Risk factors associated with rosacea

Biomarkers in rosacea: A systematic review

Rosacea is a chronic and psychologically ladened disease affecting 1%-3% of people worldwide. The identification and validation of biomarkers in rosacea patients has the potential to improve disease progression, support diagnosis, provide objective measures for clinical trials and aid in management. The objective of this review is to systematically identify all rosacea biomarkers, categorize them by type and identify trends to improve disease expression. Eligibility criteria for this review (PROSPERO CRD42023397510) include randomized controlled trials, case-control studies, cohort studies and other observational studies. No restrictions were placed on patient demographics (age, sex, ethnicity) or language of publication until February 2023. Quality of studies was assessed using the National Institute of Health quality assessment tool. The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of 805 unique articles were screened based on the applied inclusion and exclusion criteria. After the articles were screened based on title/abstract and full-text, a total of 38 studies were included, reporting on a total of 119 unique biomarkers. The results of this review and current rosacea pathogenic mechanisms provide the greatest support for the innate cathelicidin and inflammasome, Th1 and Th17 pathways. The most commonly reported biomarkers include IL-1β, TNF-α, IL-37, IFN-γ and MMP-9. Biomarkers identified in this study support current theories of rosacea pathogenesis and provide direction for research to further our knowledge. However, more research is needed to identify biomarkers panels that can provide diagnostic utility. This may be difficult due to the heterogeneity of the disease and potential differences between rosacea subtypes.

The causal relationship between blood metabolites and rosacea: A Mendelian randomization

BACKGROUND

An increasing amount of research demonstrates that metabolic disorders are related to rosacea. However, the correlations and causal relationships among them remain unknown.

METHODS

We conducted not only forward 2-sample MR (Mendelian randomization) analyses but also reverse MR analyses which showed positive results in the forward MR analysis. In the forward MR analyses, inverse-variance weighted (IVW) and MR-Egger were performed as MR analyses. Cochran's Q test and the MR-Egger Intercept were used for sensitivity analyses. Concerning reverse MR analyses, IVW, MR-Egger, weighted median, simple mode, and weighted mode were applied. Cochran's Q test, MR-Egger Intercept, and MR pleiotropy residual sum and outlier (MR-PRESSO) outlier test were applied as sensitivity analyses.

RESULTS

A total of 24 metabolites and 1 metabolite ratio were shown to have a causal effect on rosacea. N-lactoyl phenylalanine (N-Lac-Phe) was estimated as statistically significant by Bonferroni correction. Interestingly, we found three metabolites that were negatively associated with rosacea, especially caffeine, which are in line with the results of a large cohort study of females. For reverse MR analysis, we revealed that rosacea could potentially decrease the generation of two metabolites: octadecenedioate (C18:1-DC) and methyl vanillate sulfate.

CONCLUSION

This study identified blood metabolites that may be associated with the development of rosacea. However, the exact mechanism by which these positive metabolites influence rosacea remains uncertain due to the paucity of experimental investigations. The combination of genetics and metabolomics offers novel viewpoints on the research of underlying mechanisms of rosacea and has significant value in screening and prevention of rosacea.

Correlation between cigarette smoking and alcohol consumption and Rosacea: A two-sample Mendelian randomization study

BACKGROUND

Controversy persists regarding the causal relationship between Cigarette smoking, alcohol consumption, and Rosacea. This paper employs the Mendelian randomization (MR) method to elucidate the correlation between Cigarette smoking, alcohol consumption, and Rosacea. The aim is to contribute valuable insights to aid in the prevention and early treatment of Rosacea.

METHOD

Summary datasets for cigarette smoking parameters (Cigarettes smoked per day, Smoking status: Previous, smoking status: Current) and alcohol consumption (Alcoholic drinks per week) were selected alongside data for Rosacea from genome-wide association studies (GWAS). The Two-sample MR method was employed to analyze the correlation between cigarette smoking, alcohol consumption, and Rosacea. Various MR analysis methods, including inverse variance weighting (IVW), MR-Egger, Simple Mode, Weighted Mode, and Weighted Median, were chosen. IVW served as the primary analysis method.

RESULTS

The results indicate a significant negative association between Cigarettes smoked per day and Rosacea. Moreover, a significant positive correlation was observed between Smoking status: Previous and Rosacea. However, no significant associations were found between Smoking status: Current, Alcoholic drinks per week, and Rosacea.

CONCLUSION

This study provides further clarity on the association between cigarette smoking, drinking, and Rosacea through a two-sample MR analysis. Notably, the number of cigarettes smoked per day appears to be associated with a reduced incidence of Rosacea, while cigarette smoking cessation may increase the risk. Surprisingly, alcohol consumption does not emerge as a significant risk factor for Rosacea. These findings contribute to a nuanced understanding of the complex relationship between lifestyle factors and the occurrence of Rosacea, offering potential insights for preventive measures and early intervention.

Efficacy of Treatments in Reducing Inflammatory Lesion Count in Rosacea: A Systematic Review

INTRODUCTION

Rosacea is a chronic inflammatory skin condition affecting approximately 5.5% of the global population. Patients present heterogeneously with a mix of features in the central facial region, of which papules and pustules are considered to be a major feature. The identification of effective treatments for reducing inflammatory lesions in rosacea can alleviate the psychosocial burden that many rosacea patients experience, including reduced self-esteem, anxiety, and social withdrawal. The objective of this systematic review is to determine the effectiveness of topical and systemic therapies in reducing lesion count in rosacea patients.

METHODS/RESULTS

Medline, Embase, and Cochrane CENTRAL databases were searched, resulting in the inclusion of 43 clinical trials reporting on a total of 18,347 rosacea patients. The most well-studied treatments include ivermectin, metronidazole, azelaic acid, minocycline, and doxycycline. Oral isotretinoin was the most effective treatment in reducing inflammatory lesions and may be recommended for severe recalcitrant cases of rosacea.

CONCLUSIONS

Several topical and systemic therapies have demonstrated efficacy in reducing inflammatory lesion count in rosacea patients, with mechanisms of action centred around suppressing inflammation and killing Demodex folliculorum mites. Additional research is required to determine effective combination therapies in rosacea.

Association between rosacea and helicobacter pylori infection: A meta-analysis

BACKGROUND AND OBJECTIVES

The potential association between rosacea and a heightened prevalence of Helicobacter pylori (HP) infection has been previously suggested. However, existing studies offer inconsistent results. This systematic review and meta-analysis aimed to elucidate the relationship between rosacea and HP infection.

METHODS

We conducted comprehensive searches of PubMed, Embase, and Web of Science databases to identify relevant observational studies for our investigation. We utilized the random-effects model to aggregate the data to address the potential influence of heterogeneity among the studies on the outcome.

RESULTS

Our analysis incorporated twenty-five datasets from 23 case-control and cross-sectional studies, encompassing 51,054 rosacea patients and 4,709,074 controls without skin disease. The pooled results revealed a significantly higher prevalence of HP infection in individuals with rosacea compared to controls (odds ratio [OR]: 1.51, 95% confidence interval [CI]: 1.17-1.95, p<0.001; I2 = 79%). Subgroup analysis indicated an increased prevalence of HP infection in rosacea studies that utilized one (OR: 1.72, 95% CI: 1.11-2.66, p = 0.02; I2 = 76%) or more tests for HP infection (OR: 2.26, 95% CI: 1.29-3.98, p = 0.005; I2 = 56%). However, this association was not observed in population-based studies that determined HP infection based on prescription records for HP eradication drugs (OR: 0.90, 95% CI: 0.76-1.07, p = 0.024; I2 = 54%).

