Abstract
Rosacea is a common and chronic inflammatory skin disease that affects over 10 million
Americans. Although the phenotypes of rosacea are clinically heterogeneous, they are
all related by the presence of chronic facial skin inflammation. Until recently, the
pathophysiology of this disease has been poorly understood and limited to descriptions
of factors that exacerbate or improve this disorder. Recent molecular studies suggest
that an altered innate immune response is involved in the pathogenesis of the vascular
and inflammatory disease seen in patients with rosacea. These findings may help explain
the benefits of current treatments and suggest new therapeutic strategies helpful
for alleviating this disease. This article discusses the possible molecular mechanisms
for the pathogenesis of rosacea from current clinical observations and laboratory
research.
Keywords
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References
- Update on rosacea pathogenesis and correlation with medical therapeutic agents.Cutis. 2006; 78: 97-100
- Etiology, pathogenesis, and subtype classification.J Am Acad Dermatol. 2004; 51 (327-41; quiz): 42-44
- Standard classification of rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea.J Am Acad Dermatol. 2002; 46: 584-587
- Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea.J Am Acad Dermatol. 2004; 50: 907-912
- Ann Rev Immunol. 2003; 21: 335-376
- Intracellular pattern recognition receptors in the host response.Nature. 2006; 442: 39-44
- Cutaneous injury induces the release of cathelicidin anti-microbial peptides active against group A Streptococcus.J Invest Dermatol. 2001; 117: 91-97
- Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea.Nat Med. 2007; 13: 975-980
- LL-37, the neutrophil granule- and epithelial cell-derived cathelicidin, utilizes formyl peptide receptor-like 1 (FPRL1) as a receptor to chemoattract human peripheral blood neutrophils, monocytes, and T cells.J Exp Med. 2000; 192: 1069-1074
- An angiogenic role for the human peptide antibiotic LL-37/hCAP-18.J Clin Invest. 2003; 111: 1665-1672
- Syndecans, cell surface heparan sulfate proteoglycans, are induced by a proline-rich antimicrobial peptide from wounds.Proc Natl Acad Sci USA. 1994; 91: 11035-11039
- Kallikrein-mediated proteolysis regulates the antimicrobial effects of cathelicidins in skin.FASEB J. 2006; 20: 2068-2080
- Identification of a key pathway required for the sterile inflammatory response triggered by dying cells.Nat Med. 2007; 13: 851-856
- Recognition of hyaluronan released in sterile injury involves a unique receptor complex dependent on Toll-like receptor 4, CD44, and MD-2.J Biol Chem. 2007; 282: 18265-18275
- Injury enhances TLR2 function and antimicrobial peptide expression through a vitamin D-dependent mechanism.J Clin Invest. 2007; 117: 803-811
- Perioral dermatitis.Br J Dermatol. 1972; 87: 430-434
- Rosacea-like dermatitis: contraindication or intolerance reaction to strong steroids.Br J Dermatol. 1972; 86: 253-259
- Perioral dermatitis.Br J Dermatol. 1979; 101: 259-262
- Perioral dermatitis: a 12-year review.Br J Dermatol. 1979; 101: 245-257
- Glucocorticoids Enhance Toll-Like Receptor 2 Expression in Human Keratinocytes Stimulated with Propionibacterium acnes or Proinflammatory Cytokines.J Invest Dermatol. 2008;
- Rosacea: a study of clinical patterns, blood flow, and the role of Demodex folliculorum.J Am Acad Dermatol. 1992; 26: 590-593
- Enhanced skin blood flow and sensitivity to noxious heat stimuli in papulopustular rosacea.J Am Acad Dermatol. 2007;
- Rosacea: an update.Dermatology. 2005; 210: 100-108
- Successful treatment of the erythema and flushing of rosacea using a topically applied selective alpha1-adrenergic receptor agonist, oxymetazoline.Arch Dermatol. 2007; 143: 1369-1371
- Lymphangiogenesis and angiogenesis in non-phymatous rosacea.J Cutan Pathol. 2007; 34: 748-753
