Phenotypic approach of treatment in rosacea

Abstract

Introduction. Rosacea is a chronic inflammatory disorder. The prevalence of rosacea is highest among fair-skinned individuals, and according to some studies constitutes up to 10% of the adult population. Although it is a common dermatologic condition, rosacea is shockingly overlooked. The aetiology, pathogenesis, the clinical manifestasions and management of rosacea still remain disputed. The classic treatment, based on classification of rosacea in 3 successive clinico-evolutive forms (erythematous-telangiectatic, papulo-pustular and phimatosa) remains weak resulting for some patients. Aim of the study. Development of an individualized treatment based on clinical assessment of phenotypic expressions in rosacea. Materials and methods. Published literature of the last 5 years, involving the therapeutic behaviour in rosacea, was examined and summarized. Results. Rosacea is a common cutaneous condition that is frequently overlooked. As a result of its multifactorial nature and characteristic relapsis and remisions, diagnosis is complex. Although rosacea is known to be an angio-neurosis, the types of skin haemodynamic disorders that are likely to induce different clinical manifestations of the disease have not been appreciated yet. In this study, was analyzed the therapeutic action of topical and systemic drugs used in rosacea and their efficacy according to the phenotypic expression of the disease. Were appreciated the therapeutic effects of topical drugs such as: Brimonidine, Oxymetazoline, Ivermectin, Metronidazole and Azelaic Acid , as well as systemic therapies with Azithromycin, Doxycycline, Propranolol, Sulodexid and Isotretinoin, for each phenotypic lesion separately. As a result, were determined the drogs that had the highest clinical efficacy for the control of erythema, telangiectasias, papules, pustules, granulomatous or phymatous-lesions of rosacea. Topically applied Brimonidine and Oxymetazoline have been shown to be more effective for controlling erythematous flushes than Metronidazole or Azelaic Acid. Ivermectin had good results in the control of papules and pustules for uncomplicated rosacea forms.Systemic therapy with Propranolol has good clinical efficacy and better result than Doxycycline in the control of erythema and telangiectasias in patients with erythematous-telangiectatic and papulo-pustular rosacea. The phimosis monitoring in rosacea can be performed by systemic administration of Isotretinoin. Conclusions. 1.Clinicians are encouraged to determine the lesion phenotype in patients with rosacea and to select a optimal individualized treatment. 2. The treatment of skin hemodynamic disorders in rosacea with vasoactive therapies with beta-blockers, antithrombotics and flavones, has a curative potential that should be studied.