PHENOTYPE-BASED APPROACH IN THE TREATMENT OF ROSACEA: RELEVANCE AND PRACTICAL APPLICATION

Rosacea is a chronic inflammatory skin disorder with a multifactorial pathogenesis and a significant impact on patients’ quality of life. Despite its superficial resemblance to acne, rosacea is characterized by distinct pathophysiological mechanisms, including neurovascular dysregulation, alterations in innate immunity, TRP-channel hyperreactivity, dysregulation of the cathelicidin pathway, and involvement of microorganisms such as Demodex folliculorum. Disease manifestations are strongly influenced by external triggers, including ultraviolet radiation, temperature fluctuations, alcohol intake, spicy foods, and psychological stress. Recent advances have shifted the focus from subtype-based classification toward the phenotype-driven approach proposed by the ROSCO consensus group. This strategy enables individualized assessment of clinical signs and facilitates the selection of personalized therapy aimed at achieving “clear” or “almost clear” skin. Key management components include skincare optimization, trigger avoidance, lifestyle modification, and appropriate use of topical and systemic treatments. Among topical therapies, 1% ivermectin has gained relevance due to its dual anti-inflammatory and anti-Demodex effects. Clinical trials have demonstrated its superiority over metronidazole in reducing inflammatory lesions, prolonging remission, and improving overall treatment outcomes. Overall, contemporary management of rosacea relies on comprehensive targeting of pathogenic mechanisms, careful consideration of clinical phenotypes, and pursuit of durable disease control with meaningful improvement in patients’ quality of life.