Facial dystonias and rosacea: is there an association?

Benign essential blepharospasm (BEB) and hemifacial spasm (HFS) belong to a spectrum of focal movement disorders that cause involuntary, spasmodic contractions of the eyelid and facial muscles. In our clinical experience, we have observed an increased prevalence of rosacea in patients who present with BEB and HFS. We investigate our clinical findings with a review of disease pathophysiology and treatment.

Retrospective study approved by the Ochsner Institutional Review Board and literature review. A total of 140 charts dated from 1990 to 2013 were reviewed, including 87 patients with BEB and 53 patients with HFS. Rosacea, BEB, and HFS were defined by standard diagnostic criteria.

Within our BEB and HFS patient cohort, approximately 15% of patients presented with rosacea, compared to the general American population prevalence rate of 1.34% (p < 0.001). Of the 140 patients reviewed, a total of 21 patients (13 with BEB and 8 with HFS) exhibited rosacea (p = 0.995).

Dry eye and tear instability often co-exist in patients with facial dystonias and rosacea, which may provide the initial drive towards tonic eyelid contractions and simultaneously exacerbate rosacea. Studies suggest that neurogenic inflammation and altered vasoregulation jointly contribute to the pathogenesis of rosacea. From our preliminary observations, we suggest the possibility of shared immune-inflammatory pathways involved in both facial dystonias and rosacea. Identification of common inflammatory mediators involved in both disease processes may facilitate a more targeted approach in drug treatment. Further biochemical analysis will likely be necessary to elucidate this potential association.