Rosacea - The Autoimmune Chronic Inflammatory Condition

Rosacea sounds like Caucasian but actually, they are completely different. Caucasians are white-skinned people basically North Americans but I am not talking about race here, I am talking about Rosacea which is an autoimmune condition.

It is an autoimmune chronic inflammatory condition that involves recurrent episodes of skin lesions on the face. These lesions could be in the form of Telangiectasia, Pupules, Erythema, and Pustules. While the pathophysiology is not clearly understood, one important factor for Rosacea is genetics. Some other factors such as foods and beverages. It can be due to the dysregulation of innate and adaptive immune functioning, as well as vasodilation and dilation of lymphatic vessels. The dysregulation of innate and adaptive immune functioning is as a result of an increased expression in Toll-like receptors (THR-2), while the release of vasoactive peptides, and the increased expression in the activation of Transient Receptor Potential Vanilloid (TRPV-1, 2 & 4) receptor, and also an increase in the expression of TRPA1 receptor. It is also a result of Inflammasome activation which is responsible for inflammation.

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Rosacea is common in fair people affecting over 10% of white people. It is more common in females than in males and it has an incidence rate that is higher than 5% of the population worldwide it is common in women who are middle-aged, having fair skin, blonde hair, and blue eyes. Rosacea affects about 10% of the Swedish population, and about 3% in countries like france and Germany.

Rosacea can be triggered by some things and it is important that these things be avoided. Rosacea triggers Stress such as Emotional stress which could trigger symptoms as it activates and increases the expression of the TRPV-1 receptor. Exposure to Ultraviolet light activates TLR-2 and TRPV-4 receptors thereby being a trigger, Alcohol is a trigger of Rosacea as it activates TLR-2 and TRPV-1. People with Rosacea can have the condition triggered by heat which activates TRPV-1 and 2. So drinking hot liquid and staying in heat is a trigger. Spicy food is another trigger for people with Rosacea as Capsaicin activates TRPV-1 which is the heat receptor in the mouth. Cheese is also a trigger as it has histamine which causes vasodilation. Food content with Cinnamaldehyde such as chocolates and tomatoes activates TRPA1 and as such triggers Rosacea.

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Clinical manifestation of Rosacea includes Telangiectasia which are small dilated blood vessels on the skin of the face. It would also have other clinical features such as Erythema which is the redness of the face, and this can be Transient or Non-transient. Patients can have flushing on their faces, and patients can also exhibit Papules and Pustules which are inflammatory. The lesions can come with burning sensations, tingling sensations, stinging sensations, pruritis, and Rhinophyma (enlargement of the nose as a result of enlarged sebaceous glands). It can also affect the eye as about 70% of patients have their eyes involved. The ocular issues include Dryness, Redness, Tearing, Blurred vision, light sensitivity, Blepharitis, Conjunctivitis, Keratitis, and Iritis.

Clinical diagnosis of Rosacea is how to diagnose it and its treatment can be a lifestyle treatment. Avoiding exacerbating factors of Rosacea is one way, cleansing with moisturizers for lesions, and for Ocular cases, using metronidazole eye drops will help. Using Brimonidine tartrate gel, and Oxymetazoline hydrochloride gel for erythema. Using tetracycline, Azithromycin, Topical Metronidazole, ivermectin cream, and topical azelaic acid for treating the inflammatory lesions.

https://www.ncbi.nlm.nih.gov/books/NBK557574/

https://www.niams.nih.gov/health-topics/rosacea

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134688/

https://link.springer.com/article/10.1007/s40257-021-00595-7

https://emedicine.medscape.com/article/1071429-overview