Advertisement

Rosacea comorbidities and future research: The 2017 update by the National Rosacea Society Expert Committee

Published:November 01, 2017DOI:https://doi.org/10.1016/j.jaad.2017.06.150
      Although causal relationships have not been determined, many recent studies have uncovered associations between rosacea and increased risk for a variety of systemic disorders, many with potentially serious outcomes (Table I).
      • Hua T.C.
      • Chung P.I.
      • Chen Y.J.
      • et al.
      Cardiovascular comorbidities in patients with rosacea: a nationwide case-control study from Taiwan.
      • Duman N.
      • Ersoy Evans S.
      • Atakan N.
      Rosacea and cardiovascular risk factors: a case control study.
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Assessment of the risk of cardiovascular disease in patients with rosacea.
      • Egeberg A.
      • Weinstock L.B.
      • Thyssen E.P.
      • et al.
      Rosacea and gastrointestinal disorders: a population-based cohort study.
      • Egeberg A.
      • Fowler Jr., J.F.
      • Gislason G.H.
      • et al.
      Nationwide assessment of cause-specific mortality in patients with rosacea: a cohort study in Denmark.
      • Spoendlin J.
      • Karatas G.
      • Furlano R.
      • et al.
      Rosacea in patients with ulcerative colitis and Crohn's disease: a population-based case control study.
      • Kim M.
      • Choi K.H.
      • Hwang S.W.
      • et al.
      Inflammatory bowel disease is associated with an increased risk of inflammatory skin diseases: a population-based cross-sectional study.
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Exploring the association between rosacea and Parkinson disease: a Danish nationwide cohort study.

      Lyon S, Majewski S, Guide N, et al. LB766 Parkinson's disease association with rosacea: a large, single center, retrospective study. J Invest Dermatol. 136(8);B3: http://dx.doi.org/10.1016/j.jid.2016.05.015.

