Corneal Confocal Microscopy Identifies Neurodegeneration in Relation to Disease Severity and Neuropathic Symptoms in Rosacea

Abstract

Rosacea affects at least 20 million people worldwide and is characterized by erythema, papules, pustules, telangiectasia, fibrosis, and burning sensation of the facial skin (Steinhoff and Bergstresser, 2011). The underlying pathophysiology of rosacea is complex, although neurogenic inflammation is thought to play an important role, and altered cutaneous sensitivity is a hallmark of rosacea (Sulk et al, 2012). Ocular rosacea may affect >50% of patients with rosacea and is characterized by dryness and foreign body sensation (Sinikumpu et al, 2022). Corneal confocal microscopy (CCM) is a noninvasive ophthalmic imaging technique that has been used to identify neurodegeneration in diabetic and other peripheral and central neurodegenerative diseases (Petropoulos et al, 2020) and to identify corneal conjuctivalization (De Nicola et al, 2005) and meibomian and skin gland alterations (Liang et al, 2017) in patients with rosacea. We now seek to demonstrate the utility of CCM to assess neurodegeneration in relation to disease onset and progression, subtypes, and treatment efficacy in patients with rosacea.