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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] :

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    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

    • Skin Appendage Disord. 2022 Nov;8(6):462-468. doi: 10.1159/000525024. Epub 2022 Jun 7. ABSTRACT INTRODUCTION: The present study aimed to obtain fundamental data, including climate conditions and Demodex mites, on rosacea and similar diseases in the situation where the wearing of face masks is mandatory due to the coronavirus disease 2019 pandemic. METHODS: We enrolled 86 Japanese patients habitually wearing face masks with rosacea and similar diseases. Disease severity was assessed using the Investigator Global Assessment. The presence of Demodex mites was examined microscopically. Treatment involved acaricidal and antibiotic agents. RESULTS: The numbers of male and female patients enrolled were 11 and 75, respectively. Among these patients, 85 (98.8%), 57 (66.3%), and 76 (88.4%) had rosacea, rosacea-like dermatitis (RLD), and demodicosis, respectively. The monthly number of patients with rosacea and demodicosis showed two peaks from May to June and in October, during which monthly mean temperature was approximately 20°C (68°F). Improvement rates in rosacea, RLD, and demodicosis were significantly higher when Demodex mites were no longer detected after treatment. CONCLUSION: The present results suggest that a season with a mean temperature of approximately 20°C is a risk factor for rosacea and similar diseases in individuals wearing face masks in Japan, and a decrease in Demodex mites is associated with the attenuation of symptoms. PMID:36407649 | PMC:PMC9672874 | DOI:10.1159/000525024 {url} = URL to article
    • J Cosmet Laser Ther. 2022 Nov 17:1-6. doi: 10.1080/14764172.2022.2147953. Online ahead of print. ABSTRACT A chemical peel is chemexfoliation, a process of application of a chemical substance to the skin that causes controlled chemical destruction of the epidermis with or without part of the dermis leading to skin regeneration and remodeling. It can be classified depending upon the depth of penetration into superficial, medium, and deep peels. Among various indications, peels can be used to enhance treatment within a variety of conditions including skin- rejuvenation, inflammatory disorders like acne, rosacea, acne scar, and pigmentary disorders like melasma, freckles, lentigens, dyschromia, and post-inflammatory pigmentation. We did a chemical peel for six patients with facial melanosis, diagnosed with Riehl melanosis. All patients had visible clinical improvement. Detailed history and informed consent were taken both for photographs and procedures from all patients. PMID:36384385 | DOI:10.1080/14764172.2022.2147953 {url} = URL to article
    • J Clin Aesthet Dermatol. 2022 Nov;15(11):69-74. ABSTRACT OBJECTIVE: Subantibiotic dose doxycycline (SDD40), formulated as a modified-release 40mg capsule administered once daily, is used to treat inflammatory lesions of rosacea. In order to investigate whether the patient's weight or lesion severity impacts clinical outcomes with using SDD40, the efficacy and safety of SDD40 in treating rosacea were evaluated in randomized controlled studies (RCTs). METHODS: Phase II, III, and IV RCTs, and a subsequent meta-analysis were described. For all studies, the primary efficacy endpoint was the change in total inflammatory lesion count (papules, pustules, and nodules) from baseline to Week 16. For one of the studies, body weights were categorized by BMI (body mass index). Secondary efficacy endpoints included the change in Investigator's Global Assessment (IGA). Safety was assessed by monitoring adverse events (AEs). RESULTS: The efficacy of SDD40 was consistent across the studies (two trials including n=72 and n=91 subjects) and meta-analysis (n=127 and n=142). SDD40 remained effective regardless of baseline disease severity and weight (with a weak correlation coefficient below 0.75); overweight or obese subjects with severe rosacea cleared at least as well if not better than those with a normal BMI and mild disease. The treatment was well tolerated with no to minimal gastrointestinal-related AEs. LIMITATIONS: Retrospective analyses have methodological limitations. CONCLUSION: Consistency between study results including the meta-analysis supports the effectiveness and safety of SDD40, irrespective of the weight of the patient or rosacea severity based on inflammatory lesion count at baseline. PMID:36381182 | PMC:PMC9651154 {url} = URL to article
    • Transl Vis Sci Technol. 2022 Nov 1;11(11):13. doi: 10.1167/tvst.11.11.13. ABSTRACT PURPOSE: Dry eye disease (DED) is a heterogeneous condition with poorly characterized subtypes. The DREAM study was a large multicenter randomized clinical trial that did not find omega-3 to be more effective than placebo in treating symptomatic DED. We performed secondary analysis of DREAM data to characterize DED subtypes and their omega-3 response. METHODS: A total of 535 patients with moderate-to-severe DED were randomized to omega-3 or placebo treatment for one year. We used latent profile analysis to identify subtypes based on baseline Ocular Surface Disease Index, tear break-up time (TBUT), anesthetized Schirmer's test, corneal and conjunctival staining, and meibomian gland dysfunction (MGD). We evaluated omega-3's effect for each subtype using generalized linear regression. RESULTS: Five clinically meaningful DED subtypes were identified. They differed significantly in sex (P < 0.001) and race (P = 0.02). Subtype 1 had the most severe DED signs yet milder symptoms and was associated with more Sjögren's syndrome (21%, P < 0.001). Subtype 2 had the mildest DED signs except MGD. Subtype 3 had the most severe symptoms, out of proportion to DED signs. Subtype 4 had relatively milder symptoms and MGD. Subtype 5 had severe MGD and TBUT and was associated with rosacea (29%, P = 0.04). Omega-3 was not significantly more beneficial than placebo for any subtype. CONCLUSIONS: Five clinically meaningful DED subtypes differed significantly in demographics, symptoms, signs, and systemic disease associations. Omega-3 was not significantly more effective than placebo for any subtype. TRANSLATIONAL RELEVANCE: T3 translational research identifying subtypes in the DREAM study can improve DED clinical classification and targeted management. PMID:36383391 | DOI:10.1167/tvst.11.11.13 {url} = URL to article
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