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    Rosacea is a chronic inflammation of the central face characterized by flare-ups, flushing, erythema, telangiectasia, lesions with papules/pustules and possible remission and relapse conditions. It has been conventionally defined by a certain age (generally adult onset) or period for its occurrence but as we have seen in many cases there is no typical age for its occurrence. It also has been correlated with certain ethnic background and skin types particularly fair skinned people but now it is found affecting people of all different backgrounds and skin of color people. In fact, diagnosis of rosacea is very challenging and difficult in skin of color. The underlying cause of rosacea includes aberrant immune system, environmental factors, genetics and most importantly microbial flora of our skin. Sometimes only one factor predominantly plays its part and sometimes all the factors play together to cause an inflammatory response in rosacea. It mostly affects women but sometimes causes very severe form in men in cases of rhinophyma. Rosacea is a condition which in some cases co-exists with other skin conditions and ocular manifestations and may present comorbidities with other parts of the body especially correlating with intestinal inflammation. There are further theories with this condition and more yet to explore which needs further investigation into rosacea research.

    More info on the definition of rosacea

    According to the classification based on phenotypical characteristics, we will explore the characteristic patterns of each phenotype going deeper into skin.

    Flushing in Rosacea [Phenotype 1] :


    Flushing is usually but not always the earliest sign of rosacea which is marked by the redness of the skin with persistent episodes. Though the redness is caused by the dilation of the blood vessels beneath the skin, however, in its initial level, the early signs of flushing do not show the typical visible blood vessels appearing immediately. Flushing is characterized by a sudden feeling of warmth, tender, stinging, dry and itchiness of the skin. In this stage you can see your pores are very little enlarged contrasting to its natural state and are restored to its natural state when the flushing disappear. It depends on its frequency and comes and goes on its own but with physical responses such as stress and stress of their own flushing, anxiety, fear and other emotional states, it prolongs its time to disappear. Some people only show the flushing condition and never develop the other phenotypes of rosacea but for some people it is the onset and early sign of rosacea which furthers down to other phenotypes appearing at later stages. We will consider the other phenotypes later to delve into a deeper understanding of rosacea.

    You can read earlier post on phenotypes to know about characteristics and other information. This page gives you an idea of the wealth of rosacea information on our website. When you click on a link and get an error message that you don't have permission to view the rosacea information it is because you are a guest and not a member of the RRDi. The minimum requirement is to donate $2/month to subscribe as a member

