Book Review: Pathogenesis and Treatment of Acne and Rosacea

Written by on February 4, 2016 in reviews with 1 Comment

A new comprehensive hard cover text book covering acne and rosacea was recently published. This 768 page tome is aimed at dermatologists and other professionals. The publicity for this book reads;

Pathogenesis and Treatment of Acne and Rosacea will be an indispensable reference for all physicians who care for patients with acne or rosacea and for scientists working in the field.

The $185 price tag means this book probably won’t be a impulse purchase by a new rosacea sufferer. Your best bet to read this book will probably be to check your a medical library near you.

Dr. Zouboulis made a draft electronic copy of this book available to me to review.



Christos C. Zouboulis (Editor)


Andreas Katsambas (Editor)


Albert M. Kligman (Editor)

Book Details

  • Title: Pathogenesis and Treatment of Acne and Rosacea, 2014 Edition
  • Hardcover: 768 pages
  • Publisher: Springer; 2014 edition (July 29, 2014)
  • Language: English
  • Available at


This book is by far the most thorough and detailed reference for rosacea currently available.

You will not find this material discussed with such detail and authority anywhere else.

The book starts with an excellent summary of the state of the art, describing where were are at as facing –

the high frequency of controversial, confusing, contradictory reports regarding almost every aspect of this common disease; viz., epidemiology, classification, prevalence, natural course, pathogenesis, etc.

Quoting Marks who further highlights the confusion confronting rosacea sufferers and their doctors –

the areas that provoke the most disagreements, viz., the role of sunlight (is it good or bad), blood flow (increased or decreased), therapies (some help, others hurt), how do we know it is rosacea and not acne, etc.

The book moves on to deal with the main areas of interest to researchers, doctors and rosacea sufferers – for eg. very recent discoveries relating to Cathelicidins.

Table of Contents

Here are the chapter sections that relate specifically to rosacea.

Hopefully by listing all of the sections here, and an example Core Message from each chapter, you will be able to get a taste of the contents of the book and decide whether you need to get hold of a copy.

Chapter 80. Rosacea: The State of the Art

  • Rosacea has a high psychological impact.
  • Cathelicidins play a major role in the development of rosacea’s cutaneous lesions.
  • Rosacea as an actinic lymphatic vasculopathy.
80.1Controversies in Rosacea
80.2Recent Advances in Studies of Rosacea
80.3A Quality of Life Instrument for Rosacea
80.4Cathelicidins Are Key Elements in the Pathogenesis of Rosacea
80.5Rosacea as an Actinic Lymphatic Vasculopathy

Chapter 81. The Vascular Concept

  • The most-cited pathogenic theory about rosacea centers on inherent abnormalities in cutaneous vascular homeostasis.
  • Ultraviolet (UV) light-induced skin changes, such as solar elastosis and ves- sel dilatation as well as immunosup- pression, have been accused to contribute in the development of rosacea.
81.2UV Light-Induced Skin Changes
81.3Dermal Matrix Degeneration
81.4Neuropeptides Mediate Effects of UV Radiation-Induced Immunosuppression
81.5Corticotropin-Releasing Hormone: the Responseto Peripheral Stress

Chapter 82. Rosacea and Neuropeptides

  • The cutaneous nervous system includes neuropeptides produced by cutaneous sensory nerves and skin cells, target cells, neuropeptide-degrading peptidases and other inflammatory mediators such as cytokines and neurotrophins. These components interact to allow adaptation to the external environment but, if uncon- trolled, can also contribute to neurogenic inflammation and disease.
82.2Substance P.
82.3Vasoactive Intestinal Peptide
82.4Calcitonin Gene Related Peptide
82.6Neurokinin A
82.7Corticotrophin Releasing Hormone

Chapter 83. Rosacea and Demodex folliculorum

  • Demodex mites are ubiquitous in normal adults.
  • Mites are increased in number in patients with papulopustular rosacea (PPR).
  • The relevance of the increased num- bers of mites in rosacea patients is unknown.
  • Microbiological studies of mite-related bacteria have revealed specific agents that may explain the role of antibiotic therapy in the management of inflam- matory rosacea.
83.3Prevalence in Man
83.4Demodex in Animals
83.5Demodex and Rosacea
83.6Counting Mites in Human Skin
83.7Demodex in Other Clinical Settings
83.9Possible Role of Demodex in Rosacea
83.9.1Cutaneous Microenvironment
83.9.2Obstruction of Sebum Flow
83.9.3Alteration of Follicular Milieu
83.9.4Alteration of Local Immune Reactivity
83.9.5Trauma and Foreign Body Reaction
83.9.6Toxic Waste
83.9.7Enzymatic Actions
83.9.9Surface Bacteria
83.10Practical Observation

