Rosazea

Abstract

Rosacea is a chronic inflammatory skin disease mainly affecting the face. Therfore, it can be very distressing for the patient leading to psychosocial disturbances. An universally accepted definition and confirmed pathophysiology is lacking. In recent years many efforts were undertaken to close this gap. Rosacea is a frequent disease occurring in 2 - 5 % of caucasian adults, peaking between 40 and 50 years of age. The course of rosacea is variable, the disease may stop at any stage. Three main stages are differentiated: Rosacea erythemato-teleangiectatica [rosacea stage I), rosacea papulopustulosa (Rosacea stage II), hyperglandular-hypertrophic rosacea (rosacea stage III). Besides these main manifestations numerous special forms exist, which often lead to difficulties in the differential diagnoses and require specific therapeutic strategies. These include rosacea conglobata, rosacea fulminans, granulomatous rosacea, persisting erythema (Morbus Morbihan), gram-negative rosacea, ocular rosacea, and steroid rosacea. Recently several molecular features of its inflammatory process have been identified. Overproduction of Toll-like receptors 2, a serine protease, induce abnormal high levels of abnormal forms of cathelicidin. Further factors include neurovascular dysregulation, infestation of demodex, barrier dysfunction, enhanced neuroimmune communication, blood and lymphatic vessel changes, and activation of resident cells of the skin. These insights lead to developments of new treatment strategies and during the last few years several topical and systemic drugs were able to pass the high hurdles of official approval for the treatment of rosacea.