      • Egeberg M.D.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Patients with rosacea have increased risk of dementia.
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Clustering of autoimmune diseases in patients with rosacea.
      • Akin Belli A.
      • Ozbas Gok S.
      • Akbaba G.
      • et al.
      The relationship between rosacea and insulin resistance and metabolic syndrome.
      • Aldrich N.
      • Gerstenblith M.
      • Fu P.
      • et al.
      Genetic vs environmental factors that correlate with rosacea: a cohort-based survey of twins.
      • Egeberg A.
      • Ashina M.
      • Gaist D.
      • et al.
      Prevalence and risk of migraine in patients with rosacea: a population-based cohort study.
      • Li W.Q.
      • Zhang M.
      • Danby F.W.
      • et al.
      Personal history of rosacea and risk of incident cancer among women in the US.
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Association of rosacea with risk for glioma in a Danish nationwide cohort study.
      This might significantly increase the clinical significance of rosacea because evidence that rosacea might be an outcome of systemic inflammation is mounting. In addition, current scientific knowledge has pointed to a variety of promising research avenues that might help further illuminate rosacea's etiology, pathophysiology, and clinical implications.
      Table IRosacea comorbidities in descending strength of association
      Disease Studies
      Authors OR IR HR
      Cardiovascular
       Hyperlipidemia Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      6.8
      Association between comorbidity and moderate-to-severe rosacea.
       Cardiovascular diseases Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      4.3
       Hypertension Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      4,
      Association between comorbidity and moderate-to-severe rosacea.
      2.8
      Distribution of comorbidities in rosacea cases.
      Hua et al
      • Hua T.C.
      • Chung P.I.
      • Chen Y.J.
      • et al.
      Cardiovascular comorbidities in patients with rosacea: a nationwide case-control study from Taiwan.
      1.17
       Dyslipidemia Hua et al
      • Hua T.C.
      • Chung P.I.
      • Chen Y.J.
      • et al.
      Cardiovascular comorbidities in patients with rosacea: a nationwide case-control study from Taiwan.
      1.41
       Coronary artery disease Hua et al
      • Hua T.C.
      • Chung P.I.
      • Chen Y.J.
      • et al.
      Cardiovascular comorbidities in patients with rosacea: a nationwide case-control study from Taiwan.
      1.20
       PAOD Hua et al
      • Hua T.C.
      • Chung P.I.
      • Chen Y.J.
      • et al.
      Cardiovascular comorbidities in patients with rosacea: a nationwide case-control study from Taiwan.
      1.0
       All-cause mortality Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Assessment of the risk of cardiovascular disease in patients with rosacea.
      11.41
       Ischemic stroke Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Assessment of the risk of cardiovascular disease in patients with rosacea.
      3.03
       Myocardial infarction Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Assessment of the risk of cardiovascular disease in patients with rosacea.
      1.82
       Hemorrhagic stroke Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Assessment of the risk of cardiovascular disease in patients with rosacea.
      0.58
      Gastrointestinal
       GERD Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      4.6,
      Association between comorbidity and moderate-to-severe rosacea.
      4.2
      Distribution of comorbidities in rosacea cases.
       Other gastrointestinal diseases Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      3
      Distribution of comorbidities in rosacea cases.
       Crohn disease Kim et al
      • Kim M.
      • Choi K.H.
      • Hwang S.W.
      • et al.
      Inflammatory bowel disease is associated with an increased risk of inflammatory skin diseases: a population-based cross-sectional study.
      2.735
       Inflammatory bowel disease Kim et al
      • Kim M.
      • Choi K.H.
      • Hwang S.W.
      • et al.
      Inflammatory bowel disease is associated with an increased risk of inflammatory skin diseases: a population-based cross-sectional study.
      2.173
       Celiac disease Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Clustering of autoimmune diseases in patients with rosacea.
      2.03
       Ulcerative colitis Kim et al
      • Kim M.
      • Choi K.H.
      • Hwang S.W.
      • et al.
      Inflammatory bowel disease is associated with an increased risk of inflammatory skin diseases: a population-based cross-sectional study.
      1.979
       Irritable bowel syndrome Egeberg et al
      • Egeberg A.
      • Weinstock L.B.
      • Thyssen E.P.
      • et al.
      Rosacea and gastrointestinal disorders: a population-based cohort study.
      1.25
       Gastrointestinal mortality Egeberg et al
      • Egeberg A.
      • Fowler Jr., J.F.
      • Gislason G.H.
      • et al.
      Nationwide assessment of cause-specific mortality in patients with rosacea: a cohort study in Denmark.
      1.95
       Ulcerative colitis Egeberg et al
      • Egeberg A.
      • Weinstock L.B.
      • Thyssen E.P.
      • et al.
      Rosacea and gastrointestinal disorders: a population-based cohort study.
      0.7
       Crohn disease Egeberg et al
      • Egeberg A.
      • Weinstock L.B.
      • Thyssen E.P.
      • et al.
      Rosacea and gastrointestinal disorders: a population-based cohort study.
      0.42
       Celiac disease Egeberg et al
      • Egeberg A.
      • Weinstock L.B.
      • Thyssen E.P.
      • et al.
      Rosacea and gastrointestinal disorders: a population-based cohort study.
      0.22
      Neurological and autoimmune
       Type II diabetes Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Clustering of autoimmune diseases in patients with rosacea.
      2.59
       Rheumatoid arthritis Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Clustering of autoimmune diseases in patients with rosacea.
      2.14
       Parkinson disease Lyon et al

      Lyon S, Majewski S, Guide N, et al. LB766 Parkinson's disease association with rosacea: a large, single center, retrospective study. J Invest Dermatol. 136(8);B3: http://dx.doi.org/10.1016/j.jid.2016.05.015.

