The sebaceous gland (SG) is an integral part of the pilosebaceous unit and is a very active and dynamic organ that contributes significantly to the maintenance of skin homeostasis. In addition to its primary role in sebum production, the SG is involved in the maintenance of skin barrier function, local endocrine/neuroendocrine function, the innate immune response, and the regulation of skin bacterial colonization. Structural and functional alterations of SGs leading to the dysregulation of sebum production/composition and immune response may contribute to the pathogenesis of inflammatory dermatoses. This review summarises the current knowledge on the contribution of SGs to the pathogenesis of common inflammatory skin diseases. These findings are crucial for the development of more effective therapeutic strategies for the treatment of inflammatory dermatoses.

Demodex mites are among the most prevalent human parasites. While commonly found on healthy individuals, an overpopulation of this arachnid resident of human skin triggers demodicosis, a neglected yet widely prevalent disease with considerable skin and eye morbidity. Despite its health impact, demodicosis remains overshadowed by other common skin diseases. This neglect has significant consequences for individual and public health, which require a paradigm shift in our understanding and management of this ubiquitous ectoparasite. We reviewed the literature to re-evaluate the pathogenicity of the Demodex mite, paying particular attention to the primary risk factors-immune dysregulation, altered microbiota, and concurrent infections-that may contribute to pathogenicity. We discuss the challenges in combating neglect of demodicosis and provide updates on various impediments in achieving this goal. We explore the issues and research gaps in various domains such as those related to parasite biology, pathogenesis, diagnosis, treatment, prevention and control. We present potential solutions and outline future prospects for tackling this important disease. Finally, we hope to catalyze greater attention and investment for this neglected public health issue.

Raising awareness of Demodex and demodicosis and its major contribution to human diseases requires a multidisciplinary approach. Efforts to prioritize its place on the global health agenda, invest in research, improve diagnostic tools, and develop new treatment strategies will lead to improved public health outcomes and a higher quality of life for those affected.

Rosacea is a chronic inflammatory skin disease, commonly affecting the central part of the face, characterized by erythema, flushing, telangiectasias, papules, and pustules. It may also involve sensations of burning, tingling, and occasionally fibrous changes.

This study aims to compare the efficacy, side effect profiles, and patient satisfaction of topical 20% azelaic acid and 7.5% dapsone in the treatment of mild-to-moderate papulopustular rosacea (Stage 2).

Ethics approval was obtained. A retrospective analysis was conducted on the medical records of 76 patients, including 44 in the azelaic acid group and 32 in the dapsone group, all diagnosed with mild-to-moderate papulopustular rosacea. These patients were treated with either topical azelaic acid or dapsone at the dermatology outpatient clinic between August 1, 2022 and December 31, 2022. Demographic characteristics, Investigator's Global Assessment scores, lesion counts, erythema scores, side effects, and patient satisfaction data were analyzed in the study.

No statistically significant differences were found between groups based on pretreatment IGA values, separate IGA scores (2-4), lesion counts, average erythema scores, or separate erythema scores (p > 0.05 for all). Within each group, comparisons of pre- and posttreatment IGA values, lesion counts, and erythema scores revealed statistically significant differences (p < 0.001 for all), indicating that both treatments were effective. When comparing the groups based on posttreatment IGA values, separate IGA scores (0-3), improvement percentages in IGA values, lesion counts, improvement percentages in lesion counts, average erythema scores, separate erythema scores (0-2), and improvement percentages in erythema scores, no significant differences were observed (p > 0.05 for all).

Topical dapsone is as effective as azelaic acid in treating mild-to-moderate papulopustular rosacea and is associated with fewer side effects, making it a safer option.

Pediatric blepharokeratoconjunctivitis (PBKC) is a chronic and recurrent ocular surface inflammatory disorder affecting children in early life. It is frequently under- or late- diagnosed, representing a potential cause of severe visual morbidity worldwide. An expert panel consensus recently agreed on its definition and proposed diagnostic criteria for suspected and definitive PBKC to reduce confusion and avoid varied terminology previously used in the literature, improving early and precise diagnosis. Previous evidence has pointed to the role of the adaptive immune system in recognizing and handling antigenic eyelid bacterial products, particularly from the cell wall, and the direct toxic and inflammatory effects of their cytolytic exotoxins on the ocular surface. PBKC is a frequent referral in pediatric and cornea clinics characterized by a history of recurrent chalazia, blepharitis, meibomian gland dysfunction, conjunctival hyperemia, phlyctenules formation, and corneal infiltrates with vascularization and scarring. The latter is a major cause of significant visual loss and amblyopia. Current treatment strategies aim to control inflammation on the ocular surface, halt disease progression, and avoid corneal involvement. Further research on pathogenic mechanisms will shed light on novel potential therapeutic strategies. Awareness of PBKC should enhance early diagnosis, prompt adequate treatment, and improve outcomes. We compile current evidence on epidemiology, pathophysiology, clinical spectrum of disease, diagnostic criteria, and management strategies for PBKC.

Rosacea, a prevalent chronic inflammatory skin condition primarily affecting the central facial convexities, is categorized into four clinical subtypes: erythematotelangiectatic rosacea (ETR), papulopustular rosacea (PPR), phymatous rosacea (PhR), ocular rosacea (OR). While ultraviolet (UV) radiation is recognized as a risk factor for rosacea, the differential skin sensitivity to UVA and/or UVB between healthy individuals and rosacea patients remains ambiguous.

This study comprised 70 patients diagnosed with rosacea and 100 healthy controls. The minimal erythema doses (MED-UVA and MED-UVB) were ascertained using an SUV-2000 solar UV simulator. A comparative analysis was conducted on the MED-UVA and MED-UVB results between the rosacea patient group and the healthy control group, as well as among rosacea patients with varying clinical subtypes. Furthermore, the correlation between MED values in rosacea patients and factors such as age, skin type, antinuclear antibodies (ANA), and the Clinical Erythema Assessment (CEA) scale was evaluated.

In comparison to the healthy control group, the rosacea group demonstrated significantly lower MED-UVA (p < 0.05) and MED-UVB (p ≤ 0.001) values. However, no significant differences were observed in the MED-UVA (p > 0.05) and MED-UVB (p > 0.05) values among patients with varying clinical subtypes of rosacea, specifically between ETR and PPR.

Patients diagnosed with rosacea demonstrate a decreased minimal erythema dose to both UVA and UVB, suggesting heightened sensitivity to ultraviolet radiation. Consequently, it is advisable for individuals with rosacea to minimize sun exposure in order to mitigate or prevent exacerbation of the condition.