Chapter 84. The Role of Adenosine Triphosphate in the Pathogenesis of Rosacea: An Explanation for the Mode of Action of Tetracyclines for the Treatment of Rosacea

  • Systemic (oral) treatments for rosacea include antibiotics such as tetracyclines, macrolides, and metronidazole, as well as oral isotretinoin.
  • The only FDA-approved systemic treat- ment for papulopustular rosacea is anti- inflammatory dose doxycycline 40-mg.
84.2Tetracyclines and the Dermal Matrix
84.3Current Developments
84.4Adenosine Triphosphate

Chapter 85. Standard Grading System for Rosacea

  • No fully validated score for grading of rosacea severity is available, but the Standard Grading System provides basic framework for disease quantification.
  • Patient input is important to the Standard Grading System.
85.2Technological Options for Measurement of Disease Severity in Rosacea
85.3Clinical Staging Versus Grading 85.4 Standard Grading System for Rosacea
85.5Trends in Disease Severity Assessment Methods

Chapter 86 Classical Clinical Presentations of Rosacea

  • The term “rosacea” does not refer to a single entity and is characterized by multiple clinical presentations that are best defined as major subtypes and vari- ants. Subtypes of rosacea may or may not share common clinical features and/ or pathophysiologic associations.
86.2Major Rosacea Subtypes
86.3Other Clinical Presentations of Rosacea
86.4Rosaceaform Clinical Presentations

Chapter 87. Rhinophyma: A Variation of Rosacea?

  • Rhinophyma pathogenesis includes seba- ceous gland hyperplasia, vascular sprout- ing, and dermal fibrosis.
  • Rhinophyma presents in four major types, i.e., glandular, fibrous, fibroangi- omatous, and actinic type.
87.1Introduction: Definitions
87.4Clinical Manifestations
87.5Etiology and Pathogenesis
87.6Laboratory Findings
87.7Trigger Factors

Chapter 88. Ocular Rosacea

  • Ocular involvement seems to be independent of the degree of cutaneous involvement.
  • Ophthalmological diagnoses are blepharitis with or without conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and keratitis.
  • Most common cutaneous signs are teleangiectasia, irregularity of lid mar- gins, and meibomian gland dysfunction.
  • Main symptom is a foreign body sensa- tion and dry, irritated eyes, burning, itching, and tearing.
88.3Etiology and Pathogenesis
88.4Clinical Manifestations

Chapter 89. Childhood Rosacea

  • Rosacea rarely affects children.
  • Childhood rosacea may present with facial erythema, telangiectasias, flush- ing, papules and pustules, localised to the cheeks, chin and the nasolabial folds.
89.2Clinical Characteristics of Childhood Rosacea
89.3Differential Diagnosis of Rosacea in Childhood
89.4Treatment of Childhood Rosacea

Chapter 90. Differential Diagnosis of Rosacea

  • Examination of the face must be completed by examination of the skin of the rest of the body including scalp, nails, and mucous membranes.
  • Acne vulgaris, steroid-induced acne, seborrheic dermatitis, perioral dermatitis, and lupus erythematosus are among the most common dermatoses that can be confused with well established erythematotelangiectatic and papulopustu- lar rosacea.
90.2Differential Diagnosis Related to Acne Stages and Subtypes
90.2.1Stage I. (Pre-rosacea—Subtype 0)
90.2.2Stage II (Erythematotelangiectatic Subtype 1)
90.2.3Stage III (Papulopustular—Subtype 2)
90.2.4Stage IV. (Phymatous—Subtype 3)

Chapter 91. A Treatment Strategy for Rosacea

  • Only a few treatments have been proved effective in randomized clinical trials— Most treatment require the off-label use of available medications approved for other conditions.
91.2Erythematotelangiectatic Rosacea
91.2.1Erythema and Persisting Erythema
91.2.2Flushing and Blushing
91.3Papulopustular (Inflammatory) Rosacea
91.3.1Topical Therapies
91.3.2Systemic Therapies
91.3.3Plaques (Cellulitis)
91.3.4Demodex Folliculitis
91.4Phymatous Rosacea
91.4.1Hyperplastic Phymas
91.4.2Mucinous Phymas
91.5Ocular Rosacea
91.6Sensory Rosacea

Chapter 92. Topical Treatment of Rosacea

  • Topical rosacea treatments include metronidazole (0.75, 1 %), sodium 10 % with sulfur 5 %, azelaic acid (15, 20 %), benzyol peroxide, clindamycin, and erythromycin.
  • Topical treatment with metronidazole or azelaic acid is recommended for mild to moderate rosacea. Both compounds can be used in maintenance therapy.
  • Moisturizers may help to reduce redness and symptoms of dryness, burning, irritation, and itch.
92.2Topical Metronidazole
92.3Topical Azelaic Acid
92.4Topical Calcineurin Inhibitors
92.5Topical Antibiotics Other Than Metronidazole
92.6Vitamin-Receptor Antagonists
92.7Other Topical Compounds
92.8Topical Cleansers and Moisturizers
92.9Topical Sunscreens
92.10Topical Treatment in Ocular Rosacea

