• cosmetologist
• erythema
• patient
• skin care
• telangiectases
• therapy

• Ocular rosacea
• blepharitis
• dry eye disease
• rosacea

Pathophysiology of rosacea is not completely understood and involves a complex interaction among genetics, ultraviolet (UV) light, microorganisms, impaired skin barrier, neuronal and vascular dysfunction, and immune system disruption.

To describe the etiology of rosacea with an emphasis on the role of UV radiation and exposome, and to review the importance of non‐pharmacologic strategies focusing on photoprotection.

We conducted a narrative review of the literature. We performed literature searches with PubMed from January 1990 to November 2020 using the keywords “rosacea”, “pathogenesis”, “ultraviolet radiation”, “exposome”, “photoprotection”, “sunscreens” and “non‐pharmacologic agents”. The search was limited to English, Spanish, and French language articles.

Several environmental factors such as UV light, diverse microorganisms, air pollution, tobacco smoking, nutrition, and psychological stress showed to trigger or worsen rosacea. UV radiation was reported to induce pro‐inflammatory, pro‐angiogenic, and pro‐fibrotic responses. We found 6 original articles about the impact of sunscreens on rosacea. The use of sunscreens containing ingredients with emollient, anti‐inflammatory, and/or vasoregulatory properties was shown to significantly improve symptomatology.

UV radiation and the exposome play a key role in the development of rosacea. UV light is implicated in all significant aspects of rosacea: skin inflammation, neoangiogenesis, telangiectasia, and fibrosis, and may even initiate rosacea. While the use of sunscreens is widely recommended, the literature on the impact of photoprotection in rosacea is scarce. Adequately formulated sunscreens could not only provide the required level of photoprotection, but may also help to mitigate the barrier dysfunction, neutralize facial redness (tinted sunscreens), and decrease inflammation and vascular dysfunction.

• exposome
• photoprotection
• rosacea
• sunscreens
• ultraviolet radiation

• Rosacea
• ferritin
• pulsed dye laser

• Combined Modality Therapy
• Consensus
• Cost of Illness
• Humans
• Ophthalmologists
• Rosacea/diagnosis
• Rosacea/therapy

• Galderma
• Galderma

• Demodex density
• ivermectin
• papulopustular rosacea

• Demodex mites
• Immunosuppression
• Ivermectin
• Metronidazole
• Systemic therapy

• Foreign body reaction
• Granuloma
• Rosacea
• Sarcoidosis
• Xanthogranuloma

• Antimicrobial peptides
• cathelicidin
• defensins
• innate immunity
• ocular
• rosacea

Rosacea is a chronic inflammatory skin disease with different phenotypes. There is accumulating evidence that the commensal Demodex mite is linked to papulopustular rosacea. Established treatment options, including topical metronidazole, azelaic acid, and tetracyclines, are thought to work through their anti-inflammatory effects. However, none of these therapies have been shown to be curative and are associated with frequent relapses. Therefore, new and improved treatment options are needed. Topical ivermectin 1.0% cream is a new option having both anti-inflammatory and acaricidal activity against Demodex mites which might pave the way to a more etiologic approach. Its use has now been widely adopted by clinical guidelines. The objective was to review the evidence and clinical guideline recommendations concerning ivermectin 1.0% cream in the treatment of papulopustular rosacea.

A systematic review of both medical literature and clinical guideline recommendations was conducted. Numbers needed to treat (NNT) were calculated for relevant dichotomous outcomes (e.g., relapse rate and achieving full lesion clearance) to compare ivermectin with other established treatment options for rosacea.

The search identified three randomized trials, three extension studies, and two meta-analyses. Ivermectin has only been tested in moderate-to-severe papulopustular rosacea. Ivermectin is an effective treatment option for papulopustular rosacea and seems to be more effective than metronidazole (NNT = 10.5) at 12 weeks of treatment. Although ivermectin was numerically more effective than metronidazole at week 36 in preventing relapse (NNT = 17.5), relapse after discontinuation of treatment in both groups was common with 62.7% and 68.4% of patients relapsing. Based on limited generalizability of available evidence, clinical guidelines have yielded different treatment algorithms and, in some areas, conflicting recommendations.

Topical ivermectin is an effective option in the treatment of papulopustular rosacea. Although ivermectin seems to be more effective than topical metronidazole, with both treatment options about two-thirds of patient relapsed within 36 weeks after discontinuation of treatment. More research is needed to establish the clinical benefit of ivermectin’s acaricidal action in preventing relapse compared to other non-etiologic treatment approaches.

• Demodex
• Guideline
• Ivermectin
• Papulopustular
• Review
• Rosacea

• comorbidities
• genetics
• innate immunity
• management
• neurovascular dysregulation
• prevalence
• quality-of-life

• acne vulgaris
• atopic dermatitis
• impetigo contagiosa
• liposomal PVP-iodine hydrogel
• polyvinylpyrrolidone
• rosacea

Morbihan syndrome is a rare entity that more commonly affects women in the third or fourth decade of life. It is considered a special form of rosacea and its pathogenesis is not fully known. It is clinically characterized by the slow appearance of erythema and solid edemas on the upper portion of the face, with accentuation in the periorbital region, forehead, glabella, nose, and cheeks. We report the case of a patient presented with edema on the upper eyelid for a year. These findings suggested the diagnosis of Morbihan syndrome. We aim to report a rare, particularly refractory and chronic form of rosacea, which has received little attention in the literature.

• Demodex
• Erythematotelangiectatic rosacea
• Ocular rosacea
• Papulopustular rosacea
• Phymatous rosacea

• Alexandrite
• Lasers
• Neodymium
• Rosacea

Rosacea is a chronic inflammatory disease that can manifest as a spectrum of symptoms including erythema, inflammatory lesions, edema, and telangiectasia. Treatment decisions need to be adapted to reflect the nature and severity of the different symptoms present. In this report, we discuss the case of a female patient diagnosed with severe, inflamed papulopustular rosacea (PPR) presenting with a large number of inflammatory lesions and severe background erythema. This patient responded well to a treatment regimen consisting of a short course of antibiotics in combination with a corticosteroid, followed by monotherapy with isotretinoin to reduce the inflammation. Brimonidine gel, used as needed, was then added to isotretinoin to target the remaining background erythema. This case of severe PPR required a combinatorial treatment regimen to effectively target all symptoms present. The patient continued to apply topical metronidazole throughout the different treatment regimens prescribed over the course of almost 1 year. Use of topical metronidazole helped to repair and protect the skin barrier, which minimized the occurrence of dermatological adverse events when topical treatments were used. We conclude that in patients with severe disease and an important inflammatory component, a rapid response can be obtained with a multimodal, tailored approach that also includes treatment to repair and protect the skin barrier.

• brimonidine gel
• erythema
• immature scar
• scar
• topical therapy

• Anti-Infective Agents/therapeutic use
• Brimonidine Tartrate
• Cyclosporine/therapeutic use
• Dermatologic Agents/therapeutic use
• Dicarboxylic Acids/therapeutic use
• Doxycycline/therapeutic use
• Female
• Humans
• Ivermectin/therapeutic use
• Male
• Metronidazole/therapeutic use
• Middle Aged
• Ophthalmic Solutions/therapeutic use
• Quinoxalines/therapeutic use
• Randomized Controlled Trials as Topic
• Rosacea/drug therapy
• Tetracycline/therapeutic use

• Angiogenesis
• Cathelicidin LL-37
• Inflammasome
• P2X(7)
• Rosacea
• UVB