Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee

Gallo, Richard L.; Granstein, Richard D.; Kang, Sewon; Mannis, Mark J.; Steinhoff, Martin; Tan, Jerry; Thiboutot, Diane

doi:10.1016/j.jaad.2017.08.037

Cited by 343 publications

(512 citation statements)

References 40 publications

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“…It has been shown that clinical trigger factors of rosacea include heat, spicy food, ultraviolet radiation, stress and certain microbes . Consistently, our results now show that various trigger factors (i.e.…”

Section: Discussionsupporting

confidence: 90%

“…Skin from healthy patients was acquired following plastic surgery ( n = 12). The clinical diagnosis of rosacea subtypes was performed on the basis of the classification system of the National Rosacea Society . For immunohistochemistry, 31 skin biopsies from diagnosed patients with different rosacea subtypes, namely ETR ( n = 8), PPR ( n = 8), PhR ( n = 7), and healthy skin ( n = 8) were detected.…”

Section: Methodsmentioning

confidence: 99%

“…Rosacea is a common chronic inflammatory skin disease characterized by erythema, telangiectasia, papules, pustules, edema or a combination of these symptoms, which mainly affects the central facial area . Four different subtypes have been classified according to clinical characteristics: erythematotelangiectatic rosacea (ETR), papulopustular rosacea (PPR), phymatous rosacea (PhR) and ocular rosacea …”

Section: Introductionmentioning

confidence: 99%

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Claudin reduction may relate to an impaired skin barrier in rosacea

Deng

Chen

Xie

et al. 2019

The Journal of Dermatology

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Rosacea is a chronic inflammatory skin disorder whose pathophysiological mechanism remains largely unknown. Although recent studies have revealed the hypersensitivity of the skin towards chemical, thermal and biological stimuli, there is no direct molecular evidence suggesting the skin barrier is impaired in rosacea. In this study, we demonstrated that the mRNA levels of most claudins (CLDN), the main components of tight junctions determining the major barrier of the paracellular pathway between epithelial cells, were lowered in lesional skin of rosacea patients, especially with erythematotelangiectatic (ETR) and papulopustular (PPR) subtypes. Immunohistochemical analysis showed a significant decrease in the expression of CLDN1, CLDN3, CLDN4 and CLDN5 in the epidermis of ETR and PPR patients. However, the expression of other skin barrier genes, such as filaggrin, loricrin and keratin 10, was not altered. In vitro, various rosacea trigger factors reduced the protein levels of CLDN1, CLDN3 and CLDN5 in keratinocytes. Taken together, our results demonstrate a significant decrease in the expression of CLDN rather than other skin barrier genes, which may be associated with an impaired skin barrier responsible for the development of rosacea.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Claudin reduction may relate to an impaired skin barrier in rosacea

Deng

Chen

Xie

et al. 2019

The Journal of Dermatology

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“…Prior classification of rosacea proposed four subtypes of rosacea: erythematotelangiectatic, papulopustular, phymatous, and ocular . However, given the inaccuracies and shortcomings of subtyping and recommendations for its elimination, this should be replaced by phenotypes based on recommendations by National Rosacea Society 2017 and ROSCO 2017 . Rosacea is thought to be caused by dysregulation of innate immunity .…”

Section: Introductionmentioning

confidence: 99%

Systemic comorbidities associated with rosacea: a multicentric retrospective observational study

et al. 2018

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Background Once considered a disorder limited to the skin, rosacea is now known to be associated with systemic disorders. The aim of this study was to determine what systemic comorbidities accompany rosacea and to determine the relationship between the type, severity, and duration of rosacea, and the presence of and type of systemic comorbidities. Methods This retrospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Thirteen dermatology clinics throughout Turkey participated in the study. A structured physician‐administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. The principal rosacea subtype, physician global assessment of severity, and duration of rosacea were recorded. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any such comorbidity, and the use of medications to treat any comorbidities. Results The study included 1,195 rosacea patients and 621 controls without rosacea aged 18–85 years. As compared to the controls, more of the rosacea patients had respiratory tract, gastrointestinal system, and metabolic and hepatobiliary system disorders in a rosacea's severity‐ and duration‐dependent manner. Conclusion Clinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.

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“…The identification of more than 5 mites/cm 2 was defined as D. folliculorum mite infestation . PPR diagnosis was based on the classification system of the National Rosacea Society …”

Section: Methodsmentioning

confidence: 99%

Skin‐homing T‐cell responses associated with Demodex infestation and rosacea

Gazi

Güreser

Öztekin

et al. 2019

Parasite Immunology

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Aims Our aim was to investigate the skin‐homing T‐cell immune responses triggered in patients with Demodex infestation and/or rosacea. Methods Collected whole blood samples were divided into four groups: control subjects; nonrosacea patients with Demodex infestation (Demodex group); papulopustular rosacea (PPR) patients without Demodex infestation (Rosacea group); and PPR patients with Demodex infestation (Rosacea/Demodex group). Following ex vivo activation, skin‐homing CLA+CD4+ T‐cell subset levels were monitored by flow cytometry. Results When compared with control subjects, among skin‐homing CD4+ T‐cell subsets analysed, Demodex patients had higher TH9 and Treg cell levels; Rosacea subjects displayed elevated TH1 cell levels; and Rosacea/Demodex patients exhibited increased frequencies of TH9 and TH22 cells. In contrast to Rosacea subjects, Rosacea/Demodex group members displayed higher TH2 cell levels; and when compared with Demodex groups, they had higher TH1 and TH2 but lower Treg cell levels. Demodex group members also exhibited higher Treg but lower TH1 and TH22 levels than Rosacea/Demodex group subjects. Conclusions The skin‐homing T‐cell responses associated with Demodex infestation and rosacea formation seem to influence each other. The present as well as future studies could contribute to the development of effective treatment strategies for demodicosis and rosacea.

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Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee

Cited by 343 publications

References 40 publications

Claudin reduction may relate to an impaired skin barrier in rosacea

Claudin reduction may relate to an impaired skin barrier in rosacea

Systemic comorbidities associated with rosacea: a multicentric retrospective observational study

Skin‐homing T‐cell responses associated with Demodex infestation and rosacea

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