Reflectance Confocal Microscopy of Rosacea: Disease Features and Microscopic Changes During Vitamin A and Vitamin E Supplementation Therapy

Background: Rosacea is a chronic inflammatory skin disorder affecting the central face, often presenting with erythema, papules, pustules, and telangiectasia. Its pathogenesis involves dysregulation of the innate immune system, increased antimicrobial peptide (cathelicidin) activity, and microbial colonization, particularly by Demodex folliculorum and associated bacteria. Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that enables high-resolution visualization of skin structures, offering insights into the microscopic features of rosacea. Objective: This study aimed to analyze the morphological features of rosacea-affected skin using RCM and assess the clinical and microscopic effects of oral Vitamin A and E supplementation in patients with papulopustular rosacea (PPR). Methods: Fifteen patients with PPR (IGA score 2-3) were treated with oral Vitamin A (50,000 IU) and Vitamin E (50 mg) daily for a minimum of 12 weeks. Clinical evaluations included lesion counts, erythema, IGA and RASI score, and burning sensation. RCM parameters assessed included inflammatory cell types, vascular changes, and infundibular morphology. Paired t-tests, Wilcoxon signed rank tests, and McNemar’s Chi-squared test were used to compare baseline and posttreatment findings. Results: Significant reductions were observed in papules, pustules, erythema, and burning sensation scores. RCM analysis showed a reduction in dermal inflammatory cells and Demodex-infested infundibula. Discussion: Vitamin A and E supplementation was associated with clinical improvement and reduction in inflammatory and Demodex-related RCM features, suggesting a beneficial role in rosacea management. The findings highlight the potential of RCM as a noninvasive tool for monitoring rosacea treatment response. Further studies with larger sample sizes are needed to confirm these results.