    Written and Illustrated by Apurva Tathe

    Phenotype 2Phenotype 3 • Phenotype 4 • Phenotype 5 • Phenotype 6

  • Posts

    • Dermatol Pract Concept. 2023 Jul 1;13(3). doi: 10.5826/dpc.1303a182. ABSTRACT INTRODUCTION: Few studies have evaluated the histopathological characteristics of clinical rosacea subtypes in detail. OBJECTIVES: To assess rosacea histopathological features in correspondence to clinical subgroups. METHODS: The histopathological findings of 204 rosacea patients were analyzed retrospectively and were compared among clinical subtypes. RESULTS: Thirt-Two Percent of patients were male and 68% were female. Seventy-three patients had erythematotelangiectatic rosacea (ETR) and 110 had papulopustular rosacea (PPR), 12 were ETR + PPR, 4 ocular, 2 phymatous, and 3 had Morbihan's edema. Perivascular and perifollicular lymphohistiocytic infiltration, perifollicular exocytosis, follicular spongiosis, and ectatic vessels were almost found in all subtypes. Solar elastosis was higher in ETR. Spongiosis, exocytosis of inflammatory cells into epidermis, acanthosis, and granulomatous reaction were higher in PPR. Inflammatory cells exocytosis was more in PPR and phymatous. Demodex folliculorum was identified in 27% of ETR, 33.6% of PPR, 50% of phymatous, one ocular patient, and none of Morbihan edema. Demodex brevis were found in 5% of ETR, 3% of PPR, and 50% of phymatous. Demodex brevis not folliculorum was more in phymatous. Spongiosis was the most common finding in ocular rosacea. CONCLUSIONS: Spongiosis, exocytosis of inflammatory cells, and granulomatous reactions were more in PPR. Solar elastosis was more in ETR. Histopathological findings were compatible with clinical subgroups. PMID:37557115 | DOI:10.5826/dpc.1303a182 {url} = URL to article
    • Dermatol Pract Concept. 2023 Jul 1;13(3). doi: 10.5826/dpc.1303a168. ABSTRACT INTRODUCTION: Studies have suggested that botulinum toxin A may improve skin quality, and application protocols using hyper-diluted doses of botulinum toxin (microdosing) have been studied as a way to achieve therapeutic goals without fully paralyzing the targeted muscles. OBJECTIVES: To evaluate the effects of a combined protocol utilizing both the standard dosing and the microdosing of AbobotulinumtoxinA for the improvement of skin quality, measured by objective and subjective measurements. METHODS: Thirty patients were treated with botulinum toxin using both the standard technique and the microdosing technique. Objective (Sebumeter®, Mexameter® and digital dermoscopy pictures) and subjective (Global Aesthetic Improvement Scale and a clinical scale for evaluating the quality of facial skin) measurements of the effects in the treated areas were taken to assess the efficacy of the treatment. RESULTS: Digital dermoscopy showed a marked reduction of erythema and telangiectasias. Erythema and telangiectasias improved both on objective and subjective measurements. Skin oleosity, static rhytids, papules and pustules and enlarged pores improved on subjective measurements. Patient satisfaction was high (93%) despite the high rate of adverse events (56%). CONCLUSIONS: The combined application of standard doses and microdoses of AbobotulinumtoxinA is effective in improving the overall quality of facial skin. The effects on erythema and telangiectasias suggest that it is an effective treatment option for patients with erythematotelangiectatic rosacea. When applying microdoses of botulinum toxin in the lower and mid-face, the doses and pattern of injection should be customized for each patient to reduce the occurrence of adverse events. PMID:37557136 | DOI:10.5826/dpc.1303a168 {url} = URL to article
    • Dermatol Pract Concept. 2023 Jul 1;13(3). doi: 10.5826/dpc.1303a131. ABSTRACT INTRODUCTION: Superficial folliculitis of the scalp (SFS) is a common complaint in clinical practice, and initial presentation may be difficult to differentiate as they may appear very similar to each other. OBJECTIVES: The aim of this thesis is to describe the pathologies that occur clinically as folliculitis of the scalp, identify their causes and characteristics and create a standardized classification. METHODS: This is a retrospective clinical, dermoscopic and histopathological study over 10 years of dermatologic consultations. Only individuals with a confirmed diagnosis of SFS (updated diagnostic criteria or biopsy) were included. RESULTS: In this review, we describe the various clinical features of different causes of SFS in ninety-nine cases and divided into infectious due to fungus, bacteria, or virus and inflammatory conditions such as rosacea, acneiform eruption and Ofuji syndrome. CONCLUSIONS: The clinician must differentiate SFS from other underlying scarring disorders to prevent poorer outcomes. We created an algorithm to help the clinician reach a proper diagnosis. PMID:37557142 | DOI:10.5826/dpc.1303a131 {url} = URL to article
    • J Drugs Dermatol. 2023 Aug 1;22(8):838-839. doi: 10.36849/jdd.7103. ABSTRACT Improved patient-physician relationships (PPR) are associated with better patient satisfaction and disease outcomes, however, there is limited literature assessing how PPR affects adherence in dermatology. We recruited 30 subjects with a clinical diagnosis of rosacea. Subjects were instructed to use ivermectin 1% cream once daily for 3 months and adherence was measured using the Medication Event Monitoring System cap. The Patient-Doctor Relationship Questionnaire (PDRQ-9), a validated questionnaire assessing patients’ perceived strength of the relationship with their doctor, was completed. Mean adherence for all subjects over three months of the study was 62%. PDRQ-9 scores positively correlated with adherence rates for 3 months of treatment (r(26)=0.52; P=0.006). The perceived strength of the PPR may have a role in patients’ adherence to their medications. Improving the PPR, through empathy and effective communication, may facilitate better medication adherence and treatment outcomes. Perche PO, Singh R, Cook MK, et al. The patient-physician relationship and adherence: observations from a clinical study. J Drugs Dermatol. 2023;22(8):838-839. doi:10.36849/JDD.7103. PMID:37556519 | DOI:10.36849/jdd.7103 {url} = URL to article
    • JAAD Case Rep. 2023 Jun 29;39:14-16. doi: 10.1016/j.jdcr.2023.06.028. eCollection 2023 Sep. NO ABSTRACT PMID:37554359 | PMC:PMC10404599 | DOI:10.1016/j.jdcr.2023.06.028 {url} = URL to article
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