title: Major pathophysiological correlations of rosacea: a complete clinical appraisal.
abstract: BACKGROUND
  Rosacea is a characteristic cutaneous disorder with a diverse clinical manifestations ranging from facial vascular hyper-reactivity to sebaceous gland hyperplasia. Many theories on pathophysiology of rosacea were proposed over the past decade, however the pathogenicity is poorly understood.
  
  
  OBJECTIVE
  To review the evidence on different pathophysiological correlations of rosacea.
  
  
  METHODS
  A literature search was conducted for studies published between 1990 to March 2014. The inclusion criteria was pathophysiology, randomized controlled trials, controlled trials on rosacea.
  
  
  RESULTS
  Out of 5141 articles, 14 high quality studies met all the selection criteria. Of 14 articles, 5 are randomized control trials (RCTs), 2 are controlled trial, 3 comparative trials, 2 observational trials, 1 prospective and 1 diagnostic trial. The studies were categorized into two groups: the trigger factors and sub-types & symptoms. Of 7 high quality studies, 4 provided strong evidence that immune responses causing disease triggered by external/internal factors such as sunlight, food and chemical agents, 3 trials provided significant evidence of microorganisms as causative agents. The remaining trials did not provide significant evidences on pathophysiology.
  
  
  CONCLUSIONS
  Vasculature, chronic inflammatory responses, environmental triggers, food and chemicals ingested and microorganisms either alone or in combination are responsible for rosacea. Many promising drugs are under various phases of clinical trials and interestingly, probiotics could also possibly be used as one of the treatment option.
authors.affiliation: 1. Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
authors.forename: Ravi Chandra
authors.initials: RC
authors.lastname: Vemuri
authors.affiliation: 1. Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
authors.forename: Rohit
authors.initials: R
authors.lastname: Gundamaraju
authors.affiliation: 1. Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
authors.forename: Shamala Devi
authors.initials: SD
authors.lastname: Sekaran
authors.affiliation: 2. Department of Trauma and Emergency, University Malaya Medical Center, 59100 Kuala Lumpur, Malaysia.
authors.forename: Rishya
authors.initials: R
authors.lastname: Manikam
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic; D005293:Ferritins / Q000378:metabolism; D006801:Humans; D008925:Mites; D019936:Probiotics / Q000494:pharmacology; D017382:Reactive Oxygen Species / Q000378:metabolism; D012393:Rosacea / Q000188:drug therapy* / Q000209:etiology / Q000469:parasitology / Q000503:physiopathology*; D012867:Skin / Q000469:parasitology
chemical_list: D017382:Reactive Oxygen Species; D005293:Ferritins
keywords: Chronic Inflammation; Rosacea; pathophysiology; randomized control trials.; vasculature