- Ultraviolet B and H2O2 are potent inducers of vascular endothelial growth factor expression in cultured keratinocytes.J Biol Chem. 1996; 271: 21793-21797
- Induction of keratinocyte migration via transactivation of the epidermal growth factor receptor by the antimicrobial peptide LL-37.J Immunol. 2005; 175: 4662-4668
- The antimicrobial peptide LL-37 activates innate immunity at the airway epithelial surface by transactivation of the epidermal growth factor receptor.J Immunol. 2003; 171: 6690-6696
- Overexpression of vascular permeability factor/vascular endothelial growth factor and its receptors in psoriasis.J Exp Med. 1994; 180: 1141-1146
- Effect of antibiotics on the generation of reactive oxygen species.J Invest Dermatol. 1986; 86: 449-453
- Inhibitory effect of azelaic acid on neutrophil functions: a possible cause for its efficacy in treating pathogenetically unrelated diseases.Arch Dermatol Res. 1991; 283: 162-166
- The inhibition of free radical generation by human neutrophils through the synergistic effects of metronidazole with palmitoleic acid: a possible mechanism of action of metronidazole in rosacea and acne.Arch Dermatol Res. 1990; 282: 449-454
- Anti-oxidant effects of retinoids on inflammatory skin diseases.Arch Dermatol Res. 1986; 278: 177-183
- The effect of azithromycin on reactive oxygen species in rosacea.Clin Exp Dermatol. 2007; 32: 197-200
- Anti-inflammatory effects of erythromycin and tetracycline on Propionibacterium acnes induced production of chemotactic factors and reactive oxygen species by human neutrophils.Dermatol Online J. 2002; 8: 2
- The effect of azithromycin on reactive oxygen species in rosacea.Clin Exp Dermatol. 2007; 32: 197-200
- UVB activates ERK1/2 and p38 signaling pathways via reactive oxygen species in cultured keratinocytes.J Invest Dermatol. 1999; 112: 751-756
- H2O2 is an important mediator of UVB-induced EGF-receptor phosphorylation in cultured keratinocytes.J Invest Dermatol. 1998; 110: 966-971
- Reactive oxygen species in tumor necrosis factor-alpha-activated primary human keratinocytes: implications for psoriasis and inflammatory skin disease.J Invest Dermatol. 2008; 128: 2606-2614
- Roles of Reactive oxygen species in CXCL8 and CCL2 expression in response to the 30-kDa antigen of mycobacterium tuberculosis.J Clin Immunol. 2009; 29: 46-56
- ASK1-p38 MAPK-p47phox activation is essential for inflammatory responses during tuberculosis via TLR2-ROS signalling.Cell Microbiol. 2008; 10: 741-754
- The effects of ultraviolet A and reactive oxygen species on the mRNA expression of 72-kDa type IV collagenase and its tissue inhibitor in cultured human dermal fibroblasts.Arch Dermatol Res. 1996; 288: 39-44
- Molecular regulation of UVB-induced cutaneous angiogenesis.J Invest Dermatol. 1998; 111: 864-872
- Human keratinocytes express the three major splice forms of vascular endothelial growth factor.J Invest Dermatol. 1995; 104: 7-10
- Tumour necrosis factor-alpha is involved in the contrasting effects of ultraviolet B and ultraviolet A1 radiation on the release by normal human keratinocytes of vascular permeability factor.Br J Dermatol. 1998; 138: 221-224
- Functional changes induced by chronic UVA irradiation to cultured human dermal fibroblasts.Br J Dermatol. 2005; 153: 6-12
- Singlet oxygen may mediate the ultraviolet A-induced synthesis of interstitial collagenase.J Invest Dermatol. 1995; 104: 194-198
- Singlet oxygen induces collagenase expression in human skin fibroblasts.FEBS Lett. 1993; 331: 304-306
- Myeloid Differentiation Factor 88 Regulates Basal and UV-Induced Expressions of IL-6 and MMP-1 in Human Epidermal Keratinocytes.J Invest Dermatol. 2009; 129: 460-467
- Degradation of Corneodesmosome Proteins by Two Serine Proteases of the Kallikrein Family SCTE//KLK5//hK5 and SCCE//KLK7//hK7.J Invest Dermatol. 2004; 122: 1235-1244