CONCLUSION

Rosacea may be significantly associated with a higher prevalence of HP infection. High-quality prospective studies with delicately controlled confounding factors are needed to determine if HP infection is a risk factor for rosacea.

Associations of serum gamma-linolenic acid levels with erythema severity and anxiety/depression status in patients with rosacea

BACKGROUND

The development of rosacea is suggested to be closely associated with lipid metabolism, inflammation, and anxiety/depression. Gamma linolenic acid (GLA) is a key factor participating in lipid metabolism, which is also confirmed to regulate the inflammatory response. However, the associations of serum GLA levels with rosacea severity and psychological status still remain unclear.

OBJECTIVE AND LIMITATIONS OF THE STUDY

The present study aimed to investigate the associations of gamma linolenic acid (GLA), a key factor participating in lipid metabolism and the inflammatory response, with rosacea severity and psychological status. The present study still had some limitations. First, this study is a cross-sectional study and does not provide longitudinal evidence about the relationship between GLA and rosacea; Second, the cohort in this study is also relatively small, and a larger cohort is needed in further investigation to reveal the potential role of lipid metabolism in the pathogenesis of rosacea.

METHODS

A total of 62 rosacea patients were consecutively recruited. Patient's Self-Assessment (PSA) scale and Clinician Erythema Assessment (CEA) as well as 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Patient Health Questionnaire (PHQ-9) were conducted to evaluate the degree of erythema severity and anxiety/depression, respectively. Serum GLA levels were determined by gas chromatography mass.

RESULTS

Lower levels of serum GLA in rosacea patients were observed (p<0.001), and subgroup analysis revealed that patients with higher-level GLA had lower scores of PSA, CEA, GAD-7 and PHQ-9. Moreover, Spearman correlation analysis uncovered that serum GLA levels were negatively associated with PSA, CEA, GAD-7 as well and PHQ-9 scores, respectively. Linear regression model found that serum GLA levels at baseline were a predictive factor for prognosis of clinical outcomes after 1-month conventional treatment.

CONCLUSION

The present study indicates that lower levels of serum GLA in rosacea patients are negatively associated with the degree of erythema and anxiety/depression status.

Efficacy of Low-Dose Isotretinoin in the Treatment of Rosacea: A Systematic Review and Meta-Analysis

Rosacea is a common cutaneous condition caused by persistent, recurring lesions in facial skin vessels. It is a chronic skin condition with a variety of clinical symptoms and an unknown cause. Rosacea begins with the widening of capillaries and a flushed appearance. Following that, telangiectasia appears, and reddened patches persist, particularly on the cheeks and nose. Erythema persists due to repeated vasodilation and telangiectasia. In addition, skin inflammation manifests as papules, pustules, lymphedema, and fibrosis. Despite recent advances in treatment, rosacea, a chronic inflammatory relapsing central facial dermatosis, can be extremely difficult to manage.  The purpose of this meta-analysis and systematic review was to evaluate the effectiveness of low-dose isotretinoin in the treatment of rosacea. Following the guidelines set forth by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), the researcher employed the following search terms in the EMBASE, Web of Science, PubMed, Cochrane Library, and Google Scholar databases to provide a therapeutic update relevant to clinical practice: "low dose isotretinoin," "isotretinoin and rosacea," "isotretinoin treatment of rosacea," and "effectiveness of isotretinoin in treating rosacea". The search was carried out by the researcher for articles published from February 2019 to February 2024. The articles included were all published in the English language. The overall frequency of patients with adverse events differed significantly between the groups treated with low-dose isotretinoin and the comparators (minocycline, pulsed dye laser, evening primrose oil, Lactobacillus plantarum, doxycycline, combined dose or placebo) (0.80, 95% CI 0.73 to 0.88, p = 0.0001). Sub-group analysis indicated that there was a difference between the interventions used in the treatments all in favor of low-dose isotretinoin treatment. The results showed that the moderate group had RR: 0.76, 95% CI: 0.44-1.30, I2 = 0%; the mild group had RR: 0.94, 95% CI: 0.56-1.57, I2 = 0%; and the group with severe rosacea had RR: 0.73, 95% CI: 0.47-1.13, I2 = 0%. According to this study, rosacea can be treated effectively with low-dose isotretinoin even in patients at severe stages of the disease by using the recommended dose once a week. Further, the intervention has also been shown to have fewer side effects on the patients. Therefore, this study recommends randomized controlled trials to be done to fully investigate the best combination options for isotretinoin on mild to severe rosacea based on the fact that some of the treatments combined have shown to be effective on treatment.

Rosacea: Pathogenesis and Therapeutic Correlates

Rosacea is a chronic inflammatory condition of which there is no cure. The pathogenesis of rosacea is likely multifactorial, involving genetic and environmental contributions. Current understanding suggests that pro-inflammatory pathways involving cathelicidins and inflammasome complexes are central to rosacea pathogenesis. Common rosacea triggers modulate these pathways in a complex manner, which may contribute to the varying severity and clinical presentations of rosacea. Established and emerging rosacea treatments may owe their efficacy to their ability to target different players in these pro-inflammatory pathways. Improving our molecular understanding of rosacea will guide the development of new therapies and the use of combination therapies.

The impact of smoking and alcohol consumption on rosacea: a multivariable Mendelian randomization study

Backgrounds

Observational studies have shown that cigarette smoking is inversely associated with risk of rosacea, However, it remains uncertain whether this association is causal or it is a result of reverse causation, and whether this association is affected by drinking behaviors.

Methods

This study utilized the summary-level data from the largest genome-wide association study (GWAS) for smoking, alcohol consumption, and rosacea. The objective was to investigate the effect of genetically predicted exposures to smoking and alcohol consumption on the risk of developing rosacea. Two-sample bidirectional Mendelian randomization (MR) was applied, accompanied by sensitive analyses to validate the robustness of findings. Furthermore, multivariable MR was conducted to evaluate the direct impact of smoking on rosacea.

Results

A decreased risk of rosacea was observed in individuals with genetically predicted lifetime smoking [odds ratio (OR)MR - IVW = 0.53; 95% confidence interval (CI), 0.318-0.897; P = 0.017], and number of cigarettes per day (ORMR - IVW = 0.55; 95% CI, 0.358-0.845; P = 0.006). However, no significant associations were found between initiation of regular smoking, smoking cessation, smoking initiation, alcohol consumption and rosacea. Reverse MR analysis did not show any associations between genetic liability toward rosacea and smoking or alcohol drinking. Importantly, the effect of lifetime smoking and the number of cigarettes per day on rosacea remained significant even after adjusting for alcohol consumption in multivariable MR analysis.

Conclusion

Smoking was causally related to a lower risk of rosacea, while alcohol consumption does not appear to be associated with risk of rosacea.

Recent Advances in the Management of Rosacea through Natural Compounds

Rosacea is a chronic skin disorder that affects more than 5% of the world's population, with the number increasing every year. Moreover, studies show that one-third of those suffering from rosacea report a degree of depression and are less compliant with treatment. Despite being the subject of prolonged studies, the pathogenesis of rosacea remains controversial and elusive. Since most medications used for the management of this pathology have side effects or simply do not yield the necessary results, many patients lose trust in the treatment and drop it altogether. Thus, dermato-cosmetic products with natural ingredients are gaining more and more notoriety in front of synthetic ones, due to the multiple benefits and the reduced number and intensity of side effects. This review is a comprehensive up-to-date report of studies that managed to prove the beneficial effects of different botanicals that may be useful in the short and long-term management of rosacea-affected skin. Based on recent preclinical and clinical studies, this review describes the mechanisms of action of a large array of phytochemicals responsible for alleviating the clinical symptomatology of the disease. This is useful in further aiding and better comprehending the way plant-based products may help in managing this complex condition, paving the way for research in this area of study.

