Publication:

Ocular and cutaneous rosacea: early diagnosis and comprehensive approach

Rosacea is a common chronic inflammatory disease, traditionally classified as a purely dermatological disorder. However, ocular involvement (ocular rosacea) occurs in up to 58% of patients and frequently precedes dermal manifestations, underscoring the need for early diagnosis and a transdisciplinary approach. Objective of the study was to analyze the common pathophysiological aspects, clinical criteria for early diagnosis, and current strategies for the comprehensive management of cutaneous and ocular rosacea. Literature review of scientific papers published in biomedical databases, focusing on the immunopathology of the disease, clinical manifestations according to current phenotypes, and topical, systemic, and light-based therapeutic profiles. The pathophysiology of rosacea is driven by a dysregulation of innate immunity (overexpression of LL-37 cathelicidin) and neurovascular dysfunction. Ocular rosacea shares this inflammatory cascade, manifesting primarily as meibomian gland dysfunction (MGD), blefaritis, and evaporative dry eye. Early diagnosis is crucial to prevent severe sequelae such as corneal neovascularization. In the therapeutic field, subantimicrobial-dose tetracyclines (doxycycline 40 mg) and topical 1% ivermectin stand out for their anti-inflammatory efficacy, while intense pulsed light (IPL) emerges as an effective dual alternative to simultaneously treat facial erythema and eyelid alteration. Rosacea is a complex-local pathology that requires transcending the boundary of isolated dermatology. A proper literature review of the evidence shows that cooperative work between dermatology and ophthalmology optimizes symptom control, prevents the progression of ocular damage, and mitigates the negative impact on the patient's quality of life.