Magazine article Drug Topics

Rosacea: The Physical and Emotional Toll

Magazine article Drug Topics

Rosacea: The Physical and Emotional Toll

Article excerpt

Rosacea is a chronic cutaneous disorder that primarily affects the central face, including the cheeks, eyes, nose, chin, and forehead. It is important to note that there is not a specific characteristic or set of characteristics that define rosacea. Rather, there are specific features that vary in presentation and magnitude among patients (Table l).1

Although the pathophysiology of rosacea is not yet completely understood, it is believed to involve both the innate and adaptive immune systems. Patients with rosacea often have abnormal regulation of the neurovascular system. Vascular abnormalities, microbial activity, and pilosebaceous gland abnormalities may also exacerbate the condition.2 Clinical studies have shown that patients with rosacea have a high concentration of cathelicidin-derived peptide (LL-37), which can contribute to inflammation.3 Recent research has also focused on the possible influence of Demodex mites on the pathophysiology of rosacea, showing that Demodex density is almost 6 times higher in patients with rosacea than it is in the normal population.4

Rosacea affects up to 10% of the general population, with the greatest prevalence in individuals aged 30 to 50 years. Although most common in light-skinned individuals of Northern European descent, rosacea is not exclusive to Caucasians and can be seen, albeit with less frequency, in Asians, Hispanics, African-Americans, and other demographic groups.5 There is certainly a physical burden associated with rosacea, but the emotional impact of the condition is often even more substantial. Whereas acne is often considered almost a rite of passage for teenagers, many adult rosacea patients avoid going out in public due to psychological factors. A recent National Rosacea Society (NRS) survey of more than 400 rosacea sufferers showed that 75% had low self-esteem, 70% were "embarrassed" by their condition, and 56% felt robbed of pleasure/happiness.6

In 2002, the NRS identified 4 distinct subgroups of rosacea. Although there may be some overlapping characteristics of these subtypes, the classifications have helped with diagnosis and initial treatment plans:5

* Erythematotelangiectatic rosacea: Mainly characterized by flushing and persistent central facial erythema. Telangiectases are common, but not essential for diagnosis. Most common rosacea subtype.

* Papulopustular rosacea: Characterized by persistent central facial erythema with transient papules or pustules (or both) in a central facial distribution. Papules and pustules may also occur periodically. Resembles acne, except for the presence of comedones.

* Phymatous rosacea: Characterized by thickening skin, irregular surface nodularities, and enlargement. Predominantly present in male patients.

* Ocular rosacea: Characterized by watery or bloodshot eyes, foreign body sensation, burning/stinging, dryness, itching, light sensitivity, blurred vision, telangiectases of the conjunctiva and lid margin, or lid and periocular erythema.

In addition to rosacea classifications, the NRS also developed a standard grading system to provide a common reference for diagnosis, treatment, and assessment of results in clinical practice. This grading system is commonly used in clinical trials to allow for comparability of results. A modified version of an available grading scorecard is included in Table 2.7 It gives a general overview of the delineation between severity ratings.

The determination of rosacea severity is helpful, but it is important for clinicians to do more than simply perform a visual assessment of a patient's condition as they consider initial steps of treatment. For example, a patient may present with symptoms consistent with mild rosacea, but if they report significant issues with social and/or professional embarrassment due to their appearance, more-aggressive therapy may be warranted. It is also important to keep in mind that despite the gäneral conditioning of many clinicians to expect more psychological strain in women with rosacea, many men with rosacea also report a significant emotional burden. …

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