      1.7
       Multiple sclerosis Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Clustering of autoimmune diseases in patients with rosacea.
      1.65
       Diabetes mellitus Hua et al
      • Hua T.C.
      • Chung P.I.
      • Chen Y.J.
      • et al.
      Cardiovascular comorbidities in patients with rosacea: a nationwide case-control study from Taiwan.
      1.01
       Parkinson disease Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Exploring the association between rosacea and Parkinson disease: a Danish nationwide cohort study.
      7.62
       Any dementia Egeberg et al
      • Egeberg M.D.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Patients with rosacea have increased risk of dementia.
      2.03 1.4, 1.07
       Migraine Egeberg et al
      • Egeberg A.
      • Ashina M.
      • Gaist D.
      • et al.
      Prevalence and risk of migraine in patients with rosacea: a population-based cohort study.
      1.23
       Alzheimer disease Egeberg et al
      • Egeberg M.D.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Patients with rosacea have increased risk of dementia.
      0.79 1.9, 1.25
      Cancer
       Thyroid Li et al
      • Li W.Q.
      • Zhang M.
      • Danby F.W.
      • et al.
      Personal history of rosacea and risk of incident cancer among women in the US.
      1.59 1.59
       Basal cell carcinoma Li et al
      • Li W.Q.
      • Zhang M.
      • Danby F.W.
      • et al.
      Personal history of rosacea and risk of incident cancer among women in the US.
      1.50 1.50
       Glioma Egeberg et al
      • Egeberg A.
      • Hansen P.R.
      • Gislason G.H.
      • et al.
      Association of rosacea with risk for glioma in a Danish nationwide cohort study.
      4.99
      Other
       Allergy, food Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      10
      Distribution of comorbidities in rosacea cases.
       Urogenital diseases Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      7.5
      Distribution of comorbidities in rosacea cases.
       Metabolic diseases Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      4.4
      Association between comorbidity and moderate-to-severe rosacea.
       Allergy, airborne Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      4.6
      Distribution of comorbidities in rosacea cases.
       Respiratory diseases Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      4
      Distribution of comorbidities in rosacea cases.
       Female hormone imbalance Rainer et al
      • Rainer B.M.
      • Fischer A.H.
      • Luz Felipe da Silva D.
      • et al.
      Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
      3.2
      Distribution of comorbidities in rosacea cases.
      GERD, Gastroesophageal reflux disease; HR, hazard ratio; IR, incidence rate; OR, odds ratio; PAOD, peripheral arterial occlusive disease.
      Association between comorbidity and moderate-to-severe rosacea.
      Distribution of comorbidities in rosacea cases.
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hua T.C.
        • Chung P.I.
        • Chen Y.J.
        • et al.
        Cardiovascular comorbidities in patients with rosacea: a nationwide case-control study from Taiwan.
        J Am Acad Dermatol. 2015; 73: 249-254
        • Duman N.
        • Ersoy Evans S.
        • Atakan N.
        Rosacea and cardiovascular risk factors: a case control study.
        J Eur Acad Dermatol Venereol. 2014; 28: 1165-1169
        • Egeberg A.
        • Hansen P.R.
        • Gislason G.H.
        • et al.
        Assessment of the risk of cardiovascular disease in patients with rosacea.
        J Am Acad Dermatol. 2016; 75: 336-339
        • Egeberg A.
        • Weinstock L.B.
        • Thyssen E.P.
        • et al.
        Rosacea and gastrointestinal disorders: a population-based cohort study.
        Br J Dermatol. 2017; 176: 100-106
        • Egeberg A.
        • Fowler Jr., J.F.
        • Gislason G.H.
        • et al.
        Nationwide assessment of cause-specific mortality in patients with rosacea: a cohort study in Denmark.
        Am J Clin Dermatol. 2016; 17: 673-679
        • Spoendlin J.
        • Karatas G.
        • Furlano R.
        • et al.
        Rosacea in patients with ulcerative colitis and Crohn's disease: a population-based case control study.
        Inflamm Bowel Dis. 2015; 0: 1-8
        • Kim M.
        • Choi K.H.
        • Hwang S.W.
        • 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; 76: 40-48
        • Rainer B.M.
        • Fischer A.H.
        • Luz Felipe da Silva D.
        • et al.
        Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study.
        J Am Acad Dermatol. 2015; 73: 604-608
        • Egeberg A.
        • Hansen P.R.
        • Gislason G.H.
        • et al.
        Exploring the association between rosacea and Parkinson disease: a Danish nationwide cohort study.
        JAMA Neurol. 2016; 73: 529-534
      1. Lyon S, Majewski S, Guide N, et al. LB766 Parkinson's disease association with rosacea: a large, single center, retrospective study. J Invest Dermatol. 136(8);B3: http://dx.doi.org/10.1016/j.jid.2016.05.015.

