Rosacea and the Microbiome: A Systematic Review

Abstract

Rosacea, a chronic inflammatory skin disease characterized by recurrent episodes of facial flushing, erythema, pustules, and telangiectasia, largely affects fair-skinned women over 30 years of age. Although a long-recognized entity, the exact pathophysiology of this disease is still debated. Current theories highlight the role of the cutaneous microbiome and its associated inflammatory effects in rosacea’s pathogenesis. However, microbiological reverberations are not limited to the skin, as recent studies have described the potential cutaneous effects of alterations in the gastrointestinal (GI) microbiome. Associations with additional GI pathologies, including small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD), have been investigated, as well as Helicobacter pylori infection. In an attempt to better understand and characterize these relationships, as well as current treatment options, we conducted a systematic review of the literature in PubMed, Cochrane, and Embase from their inception to August 6, 2020. We have synthesized the literature findings within three sections of this manuscript: the cutaneous microbiome, the gut microbiome, and therapeutic strategies. Future studies should focus on specific mechanisms linking GI pathology with rosacea manifestations and the role of enteral drugs in mitigating cutaneous symptoms.

COVID‐19 related masks increase severity of both acne (maskne) and rosacea (mask rosacea): Multi‐center, real‐life, telemedical, and observational prospective study

“…22 Likewise, also Demodex folliculorum, regarded as the a trigger in rosacea, takes advantage from sebum overproduction producing/amplyfing inflammation (papules, pustules, and erythema). 23 T A B L E 1 GAGS scores and DLQI are reported at the baseline (T0) and after 6 weeks of quarantine (T1)…”

“…Furthermore, dehydration, transepidermal water loss, and sebum dysregulation are pro‐comedogenic factors, capable to promote Cutibacterium acnes multiplication, and hence innate immune response and leading to inflammatory lesions (papules and pustules) 22 . Likewise, also Demodex folliculorum , regarded as the a trigger in rosacea, takes advantage from sebum overproduction producing/amplyfing inflammation (papules, pustules, and erythema) 23 …”

Reexamining the Role of Diet in Dermatology

“…Rosacea has been associated with various gastrointestinal tract disorders including irritable bowel syndrome, SIBO, and IBD. [50][51][52][53][54] A single study found that patients with rosacea had a 13-fold increased risk for SIBO. 55,56 Treatment of 40 patients with SIBO using rifaximin resulted in complete resolution of rosacea in all patients, with no relapse after a 3-year follow-up period.…”

“…59 Although the long-term health consequences of the low FODMAP diet are unknown, further research on such dietary interventions for inflammatory skin conditions is warranted given the mounting evidence of a gut-skin connection and the role of the intestinal microbiome in skin health. 50,51…”

Association between Rosacea, Environmental Factors, and Facial Cutaneous Dysbiosis

“…[9][10][11] Studies have found a correlation between the relative abundances of several cutaneous microbes, including notably Demodex folliculorum (and its native microbe Bacillus oleronius), virulent strains of Staphylococcus epidermidis, cytotoxin-associated gene A positive (CagA + ) Helicobacter pylori and Chlamydophila pneumoniae, and rosacea. 1,[12][13][14][15] Because of the multifactorial nature of the pathophysiology of rosacea, twin studies offer ways to control for genetic causes and isolate environmental factors. 3,16,17 While only 50% of genes are identical between fraternal twins, identical twins share all of their genes.…”