Rozase ve D Vitamini
Özet
Rozase, genellikle yüzün orta bölgesini tutan, kızarıklık, papül, püstül, telenjiyektazi ve fimatöz değişikliklerle seyreden kronik, inflamatuar bir hastalıktır. Kesin nedeni bilinmemekle birlikte genetik, çevresel faktörler ve immün disfonksiyon etyolojide rol oynar. Son yıllarda yapılan çalışmalar, D vitamininin doğal bağışıklık sistemindeki antimikrobiyal peptitlerden katelisidin (LL-37) salınımını tetiklediğini ve bu yolla rozase gelişiminde etkili olduğunu göstermektedir. Ultraviyole (UV) ışınları, keratinositlerde D vitaminini aktive ederek katelisidin ekspresyonunu indüklemekte, bu da anjiyogenez ve inflamatuar süreçleri başlatmaktadır. Klinik olarak eritematelenjiyektazik, papülopüstüler, fimatöz ve oküler olmak üzere dört ana alt tipe ayrılır. Çeşitli vaka-kontrol çalışmalarında, rozaseli hastalarda serum D vitamini düzeyleri sağlıklı kontrol gruplarına göre anlamlı derecede yüksek bulunmuştur. Hastalığın tedavisinde tetikleyici faktörlerden (güneş, sıcak/soğuk hava, alkol, baharatlı gıdalar) kaçınma ve bariyer onarımı temeldir. İlk basamakta topikal metronidazol, azelaik asit ve ivermektin gibi ajanlar kullanılırken; şiddetli olgularda sistemik antibiyotikler (özellikle FDA onaylı düşük doz doksisiklin), izotretinoin, beta-blokerler ve lazer tedavileri tercih edilmektedir.
Rosacea is a chronic, inflammatory skin disease primarily affecting the central face, characterized by erythema, papules, pustules, telangiectasia, and phymatous changes. Although its exact etiology remains unknown, genetic predisposition, environmental factors, and immune dysfunction play significant roles. Recent studies indicate that vitamin D triggers the release of cathelicidin (LL-37), an antimicrobial peptide in the innate immune system, thereby contributing to the development of rosacea. Ultraviolet (UV) radiation activates vitamin D in keratinocytes, inducing cathelicidin expression, which consequently stimulates angiogenesis and inflammatory processes. Clinically, it is classified into four main subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. Multiple case-control studies have demonstrated that serum vitamin D levels are significantly higher in patients with rosacea compared to healthy controls. Management primarily relies on avoiding triggering factors like sunlight, extreme temperatures, alcohol, and spicy foods, alongside barrier repair. First-line management includes topical agents such as metronidazole, azelaic acid, and ivermektin, whereas severe cases utilize systemic antibiotics—specifically FDA-approved low-dose doxycycline—isotretinoin, beta-blockers, and laser therapies.
Referanslar
Navarro-Trivino FJ, Arias-Santiago S, Gilaberte-Calzada Y. Vitamin D and the skin:a review for dermatologists Actas Dermosifiliorg. 2019;110:262-72.
Çifci N. D Vitamini düzeylerinin deri hastalıkları üzerine etkisinin retrospektif değerlendirilmesi Kocaeli Med J 2018;7(3):47-54.
Ekiz Ö, Balta İ, Bülbül Şen Bilge, et al. Vitamin D status in patients with rosacea Cutan Ocul Toxicol 2014;33(1):60-2.
Gür Aksoy G. Rozasea Türkiye Klinikleri J Dermatol 2015:8(3):28-34.
Turan H, Başkan E. Rozasenin tanı ve tedavisindeki yenilikler Türkiye Klinikleri J Dermatol 2016;9(2):100-7.
Gürel G, Karadöl M, Çölgeçen E. A case-control study on rosacea and vitamin D levels J Surg Med 2018; 2(3):269-72.
Park BW, Ha JM, Cho EB, et al. A study on vitamin D and cathelicidin status in patients with rosacea: serum level and tıssue expression Ann Dermatol 2018:30(2);136-42.
