Objectives: Rosacea represent a chronic relapsing inflammatory skin disease, with an increasing prevalence (generally under-diagnosed and often overlooked), and multiple risk factors (genetics, age, phototype, alcohol consumption and ultraviolet exposure).
Rosacea is frequently associated with systemic diseases (neurologic and cardiovascular disorders, diabetes and metabolic disorders, autoimmune diseases and digestive disorders) and have an important negative impact on quality of life (anxiety, depression, embarrassment, frustration, social and professional isolation etc.).
Introduction: The cause of rosacea is still unknown but abnormalities in immune system (both innate and adaptative) and neurovascular status are implicated in pathophysiology.
Patients with rosacea present disruption of epidermal barrier, increased expression of TLR2 (associated with increasing production of IL-8, IL-1β, and TNF-α), and activation of KLK5 - Kallikrein-5 (which upmodulate production of cathelicidin LL – 37 = effects on immune modulation and inflammation).
Materials / method: Patients with rosacea present dysregulation in adaptative immunity, both in T cell mediated response and B cell mediated response.
The management of rosacea need an holistic approach, with diet and skin care (including photoprotection and cosmetic camouflage), local and systemic treatment, and EBD – Energy based Devices approach.
Some of the most efficient drugs used are characterized by immune modulation properties, like topical azelaic acid, doxycycline (including sub-antimicrobial-dose) and macrolides.
Results: Laser treatment (Pulsed Dye Laser – PDL and Nd-YAG 1064nm) have a lot of effects, like ablation of vascular anomalies (destroy small vessels and reducing the symptoms), reorganization and remodeling of dystrophic dermal connective tissue and interruption of the release of inflammatory mediators.
Conclusion: Rosacea is a frequently chronic inflammatory skin disease, and immunity, both innate and adaptative, plays an important role in rosacea pathogeny. Holistic approach (education, skin care, local and systemic treatment, vascular laser and nanotechnology) is the best ways to treat the patients. Immunomodulation by local and general treatment, laser surgery and nanotechnology will be the future.
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