Rosacea, an inflammatory skin disorder with complex pathogenesis, remains poorly understood. Through integrative bioinformatics and experimental approaches, we identified 304 differentially expressed genes in erythrotelangiectasia rosacea (ETR), primarily enriched in lipid metabolism pathways. Support vector machine (SVM), linear regression analyses and network analysis revealed ACADVL and ACSL5 as potential therapeutic targets. Immunological profiling demonstrated distinctive immune cell infiltration, with elevated M0 and M1 macrophages in patients with ETR. Immunofluorescence validation confirmed significant ACSL5 upregulation and increased M1 macrophage infiltration in the rosacea mouse model. The co-localization of ACSL5 with M1 macrophage markers suggests a mechanistic link between lipid metabolism and inflammatory responses. These findings provide new insights into ETR pathogenesis and highlight ACSL5 as a promising therapeutic target for inflammatory skin disorders.

Ocular rosacea is a chronic inflammatory disorder affecting the ocular surface, often associated with cutaneous rosacea. This review aims to explore its pathogenesis, treatment approaches, and future directions for management.

A review of current literature on the pathophysiology, clinical features, and treatment strategies of ocular rosacea in adults and children (pediatric blepharokeratoconjunctivitis) was conducted. Emerging research on immune dysregulation, microbiome alterations, and potential therapeutic targets was analyzed.

Ocular rosacea involves dysregulation of the immune and neurovascular systems, with toll-like receptor activation and complement system involvement leading to chronic ocular surface inflammation. Alterations in the ocular microbiome have been implicated in disease progression. Treatment strategies emphasize a stepwise approach, incorporating ocular and skin hygiene, lifestyle modifications, and pharmacological interventions. Recent advancements in understanding the disease mechanisms have led to the exploration of targeted therapies, including biologics and small-molecule inhibitors.

Ocular rosacea remains challenging to diagnose and treat, particularly in children (pediatric blepharokeratoconjunctivitis), often leading to delayed intervention and poor outcomes. A multidisciplinary approach, including new therapeutic options, holds promise for improving patient care. Further research into the genetic and molecular basis of ocular rosacea may enable more personalized treatments.

Rosacea is a chronic inflammatory disease characterized by persistent erythema, papules, and pustules, mainly on the skin of the face. Rosacea is difficult to treat; therefore, identifying new treatments is crucial. Mas-related G protein-coupled receptor X2 (MRGPRX2)-mediated mast cell (MC) activation is essential in the pathogenesis of rosacea. Casticin has been shown to exert anti-inflammatory effects; however, it remains unclear whether it can inhibit MRGPRX2 in treating rosacea. This study determined the therapeutic efficacy of casticin against rosacea by inhibiting MRGPRX2-mediated MC activation.

A mouse model of LL37-induced rosacea-like dermatitis was employed. The pathological changes were evaluated using hematoxylin and eosin (H&E) staining, and MCs and CD4+ T cells were observed. Inflammatory mediators were analyzed using ELISA. Mouse skin lesions were collected for transcriptomic sequencing. We used an MRGPRX2-mediated MC degranulation model to evaluate the inhibitory effects of casticin in vitro. Molecular docking analysis, molecular dynamics simulations, and surface plasmon resonance evaluated the binding between casticin and MRGPRX2.

Casticin attenuated the LL37-induced inflammatory phenotype and reactions in rosacea-like dermatitis. RNA-seq data showed that casticin inhibited MC activation in a mouse model of rosacea. Furthermore, casticin significantly reduced CD4 + T-cell infiltration. Moreover, casticin inhibited MC activation as an MRGPRX2 antagonist in vitro and in vivo by influencing the NF-κB signaling pathway.

Our study demonstrated that casticin exhibits therapeutic efficacy against rosacea by inhibiting MC activation via MRGPRX2.

Rosacea is a chronic inflammatory skin disease and is usually accompanied by extensive macrophage infiltration. There is growing evidence suggesting that neurotransmitter 5-hydroxytryptamine (5-HT) plays a crucial role in inflammatory reactions. However, the interaction between 5-HT and rosacea is still unclear. Here, we hypothesized that the inflammation of rosacea is partly caused by 5-HT, and we investigated the underlying mechanism. In this study, we employed a rosacea model induced by LL-37, which is usually applicated as a rosacea stimulator, to investigate the effects of 5-HT on rosacea in vitro and in vivo. In LL-37-(4 μM)-induced THP-1-derived macrophages, 5-HT (400 μM) further promoted the secretion of inflammatory cytokines and polarized macrophages towards M1 phenotype, which could promote an inflammatory response. Further research revealed that exposure to LL-37 and 5-HT (L5) selectively upregulated HTR3A mRNA expression but not HTR2A or HTR7 and induced colocalization of 5-HT with HTR3A. Notably, application of antagonist tropisetron (TPS) and siRNA of HTR3A suppressed L5-induced inflammation. Meanwhile, 5-HT (25 μg each injection a total of three times) deteriorated skin erythema, stimulated dermal inflammatory cell infiltration, and promoted the secretion of inflammatory cytokines in LL-37 (40 μL and 320 μM each injection a total of four times) induced rosacea-like mice, while these undesirable effects were reversed by using TPS. Our findings revealed that neurotransmitter 5-HT further promoted LL-37-induced rosacea-like inflammation through HTR3A. Our study highlights HTR3A as a promising therapeutic target, which warrants further in-depth investigation into its clinical applicability.

Rosacea is a common inflammatory skin disease, characterized by erythema, papules and pustules. The pathophysiology of rosacea remains unclear, but the complex interplay between environmental and genetic factors may act as a trigger to an abnormal innate immune response associated with a multifaceted neurovascular reaction. Increasing evidence suggests that the gut microbiota is significantly involved in the pathogenesis of rosacea, playing an important role in the inflammatory cutaneous response. Dysbiosis, small intestinal bacterial overgrowth, Helicobacter pylori infection and innate immune system dysregulation mutually contribute to the pathophysiology of rosacea, but more extensive future research is needed to better clarify their precise mechanisms of action. Many dietary triggers have been postulated for this disease; however, there is a lack of well-made and controlled studies able to undoubtedly demonstrate a causal relationship between rosacea and diet. We analyzed the available studies on the role of diet and gut microbiome in rosacea and the positive clinical effects reported by the current literature on probiotics, prebiotics, postbiotics and nutrients. Ultimately, this article improves our understanding of the gut-skin axis in rosacea, focusing on how probiotic supplementation and diet could improve the clinical management of patients affected by this common and debilitating disease.