Assessment of the Reliability and Clinical Applicability of ChatGPT's Responses to Patients' Common Queries About Rosacea

Objective

Artificial intelligence chatbot, particularly ChatGPT (Chat Generative Pre-trained Transformer), is capable of analyzing human input and generating human-like responses, which shows its potential application in healthcare. People with rosacea often have questions about alleviating symptoms and daily skin-care, which is suitable for ChatGPT to response. This study aims to assess the reliability and clinical applicability of ChatGPT 3.5 in responding to patients' common queries about rosacea and to evaluate the extent of ChatGPT's coverage in dermatology resources.

Methods

Based on a qualitative analysis of the literature on the queries from rosacea patients, we have extracted 20 questions of patients' greatest concerns, covering four main categories: treatment, triggers and diet, skincare, and special manifestations of rosacea. Each question was inputted into ChatGPT separately for three rounds of question-and-answer conversations. The generated answers will be evaluated by three experienced dermatologists with postgraduate degrees and over five years of clinical experience in dermatology, to assess their reliability and applicability for clinical practice.

Results

The analysis results indicate that the reviewers unanimously agreed that ChatGPT achieved a high reliability of 92.22% to 97.78% in responding to patients' common queries about rosacea. Additionally, almost all answers were applicable for supporting rosacea patient education, with a clinical applicability ranging from 98.61% to 100.00%. The consistency of the expert ratings was excellent (all significance levels were less than 0.05), with a consistency coefficient of 0.404 for content reliability and 0.456 for clinical practicality, indicating significant consistency in the results and a high level of agreement among the expert ratings.

Conclusion

ChatGPT 3.5 exhibits excellent reliability and clinical applicability in responding to patients' common queries about rosacea. This artificial intelligence tool is applicable for supporting rosacea patient education.

Advances in Relationship Between Alcohol Consumption and Skin Diseases

Throughout history, alcohol consumption has been an integral part of human culture. Alcohol consumption, alcoholism in particular, influences the onset and progression of liver diseases, neurological disorders, and multiple types of cancer. However, the role of alcohol consumption in influencing skin diseases has often been overlooked. In this review, we present the progress of research investigating the effects and potential mechanisms of action of alcohol consumption on acne, rosacea, psoriasis, atopic dermatitis, melanoma, and non-melanoma skin cancer.

Evaluation of Dermatological and Neurological Aspects of the Relationship between Rosacea and Headaches

This study aimed to investigate the relationship between rosacea and headaches, focusing on different subtypes, as well as the associated clinical features and triggering factors. In this prospective study, 300 patients diagnosed with rosacea and 320 control subjects without rosacea or any connected mast cell activation illness were included. Patients with rosacea were assessed by a dermatologist according to the 2019 updated rosacea classification (ROSCO panel). Accordingly, patients were classified based on their predominant rosacea subtype as follows: erythematotelangiectatic (ETR), papulopustular (PPR), or phymatous (RhR). Patients experiencing headaches were assessed using the International Headache Classification. Headaches were categorized as migraine, tension-type headaches (TTHs), secondary types (STHs), and cluster-type headaches (CTHs). The ratio of headache was 30.3% in the rosacea group, which did not show a significant difference compared to the control group (30.3% vs. 25.0%, p = 0.138). In 81.3% of rosacea patients with headaches, headache onset occurred after the diagnosis of rosacea. The rate of patients with headaches was higher in the ETR group compared to the PPR and RhR groups (35.2% vs. 16.2% vs. 23.1%, p = 0.007, respectively). In terms of headache subtypes, the rates of patients with migraine and STHs were higher in the ETR group compared to the PPR and RhR groups, while the rate of patients with TTHs was higher in the RhR group. A positive correlation was found between rosacea severity and migraine severity (r = 0.284, p < 0.05). Among the triggering factors for rosacea, only sunlight was found to be associated with headaches. Lower age, female gender, and moderate to severe rosacea severity were identified as independent factors increasing the likelihood of headaches. A significant portion of rosacea patients experience headaches. Particularly, different subtypes of rosacea may be associated with various types of headaches. This study, highlighting the connection between migraine and ETR, is a pioneering work that demonstrates common pathogenic mechanisms and potential triggers.

Rosacea pathogenesis and therapeutics: current treatments and a look at future targets

Rosacea is a chronic inflammatory skin condition associated with a significant health and economic burden from costs and loss of productivity due to seeking medical treatment. The disease encompasses multiple phenotypic manifestations involving a complex and multi-variate pathogenesis. Although the pathophysiology of rosacea is not completely understood, ongoing research is continually elucidating its mechanisms. In this review, current concepts of rosacea pathogenesis will be addressed which involve skin barrier and permeability dysfunction, the innate and adaptive immune systems, and the neurovascular system. More specifically, the cathelicidin pathway, transient potential receptor channels, mast cells, and the NLRP3 inflammasome pathway are various targets of current pharmacologic regimens. Future therapies may seek different mechanisms to act on current treatment targets, like the potential use of JAK/STAT inhibitors in ameliorating skin barrier dysfunction or TLR antagonists in alleviating cathelicidin mediated inflammation. Other potential treatments aim for entirely different molecular targets such as microvesicle particle mediated local and systemic inflammation. Ultimately rosacea is associated with a significant health and economic burden which warrants deeper research into its pathogenesis and resultant new treatment discovery.

Rosacea: Clinical Aspects and Treatments

GENERAL PURPOSE

To review the clinical presentation and treatment of rosacea.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Distinguish the clinical manifestations of rosacea subtypes.2. Identify pharmacologic and nonpharmacologic treatment options for patients who have rosacea.

Detecting potential causal relationship between inflammatory bowel disease and rosacea using bi-directional Mendelian randomization

The association between rosacea and inflammatory bowel disease (IBD) has been studied in previous observational studies. It is unclear, however, whether the association is causal or not. Independent genetic variants for IBD were chosen as instruments from published Genome-wide association studies (GWAS) studies involving 38,155 cases with an IBD diagnosis and 48,485 controls in order to investigate the causal effect of IBD on rosacea. Summarized data for rosacea were gathered from various GWAS studies that included 1195 cases and 211,139 controls without rosacea. Reverse-direction Mendelian randomization (MR) analysis was done to investigate the relationship between genetically proxied rosacea and IBD. With the use of the inverse variance-weighted (IVW), MR-Egger, and weighted median approaches, a 2-sample Mendelian randomization study was carried out. Analysis of heterogeneity and sensitivity was performed to examine the pleiotropy and robustness of effect estimates. The forward-direction of the MR study was to reveal that genetic predisposition to IBD including its two main subtypes: Crohn's disease (CD) and ulcerative colitis (UC) was associated with an increased risk of rosacea. The reverse-direction MR analyses did not demonstrate that a genetic predisposition to rosacea was associated with total IBD, UC and CD. Our findings provided evidence for a causal impact of IBD, UC, and CD on rosacea, but not vice versa. The elevated incidence of rosacea in patients with IBD should be recognized by doctors to make an early diagnosis and initiate specialized therapy.

Rosacea Topical Treatment and Care: From Traditional to New Drug Delivery Systems

Rosacea is a multifactorial chronic inflammatory dermatosis characterized by flushing, nontransient erythema, papules and pustules, telangiectasia, and phymatous alterations accompanied by itching, burning, or stinging, the pathophysiology of which is not yet fully understood. Conventional topical treatments usually show limited efficacy due to the physical barrier property of the skin that hinders skin penetration of the active ingredients, thereby hampering proper drug skin delivery and the respective therapeutic or cosmetic effects. New advances regarding the physiopathological understanding of the disease and the underlying mechanisms suggest the potential of new active ingredients as promising therapeutic and cosmetic approaches to this dermatosis. Additionally, the development of new drug delivery systems for skin delivery, particularly the potential of nanoparticles for the topical treatment and care of rosacea, has been described. Emphasis has been placed on their reduced nanometric size, which contributes to a significant improvement in the attainment of targeted skin drug delivery. In addition to the exposition of the known pathophysiology, epidemiology, diagnosis, and preventive measures, this Review covers the topical approaches used in the control of rosacea, including skin care, cosmetics, and topical therapies, as well as the future perspectives on these strategies.

