 2% tofacitinib emulsion. The results demonstrated that topical application of tofacitinib significantly ameliorated rosacea-like phenotype, reduced the infiltration of CD4+ T cells and mast cells, and suppressed dermal angiogenesis. RT-qPCR analysis revealed a reduction in mRNA expression levels of STAT1, STAT4, and STAT5a in skin lesions following topical tofacitinib treatment. Additionally, three patients diagnosed with erythematotelangiectatic rosacea (ETR) were included in the study and treated with oral tofacitinib, leading to a significant improvement in erythema and flushing symptoms. These findings collectively suggest that tofacitinib alleviates LL37-induced rosacea-like skin inflammation in mice and rosacea skin lesions by inhibiting the JAK/STAT signaling pathway.

Exploring the Link: Trichostasis Spinulosa and Its Association with Early Phymatous Rosacea

Introduction: Rosacea is a chronic inflammatory skin condition with several clinical subtypes, including phymatous rosacea, which is distinguished by thickened skin, enlarged pores, and irregular surface nodularities, primarily affecting the nose. This manuscript aims to explore the underrecognized connection between early to moderate phymatous rosacea and trichostasis spinulosa (TS), a follicular disorder characterized by the retention of multiple telogen hairs. Methods: A total of consecutive 13 patients with initial phymatous changes and black dilated openings were enrolled. Detailed dermatological assessments, including dermoscopy, were conducted to identify and confirm trichostasis spinulosa. Dermoscopy of the black openings confirmed the presence of hair tufts emerging from dilated follicular openings and plugs. Patients underwent minor procedures using a comedo extractor to remove the hair bundles. Results: All extracted follicular units showed typical characteristics of trichostasis spinulosa, including bundles of telogen hairs surrounded by a sebokeratinous plug. Conclusion: We postulate that the fibrotic processes characteristic of phymatous rosacea may promote the development of TS. Recognizing TS as an early indicator of phymatous rosacea could help prevent disease progression.

A comparative exploration of immunohistochemical markers in patients with papulopustular rosacea undergoing treatment with oral isotretinoin versus doxycycline.

Rosacea is a chronic inflammatory disease, and doxycycline is a widely recommended treatment for it due to its anti-inflammatory action. Oral isotretinoin reduces sebaceous gland activity and modulates toll-like receptors, reducing inflammation. Our aim was to investigate the effect of these two drugs on the expression of cutaneous immunohistochemical biomarkers related to etiopathogenic factors involved in rosacea. We conducted a randomized, comparative, and evaluator-blinded trial, including 40 participants with moderate and severe papulopustular and ocular rosacea. Participants were treated with doxycycline (DOXY) 100 mg or isotretinoin (ISO) 0.3 mg/kg daily. Immunohistochemistry at baseline and after 4 months was used to demonstrate the expression of the biomarker on the affected skin. The following changes were detected: a reduction in the vessel count after using VEGF with DOXY (P = 0.010); a decrease in VEGF intensity with ISO (P < 0.001) and DOXY (P = 0.020); a reduction of nitric oxide synthase enzyme with both drugs in the inflammatory infiltrate (ISO P < 0.001; DOXY P = 0.003); however, only with ISO was there a significant (P = 0.030) decrease at the level of the sebaceous glands, indicating a reduction of nitric oxide synthesis; a reduction of TRPV-1 expression at the level of the sebaceous glands was observed only with DOXY (P = 0.041); a decrease of cathelicidin LL37 expression, a key antimicrobial peptide in the etiopathogenesis of rosacea, was noted with both drugs, although at the level of sebaceous glands, only with DOXY (P = 0.007). Oral isotretinoin and doxycycline have modified the expression of cutaneous biomarkers related to rosacea etiopathogenesis, demonstrating their role in controlling inflammatory and vascular processes.

Rosacea Epidemiological Investigation and Etiology Exploration in the Plateau Area.

The epidemiology of 2 neighboring cities of differing altitude in Northwest China is unknown. The present study investigated the prevalence of rosacea in a high-altitude city and a low-altitude city. The prevalence study was conducted via clinical examination of male and female participants in the following age groups: 5-17, 18-30, 31-50, and 51-70 years. Rosacea subtype was also determined as erythematotelangiectatic rosacea (ETTR) or papulopustular rosacea (PPR). The rosacea prevalence (RP) in the low-altitude city was 33.8% ± 1.2% (95% CI, ETTR = 1794, PPR = 174, n = 5794). RP in the high-altitude city has a notably higher reading of 47.7% ± 1.4% (95% CI, ETTR = 2090, PPR = 219, n = 4796). In both cities, the ETTR subtype predominated, and there was marked increase in RP among females. RP in low-altitude city females was steady across all age groups, while RP in low-altitude city males showed a declining trend with age. RP in high-altitude city females indicated a slightly increasing trend with age, while RP in males again showed a declining trend with age. Based on the results of this high-altitude city and low-altitude city study, there are an estimated 2.1 million people with rosacea, from 2 cities with a total population of 5.4 million. Due to the high altitude and accompanying increased UV radiation, cold climate, and reduced oxygen density, the greater northwest region of China is expected to experience high RP rates.