Rosacea is an inflammatory skin disorder possessing significant mental health implications, including anxiety and depression. Although the disease's link to psychiatric outcomes has been explored, recent data highlights the need for a deeper examination of underlying pathways and overall burden. This systematic review aims to synthesize and evaluate the current literature on the association between rosacea and anxiety and depression, with particular attention to establishing multidisciplinary treatment approaches. A comprehensive review of the PubMed, Embase and Web of Science databases was performed to select peer-reviewed English studies relevant to our topic. Our results reveal that anxiety and depression continue to affect a majority of rosacea patients, with certain demographic variables such as age and gender modulating psychiatric burden. The complex interaction between rosacea and its psychological outcomes is thought to rely on inflammatory mediators, lipid metabolism, and neurotropic factors. Certain treatment options, including carvedilol, paroxetine and Cortexin, may target these core processes and hence, help alleviate psychological sequalae. Bearing these insights in mind, dermatologists should focus on adopting interdisciplinary treatment plans. Future research should prioritize longitudinal designs, diverse populations, and standardized methodologies to deepen our understanding of the relationship between anxiety, depression, and rosacea.

Rosacea is a chronic skin condition characterized by facial erythema, flushing, and telangiectasia. Abnormalities in the vascular responses are associated with the development of rosacea. Our analysis of the GSE65914 dataset revealed differential expression of angiogenesis-related genes in rosacea lesions classified rosacea samples with distinct angiogenic molecular patterns. Further investigation of immune infiltration characteristics across angiogenic patterns identified unique immune signatures associated with VEGFAhigh MMP9low and VEGFAlow MMP9high subtypes. Moreover, STAT2 proteins were higher in the VEGFAhigh MMP9low pattern group. Increased expression of STAT2 was confirmed in rosacea patients and in the mice model of rosacea induced by LL37. Knockdown of STAT2 suppressed the tube formation ability of human umbilical vein endothelial cells, which implicated STAT2 participated in regulating angiogenic responses. In conclusion, our study characterized rosacea subtypes by distinct angiogenic molecular patterns and found that STAT2 may play a critical role in the regulation of angiogenic responses in rosacea. These insights may provide a promising target of rosacea therapies.

Rosacea is a common skin condition with quite a relevance. It currently affects at least 10% of the European population at some point after the age of 30. It is a chronic disorder that mainly affects the skin on the face and is characterized by outbreaks and remissions. Under normal circumstances, the skin face presents a wide range of commensal organisms, such as Staphylococcus epidermidis or Demodex folliculorum, but dysbiosis of the skin flora plays a relevant role in inflammatory processes and the development of the disease. Metronidazole (MD) is one of the main treatments indicated to reduce redness on the cheeks, nose, chin, or forehead and also to treat flushing, erythema, pimples, and other symptoms due in part to its anti-inflammatory action. On the other hand, clindamycin (CM) is another antibiotic used for rosacea, especially for its action against anaerobic and Gram-positive bacteria. Background/Objectives: This study aimed to develop an emulgel formulation that includes MD and CM, using excipients with non-comedogenic and non-irritating properties. Methods: The formulation was characterised physiochemically, rheological measurements were made, and short-term stability studies were carried out. In vitro release, permeation studies, toxicity an in vitro inflammation model were evaluated in a HaCaT cell model. To determine the interaction between the antibiotics, the minimum inhibitory concentration was determined separately and together using the broth microdilution method. To determine the formulation's antimicrobial activity, an agar diffusion method was used. Results: The MD-CM-gel droplet size was measured by laser diffraction and the diameter obtained was less than 2.68 ± 0.18 µm in 50% of the particles. Suitable results was observed for the short-term stability. Release and permeation data revealed sustained drug release and adequate permeation through human skin. Non-toxicity was detected and the MD showed an anti-inflammatory effect with non-interference of CM. Also, there is no antagonism between the two antibiotics and the MD-CM-gel shows better results when compared to the formulations with the antibiotics separately and to commercial formulations. Conclusions: It is suggested that, following detailed preclinical and clinical studies, MD-CM-gel could be considered as an alternative for treating rosacea.

Rosacea is a common chronic inflammatory disorder primarily affecting the face. While inflammatory factors are known to play a pivotal role in its pathogenesis, their causal relationship with rosacea remains unclear. This study employed a two-sample bidirectional Mendelian randomization (MR) analysis to investigate the causal links between systemic inflammatory regulators and rosacea.

Data on 41 cytokines and growth factors were analyzed from a genome-wide association study (GWAS) meta-analysis involving 8293 individuals and genetic data from the FinnGen database, comprising 1195 rosacea cases and 211,139 controls. The principal inverse variance weighting (IVW) method was used to assess causal relationships, with sensitivity analyses, including heterogeneity and horizontal pleiotropy assessments, conducted to ensure result robustness.

MR analysis revealed that decreased expression of Stem Cell Factor (SCF), Macrophage Inflammatory Protein-1β (MIP-1β), and Monocyte Chemotactic Protein-1 (MCP-1) was associated with increased rosacea risk (OR = 1.54, 95% CI = 1.05-2.26, p = 0.026). Conversely, elevated expression levels of Stromal Cell-Derived Factor-1α (SDF-1α) and Hepatocyte Growth Factor (HGF) were linked to higher rosacea risk (OR = 1.61, 95% CI = 1.12-2.31, p = 0.009). Reverse MR analyses showed no significant impact of rosacea on systemic inflammatory regulator expression.

This study identified five inflammatory factors-SCF, SDF-1α, MCP-1, HGF, and MIP-1β-as having causal relationships with rosacea pathogenesis. Further research is required to elucidate their mechanistic roles in disease development.

Background Rosacea is a skin condition characterised by persistent facial erythema, flushing, papules, pustules, and telangiectasia. Botulinum toxin A (BoNT-A) has been used to treat a variety of conditions, but its effectiveness in improving facial erythema in rosacea patients is uncertain. Objectives The aim of the study is to evaluate the effectiveness and determine the optimal dose of BoNT-A treatment for rosacea. Methods An online database search (Pubmed, Cochrane Library and Embase) was conducted on 30th June 2023 to identify studies that used intradermal injection of BoNT-A to treat facial erythema in rosacea patients and excluded studies in which BoNT-A was used for facial erythema due to other known medical condition such as menopause, drug or pregnancy. The primary outcome measure for this study was the improvement in erythema score as objectively assessed. A random effect model was used in the meta-analysis. Results Seven studies involving a total of 167 rosacea patients were included in the meta-analysis. Meta-analysis of two randomised controlled trials showed improvement of erythema on the third month after treatment standardized mean difference (SMD): 1.676, 95% confidence interval (CI): 2.278-1.074, I2: 35.76%). A separate analysis of seven single-armed treatment studies found significant improvement in erythema with intradermal injection of BoNT-A at one, two and three months after treatment (first month: SMD: 2.712, 95% CI: 4.1182-1.243; second month: SMD:2.213, 95% CI: 3.702-0.725; third month: SMD: 1.912, 95% CI: 2.882-0.941). Adverse events, including mild facial paralysis and injectional purpura, were reported in some studies. Limitation The limitations of this study include heterogeneity in study design and a small sample size. Conclusion Intradermal injection of BoNT-A may be an effective treatment for facial erythema in rosacea. Unwanted facial muscle paralysis was seen in different BoNT-A concentration but not noted when the dose was less than 0.02ml per site. Future studies particularly randomised trials are required to identify the volume of injection required to reduce the erythema.