Whole genome sequencing identifies genetic variants associated with neurogenic inflammation in rosacea

Rosacea is a chronic inflammatory skin disorder with high incidence rate. Although genetic predisposition to rosacea is suggested by existing evidence, the genetic basis remains largely unknown. Here we present the integrated results of whole genome sequencing (WGS) in 3 large rosacea families and whole exome sequencing (WES) in 49 additional validation families. We identify single rare deleterious variants of LRRC4, SH3PXD2A and SLC26A8 in large families, respectively. The relevance of SH3PXD2A, SLC26A8 and LRR family genes in rosacea predisposition is underscored by presence of additional variants in independent families. Gene ontology analysis suggests that these genes encode proteins taking part in neural synaptic processes and cell adhesion. In vitro functional analysis shows that mutations in LRRC4, SH3PXD2A and SLC26A8 induce the production of vasoactive neuropeptides in human neural cells. In a mouse model recapitulating a recurrent Lrrc4 mutation from human patients, we find rosacea-like skin inflammation, underpinned by excessive vasoactive intestinal peptide (VIP) release by peripheral neurons. These findings strongly support familial inheritance and neurogenic inflammation in rosacea development and provide mechanistic insight into the etiopathogenesis of the condition.

Differences in clinical characteristics of rosacea across age groups: A retrospective study of 840 female patients

BACKGROUND

Aging remains a common influencing factor for many diseases. Previous studies have shown that age is significantly associated with rosacea among female cases and that the incidence of rosacea increases with age. However, previous studies did not specifically analyze the clinical characteristics of different age groups.

OBJECTIVE

This study aimed to analyze and compare the clinical characteristics of female patients of rosacea among different age groups.

METHODS

We conducted a retrospective study of 840 female rosacea subjects and compared cutaneous features, aggravating factors, systemic diseases, and psychological states across age groups. The patients were divided into three groups according to their age at diagnosis: ≤30 years，31-44 years，and ≥45 years.

RESULTS

In our study, the mean age of subjects was 35.9 ± 10.23 years. The common symptoms included telangiectasia (82.6%), persistent erythema (82.0%), burning/stinging sensation (89.3%), dry sensation (74.0%), and pruritis (41.9%). Hot temperature (89.9%), emotional changes (67.3%), spicy food (55.6%), and sun exposure (50.7%) were the common aggravating factors. Some patients had comorbidities of systemic disorders (20.4%). Of the patients, 48.8% presented with anxiety and 35.2% with depression. The clinical characteristics were found to be significantly different among the different age groups. Middle-aged and older patients (≥45 years) were more likely to have more serious persistent erythema and telangiectasia. And these patients were relatively less affected by some of the influencing factors and had more systemic diseases of the digestive system, endocrine metabolic system, and cardiovascular system (p < 0.05).

CONCLUSION

We revealed the impact of age on the characteristics of rosacea, which indicated that the clinical features of rosacea are more complex and more difficult to treat in females over the age of 45.

Associations of polysocial risk score with incident rosacea: a prospective cohort study of government employees in China

Background

The associations between single risk factors and incident rosacea have been reported, but the effects of social risk factors from multiple domains coupled remain less studied.

Objectives

To quantify the influence of social determinants on rosacea comprehensively and investigate associations between the polysocial risk score (PsRS) with the risks of incident rosacea.

Methods

This was a prospective cohort study of government employees undertaken from January 2018 to December 2021 among participants aged >20 from five cities in Hunan province of China. At baseline, information was collected by a questionnaire and participants were involved in an examination of the skin. Dermatologists with certification confirmed the diagnosis of rosacea. The skin health status of participants was reassessed every year since the enrolment of study during the follow-up period. The PsRS was determined using the nine social determinants of health from three social risk domains (namely socioeconomic status, psychosocial factors, and living environment). Incident rosacea was estimated using binary logistic regression models adjusted for possible confounding variables.

Results

Among the 3,773 participants who completed at least two consecutive skin examinations, there were 2,993 participants included in the primary analyses. With 7,457 person-years of total follow-up, we detected 69 incident rosacea cases. After adjustment for major confounders, participants in the group with high social risk had significantly raised risks of incident rosacea with the adjusted odds ratio (aOR) being 2.42 (95% CI 1.06, 5.55), compared to those in low social risk group.

Conclusion

Our findings suggest that a higher PsRS was associated with an elevated risk of incident rosacea in our study population.

Mediation roles of neutrophils and high-density lipoprotein (HDL) on the relationship between HLA-DQB1 and rosacea

BACKGROUND

Though the previous genome-wide association studies found the association between HLA alleles and rosacea in the European populations, the data is lacking among the Asians. Moreover, neutrophils are important in the immune-related mechanism of rosacea, and dyslipidemia is closely related to rosacea. We aimed to explore the association between HLA genes and rosacea in Chinese rosacea patients, as well as the mediation effect of neutrophils, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) on the relationship between HLA genes and rosacea.

METHODS

A total of 249 rosacea and 150 controls were ranked by the international investigator global rosacea severity scores. HLA genes, neutrophils, HDL, and LDL were detected. And their mediation effects on the relationship between HLA and rosacea risk or severity were analysed.

RESULTS

HLA-DQB1*03:03 allele (OR = 41.89, 95% CI: 9.80 ∼ 179.09, p = 4.7*10^-7), HLA-DQB1*04:02 allele (OR = 0.16, 95% CI: 0.03 ∼ 0.81, p = 0.026) and HLA-DQB1*03:03/05:02 genotype (OR = 5.57, 95% CI: 1.13 ∼ 27.52, p = 0.0351) were significantly associated with rosacea. Moreover, HLA-DQB1*03:03 allele (b = 1.434, SE = 0.217, p = 2.0*10^-10), HLA-DQB1*05:01 allele (b = 0.894, SE = 0.33520, p = 0.008) and HLA-DQB1*03:03/06:01 genotype (b = 0.998, SE = 0.472, p = 0.040) were positively associated with rosacea severity. Furthermore, we found both neutrophils and HDL, instead of LDL, have mediation effects on the relationship between HLA-DQB1*03:03 and risk or severity of rosacea.

CONCLUSIONS

We discovered novel susceptible HLA alleles for rosacea in the Chinese population, and disclosed the mediation effect of neutrophils and HDL on the relationship between HLA-DQB1 and rosacea, implying a possible correlation between rosacea and inflammatory or metabolic factors, providing hints for future studies in the mechanism of rosacea. Key messagesHLA-DQB1*03:03 allele, HLA-DQB1*04:02 allele and HLA-DQB1*03:03/05:02 genotype were significantly associated with rosacea.HLA-DQB1*03:03 allele, HLA-DQB1*05:01 allele and HLA-DQB1*03:03/06:01 genotype were positively associated with rosacea severity.Neutrophils and HDL have mediation effects on the relationship between HLA-DQB1*03:03 and risk or severity of rosacea.

Clinical characteristics of combined rosacea and migraine

Background

An overlap between the skin disease rosacea and the headache disease migraine has been established; however, the magnitude of this overlap and the distribution between subtypes/phenotypes remains unclear.

