Treatment strategies, including antibiotics, to target the immune component of rosacea

ABSTRACT

Introduction

Recent advances in the understanding of the pathophysiology of rosacea have led to increased focus on the disease’s immunologic etiology and to the development of immunologically based treatments. With many patients suffering from incomplete control, addressing the immune components of the disease process may provide a more effective treatment option for rosacea patients that may improve quality of life.

Areas covered

This review will provide a brief overview of the pathophysiology of rosacea, as well as specific immunologic contributions to the disease state. Current standard-of-care treatments will be described, including anti-parasitic, anti-inflammatory agents, and antibiotics. Emphasis will be placed on treatments that target the immune components of the disease process.

Expert opinion

Rosacea remains a difficult dermatologic disease to treat, partially due to an incomplete understanding of the disease pathophysiology. The immune pathophysiology of rosacea, particularly the key role of inflammation, has been clarified over the past decade. Identification of specific molecules, including cytokines and nuclear transcription factors, may allow for the development of targeted rosacea-specific biologic and topical treatments. However, medication nonadherence is a limiting factor to achieving symptomatic control among rosacea patients. Focusing on the development of oral or injectable forms of therapy may circumvent poor adherence.

KEYWORDS:

• Immune
• immunotherapy
• rosacea
• rosacea pathophysiology
• rosacea treatment
• antibiotics

Article highlights

• Recent advances in the understanding of the pathophysiology of rosacea have led to increased focus on the disease’s immunologic etiology and to the development of immunologically based treatments.

• Current standard-of-care treatments for rosacea can be broken down into topical vs. systemic/oral agents, and fall under the general categories of anti-parasitic, anti-inflammatory, and antibiotic therapies.

• Identification of specific molecules, including cytokines and nuclear transcription factors, may allow for the development of targeted rosacea-specific biologic and topical treatments.

• Medication nonadherence is a limiting factor to achieving symptomatic control among rosacea patients.

Declaration of interest

S Feldman has received research, speaking and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, AbbVie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and National Psoriasis Foundation. He is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One peer reviewer declares holding an equity position in Praxis Biotechnology. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.