Several research groups have confirmed that in the pathogenesis of the chronic inflammatory skin disorder rosacea, the composition of the skin and fecal microbiome of affected patients differs from that of healthy individuals. We studied the stool, blood and skin microbiomes of rosacea and control patients using 16S rRNA sequencing. Our goals were to determine 1. whether the microbiome characteristics of rosacea patients differ from that of healthy individuals, 2. whether the change experienced on the skin can be confirmed by alterations in the stool microbiome through the mediation of the blood and 3. whether the metabolic activity of the changed skin, blood or fecal microbiome can play a role in the pathogenesis of rosacea. The rosacea skin microbiome differed significantly from the healthy skin microbiome in both alpha and beta diversity, as well as in the abundance of the genera. Only a few genera abundances differed significantly in stool and blood samples. The most significant representatives of the rosacea skin microbiome, Staphylococcus, Cutibacterium, Corynebacterium and Neisseria, cannot be derived from the feces or blood. The metabolic pathways associated with healthy fecal microbiome contributed to the production of anti-inflammatory short-chain fatty acids. While the increased production of adenosylcobalamin, L-isoleucine and thiazole by the microbiome of healthy skin appeared to have a protective effect, the excessive heme and H2S production experienced in rosacea skin likely contribute to the deterioration of the pathology.

Rosacea, a chronic inflammatory skin condition, is marked by enduring redness, visible blood vessels, and inflammatory eruptions in facial areas. Managing rosacea remains a persistent challenge for dermatologists, especially in cases unresponsive to conventional treatments. Injectable poly-d,l-lactic acid (PDLLA) has shown promise in treating erythema and telangiectasia associated with rosacea in addition to age-related concerns. Employing Mirajet, a laser-induced microjet system, for administering PDLLA is a novel and promising treatment for rosacea.

We aimed to evaluate the efficacy and safety of injectable PDLLA delivered via a needle-free microjet system for managing rosacea.

Four Korean women with persistent and refractory rosacea received five monthly sessions of PDLLA needle-free injections. Clinical assessments were conducted using the Clinician's Erythema Assessment and Patient's Self-Assessment (PSA) at baseline, 4 weeks post-treatment, and 22 weeks post-final treatment. Adverse events were monitored throughout the study period.

At 4 weeks post-treatment, both Clinician's Erythema Assessment and PSA scores indicated significant improvements in erythema that were sustained up to the 22-week follow-up. Patients reported high satisfaction with resolution of redness and improved skin texture. Mild swelling, redness, and petechiae were observed post-treatment but resolved spontaneously. No product-related adverse events were noted during the study period.

Injectable PDLLA delivered via laser-induced microjet injection demonstrated promising efficacy in improving rosacea symptoms and skin quality for up to 22 weeks without significant adverse effects. Larger randomized controlled trials are needed to confirm these findings and evaluate long-term safety and sustainability of outcomes.

Rosacea can be seen in many patients nowadays, and the related causes are complex. Despite a certain association between smoking and rosacea being reported by several studies, the actual causality has not been established for the possible bias and confounders.

We used Mendelian randomization (MR) to evaluate a potential causal effect of smoking on rosacea risk. Statistics on smoking and rosacea were obtained from the FinnGen project and Neale Lab Consortium. The causal association was assessed by multiple methods including inverse variance weighted (IVW), MR Egger, weighted median, and weighted mode. Furthermore, sensitivity analyses were also conducted to address pleiotropy, along with the leave-one-out method.R version 4.2.3 was applied for the analyses.

The IVW estimation revealed that previous smoking has a deleterious effect on rosacea (odds ratio [OR] = 6.7729, 95% confidence interval [CI] = 1.5691-29.2356, p = 0.0104). By contrast, there was no statistically relationship between current smokers and rosacea (OR = 0.6180, 95% CI = 0.0605-6.3094, p = 0.6847). Results were similar in the analysis based on the weighted median method (previous smoking: OR = 8.6297, 95% CI = 1.0131-73.5071, p = 0.0486; current smoking: OR = 0.2896, 95% CI = 0.0106-7.9132, p = 0.4627). The stability of the causal effect estimates was supported by several sensitivity analyses and the leave-one-out method.

Our MR study found support forrosacea risk and previous smoking. Although no evidence was found to increase the risk of rosacea in current smokers, to prevent various diseases associated with smoking, the public should be encouraged to avoid smoking at the very beginning.

Rosacea is a chronic inflammatory skin condition marked by facial erythema, telangiectasia, and acne-like eruptions, affecting millions worldwide. While antibiotics remain a common treatment, prolonged use has significant adverse effects and can lead to antibiotic resistance. This study evaluated the impact of combined probiotics and doxycycline treatment on rosacea, emphasizing the gut-skin axis. Sixty rosacea patients were randomly assigned to the probiotic, placebo, or control groups. After a 2-week doxycycline treatment, participants underwent a 3-month intervention with either a placebo, probiotic, or no further treatment. Clinical outcomes were assessed at baseline and after the 14-week intervention. Our results showed that probiotic administration improved facial skin conditions, alleviated inflammation, and reduced facial skin microbiota diversity while enhancing gut microbiota heterogeneity. Multivariate analysis identified microbial markers distinguishing the probiotic group from the control and placebo groups, and some markers were associated with skin health parameters. After the probiotic intervention, some facial skin-associated taxa, such as Aquabacterium sp., UBA4096 sp. 1, UBA4096 sp. 2, and Yimella indica, decreased in abundance. Additionally, the fecal microbiota of the probiotic group was enriched in specific gut microbes, including Streptococcus parasanguinis, Erysipelatoclostridium ramosum, and Coprobacillus cateniformis, while showing a reduced abundance of Bacteroides vulgatus. These changes were associated with reduced facial sebum levels and a lower physician's global assessment score. Finally, fewer antibiotic resistance genes, particularly tetracycline resistance genes, were detected in the probiotic group compared with the control and placebo groups. Our study supports the existence of a gut-skin axis and the application of probiotics in managing rosacea.

