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    No one really knows the cause of rosacea but there are many theories. "Rosacea is a skin disease with an obscure and complicated pathogenesis." [1]

    The current most popular theory is that rosacea is a disorder of the innate immune system. For over twenty years the vascular theory was held as the most promising. What is interesting is at the heart of the innate immune system theory is that this includes an overproduction of cathelicidin (a killer of microscopic organisms that is at the cellular level found in white blood cells and also found in cells on the skin) which is transported in the vascular system, so we have come full circle. Some consider the nervous system as the root cause of rosacea, and the list goes on with many other theories worth considering (the latest theory is the Trigeminal sensory malfunction theory) but a good place to start your research is our post on Theories Revisited

    End Notes

    [1] Dovepress
    Rosacea and Helicobacter pylori: links and risks
    Elizabeth Lazaridou, Chrysovalantis Korfitis, Christina Kemanetzi, Elena Sotiriou, Zoe Apalla, Efstratios Vakirlis, Christina Fotiadou, Aimilios Lallas, Demetrios Ioannides

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    • [Idiopathic facial aseptic granuloma: A case report]. Arch Argent Pediatr. 2019 Feb 01;117(1):e56-e58 Authors: Garais JA, Bonetto VN, Frontino L, Salduna MD, Ruiz Lascano A Abstract
      Idiopathic facial aseptic granuloma is a childhood condition characterized by asymptomatic erythematous-violaceous nodules, often confused with abscesses. Its pathogenesis is unknown, but some authors have postulated its relationship with infantile rosacea. We present a case of a patient with a clinical diagnosis of idiopathic facial aseptic granuloma, with ocular involvement and a good response to oral metronidazole treatment.
      PMID: 30652457 [PubMed - in process] {url} = URL to article
    • Rosacea: Relative risk vs Absolute Risk of Malignant Comorbidities. J Am Acad Dermatol. 2019 Jan 14;: Authors: Tjahjono LA, Cline A, Huang WW, Fleischer AB, Feldman SR PMID: 30654083 [PubMed - as supplied by publisher] {url} = URL to article
    • Trigger, tripwire, flareup and flush. These are probably the four most common terms used when discussing rosacea. Because of poor communication and rosaceans not understanding what there terms actually mean much confusion results, adding to the already confusing dilemma of rosacea understanding. So to set the record: 

      Flare up according to the NRS is "a more intense outbreak of redness, bumps or pimples.."  

      Tripwire or Trigger is the same thing according to the NRS who uses these words interchangeably and states that both terms mean, "factors that may cause a rosacea sufferer to experience a flare-up—a more intense outbreak of redness, bumps or pimples. [1]

      A medical dictionary source defines flush as: flush 1. transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. See also erythema. [2]

      A blush is a flush usually caused by psychological factors. A flush can be caused by a any number of factors as noted above including psychological factors. 

      The reason this is brought up is that while most rosaceans confuse flushing with a flare up there are rosaceans who report having a flare up of rosacea and DO NOT FLUSH. These ones are admittedly fewer in number, and flushing is usually associated with a flare up, but nevertheless demonstrates that flushing is not necessarily a rosacea flare up. One could flush or blush and the skin returns to normal in a rosacea sufferer. Flushing does not NECESSARILY mean a rosacea flare up and it only means that it MAY produce a rosacea flare up. Those who think flushing is rosacea is like thinking pimples mean you have rosacea (or for that matter, believing that erythema is rosacea). There is more to a diagnosis of rosacea than simply having pimples and erythema (see Diagnosis). For example, one could have erythema and have Atopic Dermatitis, not rosacea.  Flushing is one of the signs or symptoms usually associated with rosacea, but not necessarily required. Pimples are associated with rosacea but not necessarily required, i.e., Phenotype 2. Rosacea is always associated with redness or erythema.  Hopefully, if rosaceans understand these terms, trigger, tripwire, flareup and flush better, we will all be on the same page when we discuss rosacea. 

      End Notes

      [1] Coping With Rosacea, National Rosacea Society, page 1

      [2] Dorland’s Illustrated Medical Dictionary
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