A clinical and histopathologic study of granulomatous rosacea

Anais Brasileiros de Dermatologia, 2006

Os autores descrevem um caso de rosácea granulomatosa em um homem de 39 anos de idade, tratado com a associação de limeciclina oral e metronidazol gel tópico. A rosácea granulomatosa é uma variante da rosácea clássica, rara, caracterizada pela presença de pápulas vermelho-acastanhadas ou pequenos nódulos com base eritematosa e infiltrada, surgindo geralmente na superfície lateral da face e no pescoço. O exame histopatológico evidencia granulomas perifoliculares e perivasculares. A evolução é crônica, e o tratamento inclui antibióticos orais, como a tetraciclina e seus derivados, e medicações tópicas, como metronidazol, ácido retinóico, entre outras.

Journal of Investigative Dermatology, 1986

F1000Research

Rosacea is a common chronic inflammatory skin disease of the central facial skin and is of unknown origin. Currently, two classifications of rosacea exist that are based on either “preformed” clinical subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) or patient-tailored analysis of the presented rosacea phenotype. Rosacea etiology and pathophysiology are poorly understood. However, recent findings indicate that genetic and environmental components can trigger rosacea initiation and aggravation by dysregulation of the innate and adaptive immune system. Trigger factors also lead to the release of various mediators such as keratinocytes (for example, cathelicidin, vascular endothelial growth factor, and endothelin-1), endothelial cells (nitric oxide), mast cells (cathelicidin and matrix metalloproteinases), macrophages (interferon-gamma, tumor necrosis factor, matrix metalloproteinases, and interleukin-26), and T helper type 1 (TH1) and TH17 cells. Additionally...

American Journal of Clinical Dermatology, 2021

Rosacea is a chronic inflammatory dermatosis mainly affecting the cheeks, nose, chin, and forehead. Rosacea is characterized by recurrent episodes of flushing or transient erythema, persistent erythema, phymatous changes, papules, pustules, and telangiectasia. The eyes may also be involved. Due to rosacea affecting the face, it has a profound negative impact on quality of life, self-esteem, and well-being. In addition to general skin care, there are several approved treatment options available for addressing these features, both topical and systemic. For some features, intense pulse light, laser, and surgery are of value. Recent advances in fundamental scientific research have underscored the roles of the innate and adaptive immune systems as well as neurovascular dysregulation underlying the spectrum of clinical features of rosacea. Endogenous and exogenous stimuli may initiate and aggravate several pathways in patients with rosacea. This review covers the new phenotype-based diagnosis and classification system reflecting pathophysiology, and new and emerging treatment options and approaches. We address new topical and systemic formulations, as well as recent evidence on treatment combinations. In addition, ongoing studies investigating novel therapeutic interventions will be summarized. Key Points The updated phenotype-based diagnosis and classification system based on features enables accurate characterization of individual patients and the potential for optimizing outcomes by addressing features most bothersome to the patient. Treatment optimization may be enabled by new evidence on treatment combinations and the upcoming availability of new topical/oral formulations of existing medications. Various novel therapeutic interventions are being investigated , some based on the increased understanding of rosacea's pathophysiology.

2002

OBJECTIVE To increase awareness of the oculocutaneous manifestations of two common skin diseases. QUALITY OF EVIDENCE We reviewed clinically relevant articles from the dermatologic and ophthalmologic literature. The PubMed database was searched from January 1965 to January 2001 to locate retrospective and prospective cohort and descriptive studies using the MeSH terms acne rosacea; eczema; and dermatitis, atopic. Most literature on the topic is based on descriptive research. MAIN MESSAGE Several dermatologic problems are known to have ophthalmologic sequelae. Rosacea and atopic dermatitis are two common skin conditions that can have concomitant eye disease. Degrees of skin and eye disease vary; certain cases require specialty referral and other cases can be managed effectively by family physicians. CONCLUSION Better appreciation of how rosacea and atopic dermatitis overlap with eye disease will result in more appropriate referrals and more comprehensive patient care. RÉSUMÉ OBJECTIF Accroître la sensibilisation aux manifestations oculo-cutanées de deux maladies fréquentes de la peau. QUALITÉ DES DONNÉES Nous avons examiné les articles pertinents sur le plan clinique des ouvrages en dermatologie et en ophtalmologie. La base de données PubMed a fait l'objet d'une recension, de janvier 1965 à janvier 2001, pour trouver des études rétrospectives et prospectives de cohortes ainsi que des études descriptives à l'aide des termes MeSH en anglais pour « acné rosacée », « eczéma » et « dermatite, atopique ». La majorité des ouvrages sur le sujet se fondent sur des recherches descriptives. PRINCIPAL MESSAGE Plusieurs problèmes dermatologiques sont reconnus pour avoir des séquelles ophtalmologiques. L'acné rosacée et la dermatite atopique sont deux maladies courantes de la peau qui peuvent présenter une affection concomitante de l'oeil. Les degrés de sévérité des maladies de la peau et de l'oeil varient; certains cas exigent un aiguillage vers un spécialiste et d'autres peuvent être efficacement pris en charge par les médecins de famille. CONCLUSION Une meilleure appréciation de la façon dont l'acné rosacée et la dermatite atopique peuvent être concomitantes à une maladie de l'oeil se traduira par des aiguillages plus appropriés et des soins plus complets aux patients. This article has been peer reviewed. Cet article a fait l'objet d'une évaluation externe.