This research elucidates rosacea management with novel insights into probiotic use alongside doxycycline, showing dual benefits in symptom relief and inflammation reduction in patients. The study maps probiotic-induced shifts in gut and skin microbiota, underscoring microbial shifts correlating with skin health improvements. Crucially, it deciphers the gut-skin axis modulation by probiotics, proposing a method to curb antibiotic resistance in rosacea therapies. This study furnishes robust evidence for probiotics in rosacea, advancing our grasp of the gut-skin relationship.

The purpose of this study was to examine ocular surface symptoms, tear metrics, and tear cytokines by Meibomian gland dysfunction (MGD) features.

Symptom questionnaires and an ocular surface evaluation were performed on 40 individuals with varied MGD signs (Meibomian gland [MG] plugging, eyelid vascularity, meibum quality, and MG dropout). Tear proteins were extracted off Schirmer strips and analyzed for 23 human inflammation-related proteins. Statistical analysis was performed to examine associations between dry eye metrics inflammatory proteins and MGD features.

The study involved 40 South Florida veterans with a mean age of 61 ± 13 years; most individuals were male (95%), White (31%), and non-Hispanic (85%). MGD features differentially related to dry eye signs. Eyelid vascularity, meibum quality, and MG dropout, but not MG plugging, correlated with higher corneal staining and lower tear production. MGD features also differentially related to tear cytokines. Eyelid vascularity most closely related to inflammation with significant correlations for interferon-gamma-γ (r = 0.36, P = 0.02), interleukin-4 (IL-4) (r = 0.43, P = 0.006), IL-17A (r = 0.42, P = 0.007), matrix metalloproteinase-2 (r = 0.39, P = 0.01), C-X-C motif chemokine ligand 5 (Regulated upon Activation, Normal T-Cell Expressed and presumably Secreted [RANTES]) (r = 0.32, P = 0.04), and tumor necrosis factor α (r = 0.36, P = 0.02). The other 3 MGD signs were less related to inflammation. Multivariable models revealed IL-4 to be most closely related to eyelid vascularity (standardized β = 0.39, P < 0.0001).

Eyelid vascularity was the MGD sign most closely related to inflammatory cytokines, suggesting that different MGD features may be driven by different pathophysiological mechanisms.

Cutaneous tuberculosis is an infection caused by Mycobacteria tuberculosis, the rare Mycobacterium bovis and the bacillus Calmette-Guérin vaccine. This disease has many clinical types with diverse clinical manifestations, mainly includes lupus vulgaris, tuberculosis verrucosa cutis, orificial tuberculosis and scrofuloderma that are difficult to identify. We report a case of cutaneous tuberculosis in a female who presented with disseminated papular and nodular lesions on her face and hands. The results of skin biopsy, PCR, and IGRA test contributed to the diagnosis. All lesions were resolved leaving only superficial scars after 5 months treatment.

Background/Objectives: Aggregate prescribing behavior for inflammatory lesions of rosacea has been described, but individual physician behavior has not been characterized. This study aims to assess the modern state of topical rosacea drug selection by analyzing prescribing patterns among individual dermatologists. Methods: We assessed utilization patterns of four topical papulopustular rosacea agents in 2021 Medicare Part-D data. K-means cluster analysis identified prescriber phenotypes based on the proportion of claims for each drug by physician. Results: Cluster analysis identified four prescriber phenotypes for topical rosacea agents, with the majority favoring metronidazole. In each of the other clusters, metronidazole was co-prescribed alongside the primary agent. Significant predictors of phenotype included patient ages, patient risk scores, and a group practice setting. Conclusions: The study reveals nonuniform prescribing patterns for topical papulopustular rosacea treatments among U.S. dermatologists. While aggregate data indicate diverse drug utilization, cluster analysis suggests that individual prescribers tend to use a limited selection of agents.

Rosacea is a chronic inflammatory skin disorder, whose underlying cellular and molecular mechanisms remain obscure. Here, we generate a single-cell atlas of facial skin from female rosacea patients and healthy individuals. Among keratinocytes, a subpopulation characterized by IFNγ-mediated barrier function damage is found to be unique to rosacea lesions. Blocking IFNγ signaling alleviates rosacea-like phenotypes and skin barrier damage in mice. The papulopustular rosacea is featured by expansion of pro-inflammatory fibroblasts, Schwann, endothelial and macrophage/dendritic cells. The frequencies of type 1/17 and skin-resident memory T cells are increased, and vascular mural cells are characterized by activation of inflammatory pathways and impaired muscle contraction function in rosacea. Most importantly, fibroblasts are identified as the leading cell type producing pro-inflammatory and vasodilative signals in rosacea. Depletion of fibroblasts or knockdown of PTGDS, a gene specifically upregulated in fibroblasts, blocks rosacea development in mice. Our study provides a comprehensive understanding of the aberrant alterations of skin-resident cell populations and identifies fibroblasts as a key determinant in rosacea development.

To compare the choroidal thickness (CT) and choroidal vascularity index (CVI) values in ocular rosacea (OR) patients across skin subtypes of the disease and healthy controls.

This prospective study included 90 eyes of 90 mild-moderate OR patients with different skin subtypes (30 phymatous, 30 papulopustular and 30 erythematotelangiectatic) and 30 eyes of 30 age-gender matched healthy volunteers. After obtaining the enhanced depth imaging optical coherence tomography images, the CT was measured at subfoveal, 1500 μm nasal and 1500 μm temporal to the fovea, and the CVI was calculated using Image J software in the subfoveal, nasal and temporal areas.

There was no CT significant difference between OR patients and healthy controls in all regions (p > 0.05). CVI values of OR patients were found to be significantly lower in the subfoveal, nasal and temporal regions compared to healthy controls (p = 0.02, p = 0.01, p = 0.01, respectively). No CT difference was detected between the subtypes and healthy controls in all regions (p > 0.05). Subfoveal-CVI was significantly lower in the phymatous subtype than the other subtypes and controls (p < 0.05), while nasal and temporal-CVI were significantly lower in the phymatous and papulopustular subtypes than the erythematotelangiectatic subtype and controls.

Our study demonstrated no difference between rosacea skin types and healthy controls in terms of CT. Phymatous and papulopustular subtypes were more likely to be affected by chronic inflammation with having lower CVI in most of the regions. Further studies are needed to investigate the association of inflammatory factors with CVI in OR.

