Elsevier

Dermatologic Clinics

Volume 36, Issue 2, April 2018, Pages 115-122
Dermatologic Clinics

Rosacea Comorbidities

https://doi.org/10.1016/j.det.2017.11.006Get rights and content

Section snippets

Key points

  • Several comorbidities have been found to be associated with rosacea, including cardiovascular diseases, depression, gastrointestinal disorders, malignancies, neurologic diseases, and autoimmune conditions.

  • Although the exact etiologic factors of rosacea remain to be elucidated, the physiopathology of rosacea is multifactorial, and numerous cell and molecular mechanisms may contribute to the development of rosacea and its comorbidities.

  • A chronic inflammatory state may be the underlying mechanism

Methods

A review of English-language articles was performed using PubMed and Google Scholar. Search terms included rosacea, comorbidities, depression, CVD, autoimmune disease, malignancy, and neurologic disorders. Results were categorized by the comorbidity associated with rosacea or by pathophysiologic relationship linking rosacea to a comorbid condition. Results included information since the first description of the association between migraines and rosacea in 1976, as well as more contemporary

Cardiovascular Diseases

Inflammation plays a key role in the pathogenesis of rosacea and is an established risk factor in the development of atherosclerosis and its complications. Rosacea and atherosclerosis share the upregulation of cathelicidin in inflammatory cells and low serum paraoxonase-1 (PON-1) activity.1, 8, 9, 10 In the skin and vasculature, apart from its antimicrobial activity, cathelicidin functions as an immune modulator, inducing expression of inflammatory genes, leading to cytokine and chemokine

Summary

A growing body of literature exists that links rosacea to multiple comorbidities. However, the strength and interpretation of these associations remains to be clearly delineated. Existing literature seems to implicate the potential for underlying pathogenic mechanisms responsible for multiple disease states. Neural dysregulation, aberrant immune activation, systemic inflammation, in addition to genetic and environmental factors, are all potential contributors to a seemingly multifactorial

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References (56)

  • K. Socala et al.

    Evaluation of the antidepressant- and anxiolytic-like activity of α-spinasterol, a plant derivative with TRPV1 antagonistic effects, in mice

    Behav Brain Res

    (2016)
  • M. Sulk et al.

    Distribution and expression of non-neuronal transient receptor potential (TRPV) ion channels in rosacea

    J Invest Dermatol

    (2012)
  • A. Parodi et al.

    Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication

    Clin Gastroenterol Hepatol

    (2008)
  • L.B. Weinstock et al.

    Rosacea and small intestinal bacterial overgrowth: prevalence and response to rifaximin

    J Am Acad Dermatol

    (2013)
  • F. Drago et al.

    The role of small intestinal bacterial overgrowth in rosacea: a 3-year follow-up

    J Am Acad Dermatol

    (2016)
  • M. Kim et al.

    Inflammatory bowel disease is associated with an increased risk of inflammatory skin diseases: a population-based cross-sectional study

    J Am Acad Dermatol

    (2017)
  • C.-Y. Wu et al.

    Risk of inflammatory bowel disease in patients with rosacea: results from a nationwide cohort study in Taiwan

    J Am Acad Dermatol

    (2017)
  • A.L.S. Chang et al.

    Assessment of the genetic basis of rosacea by genome-wide association study

    J Invest Dermatol

    (2015)
  • M. Steinhoff et al.

    New insights into rosacea pathophysiology: a review of recent findings

    J Am Acad Dermatol

    (2013)
  • J.Q. Del Rosso et al.

    Why is rosacea considered to be an inflammatory disorder? The primary role, clinical relevance, and therapeutic correlations of abnormal innate immune response in rosacea-prone skin

    J Drugs Dermatol

    (2012)
  • M.A. Gupta et al.

    Comorbidity of rosacea and depression: an analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey–Outpatient Department data collected by the U.S. National Center for Health Statistics from 1995 to 2002

    Br J Dermatol

    (2005)
  • A. Egeberg et al.

    Rosacea and gastrointestinal disorders: a population-based cohort study

    Br J Dermatol

    (2017)
  • A. Egeberg et al.

    Clustering of autoimmune diseases in patients with rosacea

    J Am Acad Dermatol

    (2016)
  • W.-Q. Li et al.

    Personal history of rosacea and risk of incident cancer among women in the US

    Br J Cancer

    (2015)
  • K. Edfeldt et al.

    Involvement of the antimicrobial peptide LL-37 in human atherosclerosis

    Arterioscler Thromb Vasc Biol

    (2006)
  • P.N. Durrington et al.

    Paraoxonase and atherosclerosis

    Arterioscler Thromb Vasc Biol

    (2001)
  • Z. Takci et al.

    Decreased serum paraoxonase and arylesterase activities in patients with rosacea

    J Eur Acad Dermatol Venereol

    (2015)
  • K. Yamasaki et al.

    Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea

    Nat Med

    (2007)
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      RosalQol has already been translated and validated for Brazilian Portuguese, and should be considered as a measure of effectiveness in future clinical studies.223 Once considered a limited skin disorder, rosacea has been described in association with systemic diseases.224–226 In 2015, Hua et al. published an important study, describing rosacea as a “systemic inflammatory disease,” showing similarities with psoriasis in relation to the risk of cardiovascular (CV) disease, possibly because both diseases have altered innate immunity, increased cathelicidin and C-reactive protein, in addition to decreased paraoxonase activity, which are predictors of CV events.

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    Disclosure Statement: Nora Vera, Nupur U. Patel and Lucia Seminario-Vidal have no conflicts to disclose.

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