- Corneodesmosomal Cadherins Are Preferential Targets of Stratum Corneum Trypsin- and Chymotrypsin-like Hyperactivity in Netherton Syndrome.J Invest Dermatol. 2006; 126: 1622-1632
- Biochemical and enzymatic characterization of human kallikrein 5 (hK5), a novel serine protease potentially involved in cancer progression.J Biol Chem. 2005; 280: 14628-14635
- Chemically modified tetracyclines as inhibitors of matrix metalloproteinases.Drug Resist Updat. 2004; 7: 195-208
- Tetracyclines: nonantibiotic properties and their clinical implications.J Am Acad Dermatol. 2006; 54: 258-265
- Doxycycline in the protection of serum alpha-1-antitrypsin from human neutrophil collagenase and gelatinase.Antimicrob Agents Chemother. 1993; 37: 592-594
- Matrix metalloproteinases and angiogenesis.J Cell Mol Med. 2005; 9: 267-285
- The Demodex mite population in rosacea.J Am Acad Dermatol. 1993; 28: 443-448
- Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy.Br J Dermatol. 1993; 128: 650-659
- The significance of Demodex folliculorum density in rosacea.Int J Dermatol. 1998; 37: 421-425
- Mite-related bacterial antigens stimulate inflammatory cells in rosacea.Br J Dermatol. 2007; 157: 474-481
- Role of chlamydial heat shock protein 60 in the stimulation of innate immune cells by Chlamydia pneumoniae.Eur J Immunol. 2002; 32: 2460-2470
- Helicobacter pylori heat shock protein 60 mediates interleukin-6 production by macrophages via a toll-like receptor (TLR)-2-, TLR-4-, and myeloid differentiation factor 88-independent mechanism.J Biol Chem. 2004; 279: 245-250
- Helicobacter pylori in patients with rosacea.Am J Gastroenterol. 1994; 89: 1603-1604
- Rosacea: a cutaneous marker of Helicobacter pylori infection? Results of a pilot study.Acta Derm Venereol. 2003; 83: 282-286
- Incidence of anti-Helicobacter pylori and anti-CagA antibodies in rosacea patients.Int J Dermatol. 2003; 42: 601-604
- The link between Helicobacter pylori infection and rosacea.J Eur Acad Dermatol Venereol. 2002; 16: 328-333
- Helicobacter pylori in rosacea: lack of an association.Arch Dermatol. 1998; 134: 511
- The seroprevalence of Helicobacter pylori and nitric oxide in acne rosacea.Int J Dermatol. 2002; 41: 768-770
- Helicobacter pylori eradication treatment reduces the severity of rosacea.J Am Acad Dermatol. 1999; 40: 433-435
- Has Helicobacter pylori eradication therapy any effect on severity of rosacea symptoms?.J Eur Acad Dermatol Venereol. 2005; 19: 398-399
- Effect of Helicobacter pylori eradication therapy in rosacea patients.Rev Esp Enferm Dig. 2006; 98: 501-509
- Helicobacter pylori infection induces oxidative stress and programmed cell death in human gastric epithelial cells.Infect Immun. 2007; 75: 4030-4039
- Production of reactive oxygen species in peripheral blood is increased in individuals with Helicobacter pylori infection and decreased after its eradication.Helicobacter. 2006; 11: 266-271
- Production of reactive oxygen species by gastric cells in association with Helicobacter pylori.Free Radic Res. 1996; 24: 439-450
- Plasma reactive oxygen species activity and antioxidant potential levels in rosacea patients: correlation with seropositivity to Helicobacter pylori.Int J Dermatol. 2004; 43: 494-497
- Toll-like receptor 4 regulates gastric pit cell responses to Helicobacter pylori infection.J Med Invest. 2001; 48: 190-197
- Toll-like receptor (TLR) 2 and TLR5, but not TLR4, are required for Helicobacter pylori-induced NF-kappa B activation and chemokine expression by epithelial cells.J Biol Chem. 2003; 278: 32552-32560
Article info
Publication history
Published online: July 12, 2010
Accepted:
April 29,
2009
Received in revised form:
April 27,
2009
Received:
February 28,
2009
Identification
Copyright
© 2009 Japanese Society for Investigative Dermatology. Published by Elsevier Inc. All rights reserved.