Objective

The aim was to determine the magnitude of the overlap between rosacea and migraine, and to determine which subtypes/phenotypes were present in patients with concomitant rosacea and migraine.

Methods

In this cross-sectional study, 604 patients with a diagnosis of either rosacea or migraine were phenotyped through a face-to-face interview with clinical examination, to determine prevalence and phenotype of rosacea, and prevalence and subtype of migraine.

Results

We found a prevalence of migraine of 54% in patients with rosacea, and a prevalence of rosacea of 65% in patients with migraine. Concomitant migraine was significantly associated with the rosacea features flushing (odds ratio = 2.6, 95% confidence interval = 1.4–4.7, p = 0.002), ocular symptoms (odds ratio = 2.4, 95% confidence interval = 1.5–3.9, p < 0.001), and burning (odds ratio = 2.1, 95% confidence interval = 1.3–3.4, p = 0.002), whereas papules/pustules were inversely related with concomitant migraine (odds ratio = 0.5, 95% confidence interval = 0.3–0.8, p = 0.006). No association was found between concomitant migraine and centrofacial erythema, rhinophyma, telangiectasia, edema, or dryness. Concomitant rosacea was not associated with any specific migraine subtype in patients with migraine.

Conclusion

This study highlights a substantial overlap between rosacea and migraine, particularly in patients with certain rosacea features. Individuals with rosacea should be asked about concomitant migraine, and comorbidities should be considered when choosing between treatments.

Current research and clinical trends in rosacea pathogenesis

Background

Rosacea is a common and complex chronic inflammatory skin disorder, the pathophysiology and etiology of which remain unclear. Recently, significant new insights into rosacea pathogenesis have enriched and reshaped our understanding of the disorder. A systematic analysis based on current studies will facilitate further research on rosacea pathogenesis.

Objective

To establish an international core outcome and knowledge system of rosacea pathogenesis and develop a challenge, trend and hot spot analysis set for research and clinical studies on rosacea using bibliometric analysis and data mining.

Methods

A search of the WoS, and PubMed, MEDLINE, Embase and Cochrane collaboration databases was conducted to perform visual bibliometric and data analysis.

Results

A total of 2,654 studies were used for the visualization and 302 of the 6,769 outcomes for data analysis. It reveals an increased trend line in the field of rosacea, in which its fast-growing pathogenesis attracted attention closely related to risk, comorbidity and therapeutic strategies. The rosacea pathogenesis has undergone the great development on immunology, microorganisms, genes, skin barriers and neurogenetics. The major of studies have focused on immune and microorganisms. And keyword visualization and data analyses demonstrated the cross-talk between cells or each aspect of pathogenesis, such as gene-gene or gene-environment interactions, and neurological mechanisms associated with the rosacea phenotype warrant further research.

Limitations

Inherent limitations of bibliometrics; and reliance on research and retrospective studies.

Conclusions

The understanding of rosacea's pathogenesis has been significantly enhanced with the improved technology and multidisciplinary integration, but high-quality, strong evidence in favor of genomic and neurogenic requires further research combined with a better understanding of risks and comorbidities to guide clinical practice.

Carvedilol ameliorates persistent erythema of erythematotelangiectatic rosacea by regulating the status of anxiety/depression

The treatment of persistent erythema and rosacea flushing is extremely challenging, especially for patients with anxiety. The aim of this study was to verify the efficacy of carvedilol in rosacea patients with persistent erythema and flushing. A total of 156 patients were randomized to use oral carvedilol 5 mg bid (twice per day) (n = 105) or topical brimonidine (n = 51) for a 10-week period with 6 weeks of follow-up. Both the efficacy of carvedilol and the status of anxiety/depression were analyzed by patient self-assessment (PSA), clinician erythema assessment (CEA), generalized anxiety disorder (GAD-7), and patient health questionnaire-9 (PHQ-9). Our study found that carvedilol exerted a dramatic reduction in CEA/PSA scores and sting/burning sensation scores in comparison to topical brimonidine. Additionally, carvedilol treatment dramatically improved telangiectasia, erythema, and pigmentation with no obvious side effects. Patients with carvedilol treatment showed an improvement of depression/anxiety, as reflected by lower GAD-7 and PHQ-9 scores than patients with topical brimonidine. Notably, we found carvedilol treatment had better outcomes among patients under 30 years of age with rosacea younger than 30 years old. Conclusively, our findings reveal that carvedilol could quickly and effectively improve facial erythema, which might stem from the improved the status of anxiety/depression.

Relationships of Serum Homocysteine, Vitamin B12, and Folic Acid Levels with Papulopustular Rosacea Severity: A Case-Control Study

Background

Rosacea is a chronic inflammatory skin disease with a multifactorial etiology. Recently, associations between serum homocysteine (Hcy) levels and inflammatory skin diseases, such as psoriasis and hidradenitis suppurativa, have been reported. However, no study has explored the levels of serum Hcy, folic acid, and vitamin B₁₂ in patients with rosacea.

Objective

To investigate serum Hcy, vitamin B₁₂, and folic acid levels in patients with papulopustular rosacea (PPR), we characterized the association of these levels with PPR severity.

Methods

This case-control study included 138 PPR patients and 58 healthy controls. The serum levels of Hcy, vitamin B₁₂, and folic acid were measured. A correlation was assessed between disease severity and serum levels of Hcy, vitamin B₁₂, and folic acid.

Results

Serum vitamin B₁₂ and folic acid levels were significantly lower in PPR patients than in the healthy controls (p = 0.011 and p = 0.0173, respectively). Although serum Hcy levels did not significantly differ between PPR patients and healthy controls, PPR severity was positively correlated with serum Hcy levels (p < 0.001).

Conclusions

Our results suggest a possible association between hyperhomocysteinemia and vitamin B₁₂ deficiency in patients with PPR.

Rosacea and Dry Eye Disease

Ocular rosacea is a chronic potentially sight-threatening inflammatory condition, which can occur in approximately 20% of patients without skin involvement. However, an accurate diagnosis of ocular rosacea has not been defined yet due to its rather nonspecific symptoms and clinical findings. Therefore, this article updates the current recommendations for diagnosis and treatment of ocular rosacea and the previously published consensus recommendations from the ROSCO expert panel on the management of rosacea.

Depression and Anxiety in Rosacea Patients: A Systematic Review and Meta-Analysis

INTRODUCTION

Depression and anxiety are common among people with rosacea. However, the exact magnitude of the prevalence rate and odds ratios (ORs) for depression and anxiety, respectively, in rosacea patients is unclear, and no systematic review or meta-analysis of published data has yet been performed. We therefore performed as systematic review and meta-analysis to determine the prevalence rates and ORs for depression and anxiety in rosacea patients.

METHODS

We performed a systematic search of the PubMed, Embase and Medline databases for all observational studies published up to October 2020 that reported the prevalence rates and ORs for depression and anxiety in patients with rosacea. The primary outcome measures were prevalence rates and ORs for depression and anxiety in patients with rosacea. Heterogeneity across studies was assessed with the I² statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses.

RESULTS

A total of 14 studies involving 14,134,021 patients with rosacea were included in the systematic review and meta-analysis. The pooled prevalence of depression was 19.6% (95% confidence interval [CI] 15.0-24.3%) and that of anxiety was 15.6% (95% CI 11.8-19.3%). The prevalence of depression and anxiety was significantly lower in studies using clinical criteria to diagnose depression and anxiety (9.2 and 10.2%, respectively) than in those studies using screening tools (26.2% [P < 0.01] and 22.7% [P = 0.03], respectively). The methodological quality of the included studies greatly contributed to the heterogeneity. Patients with rosacea were more likely to experience depression (OR 2.21, 95% CI 1.79-2.72) and anxiety (OR 2.31, 95% CI 1.56-3.44) than healthy controls.

