review
A novel approach to the
management of papulopustular
rosacea
Topical ivermectin represents an effective and alternative first-line treatment option for patients
with mild to moderate papulopustular rosacea
Rosacea can be defined as a chronic, relapsing
inflammatory condition that affects the
central portion of facial skin. The condition is
thought to affect up to 10% of the population and
is more commonly experienced by fair-skinned
individuals of Celtic or Northern European heritage. 1
Rosacea occurs more frequently in women (although
men tend to experience more severe disease) and in
those aged between 30 and 50 years. Patients
complain of a burning or stinging sensation in their
skin and the disease has a negative impact on
quality of life. 2
A system for classifying rosacea was developed
in 2002 and revised in 2004 3 although, more
recently, an expert panel concluded that rosacea
can be defined by persistent, centrofacial erythema
associated with periodic intensification and
phymatous changes. Flushing, telangiectasia,
inflammatory lesions and ocular manifestations,
were not considered individually to be diagnostic
features. 4
Nevertheless, rosacea is still classified into one
of four subtypes:
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• Erythematotelangiectatic – characterised by
flushing and persistent facial erythema
• Papulopustular – presence of papules/pustules
on the cheeks, forehead and chin
• Phymatous – typified by skin thickening,
prominent pores and enlargement of the nose
(rhinophyma)
• Ocular – with inflammation of the eyes and lids.
Whether these subgroups represent distinct
clinical entities or merely a continuum of the
severity spectrum remains to be determined, yet
for many patients there is some degree of symptom
overlap.
Pathophysiology
The precise cause of rosacea remains unclear and,
given the different sub-types, it is likely to be
multifactoral. Inheritable factors are important and
a family history is reported in as many as 30% of
sufferers. Patients with rosacea cite potential trigger
factors such as increased temperature, ingestion
of hot drinks, alcohol, spicy foods and exposure to
both cold weather and ultraviolet radiation. These
Rod Tucker BPharm PhD
Robert Gordon University,
Aberdeen, UK