Rosazea

Die Rosazea ist eine der häufigsten chronisch-rezidivierenden Dermatosen des Erwachsenenalters. Die Erkrankung befällt hauptsächlich das Gesicht, aber auch extrafaziale Manifestationsformen sind bekannt. Dieser Beitrag gibt einen Überblick über die klinische Einteilung, die diagnostischen Schritte und die therapeutischen Optionen bei dieser für den Patienten oft psychisch schwer belastenden Erkrankung.

Abstract

Rosacea is a chronic inflammatory skin disease mainly affecting the face. Therfore, it can be very distressing for the patient leading to psychosocial disturbances. An universally accepted definition and confirmed pathophysiology is lacking. In recent years many efforts were undertaken to close this gap.

Rosacea is a frequent disease occurring in 2 – 5 % of caucasian adults, peaking between 40 and 50 years of age.

The course of rosacea is variable, the disease may stop at any stage. Three main stages are differentiated: Rosacea erythemato-teleangiectatica [rosacea stage I), rosacea papulopustulosa (Rosacea stage II), hyperglandular-hypertrophic rosacea (rosacea stage III). Besides these main manifestations numerous special forms exist, which often lead to difficulties in the differential diagnoses and require specific therapeutic strategies. These include rosacea conglobata, rosacea fulminans, granulomatous rosacea, persisting erythema (Morbus Morbihan), gram-negative rosacea, ocular rosacea, and steroid rosacea.

Recently several molecular features of its inflammatory process have been identified.

Overproduction of Toll-like receptors 2, a serine protease, induce abnormal high levels of abnormal forms of cathelicidin. Further factors include neurovascular dysregulation, infestation of demodex, barrier dysfunction, enhanced neuroimmune communication, blood and lymphatic vessel changes, and activation of resident cells of the skin.

These insights lead to developments of new treatment strategies and during the last few years several topical and systemic drugs were able to pass the high hurdles of official approval for the treatment of rosacea.

Kernaussagen

• Die Rosazea ist eine der häufigsten chronisch-rezidivierenden Dermatosen des Erwachsenenalters.

• Die Erkrankung befällt hauptsächlich das Gesicht, aber auch extrafasziale Manifestationsformen sind bekannt.

• Im Allgemeinen werden neben einem Vorstadium und Sonderformen 3 Hauptstadien unterschieden:

  • Rosacea erythematosa-teleangiectatica (Stadium I),

  • Rosacea papulopustolosa (Stadium II),

  • glandulär-hyperplastische Rosazea (Stadium III).

• Pathophysiologisch ist erwiesen, dass eine gesteigerte Aktivierung der natürlichen Immunität wesentlich an der gestörten vaskulären und neuronalen Aktivität und auch an den entzündlichen Reaktionen beteiligt ist.

• Diese Erkenntnisse führten zu neuen modifizierten Strategien – topisch, systemisch, lasertherapeutisch und chirurgisch – zur Behandlung dieser schwer beeinträchtigenden Dermatose.

• Bei der systemischen Therapie der schweren Rosazea ist Isoretinoin eines der wirksamsten Mittel, der Einsatz erfolgt derzeit jedoch noch Off-Label.

Schlüsselwörter

Rosazea, klinische Einteilung, Sonderformen, Pathophysiologie, Therapie

Key Words

Rosacea, clinical classification, special forms, pathophysiology, treatment

• Literatur

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