Sarıcaoğlu H, Ünal İ, Karaman G, Ferahbaş Kesikoğlu A, Karadağ AS, Şikar Aktürk A, Kalkan G. Akne ve Rozasea Tanı ve Tedavi Ünal İ Rozase 2018;335-450 Galenos Yayın Evi, İstanbul.
Akdoğan N, Allı N, İncel Uysal P, et al. Role of serum 25-hydroxyvitamin D levels and vitamin D receptor gene polymorphısms in patiens with rosacea: a case-control study Clin Exp Dermatol 2018;44(4):397-403.
Hagag MM, Bayomy NR, El-Horish DBM. Study of vitamin Dand calcium levels in patient with rosacea EJHM 2021; 84: 2405-10.
Aşkar Ş, Aşkar TK. Antimikrobiyel proteinler ve bağışıklıktaki önemi. Balıkesir Sağlık Bil Derg 2017; 6(2);82-6.
Nair R, Maseeh A. Vitamin D: The ‘’sunshine’’ vitamin J Pharmacol Pharmacother 2012;3(2):118-26.
Segaert S. Vitamin D regulation of cathelicidin in the skin: toward a renaissance of vitamin D in dermatology? J Invest Dermatol 2008; 128(4):773-5.
Palatsi R, Kelhada HL, Hagg P. New insights in the pathogenesis and treatment of rosasea. Duodecim. 2012;128(22):2327-35.
Salzar S, Kresse S, Hirai Y, Koglin S, Reinholz M, Ruzicka T, Schauber J. Cathelicidin peptide LL-37 increases UVB-triggered inflammasome activation:possible implications for rosacea. J Dermatol 2014;76(3):173-9.
Two AM, Wu W, Gallo RL, et al. Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol 2015; 72(5): 749-58;quiz 759-60.
Steinhof M, Schauber J, Leyden JJ. New insights into rosacea pathophysiology: a review of recent findings. J Am Acad Dermatol 2013;69:15-26.
Wirth PJ, Henderson BergMH, Sadick N. Real-world effcacy azelaic acid 15% gel fort he reduction of inflammatory lesıons of rosacea. Skin Therapy Lett 2017;22:5-7.
Coda AB, Hata T, Miller J, et al. Cathelicidin, kallikrein 5 and serin protease activity is inhibited during treatment of rosacea with azelaic acid 15% gel. J Am Acad Dermatol 2013;69(4):570-7.
Liu RH, Smith MK, Basta SA, Farmer AR. Azelaic acid in the treatment of papulopustuler rosacea:a systematic review of randomized controlled trials Arch Dermatol 2006;142(8):1047-5233.
Two AM, Hata TR, Nakatsuji T, et al. Reduction in serine protease activity correlates with improved rosacea severity in a small, randomized pilot study of a topical serine protease inhibitor. J Invest Dermat 2014;134:1143-5.
Muto Y, Wang Z, Vanderberghe M, et al. Mast cells are key mediators of cathelicidin-initiated skin inflammation in rosacea. J Invest Dermatol 2014;134:2728-36.
Zhang H, Tang K, Wang Y, et al. Rosacea treatment :review and update. Dermatol Ther (Heidelb) 2021;11(1):13-24.
Chen L, Tsai TF. The role of β-blockers in dermatological treatment: a review. J Eur Acad Dermatol Venereol. 2018;32(3):363–71.
Logger JGM, Olydam JI, Driessen RJB. Use of beta-blockers for rosacea-associated facial erythema and flushing: a systematic review and update on proposed mode of action. J Am Acad Dermatol. 2020 doi: 10.1016/j.jaad.2020.04.129.
Li J, Yuan X, Tang Y, et al. Hydroxychloroquine is a novel therapeutic approach for rosacea. Int Immunopharmacol. 2020;79:106178.
Zhang H, Tang K, Wang Y,et al. Use of Botulinum Toxin in Treating Rosacea: A Systematic Review Clin Cosmet Investig Dermatol 2021;14:407-17.
Amir Ali A, Vender R, Vender R. The role of IL-17 in papulopustular Rosacea and future directions. J Cutan Med Surg 2019;23(6):635–41.