CONCLUSIONS

This systematic review and meta-analysis indicates that patients with rosacea are at a higher risk of experiencing depression and anxiety. More efforts are warranted to recognize and manage depression and anxiety in patients with rosacea.

Prevalence of Helicobacter pylori Infection Among Rosacea and Chronic Spontaneous Urticaria Patients in a Tertiary Hospital in Riyadh, Saudi Arabia

BACKGROUND

The multifactorial nature of rosacea and chronic spontaneous urticaria (CSU) pathogenesis complicates the achievement of satisfactory treatment outcomes. 13C urea breath test (UBT) has been identified as an accurate, non-invasive, and quick procedure to detect the presence of Helicobacter pylori (H. pylori) with high sensitivity and specificity.

OBJECTIVE

In this study, we aim to assess the correlation between H. pylori infection and rosacea and CSU patients.

METHODS

A cross-sectional, observational study was conducted on patients with rosacea and CSU in the dermatology clinic at King Khalid University Hospital in Riyadh, Saudi Arabia. History and physical examination were performed by a dermatologist. H. pylori 13C-UBT detection was performed in all subjects.

RESULTS

In total, 114 patients were included in this current study, with 41 rosacea and 73 urticaria patients. The vast majority of our subjects were females (96.5%). The mean (±SD) age was 42.3 (±12.7). More than half (58.8%) of the examined samples were positive for 13C-UBT; however, positive results were significantly higher in the rosacea patients (73.2%) compared to the urticaria group (50.7%), with a p-value of 0.019.

CONCLUSION

Our findings underline the significant association of H. pylori with rosacea and CSU regardless of the presence or absence of gastrointestinal symptoms. We thus recommend the inclusion of H. pylori testing in the routine workup of CSU and rosacea patients.

Alcohol consumption and the risk of rosacea: A systematic review and meta-analysis

BACKGROUND

Rosacea is a chronic inflammatory skin disease that affects people's life quality. It has been found to be related to many detrimental factors including ultraviolet exposure. However, the association between alcohol consumption and rosacea has long been debated.

AIMS

To elucidate this association, we conducted a systematic review and meta-analysis.

METHODS

We performed a systematic search of the literature published before February 16, 2021 on PubMed, Embase, and the Cochrane database and used a meta-analytic approach to calculate the pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs).

RESULTS

Finally, 14 eligible studies were identified, and alcohol consumption was not found to be a risk factor for rosacea. However, in subgroup analysis, alcohol consumption increased the risk of phymatous rosacea (PhR) and the pooled OR was 4.17 (95% CI = 1.76-9.91).

CONCLUSION

Overall, our study showed that alcohol consumption was a risk factor in phymatous rosacea (PhR). More studies of rosacea investigating sex distribution, alcohol intake levels, and types of alcoholic beverages consumed are needed in the future.

Immune signaling in rosacea

Rosacea is a common chronic skin disease affecting mostly people aged 40 and above, with currently no cure. When it affects the eyelids and periocular skin, it leads to dry eye and potentially corneal damage. Research performed over the last decade shed light into the potential mechanisms leading to skin hypersensitivity and provided promising avenues for development of novel, rational therapeutics aimed at reducing the skin inflammatory state. In this review, we discuss the current knowledge on the mechanisms of rosacea in general and of periocular skin-affecting disease in particular, identify key questions that remain to be answered in future research, and offer a disease model that can explain the key characteristics of this disease, with particular emphasis on a potential positive feedback loop that could explain both the acute and chronic features of rosacea.

Clinical Features and Risk Factors for Nasal Rosacea: A Hospital-Based Retrospective Study

Introduction

At present, some studies have reported that nasal rosacea may be an independent disease, but phenotypic characteristics and risk factors for nasal rosacea remain unknown. This study aimed to clarify the clinical features and explore the risk factors for nasal rosacea.

Methods

A hospital-based retrospective study was conducted, including 1615 rosacea patients and 1501 healthy individuals. The patients were divided into three groups based on the involved areas of the lesions (non-nasal, intermediate and nasal rosacea group). Their demographic data and clinical features were obtained from patients’ medical records, and risk factors of nasal rosacea were analyzed.

Results

There were 927 (57.4%), 647 (40.1%) and 41 (2.5%) cases in the non-nasal, intermediate and nasal rosacea groups, respectively. Of 41 patients with nasal rosacea, all (100.0%) had fixed erythema and 17 cases (41.5%) had phymatous changes. Compared with control group, male gender (adjusted odds ratio [aOR] = 2.39, 95% confidence interval [CI] = 1.14, 4.99), obesity (aOR = 3.19, 95% CI 1.86, 11.79) and alcohol use (aOR = 1.58, 95% CI 1.22, 5.40) were risk factors for nasal rosacea, but these three factors were not risk factors for non-nasal rosacea and intermediate rosacea groups. Among patients with nasal lesions (compared with patients without nasal phymatous changes), family history of rosacea was a risk factor (aOR = 2.12, 95% CI 1.01, 4.46) for nasal phymatous changes and Fitzpatrick IV skin type was a protective factor (aOR = 0.49, 95% CI 0.28, 0.86).

Conclusion

Nasal rosacea has relatively specific clinical features and independent risk factors, suggesting that it may be a special type of rosacea.

Clinical case of papulo-pustular rosacea

The article presents a clinical case of papulopustular rosacea from our own practice. First of all, the patient's anamnesis is extremely interesting: family history (his brother has episodes of reddening of the face), the onset of rosacea against the background of a stressful situation, the presence of gastric diseases, the connection with nutritional factors. One of the first mentions of rosacea belongs to Avicenna, who in his writings described the clinical picture of rhinophyma ("badschenan", later renamed "abedsamen"). The pineal nose, dotted with "serpentine" vessels, has traditionally been associated with excessive drinking. Currently, the role of alcohol as an etiological factor is not paramount, but its aggravating effect has been proven. Despite the typical picture of rosacea, our patient has been receiving therapy for seborrheic dermatitis and other diseases several times over the course of several years. Probably, the specialists had doubts about the possible diagnosis of rosacea in a male patient under the age of 30.

Low-dose isotretinoin versus minocycline in the treatment of rosacea

Rosacea is a common inflammatory facial skin condition affecting the adult population. Its papulopustular subtype is mainly treated pharmacologically by topical and oral antibiotics. For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective. However, no previous study has assessed the efficacy of once-weekly administered isotretinoin for papulopustular rosacea. For this purpose, a retrospective comparative study was conducted. For severe rosacea, 40 mg/week isotretinoin (24 patients) was administered. For mild to moderate rosacea, once-weekly 20 mg/week isotretinoin (28 patients) was compared with 100 mg/day minocycline (24 patients). Treatment courses lasted 4 to 7 months. Forty milligrams per week isotretinoin was highly effective for severe rosacea, achieving complete response (over 90% improvement) in 62.5% of patients and partial response (50%-90% improvement) in additional 29.2% of patients. Twenty milligrams per week isotretinoin and hundred milligrams per day minocycline showed comparable efficacy for mild to moderate rosacea (complete response of 10.7% vs 8.3% and partial response of 28.6% vs 33.3%, respectively). This study demonstrates that that the use of a weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea, including among patients with severe disease.

The association between rosacea and the condition of low tolerance to skincare of the facial skin: a case-control study in China

BACKGROUND

Patients with rosacea often complained of low tolerance to skincare.

AIM

To examine if the preexisted low tolerance to skincare is associated with rosacea the occurrence of the Chinese population.