Rosacea is a common dermatosis with multiple pathogeneses, among which, rosacea fulminans may serve as a rare but severe subtype. This inflammatory disease usually presents as abrupt multiple erythema, pustules, and nodules localized on the face. Pregnancy and related changes of hormone levels may play a key role in the development and progression of the disease, although the exact mechanisms are unknown. In particular, treatment options, which includes systemic glucocorticosteroids, isotretinoin, and partial oral antibiotics, may be limited in pregnancy. Owing to the limited number of reported cases, standard diagnosis, treatment, and management guidelines remain unclear. Here, we report a case of rosacea fulminans happening in pregnancy treated successfully with oral erythromycin and short-term glucocorticosteroids, and share our review of the characteristics of RF cases during pregnancy.

Rosacea is a chronic inflammatory disorder primarily affecting the facial skin, prominently involving the cheeks, nose, chin, forehead, and periorbital area. Cutaneous manifestations encompass persistent facial erythema, phymas, papules, pustules, telangiectasia, and flushing. The pathogenesis of rosacea is associated with various exacerbating or triggering factors, including microbial infestation, temperature fluctuations, sunlight exposure, physical exertion, emotional stress, consumption of hot beverages and spicy foods, and exposure to airborne pollen. These environmental factors interact with genetic predispositions in the development of rosacea. The roles of the lipophilic microbiome, ultraviolet radiation, nociceptive responses, and vascular alterations have been proposed as significant factors in the pathogenesis. These insights contribute to understanding the anatomical specificity of facial involvement and the progressive nature of rosacea. East Asian skin, predominantly classified as Fitzpatrick skin phototypes III to IV, is characterized by relatively diminished skin barrier function and increased sensitivity to irritants. Airborne pollen exposure may particularly act as a trigger in East Asian individuals, possibly mediated through toll-like receptors. The lack of specificity in objective clinical and histopathological findings leads to diagnostic challenges for individuals with colored skin, including East Asians, particularly when erythema is the sole objective manifestation. An alternative diagnostic scheme may thus be necessary. A diagnostic approach emphasizing vascular manifestations and nociceptive symptoms potentially holds promise for individuals with darker skin tones. More research focusing on potential variations in skin physiology across different racial groups is essential to establish more effective diagnostic schemes applicable to both dark and light skin colors.

The epidemiology of 2 neighboring cities of differing altitude in Northwest China is unknown. The present study investigated the prevalence of rosacea in a high-altitude city and a low-altitude city.

The prevalence study was conducted via clinical examination of male and female participants in the following age groups: 5-17, 18-30, 31-50, and 51-70 years. Rosacea subtype was also determined as erythematotelangiectatic rosacea (ETTR) or papulopustular rosacea (PPR).

The rosacea prevalence (RP) in the low-altitude city was 33.8% ± 1.2% (95% CI, ETTR = 1794, PPR = 174, n = 5794). RP in the high-altitude city has a notably higher reading of 47.7% ± 1.4% (95% CI, ETTR = 2090, PPR = 219, n = 4796). In both cities, the ETTR subtype predominated, and there was marked increase in RP among females. RP in low-altitude city females was steady across all age groups, while RP in low-altitude city males showed a declining trend with age. RP in high-altitude city females indicated a slightly increasing trend with age, while RP in males again showed a declining trend with age. Based on the results of this high-altitude city and low-altitude city study, there are an estimated 2.1 million people with rosacea, from 2 cities with a total population of 5.4 million.

Due to the high altitude and accompanying increased UV radiation, cold climate, and reduced oxygen density, the greater northwest region of China is expected to experience high RP rates.

The increased proliferation of Demodex mites in the pilosebaceous unit can be the cause of rosacea flare-ups on the face. Signs and symptoms of the scalp (e.g., itching, dandruff) have sometimes been reported in patients with papulopustular rosacea of face; they may be due to a proliferation of Demodex mites on the scalp.

To study the Demodex mites count, a standardized skin surface biopsy was performed on the cheek and on the scalp. Microscopic examination and molecular identification of Demodex were performed. Pearson's χ2 Test or Fisher's Exact Test were used to test for any association between categorical variables and outcome.

Patients affected by papulopustular rosacea had a greater frequency of Demodex-positive standardized skin surface biopsy than controls at the scalp (35.0% vs. 0%, P=0.033), at the face and/or at the scalp (50% vs. 10%, P=0.032). Demodex positive patients with a Demodex-positive face sample were more frequently found to have a Demodex-positive scalp sample (P=0.035). The predominant species was found to be Demodex folliculorum (92.6% of samples); the species Demodex brevis was identified only in 7.4% of samples.

Demodex folliculorum is more frequently found on the scalp and face of patients with rosacea than controls, even though it is not statistically associated with scalp symptoms. The scalp may be a reservoir area for Demodex mites which could migrate on the face again after an acaricidal treatment.

Background/Objective: The aim of this study was to compare thiol/disulfide homeostasis and clinical parameters of rosacea patients across skin subtypes of the disease and healthy controls. Methods: This prospective study included 90 rosacea patients with different skin subtypes (phymatous, erythematotelangiectatic and papulopustular) and ocular involvement and 30 healthy controls. Plasma native thiol (NT), total thiol (TT) and disulfide levels of the patients and controls were measured using an automated spectrophotometric method, and disulfide/native thiol ratio (DNTR), disulfide/total thiol ratio (DTTR) and native thiol/total thiol ratio (NTTR) were calculated. Tear breakup time (TBUT), meiboscore, Schirmer, ocular surface disease index (OSDI) and rosacea-specific quality of life scale (RosaQoL) were measured clinically. Results: Disulfide, DNTR and DTTR were significantly higher, and NT, TT and NTTR were significantly lower in the rosacea patients compared to the controls (p < 0.001). TBUT and Schirmer were significantly lower, and meiboscore and OSDI were significantly higher in the patients compared to the controls (p < 0.01). According to the skin subtypes, disulfide, DNTR and DTTR were significantly higher, and NTTR was significantly lower in the erythematotelangiectatic subtype compared to the other subtypes (p < 0.002). TBUT was significantly lower, and RosaQol was significantly higher in the erythematotelangiectatic subtype (p < 0.0083). Strong correlations were found between DNTR and TBUT and between DNTR and Meiboscore in all subtypes (p < 0.005), while there were strong correlations between DNTR and OSDI and between DNTR and RosaQol only in the erythematotelangiectatic and papulopustular subtypes (p < 0.05). Conclusions: The thiol/disulfide homeostasis shifted towards disulfides, an indicator of oxidative stress in rosacea, and this was more pronounced in the erythematotelangiectatic subtype. The impairment in TBUT and RosaQol was also more prominent in the erythematotelangiectatic subtype and strongly associated with the DNTR.

