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Rosacea is a disorder the affects millions of people and remains unexplained in terms of its pathophysiology. Many hypothesis have been put forward bun none has led to the breakthrough that so many researchers want. I believe that this is due in part because of the nature of basic research that limits forward movement to small steps, each adding another piece to the puzzle, but not enough to allow for completion of the big picture. I have been fortunate enough to have treated a patient who developed Rosacea as a consequence of another medical problem, thus allowing me to start with the big picture and work back through the pathophysiology and determine how this could have happened. The disorder in question is renovascular hypertension which occurred as a result of an acute renal artery dissection. The renin angiotensin system is activated in this situation and the cascade of events that follows can both initiate and sustain a state of vasodilation in the vasculature of the face that results in the clinical expression of Rosacea. Hypertension and Rosacea are recognized as comorbid conditions that are linked in s severity dependent manner and the hypothesis presented in this paper explains why this is so. It also presents the Angiotensin AT2 receptor as a possible target for therapeutic intervention.

Rationale for the Treatment of Rosacea with an Angiotensin At2 Antagonist