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Rosacea

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Dermatology in Public Health Environments

Abstract

Rosacea is a frequent chronic dermatosis on the central region of the face. It is underdiagnosed and can have a significant impact on the sufferers’ quality of life. It is more often seen in an intermediate age range and is prevalent in women, although it can occur during childhood and severe cases are seen in men. Rosacea has a multiple etiopathogenic basis and different clinical types. The vascular and the inflammatory processes in a deconstructing dermal framework account for the most often found clinical types: erythematous telangiectatic, papulopustular, and phymatous. Ocular rosacea should be properly investigated. The differential diagnosis is made mainly with other facial dermatoses, such as acne, seborrheic dermatitis, atopic dermatitis, periorificial dermatitis, contact dermatitis, dermatomyositis, and lupus erythematosus. Treatment includes refraining from exposition to triggering factors and the use of topical and systemic medication. Topical metronidazole, ivermectin, azelaic acid, and brimonidine, as well as systemic doxycycline, carvedilol, and isotretinoin, are drugs of choice, besides different types of laser.

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Authors and Affiliations

  1. Dermatology Service, Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Renan Rangel Bonamigo MD, MSc, PhD

  2. Sanitary Dermatology Service of the Department of Health of Rio Grande do Sul State (ADS-SES), Porto Alegre, Brazil

    Renan Rangel Bonamigo MD, MSc, PhD

  3. Graduate Pathology Program of Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil

    Renan Rangel Bonamigo MD, MSc, PhD

  4. Santa Casa Hospital, Porto Alegre, Brazil

    Wagner Bertolini MD, MSc

  5. Sanitary Dermatology Service of Health Department of Rio Grande do Sul State (ADS-SES), Porto Alegre, Brazil

    Sérgio Ivan Torres Dornelles MD, MSc

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  1. Renan Rangel Bonamigo MD, MSc, PhD
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  2. Wagner Bertolini MD, MSc
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  3. Sérgio Ivan Torres Dornelles MD, MSc
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Correspondence to Renan Rangel Bonamigo MD, MSc, PhD .

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Editors and Affiliations

  1. Dermatology Service of Clinical, Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Renan Rangel Bonamigo

  2. Health Secretary of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Sergio Ivan Torres Dornelles

Glossary

Cathelicidin

Antimicrobial peptides found in the mammalian tissue induced by injury or inflammation. They belong to the immune system and work as activators and controllers of immune reactions.

Flushing

The most common symptom of rosacea, characterized by a transient facial blush or redness. The skin can be lightly rose as if blushed, or it may seem slightly sunburned. Sufferers may refer to itching or pricking during rosacea flares.

GRADE (Grading of Recommendations Assessment, Development, and Evaluation)

System developed by a group of collaborative researchers aiming at the creation of a universal, transparent, and sensitive system to grade the quality of scientific evidence and recommendation power. The GRADE system classifies evidence quality (reliability of the used information) at four levels: high (powerful reliability of the real effect is near the assessed one), moderate (moderate reliability of the assessed effect), low (limited effect reliability), and very low (very limited reliability of the effect assessment). There is a significant uncertainty degree in the findings. Evidence from randomized clinical trials begins with high evidence level; evidence from observational studies begins with low evidence level.

Kallikrein

A polypeptide of proteolytic reaction which acts upon protein substrates of varied nature. Kallikrein has a vasodilating direct action, but also an indirect one because of its proteolytic feature.

Metalloproteinases

An important group of zinc-dependent proteolytic enzymes (endopeptidases) that account for the degradation of the extracellular matrix and the basal membranes. The metalloproteinases degrade the matrix macromolecules including interstitial collagen, fibronectin, lamina, and proteoglycan, among others. The expression of many metalloproteinases is increased in the skin of rosacea patients.

Photodamage

Represented by clinical changes resulting from acute or chronic events determined by biochemical and molecular processes caused by ultraviolet radiation exposure.

Phyma

A rosacea phase determined by sebaceous gland hyperplasia, initially showing erythema, edema, and follicular orifice dilation, followed by the development of fibrous tissue. This process can affect the nose (rhinophyma), the mentum/chin (gnatophyma), the forehead (metophyma), the ears (otophyma), and the eyelids (blepharophyma).

Transcriptome

The transcriptome corresponds to the genetic code fraction (DNA) transcribed by the RNA polymerase into the RNA molecules, that is, an organ, tissue, or cell lineage’s total set of transcripts (RNA messengers, ribosomal RNAs, transporter RNAs, and microRNAs).

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Bonamigo, R.R., Bertolini, W., Dornelles, S.I.T. (2018). Rosacea. In: Bonamigo, R., Dornelles, S. (eds) Dermatology in Public Health Environments. Springer, Cham. https://doi.org/10.1007/978-3-319-33919-1_22

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