Updates on the Risk of Neuropsychiatric and Gastrointestinal Comorbidities in Rosacea and Its Possible Relationship with the Gut–Brain–Skin Axis

Woo, Yu Ri; Han, Yu Jin; Kim, Hei Sung; Cho, Sang Hyun; Lee, Jeong Deuk

doi:10.3390/ijms21228427

Cited by 22 publications

(36 citation statements)

References 79 publications

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“…These results describe the intestinal microbiological signature of patients with inflammatory rosacea and support the existence of intestinal dysbiosis, as was previously described in patients with nonclassified rosacea 2,4 . The rising evidence of the existence of an altered gut microbiota in patients with rosacea shows that this organ may be key to a better understanding of this pathology and a target for treatment in the future.…”

Section: Figuresupporting

confidence: 87%

“…Its aetiology is multifactorial and appears to be determined by genetic predisposition, alteration of the neurovascular and immune response, and an altered dialogue with the microbiota 1,2 . Additionally, the disease has been linked to gastrointestinal disorders such as Helicobacter pylori infection or small intestine bacterial overgrowth, and even neurological disorders such as Parkinson disease, 3,4 revealing the existence of a brain–gut–skin axis. Currently there is a high suspicion that these different organs are interrelated in their mechanisms of homeostasis and allostasis.…”

Section: Figurementioning

confidence: 99%

“…Currently there is a high suspicion that these different organs are interrelated in their mechanisms of homeostasis and allostasis. They might be involved in the aetiopathogenesis of some chronic inflammatory skin diseases such as rosacea through immune, neuroendocrine and metabolic mechanisms that are not well elucidated 2,4 . The aim of this study was to determine whether the gut microbiome composition of patients with inflammatory rosacea was different from that of healthy controls, and to investigate possible bacterial biomarkers of the disease.…”

Section: Figurementioning

confidence: 99%

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Dysbiotic gut microbiota in patients with inflammatory rosacea: another clue towards the existence of a brain–gut–skin axis

et al. 2021

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D levels. 4 Therefore, we hypothesize that patients with BCC have higher vitamin D levels, which may protect against severe COVID-19 outcomes. While serum 25-hydroxyvitamin D has been positively associated with melanoma and keratinocyte carcinoma, particularly BCC, 5,6 there may be other residual confounders in patients with COVID-19 with SCC and melanoma that were impossible to elucidate from the data, such as duration of immunosuppression, severity of chronic skin inflammation and genetic make-up, which could have contributed to the findings of the given outcomes. A limitation of this study is that because vitamin D levels are not routinely assessed in either in-or outpatients, there were incomplete records of vitamin D levels in the database and so pre-existing levels could not be examined. Other limitations include possible errors in coding/data entry, a bias towards sicker patients and the inability to monitor progression through the clinical course of the disease. Further studies are warranted in patients with skin cancer to validate this finding.

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Section: Figuresupporting

confidence: 87%

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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Dysbiotic gut microbiota in patients with inflammatory rosacea: another clue towards the existence of a brain–gut–skin axis

et al. 2021

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“…The exact pathophysiology of rosacea remains unknown 6 . In addition to genetic predisposition, impairment in epidermal barrier and dysregulation of the immune system, rosacea is characterized by neurovascular dysregulation and neurogenic inflammation, thus sharing similar pathomechanisms with migraine 6,7 .…”

Section: Positive Answer For the Question Men Women Total (N) N (%) Or (95% Ci) Adjusted Or (95% Ci) Total (N) N (%) Or (95% Ci) Adjustementioning

confidence: 99%

“…6 In addition to genetic predisposition, impairment in epidermal barrier and dysregulation of the immune system, rosacea is characterized by neurovascular dysregulation and neurogenic inflammation, thus sharing similar pathomechanisms with migraine. 6,7 Furthermore, in both rosacea and migraine, symptoms (such as episodes of flushing, erythema, telangiectasia, headache, photophobia and phonophobia) are presented mainly in the area innervated by the trigeminal nerve. 6,7 Thus, changes in facial blood flow and neuroinflammation have been considered to suggest a possible relationship between these two diseases.…”

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confidence: 99%

Male patients with rosacea have increased risk for migraine: a population‐based study

et al. 2021

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patients had died (33%). Among the patients who died, only two died of the disease. The other four patients died of COVID-19, brain haemorrhage (after a fall), acute leukaemia and immune thrombocytopenic purpura associated with chronic lymphocytic leukaemia. Estimated median overall survival (OS) was 24Á1 months (95% CI 16Á4-31Á8) and diseasespecific OS was not reached.We observed 33% (n = 6) adverse events (AE) in six different patients: four grade 2 AEs (psoriasis, asthenia, bullous pemphigoid and liver toxicity), one grade 3 AE (hepatitis) and one grade 5 AE (death as a result of immune thrombocytopenic purpura).Our data confirm the results of phase II data evaluating immune checkpoint inhibitors 1,3-5 in advanced cSCC, in a real-world setting. In contrast to previous phase I and II trials, 1,3,5,6 we observed a higher ORR (67% vs. 41-50%), although our series included a majority of stage IV cSCC. A recent real-world study reporting data about anti-PD1 antibodies in cSCC, which included eight patients treated with CEMI, reported an ORR of 59%. 7 It is remarkable to notice that patients are older in real-world studies compared with trials. Furthermore, patients over 60 years old and patient who were immunocompromised with chronic lymphocytic leukaemia may respond to CEMI. This may be related to a high tumour mutational burden, associated with increased immunogenicity, commonly observed in the tumours of older patients. 8 In terms of safety, CEMI was overall well-tolerated, with about 10% of patients discontinuing therapy because of toxicity. 7 AEs were less frequent than previously reported in trials, 1,3 which may be explained by the retrospective nature of the study.In conclusion, our data confirm the efficacy and safety of CEMI for the treatment of patients with advanced cSCC in a real-world setting, including older patients and individuals who are immunocompromised. Owing to the durable nature of the responses and the lack of treatment alternatives, CEMI should be considered as first-line treatment in advanced cSCC. 9

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Rosacea

van Zuuren,

Tan,

van der Linden

et al. 2024

Rook's Textbook of Dermatology

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Rosacea is a chronic inflammatory disease affecting the cheeks, chin, nose, forehead and frequently the eyes. Recent advances have emphasised the roles of the innate and adaptive immune systems and neurovascular dysregulation underlying the spectrum of clinical features of rosacea. This chapter covers the phenotype‐based diagnosis and classification system as well as management options based on the latest evidence. Recommendations for management of paediatric rosacea and management of pregnant or lactating women are included. Furthermore, differential diagnoses and facial dermatoses with an uncertain nosological relationship to rosacea will be discussed.

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Updates on the Risk of Neuropsychiatric and Gastrointestinal Comorbidities in Rosacea and Its Possible Relationship with the Gut–Brain–Skin Axis

Cited by 22 publications

References 79 publications

Dysbiotic gut microbiota in patients with inflammatory rosacea: another clue towards the existence of a brain–gut–skin axis

Dysbiotic gut microbiota in patients with inflammatory rosacea: another clue towards the existence of a brain–gut–skin axis

Male patients with rosacea have increased risk for migraine: a population‐based study

Rosacea

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