To evaluate the effects of rosacea on ocular surface changes such as alterations in dry eye parameters, corneal densitometry, and aberrations, in comparison with healthy controls.

A total of 88 eyes of 44 patients diagnosed with rosacea and 88 eyes of 44 healthy controls were enrolled in this cross-sectional study. All participants underwent a comprehensive dermatologic and ophthalmic examination and Tear Break-Up Time (TBUT) and Schirmer-1 tests were performed. The rosacea subtype and Demodex count and OSDI scores of all participants were recorded. Corneal topographic, densitometric, and aberrometric measurements were obtained using the Scheimpflug imaging system.

The mean age of the 44 patients was 41.2 ± 11.0 years of whom 31 (70.5%) were female. The mean TBUT and Schirmer-1 test values were significantly decreased and OSDI scores were significantly increased in the rosacea group compared to healthy controls (p < 0.01 for all). The most common subtype of rosacea was erythematotelangiectatic rosacea (70.4%). The severity grading of rosacea revealed that 18 (40.9%) patients had moderate erythema. The median (min-max) Demodex count was 14.0 (0-120) and the disease duration was 24.0 (5-360) months. The comparison of the corneal densitometry values revealed that the densitometry measurements in all concentric zones, especially in central and posterior zones were higher in rosacea patients. Corneal aberrometric values in the posterior surface were also lower in the rosacea group compared to healthy controls. The topographic anterior chamber values were significantly lower in the rosacea group.

Relatively small sample size, variable time interval to hospital admission, and lack of follow-up data are among the limitations of the study. Future studies with larger sample sizes may also enlighten the mechanisms of controversial anterior segment findings by evaluating rosacea patients who have uveitis and those who do not.

Given the fact that ocular signs may precede cutaneous disease, rosacea is frequently underrecognized by ophthalmologists. Therefore, a comprehensive examination of the ocular surface and assessment of the anterior segment is essential. The main priority of the ophthalmologist is to treat meibomian gland dysfunction and Demodex infection to prevent undesired ocular outcomes.

Patients with rosacea commonly experience stigmatization, which induces stress and thereby exacerbates their symptoms. Given the strong effects of rosacea on health-related quality of life (HRQoL), addressing the physical and psychosocial aspects of rosacea is essential. To examine the effects of rosacea on HRQoL, we conducted a systematic review and meta-analysis involving real-world data. PubMed, EMBASE, and the Cochrane Library were searched, and randomized controlled trials (RCTs), cross-sectional studies, and case series evaluating the HRQoL of patients with rosacea were included. HRQoL assessment tools such as the Dermatology Life Quality Index (DLQI) and Rosacea-Specific Quality-of-Life Questionnaire (RosaQoL) were used. Data on 13,453 patients were retrieved from 52 eligible studies: 4 RCTs, 15 case series, and 33 cross-sectional studies. Compared with healthy controls, patients with rosacea had significantly lower DLQI scores (standardized mean difference [SMD] = -1.09, 95% confidence interval [CI] = -0.81 to -1.37). The DLQI scores after treatment were higher than those before treatment (SMD = -1.451, 95% CI = -1.091 to -1.810). The pooled estimates for the overall DLQI and RosaQoL scores were 8.61 and 3.06, respectively. In conclusion, patients with rosacea have lower HRQoL compared with healthy individuals, and treatment for rosacea improves their HRQoL.

In addition to the non-specific symptomatology of ocular rosacea, currently, there are no reliable diagnostic tests for the disease, which may lead to its misdiagnosis. Here, we report a case of ocular rosacea presenting with multiple recurrent chalazion on both eyelids.

A 63-year-old female patient presented with multiple chalazion and dry eyes in both eyes, with no facial erythema. Initial management done were application of steroid eye ointment on both eyelids, hot compresses, and eyelid margin cleaning; noting that there was no relief of symptoms. Surgical excision of the chalazion was done on both eyes, however, bilateral recurrence occurred post-operatively. The pathological studies showed infiltration of a small amount of fibrous tissue with many chronic inflammatory cells. Immunohistochemistry studies were positive for LL-37. Resolution of the chalazion occurred after oral administration of doxycycline and azithromycin.

Our findings show that ophthalmologists should recognize the ocular manifestations of skin diseases.

Previous clinical studies have shown that pulsed dye laser (PDL) and intense pulsed light (IPL) are effective for treating erythematotelangiectatic rosacea(ETR). This article aims to compare the efficacy and safety of PDL and IPL at three different wavelength bands (broad-band, single-narrow-band, and dual-narrow-band) in treating ETR. Sixty subjects with ETR were randomly categorized into four groups and received one of the following laser treatments: PDL (595 nm), IPL with Delicate Pulse Light (DPL, 500-600 nm), IPL with M22 590 (590-1200 nm), or IPL with M22 vascular filter (530-650 nm and 900-1200 nm). Four treatment sessions were administered at 4-week intervals, with one follow-up session 4 weeks after the final treatment. The efficacy of the four lasers was evaluated by comparing the clinical symptom score, total effective rate, VISIA red area absolute score, and RosaQoL score before and after treatment. The safety was evaluated by comparing adverse reactions such as pain, purpura, erythematous edema, and blister. All 60 subjects completed the study. Within-group effects showed that the clinical symptom score, VISIA red area absolute score, and RosaQoL score of all four groups were significantly reduced compared to before treatment (p < 0.001). Between-group effects showed no statistically significant difference among the four laser groups. Safety analysis showed that all four lasers were safe, but the incidence of blister was higher in the M22 vascular group. Nonpurpurogenic PDL, DPL, M22 590, and M22 vascular were equally effective in treating ETR and were well-tolerated. ClinicalTrial.gov Identifier: NCT05360251.

Rosacea is a chronic inflammatory skin disease. Previous studies have determined that IL-36, IL-37, and IL-38 may play a role in the pathogenesis of various inflammatory diseases.

The present study aims to evaluate the relationship of these cytokines with rosacea.

A total of 100 individuals, including 50 patients with rosacea and 50 healthy controls, were included in the study. IL-36, IL-37, and IL-38 levels were measured using the ELISA method by taking serum samples from all participants.