METHODS

A retrospective case-control survey of 997 rosacea cases and 1012 skin-healthy controls was carried out in China. Low tolerance to skincare was evaluated based on the history of facial skin allergic reactions related to skincare in the past 5 years before the onset of rosacea. A comparative analysis was performed between the case and control groups by the chi-square test and the logistic regression analysis.

RESULTS

History of facial skin allergic reaction due to skin care products (OR = 5.110, 95% CI = 3.893-6.706) and skin care in beauty salons (OR = 3.002, 95% CI = 1.506-5.981) both presented a positive correlations with the occurrence of rosacea. Facial masks and cosmetics were two of the most common products causing facial allergic reaction. The OR values increased with the increased frequency of allergic reactions related to facial mask and cosmetics. In addition, the history of facial skin allergic reaction had a significantly associated with the severity of self-reported symptoms of rosacea including dryness, burning, stinging and itching.

CONCLUSIONS

The condition of low tolerance of the facial skin to skincare was closely associated with the occurrence of rosacea.

Radiofrequency Irradiation Modulates TRPV1-Related Burning Sensation in Rosacea

Rosacea is a skin inflammatory condition that is accompanied by not only redness and flushing but also unseen symptoms, such as burning, stinging, and itching. TRPV1 expression in UVB-exposed skin can lead to a painful burning sensation. Upregulated TRPV1 expression helps release neuropeptides, including calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptide, and vasoactive intestinal peptide, which can activate macrophage and inflammatory molecules. In this study, we found that radiofrequency (RF) irradiation reduced TRPV1 activation and neuropeptide expression in a UVB-exposed in vivo model and UVB- or heat-treated in an in vitro model. RF irradiation attenuated neuropeptide-induced macrophage activation and inflammatory molecule expression. Interestingly, the burning sensation in the skin of UVB-exposed mice and patients with rosacea was significantly decreased by RF irradiation. These results can provide experimental and molecular evidence on the effective use of RF irradiation for the burning sensation in patients with rosacea.

Characterization of rosacea in Chinese: An analysis of 254 cases

BACKGROUND

Rosacea is a common chronic inflammatory dermatosis with uncertainty of etiology. Although clinical features and risk factors of the disease in Caucasians have been reported, this information in Chinese is largely unavailable.

AIMS

To analyze the clinical features and associated risk factors of rosacea in Chinese.

METHODS

A questionnaire was given to outpatients with rosacea who visited the dermatology department of the first affiliated hospital of Kunming Medical University from June 2018 to March 2019. Analyses included demographic characteristics of subjects, clinical characteristics, and risk factors of rosacea.

RESULTS

A total of 254 outpatients completed the questionnaire. The ratio of female to male was 5.68:1.00. The mean age at onset was 31.18 ± 10.23 years. Erythematotelangiectatic subtype accounted for 51.60%, while 39% of the subjects were of papulopustular subtype. The rest were phymatous type (9.40%). Subjects with flushing, persistent facial erythema, and telangiectasia accounted for 91.73%, 90.55%, and 83.07%, respectively. One hundred and thirteen subjects (44.49%) had papules or pustules, and 24 subjects (9.40%) were with phymatous changes. The most commonly involved sites were the cheeks (93.31%), followed by the nose (82.68%), the perioral area (61.42%), and the forehead (51.97%). The clinical symptoms included burning (93.70%), dryness (90.55%), and itching (75.59%). The main risk factors were sun exposure (90.94%), temperature change (87.40%), etc. Fifty-one (20.08%) patients had comorbidities.

CONCLUSIONS

Rosacea mainly affects young females. The common signs and symptoms include flushing, persistent facial erythema, and burning. Sun exposure and temperature changes are the common risk factors. Patients can have comorbidities of systemic disorders.

Rosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut-Skin Axis of Rosacea

Rosacea is a chronic inflammatory disease with complicated pathophysiology that involves genetic and environmental elements and dysregulation of innate and adaptive immunity, neurovascular responses, microbiome colonization or infection, resulting in recurrent inflammation. Rosacea has been reported associated with various gastrointestinal diseases including inflammatory bowel disease, celiac disease, irritable bowel syndrome, gastroesophageal reflux disease, Helicobacter pylori (HP) infection, and small intestine bacterial overgrowth (SIBO). The link may involve common predisposing genetic, microbiota, and immunological factors, comprising the theory of the gut–skin axis. Although the evidence is still controversial, interestingly, medications for eradicating SIBO and HP provided an effective and prolonged therapeutic response in rosacea, and conventional therapy for which is usually disappointing because of frequent relapses. In this article, we review the current evidence and discuss probable mechanisms of the association between rosacea and gastrointestinal comorbidities.

Association between rosacea and smoking: A systematic review and meta-analysis

Rosacea is a chronic inflammatory disease of the centrofacial region. However, the association between rosacea and smoking remains controversial. To evaluate the association between rosacea and smoking, we performed a systematic review and meta-analysis. A comprehensive systematic search of literature published before October 15, 2020 on online databases (including Web of Science, PubMed, Cochrane Library, and Embase) was performed. The pooled odds ratios (ORs) were calculated. 12 articles were included, covering 80 156 controls and 54 132 patients with rosacea. Tobacco consumption was not found to increase the risk of rosacea. However, using subtype analysis (involving 5 articles), we found there was a decreased risk of rosacea in current smokers but an increased risk in ex-smokers. In addition, smoking appears to increase the risk of papulopustular rosacea and phymatous rosacea. Analysis of all included studies also showed that ex-smoking was associated with an increased risk, while current smoking was associated with a reduced risk of rosacea. In order to prevent many diseases, including rosacea, the public should be encouraged to avoid smoking.

Evolution of surgical modalities in the management of rhinophyma: our experience

Rhinophyma is a progressive disease of the nose, which is characterised by skin thickening and sebaceous hyperplasia. Patients with rhinophyma are often stigmatised due to worsening disfigurement of their nose. This can also result in functional impairment such as reduced nasal patency. Severe cases of rhinophyma are best managed with varied surgical interventions, as there is no clear 'gold standard' treatment that has been described. We present our experiences in the management of rhinophyma and the evolution of treatment modalities that have been employed over a nine-year period.

Cohort profile: COpenhagen ROsacea COhort (COROCO) and COpenhagen MIgraine COhort (COMICO)

PURPOSE

Migraine has consistently been connected with rosacea. Commonalities in epidemiology, trigger factors and associated neuropeptides support shared aetiology and pathophysiological pathways, though underlying mechanisms remain unclear. We established two cohorts of patients diagnosed with either migraine and/or rosacea. All patients were phenotyped in regard to migraine and rosacea. In this article, we describe the baseline parameters of the cohorts. In the future, we expect that these cohorts will help uncover potential disease overlaps and allow for prolonged follow-up through national Danish health registers.

PARTICIPANTS

COpenhagen ROsacea COhort (COROCO) and COpenhagen MIgraine COhort (COMICO) are prospective cohorts based in the Capital region of Denmark. Participants for COROCO were recruited primarily through two tertiary dermatology clinics in Copenhagen, Denmark and patients for COMICO were recruited through a tertiary neurology clinic in Copenhagen, Denmark.

FINDINGS TO DATE

COROCO: 67.7% women (median age 51 years (interquartile range (IQR) 43.0-61.0)). Family history of migraine: 44.3%. Family history of rosacea: 45%. There were 13% who currently smoked, and 36.6% were former smokers. Regular intake of alcohol was present in 79.3% (median 4 items/week (IQR 1.0-9.0)). Median body mass index (BMI): 25.7 (IQR 23.1-29.0). Median Dermatology Life Quality Index (DLQI): 2 (IQR 1-5).

