REVIEW – October 2007

Rosacea and perioral dermatitis: an overview


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Rosacea is a common chronic dermatosis with unknown etiology, affecting central parts of the face. For the diagnosis of rosacea, presence of one or more primary features is required: flushing (transient erythema), transient erythema, papules and pustules, telangiectasia. According to the National Rosacea Society Expert Committee Classification, rosacea is divided into four subtypes: subtype 1 – erythematotelangiectatic rosacea, subtype 2 – papulopustular rosacea, subtype 3 – phymatous rosacea, subtype 4 – ocular rosacea.
The aim of the study was to review recent reports of the epidemiology, etiology, pathogenesis and treatment options of rosacea.
The articles available in the electronic database of the Tartu University Library were used. There are only a few data about the epidemiology of rosacea. The disease is common among the Celtic and North-European populations but it is very rare in blacks. The etiology of rosacea is still unknown. Possible mechanisms are associated with cutaneous vasculature disorders, pilosebaceous unit abnormalities and/or matrix degeneration in genetically predisposed persons due to climatic factors, infections, chemicals or ingested agents. The detrimental effect of UV-radiation on rosacea is well known. The data about the effect of caffeine and  alcochol intake and smoking on rosacea are contradictory.
The most common micro-organisms responsible for the pathogenesis of rosacea are Demodex folliculorum and Helicobacter pylori. Treatment of rosacea consists in oral and topical therapy with antibiotics, retinoids and other medications, besides additional methods, e.g. lasers, massage and surgery and changing of life-style to avoid triggers. Treatment courses last from several weeks to several months and flares after stopping therapy are common.
Another very close problem is perioral dermatitis (PD), which usually occurs in children and young women, but its factual epidemiology is unknown. PD is characterized by grouped reddish papules, papulovesicles, and papulopustules over an erythematous area around the mouth. Possible triggers are infective agents, hormonal factors and topical irritants and allergens. The therapy of PD is similar to that of rosacea while systemic treatment is preferable. Rosacea is a common condition but its etiology is still unclear. Presumably the disease is caused by various endo- and exogenic factors affecting genetically predisposed people. Further investigations are needed to find more effective treatment methods, as well as to determine liable candidate genes.