The mean serum levels of IL-36, IL-37, and IL-38 in the patient group were 52.17 ± 24.07 pg/ml, 18.46 ± 8.18 pg/ml, and 25.74 ± 8.36 ng/l, respectively. The mean serum levels of IL-36, IL-37, and IL-38 in the control group were 32.99 ± 19.90 pg/ml, 44.61 ± 22.27 pg/ml, and 45.61 ± 17.32 ng/l, respectively. The difference between the serum levels of IL-36, IL-37, and IL-38 in the patient and control groups was statistically significant (P < 0.001).

Based on these findings, an increase in IL-36 and a decrease in IL-37 and IL-38 may contribute to the pathogenesis of rosacea. Future rosacea treatments could target and/or interact with these possible steps in the pathogenesis of rosacea.

Rosacea, a chronic inflammatory skin condition affecting millions worldwide, is influenced by complex interactions between genetic and environmental factors. Although gut microbiota's role in skin health is well-acknowledged, definitive causal links between gut microbiota and rosacea remain under-explored.

Using a two-sample Mendelian randomization (MR) design, this study examined potential causal relationships between gut microbiota and rosacea. Data was sourced from the largest Genome-Wide Association Study (GWAS) for gut microbiota and the FinnGen biobank for rosacea. A total of 2078 single nucleotide polymorphisms (SNPs) associated with gut microbiota were identified and analyzed using a suite of MR techniques to discern causal effects.

The study identified a protective role against rosacea for two bacterial genera: phylum Actinobacteria and genus Butyrivibrio. Furthermore, 14 gut microbiota taxa were discovered to exert significant causal effects on variant categories of rosacea. While none of these results met the strict False Discovery Rate correction threshold, they retained nominal significance. MR outcomes showed no pleiotropy, with homogeneity observed across selected SNPs. Directionality tests pointed toward a robust causative path from gut microbiota to rosacea.

This study provides compelling evidence of the gut microbiota's nominal causal influence on rosacea, shedding light on the gut-skin axis's intricacies and offering potential avenues for therapeutic interventions in rosacea management. Further research is warranted to validate these findings and explore their clinical implications.

Facial follicular scales, dandruff, scalp itching and ocular alterations are lesser-known signs of rosacea and demodicosis. The aim of this prospective original study was to investigate the presence of these signs and symptoms in patients with almost-clear, mild and moderate papulopustular rosacea (PPR) and to study the differences between Demodex-positive (D+) and Demodex-negative (D-) rosacea. Twenty-seven out of 60 patients (45%) presented follicular scales, 24 (40%) ocular involvement and 22 (36.67%) scalp involvement. Follicular scales were more frequently observed in mild and moderate than in almost-clear rosacea (P<0.001). Itching of the scalp was more frequently reported in patients with moderate rosacea than in those with mild disease (P=0.05). Follicular scales (P=0.002) and scalp itching (P=0.05) were more frequently reported in D+ than in D- patients. Among D+ patients, scalp itching was more frequently reported in mild than in almost clear rosacea (P=0.01) and ocular symptoms associated to scalp itching were more frequently reported in moderate than in almost-clear rosacea (P=0.05). We suggest looking for these signs and symptoms in all patients with PPR, because they can be a sign of a more severe form of rosacea or of demod-icosis.

Well-being is commonly communicated across industries; however, experimental understanding how human perceive skin health and skin stresses are not sufficient.

Image analysis algorithm, a* gradient, was developed to evaluate spatial pattern and shape of red signal on skin. Human perception for skin health and stresses were compared with technical measurements in two visual perception studies.

a* gradient correlated with perceived Inflamed Skin (R = 0.73, p < 0.01), Stressed Skin (R = 0.79, p < 0.01), Sensitive Skin (R = 0.75, p < 0.01), Healthy Skin (R = -0.83, p < 0.01), and Start Aging (R = 0.75, p < 0.01).

Disordered spatial pattern of redness signal drives human perception of skin health, stress, and aging. This new skin index of redness signal shows higher correlation with those human perception than basal a* mean, unevenness of a*, and other conventional skin color attributes.

Rosacea is a chronic inflammatory condition of which there is no cure. The pathogenesis of rosacea is likely multifactorial, involving genetic and environmental contributions. Current understanding suggests that pro-inflammatory pathways involving cathelicidins and inflammasome complexes are central to rosacea pathogenesis. Common rosacea triggers modulate these pathways in a complex manner, which may contribute to the varying severity and clinical presentations of rosacea. Established and emerging rosacea treatments may owe their efficacy to their ability to target different players in these pro-inflammatory pathways. Improving our molecular understanding of rosacea will guide the development of new therapies and the use of combination therapies.

Rosacea is a chronic skin disorder that affects more than 5% of the world's population, with the number increasing every year. Moreover, studies show that one-third of those suffering from rosacea report a degree of depression and are less compliant with treatment. Despite being the subject of prolonged studies, the pathogenesis of rosacea remains controversial and elusive. Since most medications used for the management of this pathology have side effects or simply do not yield the necessary results, many patients lose trust in the treatment and drop it altogether. Thus, dermato-cosmetic products with natural ingredients are gaining more and more notoriety in front of synthetic ones, due to the multiple benefits and the reduced number and intensity of side effects. This review is a comprehensive up-to-date report of studies that managed to prove the beneficial effects of different botanicals that may be useful in the short and long-term management of rosacea-affected skin. Based on recent preclinical and clinical studies, this review describes the mechanisms of action of a large array of phytochemicals responsible for alleviating the clinical symptomatology of the disease. This is useful in further aiding and better comprehending the way plant-based products may help in managing this complex condition, paving the way for research in this area of study.

Rosacea is a common, chronic inflammatory disease characterized by both fluctuating and fixed heterogeneous signs such as facial erythema, papules/pustules, telangiectasia, acute vasodilation (flushing), and phymatous changes, and symptoms such as cutaneous stinging and burning. The shift to a phenotype-based approach to rosacea management has improved the consistency of recommendations across recent published guidelines. Consistent and thorough guidance for the classification, diagnosis, and management of the disease is difficult, as the mechanisms underlying the development of rosacea are still not completely understood nor universally accepted. Here, we provide a critical review of current published guidance, and gaps in the knowledge and management of rosacea. We present the recently approved microencapsulated benzoyl peroxide as an effective topical treatment option for papulopustular rosacea. Benzoyl peroxide (BPO) has been used in acne management for many years; however, many clinicians perceive treatment of rosacea with any BPO formulation to be counterintuitive because of concerns of potential skin irritation, while the lack of an accepted mechanism of action on rosacea pathophysiology means that others may be hesitant to use BPO as a treatment. Minocycline foam 1.5% is also an option for the treatment of inflammatory lesions in rosacea, with a decreased risk of systemic adverse events compared with oral minocycline.