rosacea: its all in the follicles !

Written by on November 25, 2005 in research with 0 Comments

A article on a paper recently highlighted by Rosacea News was no histological pattern for rosacea. The title of that paper was Rosacea: a clinicopathological approach. That paper appeared as article in `Dermatology’ in 2004.

An editorial preceding that article is titled “The histopathology of rosacea: ‘where’s the beef?’“, by Powell, F.C. from the Regional Centre of Dermatology, Mater Hospital, Dublin.

If you look at the PubMed extract you will only see the editorial title. Dr. Powell was kind enough to provide a copy of his editorial. The editorial poses the question “after so much time and effort, why can we still not find a histological explanation for rosacea ?“.

Here are some comments lifted from the editorial that I believe captures the thrust of the editorial.

The understanding of the pathogenesis of rosacea has been hindered in the past by poor clinical definition of the disease and an over-emphasis on the possible role of actinic damage and vasodilation in its causation. Histological findings have therefore been diverse and often interpreted in an effort to fit a hypothesised pathogensis.

The recurring finding of follicular inflammation has either been dismised as irrelevant or explained on the basis of involvement of the perifollicular vasculature.

In my opinion we should try looking in the follicles !

The recurring finding of follicular inflammation and in particular the almost exclusive localisation of the neutrophilic componenent of the infiltrate to the follicular epthelium or epidermis adjacent of the follicular ostium, together with the frequent evidence of follicular rupture and granuloma formation of the foreign-body type (almost certainly a reaction to extruded follicular epithelium or contents), has been minismised in the past. A re-evaluation of the widely accepted vascular pathogenesis of this common facial dermatosis is now merited, and a reassessment of the follicle and its contents as a potential central focus of the inflammatory process is urgently required.

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

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