Acta Dermato Venereologica, 2014

Rosacea is a common chronic skin condition that displays a broad diversity of clinical manifestations. Although the pathophysiological mechanisms of the 4 subtypes are not completely elucidated, the key elements often present are augmented immune responses of the innate and adaptive immune system, and neurovascular dysregulation. The most common primary feature of all cutaneous sub types of rosacea is transient or persistent facial ery thema. Perilesional erythema of papules or pustules is based on the sustained vasodilation and plasma extravasation induced by the inflammatory infiltrates. In contrast, transient erythema has rapid kinetics induced by trigger factors independent of papules or pustules. Amongst the current treatments for facial erythema of rosacea, only the selective α 2-adrenergic receptor agonist brimonidine 0.33% topical gel (Mirvaso ®) is approved. This review aims to discuss the potential causes, different pathophysiologies and current treatment options to address the unmet medical needs of patients with facial erythema of rosacea.

Serbian Journal of Dermatology and Venerology, 2010

Granulomatous rosacea is considered to be the only true variant of rosacea. Diascopy of larger lesions often reveals apple-jelly nodules, indicating their granulomatous histology. Other signs and symptoms of rosacea are not required to make a diagnosis of granulomatous rosacea. The response to treatment may be slow, which must be the most important consideration for both the clinician and the patient. We present an otherwise healthy 62-year-old non-atopic woman with a 15-year history of episodic facial flushing, often accompanied by a burning sensation without sweating. Exclusively affecting the face, lesions had a high tendency to spread each year. The patient was a lifelong non-smoker. A seller on the local market, she spent most of her time outdoors. She had no positive family history of rosacea. At the time of presentation, she was not taking any medications, except for topical neutral creams. Multiple reddish-brown papules without comedones, associated with telangiectasia were ...

Journal of The European Academy of Dermatology and Venereology, 2010

Background There is a granulomatous variant which is recognized in the rosacea spectrum. However, the pathogenesis of granuloma formation in rosacea has not been clearly demonstrated. Matrix metalloproteinases (MMPs) are required for recruitment of inflammatory cells and for tissue remodelling, making way for the development of well-organized granuloma.Objective The aim of this study was to investigate the expression of transforming growth factor (TGF)-β, TGF-β type II receptor (TβRII), Tumour necrosis factor (TNF)-α, MMP-1, 2 and 9 in the granulomatous rosacea (GR) compared with the non-granulomatous rosacea (NGR) and test the hypothesis that the changes of these profiles in GR would be related with chronic ultraviolet radiation (UVR)-exposure.Methods Facial skin samples were obtained from 20 patients with GR and NGR (control group). The sections were stained using haematoxylin and eosin, Verhoeff’s elastic stain, and antibodies to TGF-β, TβRII, TNF-α, MMP-1, -2 and -9.Results The amount of elastotic material was significantly increased in the dermis of GR lesions. Expression of TGF-β was significantly decreased in the epidermis of GR lesions compared with NGR lesions. In addition, the expression of MMP-9 was significantly increased in the dermis of GR lesions compared with NGR lesions, especially at the centre of the granuloma on a semi-quantitative analysis. MMP-2 expression was also increased in GR lesions, although the difference between the two groups was not statistically significant.Conclusions The results of this study suggest that the increased expression of MMPs in the dermis may participate in granuloma formation of GR in association with UVR.

Journal of Translational Medicine and Research, 2016

Objectives: Rosacea is currently defined as an inflammatory cutaneous disease without systemic echoes. The objective of our paper is to review the published articles to confirm our belief that rosacea is associated to or can predispose to various diseases, mainly inflammatory diseases. Material and methods: Review all the papers published in the last two decades in PubMed, Google Academic and Medscape databases, linking rosacea and various disorders of the body systems. Results: We found that rosacea is associated to several illnesses of major systems (gastrointestinal, cardiovascular, respiratory) and that there are also links between rosacea and immune system disorders and psychiatric diseases. Rosacea clinical course can be influenced by various drugs prescribed for the previous mentioned diseases. Conclusions: Rosacea should no longer be considered a localized cutaneous condition but rather a complex pathology with systemic reverberation. Patients suffering of severe forms of rosacea for a long period of time should have a careful evaluation of body systems.

