Exploring the Pathogenesis and Mechanism-Targeted Treatments of Rosacea: Previous Understanding and Updates

Abstract

Rosacea is a chronic inflammatory skin disease characterized by recurrent erythema, flushing, telangiectasia, papules, pustules, and phymatous changes in the central area of the face. Patients with this condition often experience a significant negative impact on their quality of life, self-esteem, and overall well-being. Despite its prevalence, the pathogenesis of rosacea is not yet fully understood. Recent research advances are reshaping our understanding of the underlying mechanisms of rosacea, and treatment options based on the pathophysiological perspective hold promise to improve patient outcomes and reduce incidence. In this comprehensive review, we investigate the pathogenesis of rosacea in depth, with a focus on emerging and novel mechanisms, and provide an up-to-date overview of therapeutic strategies that target the diverse pathogenic mechanisms of rosacea. Lastly, we discuss potential future research directions aimed at enhancing our understanding of the condition and developing effective treatments.

Advances in the Pathogenesis and Treatment of Rosacea: A Phenotype-Based Therapeutic Approach

“…Recent evidence has pointed to the role of activated B cells, as testified by high levels of B cell markers in skin biopsies of rosacea patients [47]. Additionally, B lymphocytes are responsible for the production of fibrogenic cytokines, such as IL-6 and transforming growth factor beta (TGFb), implicated in the fibrotic changes in phymatous rosacea [8].…”

“…Notably, the sebaceous fatty acid profile in patients with rosacea shows a decrease in long-chain saturated fatty acids that leads to skin dryness and hypersensitivity [61]. In this context, sebocytes could contribute to the general inflammatory status by releasing proinflammatory cytokines and adypokines, including IL-6 [8]. Although the pathophysiological link between chronic inflammation and glandular hyperplasia remains elusive, sebaceous gland dysfunction in rosacea might arise from TLR-mediated inflammatory status, changes in the skin microbiome, alteration in neuronal and endocrine factors, and alteration in skin barrier permeability [62].…”

“…Although the real nature of rosacea remains largely elusive, it is known that its pathogenesis encompasses a complex interplay between innate and adaptive immune system Cosmetics 2024, 11, 11 2 of 18 dysregulation, neurovascular dysfunction, and genetic and environmental factors [8]. To date, most evidence points towards several triggering factors that may initiate or worsen the disease, including ultraviolet (UV) exposure, local inflammation responses to skin microorganisms (Demodex mites), temperature changes, and stressors [9].…”

Improvement in Cutaneous Conditions Can Benefit Some Health Conditions in the Elderly

“… 70 An over 14-year follow-up study showed that body mass index positively correlates with the risk for rosacea at least in females (p < 0.0001). 71 Because of the pathogenic role of inflammation in both obesity and rosacea, 29 , 72 , 73 management of one condition can benefit the other one. The links of seborrheic dermatitis and bullous pemphigoid to neurological, metabolic and cardiovascular diseases have also been well documented.…”

Correlation between cigarette smoking and alcohol consumption and Rosacea: A two‐sample Mendelian randomization study

“…2 The related symptoms of rosacea seriously affect the psychological state of patients. 3 Despite its prevalence, the precise mechanisms underlying Rosacea remain uncertain, with potential links to immune and neurovascular disorders, 4 it may also be related to solar damage 5 and demodex mites. 6 Environmental triggers are also believed to contribute to Rosacea's development and progression.…”