Chapter 93. Systemic Treatment

  • Systemic (oral) treatments for rosacea include antibiotics such as tetracyclines, macrolides, and metronidazole, as well as oral isotretinoin.
  • The only FDA-approved systemic treatment for papulopustular rosacea is antiinflammatory dose doxycycline 40 mg.
  • Doxycycline inhibits the activity of matrix metalloproteinases (MMPs) in human skin. So, it prevents the tryptic KLK activation by MMPs and the production of the active antimicrobial peptide LL-37 (cathelicidin).
93.2Overview of the Treatment Principles
93.3Systemic Therapies for Rosacea
93.3.1Antibiotics: Tetracyclines, Macrolides, Metronidazole
93.5Oral Zinc Sulfate
93.6Other Oral Therapies
93.7Systemic Therapies for Rosacea: Where Do We Stand?
93.8Future Perspectives

Chapter 94. Laser and Light Therapy of Rosacea

  • Faster and more complete symptom resolution can be achieved by laser and IPL when they are paralleled with topical and oral rosacea treatment agents. Though high cost is a practical problem in clinics, these non-ablative lasers are well tolerated and have little side effects. In addition to erythema, these laser therapies may induce remodeling of abnormal dermal connective tissue by thermally induced fibroblast or endothelial damage.
94.1Vascular Laser
94.2Intense Pulsed Light
94.3Other Laser Therapies in Rosacea

Chapter 95. Nonclassical Treatments

  • Emerging treatments results from anti- inflammatory activity of certain compounds like zinc, neurophysiological activity like oxymetazoline or ondansetrone, or probably from antifibrotic compounds in the future.
95.2Treatment of Flushing
95.3Treatment of Teleangiectasias and Vascular Sprouts
95.4Treatment of Papulopustules (Inflammatory Rosacea)
95.5Treatment of Phymas
95.6Treatment of Ocular Rosacea

Chapter 96. Cosmetics in Rosacea

  • Skin care products and cosmetics can be valuable in the rosacea patient to complement prescription therapies and provide redness camouflage.
  • Cleansers for rosacea patients should preserve the intercellular lipids while maintaining a healthy biofilm.
  • Moisturizers for rosacea patients should assist in barrier repair and provide broad-spectrum photoprotection.
  • Cosmeceuticals with anti-inflammatory properties may be a useful adjunct to traditional therapy in some rosacea patients.
96.2Sensitive Skin and Rosacea
96.3Facial Product Testing for Sensitive Skin
96.4Facial Cleansers
96.5Facial Moisturizers
96.6Facial Cosmeceuticals
96.7Facial Camouflaging Cosmetics
96.8Facial Cosmetics and Skin Care in the Problem Patient

Chapter 97. Treatment of Rhinophyma

  • The cornerstone of drug therapy of rhinophyma in milder cases is systemic isotretinoin.
  • The more advanced cases of rhinophyma need a surgical approach. Healing by secondary intention is the gold standard with superior cosmetic outcome.
97.2Retinoid Therapy
97.3Antifibrotic Treatment
97.4Ablative Treatment

Chapter 98. The Future of Rosacea Treatment

  • Some complementary and alternative medicines have effects, such as anti-inflammatory and antimicrobial actions, that may impact on rosacea.
  • Low-dose antimicrobial agents, topical benzoyl peroxide, trichloroacetic acid skin peels and photodynamic therapy have been shown to be effective in papulopustular rosacea (PPR).
  • The development of drugs directed at sebaceous gland hypertrophy may aid patients with phymatous rosacea.
98.2Classification of Rosacea
98.3Present Treatmentand Future Options
98.3.1ErythematotelangiectatiRosacea (Subtype 1)
98.3.2Papulopustular Rosacea (Subtype2)
98.3.3Phymatous Rosacea (Subtype 3)
98.3.4Ocular Rosacea (Subtype 4)

Chapter 99. Impact of Rosacea on Quality of Life

  • The impact of rosacea may extend far beyond the physical lesions into the psyche of patients.
  • Low self esteem, low self confidence, social anxiety, depression and social avoidance behaviour are important ways in which a rosacea patient’s quality of life may be impacted.
  • Emotional distress can both be a triggering factor as well as a consequence of rosacea.
  • The magnitude of quality of life impact may vary with different types of rosacea.
99.2Quality of Life Impact of Rosacea
99.3Measurement of Quality of Life in Rosacea Patients

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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1 Reader Comment

  1. mouse38 says:

    This book certainly sounds comprehensive. Thanks so much for this (& all your other) helpful & informative posts.

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