Rosacea is a chronic relapsing inflammatory skin disease with high prevalence worldwide. Recent research suggests that dysregulation of innate and adaptive immune pathways as well as neurovascular changes is present, with different degrees of importance in the various subtypes. Neither the aetiology, genetics nor pathophysiological basis of the vascular, inflammatory or fibrotic changes is well understood. The clinical spectrum comprises a huge variability from erythema (vasodilation) to papules/pus-tules (inflammatory infiltrate) to phymata (fibrosis, glandular hyperplasia) making it a valuable human disease model to understand the interplay between the neurovascular and immune systems as well as the progression from chronic inflammation to fibrosis in skin. The lack of appropriate animal models emphasizes the importance of further translational research validating observed molecular pathways under disease conditions. A wide spectrum of physical (UV, temperature), biological (microbiota, food) and endogenous (genetic, stress) stimuli has been discussed as " trigger factors " of rosacea. Novel findings implicate keratinocytes, smooth muscle cells, endothelial cells, mac-rophages, mast cells, fibroblasts, Th1/Th17 cells, antibody-producing B cells and neu-rons in the pathobiology of rosacea. So far, pattern recognition receptors like TLR2, transient receptor potential ion channels, cytokines, chemokines and proteases have been implicated as critical receptors/mediators. However, our understanding of the interactive networks on the molecular level is very limited. Identification of critical molecular components of the inflammatory cascade including antimicrobial peptides, the IL-1β inflammasome, TNF, IFN-γ, proteases and neuropeptides may provide the basis for novel pathomechanism-based therapeutic approaches for this frequent and bothersome skin disease.

Journal of Investigative Dermatology, 2020

Rosacea is a common chronic inflammation of sebaceous glanderich facial skin characterized by severe skin dryness, elevated pH, transepidermal water loss, and decreased hydration levels. Until now, there has been no thorough molecular analysis of permeability barrier alterations in the skin of patients with rosacea. Thus, we aimed to investigate the barrier alterations in papulopustular rosacea samples compared with healthy sebaceous glanderich skin, using RNA sequencing analysis (n ¼ 8). Pathway analyses by Cytoscape ClueGO revealed 15 significantly enriched pathways related to skin barrier formation. RT-PCR and immunohistochemistry were used to validate the pathway analyses. The results showed significant alterations in barrier components in papulopustular rosacea samples compared with sebaceous glanderich skin, including the cornified envelope and intercellular lipid lamellae formation, desmosome and tight junction organizations, barrier alarmins, and antimicrobial peptides. Moreover, the barrier damage in papulopustular rosacea was unexpectedly similar to atopic dermatitis; this similarity was confirmed by immunofluorescent staining. In summary, besides the well-known dysregulation of immunological, vascular, and neurological functions, we demonstrated prominent permeability barrier alterations in papulopustular rosacea at the molecular level, which highlight the importance of barrier repair therapies for rosacea.

The Pharma Innovation Journal, 2020

Rosacea is a chronic inflammatory condition of the central facial skin affecting the blood vessels and pilosebaceous units. It is a common skin state that causes redness and visible blood vessels particularly in facial region. Generally, there are two types of rosacea based on either "performed" clinical or patient adopted analysis of rosacea. The etiology and pathophysiology are poorly understood. It may also produce small, red pus-filled bumps. These signs and symptoms may flare up for weeks to months and then go away for a while. In some circumstances it can be mistaken for acne, other skin problems or natural rosiness. Rosacea has a variety of triggers: lead to deliver of diverse mediators like endothelial cells, keratinocytes, macrophages, T1 and T17 cells. In addition, these trigger factors directly spread to the nurvous system, lead to the reflection of rosacea injury. Rosacea can affect anyone but it is most common in middle-aged women who have light skin. There is no permanent cure for rosacea, but treatment can control and reduce the signs and symptoms. Patients generally complaints of flushing and blushing and sensitive skin, and their skin may be especially irritated by any kind of topical preparations. Rosacea has a variety of triggers; however, they may be unnoticed by the patient. Validated treatments and drugs approved by the FDA which includes ivermectin, oxymetazoline hydrochloride, azelaic acid, topical metronidazole, and oral tetracyclines, in particular minocycline and doxycycline, brimonidine etc. Here, the aim of present strategies to sum up the modern concept along with diagnosis and address a symptom-based approach in the management of patients with rosacea.

Journal of the Royal Society of Medicine, 1997

Journal of the American Academy of Dermatology, 1992

Background: Rosacea is a common facial eruption that has various clinical presentations. Objective: We studied blood flow in lesional skin and explored the role of Demodexfolliculorum in patients with rosacea. Methods: A survey of clinical presentations was made in 108 patients with rosacea. Facial blood flow was studied by. laser-Doppler flowmetry. The presence of Demodex was determined by microscopy of skin samples. Results: The sex incidence was equal. The incidence peaked in the fourth and seventh decades of life. Lymphedema was common and was seen in 26 patients. Rhinophyma was present in 15 patients, mostly men. Eleven patients were black, an unexpectedly high number. Laser-Doppler fiowmetry showed that lesional blood flow was three to four times that of control subjects. Demodexfolliculorum was found in 20 of 25 rosacea patients examined but in only 2 of 20 control subjects.

Skin redness is a growing cosmetic concern. Erythema may be transient and of variable intensity as seen in sensitive skin, or recurrent with a tendency to increase in magnitude over time as part of rosacea manifestations. There is often some confusion between the two phenomena. The present paper briefly reviews and compares the background, pathophysiology, and potential treatments of sensitive skin and rosacea, highlighting similarities, differences, and new developments in the comprehension of these two skin conditions.