In short: Rosacea is a chronic inflammatory skin condition of the face involving an overactive immune response, dysregulated facial blood vessels and an imbalanced skin microbiome. UV radiation increases this inflammation. Basic treatment therefore always combines consistent, year-round sun protection with improving the skin microbiome, for example with metronidazole, azelaic acid or ivermectin.

Overview

Rosacea is a chronic inflammatory skin condition of the face whose development involves several interacting factors: an excessively activated innate immune response, dysregulation of the facial blood vessels, and an imbalanced skin microbiome.

Sunlight plays a dual role here: UV radiation increases the activation of an inflammatory complex (the NLRP3 inflammasome) in skin cells, releasing more pro-inflammatory messenger substances — put simply, the skin responds to sunlight with an excessive inflammatory reaction. An increased density of the skin mite Demodex folliculorum, along with a disruption of the rest of the skin's microbial community, also contributes to the inflammation.

Basic treatment therefore always consists of two elements: consistent, year-round sun protection and improvement of the skin microbiome, medically for example with metronidazole, azelaic acid or ivermectin, complemented by preventive skincare.

Treatment Options

Telangiectatic stage

Small new blood vessels (telangiectasias) form permanently on the face. These vascular changes are permanent and cannot be reversed with creams or tablets — only targeted laser treatment can help here.

Papular stage

Small, inflamed, reddish papules develop on the face.

Pustular stage

In addition, pus-filled pustules form, which, if they recur repeatedly, can lead to scarring and a permanent change in the skin's surface.

Rhinophyma (extreme variant)

Chronic inflammation of the sebaceous glands can lead to enlargement and a change in the shape of the nose. The standard therapy is ablative laser treatment, for example with CO2 or Er:YAG lasers, which allows precise recontouring and volume reduction of the nose.

Because sunlight has been shown to intensify the inflammatory processes in rosacea, consistent sun protection is a fixed part of every rosacea treatment within the Dermetrics concept, not merely an accompanying recommendation.

Sources

Buttaro L. et al., Molecular Mechanisms in the Etiopathology of Rosacea, systematic review.
Woo Y.R. et al., Rosacea pathogenesis and therapeutics: current treatments and future targets, Frontiers in Medicine.
Two A.M. et al., Impact of ultraviolet radiation and exposome on rosacea.
Daou H. et al., Rosacea, microbiome and probiotics: the gut-skin axis.
Two A.M. et al., Rosacea Management, PMC.
Laser-Based Therapies in Rosacea, A Comprehensive Review.

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