Review
Comorbidities in rosacea: A systematic review and update

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Background

Rosacea is linked to abnormalities of cutaneous vasculature and dysregulation of the inflammatory response. Recent reports on rosacea have shown a significant association with cardiovascular, gastrointestinal, and psychiatric diseases, all of which may affect morbidity and mortality among these patients.

Objective

To review available data regarding comorbidities associated with rosacea, discuss their pathogenesis, and highlight the evaluation of affected patients.

Methods

We performed a complete and systematic literature review in PubMed/Medline, Embase, and the Cochrane Collaboration databases, searching for all articles on possible associated diseases that have been reported with rosacea, with no limits on publication date, participant age, sex, or nationality.

Results

A total of 29 studies were included in this systematic review, including 14 case-control, 8 cross-sectional, and 7 cohort studies. Statistically significant association with rosacea has been mostly demonstrated with depression (n = 117,848 patients), hypertension (n = 18,176), cardiovascular diseases (n = 9739), anxiety disorder (n = 9079), dyslipidemia (n = 7004), diabetes mellitus (n = 6306), migraine (n = 6136), rheumatoid arthritis (n = 4192), Helicobacter pylori infection (n = 1722), ulcerative colitis (n = 1424), and dementia (n = 1194).

Limitations

Limitations included the accuracy of the published data, potential patient selection, and possible confounding factors. The true nature of the drawn correlations is uncertain, and causality cannot be established.

Conclusions

Rosacea is associated with a number of systemic disorders. Recognition of these conditions is critical to providing appropriate screening and management of affected patients.

Section snippets

Methods

Two reviewers (R.H. and M.G.) independently performed a systematic literature review in the Pubmed/Medline, Embase and Cochrane collaboration databases. The search included all articles on possible comorbidities that have been reported with rosacea. The corresponding authors of unavailable articles were contacted by e-mail.

Articles published in English or French and dated between January 1955 and January 2017 were included in this study. To determine eligibility for inclusion in this review, we

Results

Our initial search yielded a total of 552 articles. Of those, 54 were duplicates and 286 records were excluded after title and abstract revision. In all, 29 articles were included in the systematic review: 14 case-control, 8 cross-sectional, and 7 cohort studies. The stepwise approach for study selection is summarized in Fig 1, and the characteristics of the included studies can be found in Supplemental Table I5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27

Discussion

Rosacea is a common facial skin disorder with poorly understood pathogenesis. Recent data show that it involves proinflammatory mediators and activation of the adaptive immune system.1, 33, 34 To the best of our knowledge, our study is the first review analyzing available data regarding the diseases associated with rosacea. We also discussed the possible underlying disease mechanisms and made recommendations for early monitoring and prevention of those comorbidities.

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    Funding sources: None.

    Conflicts of interest: None disclosed.

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    © 2017 by the American Academy of Dermatology, Inc.