Regulatory Mechanism of the HPA Axis in Neurogenic Rosacea

Abstract

Neurogenic rosacea is a special rosacea subtype marked by flushing, erythema, telangiectasia and burning pain. Its pathogenesis relies on complicated neuro immune skin barrier crosstalk that remains incompletely understood. As a core neuroendocrine system, the hypothalamic pituitary adrenal (HPA) axis participates in disease progression via stress response, neuroinflammation and skin barrier regulation. This review summarizes HPA axis physiology and its crosstalk with nerves, immunity and skin barrier. We highlight key dysregulated pathways in neurogenic rosacea including stress triggered axis hyperactivation, neurogenic inflammation, skin barrier damage and immune imbalance. Therapeutic strategies targeting the HPA axis and existing research limitations are also discussed, providing evidence for mechanistic study and clinical translation.