        • Egeberg M.D.
        • Hansen P.R.
        • Gislason G.H.
        • et al.
        Patients with rosacea have increased risk of dementia.
        Ann Neurol. 2016; 79: 921-928
        • Egeberg A.
        • Hansen P.R.
        • Gislason G.H.
        • et al.
        Clustering of autoimmune diseases in patients with rosacea.
        J Am Acad Dermatol. 2016; 74: 667-672
        • Akin Belli A.
        • Ozbas Gok S.
        • Akbaba G.
        • et al.
        The relationship between rosacea and insulin resistance and metabolic syndrome.
        Eur J Dermatol. 2016; 26: 260-264
        • Aldrich N.
        • Gerstenblith M.
        • Fu P.
        • et al.
        Genetic vs environmental factors that correlate with rosacea: a cohort-based survey of twins.
        JAMA Dermatol. 2015; 151: 1213-1219
        • Egeberg A.
        • Ashina M.
        • Gaist D.
        • et al.
        Prevalence and risk of migraine in patients with rosacea: a population-based cohort study.
        J Am Acad Dermatol. 2017; 76: 454-458
        • Li W.Q.
        • Zhang M.
        • Danby F.W.
        • et al.
        Personal history of rosacea and risk of incident cancer among women in the US.
        Br J Cancer. 2015; 113: 520-523
        • Egeberg A.
        • Hansen P.R.
        • Gislason G.H.
        • et al.
        Association of rosacea with risk for glioma in a Danish nationwide cohort study.
        JAMA Dermatol. 2016; 152: 541-545
        • Al-Dabagh A.
        • Davis S.A.
        • McMichael A.J.
        • et al.
        Rosacea in skin of color: not a rare diagnosis.
        Dermatol Online J. 2014 Oct 15; 20 (pii:13030/qt1mv9r0ss)
        • Bae Y.I.
        • Yun S.j.
        • Lee J.B.
        • et al.
        Clinical evaluation of 168 Korean patients with rosacea: the sun exposure correlates with the erythematotelangiectatic subtype.
        Ann Dermatol. 2009; 21: 243-249
        • Khaled A.
        • Hammami H.
        • Zeglaoui F.
        • et al.
        Rosacea: 244 Tunisian cases.
        Tunis Med. 2010; 88: 597-601
        • Dlova N.
        • Mosam A.
        Rosacea in black South Africans with skin phototypes V and VI.
        Clin Exp Dermatol. 2017; 42: 670-673
        • Tan J.
        • Schöfer H.
        • Araviiskaia E.
        • et al.
        Prevalence of rosacea in the general population of Germany and Russia – the RISE study.
        J Eur Acad Dermatol Venereol. 2016; 30: 428-434
        • Tan J.
        • Leyden J.
        • Cribier B.
        • et al.
        Development and evaluation of a rosacea screening instrument (Rosascreen).
        J Cutan Med Surg. 2016; 20: 317-322
        • Chang A.L.
        • Raber I.
        • Xu J.
        • et al.
        Assessment of the genetic basis of rosacea by genome-wide association study.
        J Invest Dermatol. 2015; 135: 1548-1555
        • Muto Y.
        • Wang Z.
        • Vanderberghe M.
        • et al.
        Mast cells are key mediators of cathelicidin-initiated skin inflammation in rosacea.
        J Invest Dermatol. 2014; 134: 2728-2736
        • Yamasaki K.
        • Kanada K.
        • Macleod D.T.
        • et al.
        TLR2 expression is increased in rosacea and stimulates enhanced serine protease production by keratinocytes.
        J Invest Dermatol. 2011; 131: 688-697
        • Forton F.M.
        Papulopustular rosacea, skin immunity and Demodex: pityriasis folliculorum as a missing link.
        Eur J Acad Dermatol Venereol. 2012; 26: 19-28
        • Lacey N.
        • Delaney S.
        • Kavanagh K.
        • et al.
        Mite-related bacterial antigens stimulate inflammatory cells in rosacea.
        Br J Dermatol. 2007; 157: 474-481
        • Parodi A.
        • Paolino S.
        • Greco A.
        • et al.
        Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication.
        Clin Gastroenterol Hepatol. 2008; 6: 759-764
        • Weinstock L.B.
        • Steinhoff M.
        Rosacea and small intestinal bacterial overgrowth: prevalence and response to rifaximin.
        J Am Acad Dermatol. 2013; 68: 875-876
        • Holmes A.D.
        • Steinhoff M.
        Integrative concepts of rosacea pathophysiology, clinical presentation and new therapeutics.
        Exp Dermatol. 2017; 26: 659-667
        • Steinhoff M.
        • Ständer S.
        • Seeliger S.
        • et al.
        Modern aspects of cutaneous neurogenic inflammation.
        Arch Dermatol. 2003; 139: 1479-1488
        • Buhl T.
        • Sulk M.
        • Nowak P.
        • et al.
        Molecular and morphological characterization of inflammatory infiltrate in rosacea reveals activation of Th1/Th17 pathways..
        J Invest Dermatol. 2015; 135: 2198-2208
        • Wladis E.J.
        • Swamy S.
        • Hermann A.
        • Yang J.
        • Carlson J.A.
        • Adam A.P.
        Activation of p38 and Erk mitogen-activated protein kinase signaling in ocular rosacea.
        Invest Ophthalmol Vis Sci. 2017; 58: 843-848
        • Forton F.M.N.
        • De Maertelaer V.
        Two consecutive standardized skin surface biopsies: an improved sampling method to evaluate Demodex density as a diagnostic tool for rosacea and demodicosis.
        Acta Derm Venereol (Stockh). 2017; 97: 242-248