Rosacea Recap: The Science and the Symptom

From subtle symptoms to sweeping innovation in treatment, rosacea took center stage in a session at the 2022 Fall Clinical Dermatology Conference for PAs & NPs, held June 3 to 5, 2022 in Scottsdale, Arizona, presented by James Q. Del Rosso, DO. He is research director of JDR Dermatology Research in Las Vegas, Nevada and senior vice president of clinical research and strategic development at Advanced Dermatology & Cosmetic Surgery in Maitland, Florida.

Del Rosso took a deep dive into the pathogenesis of the disease, its symptoms and manifestations, and the factors to be weighed when assessing established and novel treatments.

Rosacea Characteristics

He explained that individuals who develop rosacea exhibit “rosacea-prone skin”, characterized by physiochemical differences compared to normal skin.

This includes:

• Altered co-localization of cutaneous nerves and vessels;
• an increase in perivascular mast cells;
• altered patterns of cutaneous receptor distribution and magnitude;
• altered gene expression with potential correlation with clinical manifestations;
• aberrant response to environmental triggers;
• progressive changes in superficial cutaneous vasculature; and
• augmented immunologic or inflammatory responses through the cathelicidin pathway.

Del Rosso pointed out that rosacea pathophysiology involves multiple pathways—for example, neurovascular dysregulation and augmented immune response. Potential triggers for the skin condition can range from a genetic predisposition to other endogenous factors such as corticosteroids. Exogenous factors include Demodex colorization and ultraviolent radiation.

Other factors that contribute to rosacea include:

Sebaceous Gland Deregulation

• Epidermal barrier dysfunction
• Lipid film quality
• Demodex mites

Meibomian Gland Deregulation

• Hyperkeratinization
• Viscosity of meibum
• SPRR/S100A7, A8, and A9

Aberrant Immune System: Innate Immune System

• TLR-2/4
• LL-37/cathelicidin/KLK-5
• Mast cells

Aberrant Immune System: Adaptatif Immune System

• T-cell-mediated responses
• B-cell-mediated responses

Vascular Deregulation

• VEGF
• V-CAM/1-CAM/E-Selectin

Neurovascular Deregulation

• TRP
• Neuropeptides PACAP/SP/VIP/CGRP

Rosacea can manifest as transient vasodilation, persistent facial erythema, and telangiectasia, or papulopustular lesions, transient lesional/perilesional erythema, indirect long-term chronic vasodilation, and increased vessel density that can result in persistent facial erythema and telangiectasia, and ocular manifestations, according to Del Rosso.

Whether the facial redness showcased includes perilesional erythema or not, a primary diagnostic feature of rosacea is central facial persistent erythema, he said.

New research continues to reveal intricacies in rosacea causes, manifestations, and treatment, and further research on potential therapies will widen the physician armamentarium to help these patients. 

Disclosures:

Del Rosso reported being a research investigator (*), consultant/advisor (^), and/or speaker (#) for AbbVie^, Aclaris Therapeutics*^#, Amgen Inc*^#, Almirall SA*^#, AnaptysBio*, Arcutis Biotherapeutics*^, ASLAN Pharmaceuticals*, Athenex*, Ortho Dermatologics*^#, Beiersdorf AG#, Biofrontera^#, BioPharmX Corporation*^, Biorasi*, BlueCreek Dermatologics, Inc^, Boehringer Ingelheim^, Botanix Pharmaceuticals*, Brickell Biotech, Inc*, Bristol Myers Squibb^#, Cara Therapeutics*, Cassiopea SpA*^, Dermata Therapeutics^, Dermavant Sciences, Inc*^, Encore Dermatology Inc^#, EPI Health*^#, Evommune, Inc^, Ferndale Pharma Group, Inc^#, Galderma*^#, Genentech, Inc*#, Incyte*^#, Janssen Pharmaceuticals*, Jem Health^#, LEO Pharma*^#, La Roche-Posay^, Eli Lilly and Company*^#, MC2^, Mindera Health^, Novan*^, Pfizer Inc*^#, Ralexar Therapeutics, Inc*, Regeneron Pharmaceuticals, Inc*^#, Sanofi-Genzyme^#, Sente, Inc^, Sol–Gel*^, Sonoma Pharmaceuticals^, Sun Pharmaceutical Industries Ltd*^#, UCB*^#, Verrica Pharmaceuticals^#, Vyne Therapeutics Inc*^#

References:

Del Rosso JQ. What you need to know about rosacea. Presented at: 2022 Fall Clinical Dermatology Conference for PAs & NPs. June 3-5, 2022. Scottsdale, Arizona and virtual.