Remission of rosacea induced by reduction of gut transit time

Abstract

Rosacea is a chronic disorder characterized by hypersensitivity of the facial vasculature, presenting with intense flushing eventually leading to chronic erythema and telangiectasia. Although the precise aetiology of rosacea is not known, numerous associations with inflammatory gastrointestinal tract disorders have been reported. Furthermore, substance P-immunoreactive neurones occur in considerably greater numbers in tissue surrounding affected blood vessels suggesting involvement of neurogenic inflammation and moreover plasma kallikrein-kinin activation is consistently found in patients. In this report, a patient without digestive tract disease is described, who experienced complete remission of rosacea symptoms following ingestion of a material intended to sweep through the digestive tract and reduce transit time below 30 h. It is possible that intestinal bacteria are capable of plasma kallikrein-kinin activation and that flushing symptoms and the development of other characteristic features of rosacea result from frequent episodes of neurogenic inflammation caused by bradykinin-induced hypersensitization of facial afferent neurones. The possible relevance of this hypothesis to other conditions featuring afferent hypersensitivity, such as fibromyalgia, is considered.

The potential role of microorganisms in the development of rosacea

“…Intestinal bacteria that are involved in the pathogenesis of inflammatory bowel disease (IBD) are also hypothesized to play a role in rosacea through the development of neurogenic inflammation [38]. Kendall has described a case of a patient without digestive tract disease who experienced complete remission of his rosacea after treatment for reduction of the gut transit time below 30 hours [39].…”

“…Kendall has described a case of a patient without digestive tract disease who experienced complete remission of his rosacea after treatment for reduction of the gut transit time below 30 hours [39]. Intestinal bacteria can activate plasma kallikrein‐kinin system (PKKS) and it is of interest that rosacea patients consistently demonstrate an activation of PKKS [38]. The possible involvement of intestinal bacteria in the pathogenesis of rosacea would also explain why metron‐idazole is efficacious in both rosacea and IBD, but the data available are currently inadequate to prove this hypothesis.…”

Rosacea and its comorbidities

“…The author also believes that facial flushing is a consequence of the neurogenic inflammation caused by the hyper sensibility of facial neurons, due to a kinin-kalikrein system activation under the influence of intestinal bacteria. Although this case sustains the hypothesis of rosacea-gastrointestinal conditions connection, additional studies regarding the length of the intestinal transit in RS patients should be conducted (22).…”

Die mögliche Bedeutung von Mikroorganismen für die Entstehung der Rosazea

“…Die klinische Wirksamkeit der Rosazea infoolge SIBO-Eradikation deuetet daraufhin, dass diese Bakterien eine Rolle in der Pathogenese der Rosazea einnehmen könnten, bislang liegen aber hierfür noch nicht ausreichend Beweise vor. Auch den für chronisch entzündliche Darmerkrankungen (CED) pathogenetisch bedeutsamen Darmkeimen wird über die Auslösung einer neurogenen Entzündung eine Rolle für die Rosazea zugesprochen [38]. Kendall lieferte den Fallbericht eines Patienten ohne Erkrankung des Verdauungstraktes, der unter einer Behandlung zur Reduktion der Magendarmpassage auf unter 30 Stunden Dauer eine komplette Abheilung seiner Rosazea erfuhr [39].…”

“…Kendall lieferte den Fallbericht eines Patienten ohne Erkrankung des Verdauungstraktes, der unter einer Behandlung zur Reduktion der Magendarmpassage auf unter 30 Stunden Dauer eine komplette Abheilung seiner Rosazea erfuhr [39]. Darmbakterien vermögen das Plasma-KallikreinKinin System (PKKS) zu aktivieren; interessanterweise lässt sich bei Patienten mit Rosazea durchwegs eine Aktivierung des PKKS nachweisen [38]. Eine mögli-che Beteiligung von Darmkeimen an der Pathogenese der Rosazea würde erklären, warum Metronidazol sowohl bei Rosazea als auch bei CED wirksam ist, die derzeitige Datenlage ist aber zu dünn, um diese Hypothese zu bestätigen.…”