COMICO

88.5% women (median age 41 years (IQR 29.5-51.0)). Family history of migraine: 73.4%. Family history of rosacea: 18.4%. There were 17.1% who currently smoked, and 26.0% former smokers. Regular intake of alcohol was present in 62.2% (median intake: 2 item/week (IQR 1.0-3.0)). Median BMI was 24.6 (IQR 21.5-28.2). Median DLQI was 1 (IQR 0-2).

FUTURE PLANS

COROCO and COMICO serve as strong data sources that will be used for future studies on rosacea and migraine with focus on risk factors, occurrence, treatment, natural history, complications, comorbidities and prognosis.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT03872050).

Radiofrequency irradiation attenuates angiogenesis and inflammation in UVB-induced rosacea in mouse skin

Rosacea is a skin inflammatory condition accompanied by cutaneous signs such as oedema, flushing, erythema, telangiectasia and pustules. Generally, rosacea is triggered by ultraviolet B (UVB) exposure. When exposed to UVB, skin epidermis thickens and produces elevated levels of pro-inflammatory cytokines, especially keratinocyte-related VEGF, a potent angiogenic factor. The upregulations of VEGF expression and its secretion promote the formation of new blood vessels and exacerbates rosacea. In this study, radiofrequency (RF) irradiation reduced keratinocyte proliferation in the epidermal layer, the expressions of pro-inflammatory cytokines, angiogenesis-related inflammatory factors and VEGF in our UVB-induced model of rosacea in vitro and in vivo. RF irradiation attenuated VEGF-induced angiogenesis-associated processes such as tube formation, cell migration and endothelial cell proliferation. Notably, blood vessel densities in the skins of UVB-treated mice and rosacea patients were significantly decreased by RF irradiation. These results provide experimental and molecular evidence regarding the effectiveness of RF irradiation for the treatment of rosacea.

Effects of skin care habits on the development of rosacea: A multi-center retrospective case-control survey in Chinese population

BACKGROUND

Certain cosmetic habits may trigger or aggravate rosacea, while there is little published epidemiologic evidence to support this point.

PURPOSE

To examine if daily skin care habits have an effect on the development of rosacea in Chinese population.

METHODS

A multi-center retrospective case-control survey of 1,245 rosacea cases and 1,538 skin-healthy controls was conducted in China. Participants completed the questionnaire comprised of demographic characteristics, socioeconomic data and daily skin care habits. Data were collected retrospectively and analyzed using the chi-square test and t-test. Multivariate logistic regression analyses were used to predict rosacea.

RESULTS

The multivariate logistic regression analysis highlighted some results: Dry, oily or mixed skin (OR = 6.3-6.9, P< .001), the usage of foaming cleanser (OR = 1.45, 95%CI 1.115-1.886, P = .01), make up more than 6 times a week (OR = 2.839, 95%CI 1.962-4.108, P< .001), using facial mask more than 4 times a week (OR = 2.56-3.069, P< .001), facial treatments at beauty salon more than once a week (OR = 4.946, 95%CI 2.005-12.198, P = .0018) and using beauty salon products (OR = 2.334, 95%CI 1.435-3.976, P = .0018) are positively correlated with the development of rosacea. Using of moisturizing products (OR = 0.602, 95%CI 0.386-0.983, P = .035) and sunscreen cream (OR = 0.303-0.507, P< .001 or P = .0167 for different frequency) presented significantly negative correlations with rosacea. Frequency of cleansing showed a nonlinear association with rosacea: using facial cleansers 1~3 times per week (OR = 0.647, 95%CI 0.429-0.975, P  =  .038) showed beneficial effects while using facial cleanser excessively (twice or more daily) (OR = 2.131, 95%CI 1.394-3.256, P< .001) positively correlated to rosacea strongly.

CONCLUSIONS

Excessive use of facial cleanser (twice or more a day) and facial mask (more than 4 times a week), frequent makeup (more than 6 times a week), regular skin care in beauty salon (more than once a week), and using beauty salon products were closely correlated to the development of rosacea in Chinese population.

Association of rosacea with inflammatory bowel disease: A MOOSE-compliant meta-analysis

Rosacea has been reported with several systemic comorbidities, but its relationship with inflammatory bowel disease (IBD) is unclear. Thus, our objective is to conduct a meta-analysis on the association of rosacea with IBD.We conduct a meta-analysis and searched MEDLINE, CENTRAL, and Embase databases for case-controlled and cohort studies that assessed the association of rosacea with IBD from inception to July 2nd, 2018. Two authors independently selected studies, extracted data, and assessed the risk of bias of included studies. Disagreement was resolved by discussion. We performed random-effects model meta-analysis to obtain the pooled risk estimates for Crohn disease (CD) and ulcerative colitis (UC) in patients with rosacea.We included three case-control and three cohort studies. The risk of bias of included studies was generally low. The meta-analysis on case-control studies showed marginally increased odds of CD (pooled odds ratio (OR) 1.30, 95% confidence interval (CI) 0.99-1.69) and a significantly increased odds of UC (pooled OR 1.64, 95% CI 1.43-1.89) in patients with rosacea. The meta-analysis on cohort studies demonstrated significant increased risk of CD (pooled hazard ratio (HR) 1.58, 95% CI 1.14-2.20) and UC (pooled HR 1.18, 95% CI 1.01-1.37) in patients with rosacea.The evidence indicates an association of rosacea with IBD. If patients with rosacea suffer from prolonged abdominal pain, diarrhea, and bloody stool, referral to gastroenterologists may be considered.

Association of Caffeine Intake and Caffeinated Coffee Consumption With Risk of Incident Rosacea in Women

Importance

Caffeine is known to decrease vasodilation and have immunosuppressant effects, which may potentially decrease the risk of rosacea. However, the heat from coffee may be a trigger for rosacea flares. The relationship between the risk of rosacea and caffeine intake, including coffee consumption, is poorly understood.

Objective

To determine the association between the risk of incident rosacea and caffeine intake, including coffee consumption.

Design, Setting, and Participants

This cohort study included 82 737 women in the Nurses' Health Study II (NHS II), a prospective cohort established in 1989, with follow-up conducted biennially between 1991 and 2005. All analysis took place between June 2017 and June 2018.

Exposures

Data on coffee, tea, soda, and chocolate consumption were collected every 4 years during follow-up.

Main Outcomes and Measures

Information on history of clinician-diagnosed rosacea and year of diagnosis was collected in 2005.

Results

A total of 82 737 women responded to the question regarding a diagnosis of rosacea in 2005 in NHS II and were included in the final analysis (mean [SD] age at study entry, 50.5 [4.6] years). During 1 120 051 person-years of follow-up, we identified 4945 incident cases of rosacea. After adjustment for other risk factors, we found an inverse association between increased caffeine intake and risk of rosacea (hazard ratio for the highest quintile of caffeine intake vs the lowest, 0.76; 95% CI, 0.69-0.84; P < .001 for trend). A significant inverse association with risk of rosacea was also observed for caffeinated coffee consumption (HR, 0.77 for those who consumed ≥4 servings/d vs those who consumed <1/mo; 95% CI, 0.69-0.87; P < .001 for trend), but not for decaffeinated coffee (HR, 0.80; 95% CI, 0.56-1.14; P = .39 for trend). Further analyses found that increased caffeine intake from foods other than coffee (tea, soda, and chocolate) was not significantly associated with decreased risk of rosacea.

Conclusions and Relevance

Increased caffeine intake from coffee was inversely associated with the risk of incident rosacea. Our findings do not support limiting caffeine intake as a means to prevent rosacea. Further studies are required to explain the mechanisms of action of these associations, to replicate our findings in other populations, and to explore the relationship of caffeine with different rosacea subtypes.