Biomarkers in rosacea: A systematic review

Abstract

Rosacea is a chronic and psychologically ladened disease affecting 1%–3% of people worldwide. The identification and validation of biomarkers in rosacea patients has the potential to improve disease progression, support diagnosis, provide objective measures for clinical trials and aid in management. The objective of this review is to systematically identify all rosacea biomarkers, categorize them by type and identify trends to improve disease expression. Eligibility criteria for this review (PROSPERO CRD42023397510) include randomized controlled trials, case–control studies, cohort studies and other observational studies. No restrictions were placed on patient demographics (age, sex, ethnicity) or language of publication until February 2023. Quality of studies was assessed using the National Institute of Health quality assessment tool. The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines. A total of 805 unique articles were screened based on the applied inclusion and exclusion criteria. After the articles were screened based on title/abstract and full‐text, a total of 38 studies were included, reporting on a total of 119 unique biomarkers. The results of this review and current rosacea pathogenic mechanisms provide the greatest support for the innate cathelicidin and inflammasome, Th1 and Th17 pathways. The most commonly reported biomarkers include IL‐1β, TNF‐α, IL‐37, IFN‐γ and MMP‐9. Biomarkers identified in this study support current theories of rosacea pathogenesis and provide direction for research to further our knowledge. However, more research is needed to identify biomarkers panels that can provide diagnostic utility. This may be difficult due to the heterogeneity of the disease and potential differences between rosacea subtypes.

Biomarkers for rosacea?

“…The statement that 'elevated levels of cathelicidin, KLK5, TLR2, MMP-9, inflammasome proteins, and neutrophil and macrophage markers in rosacea skin compared to normal skin' supports an association to a specific pathogenic pathway is not supported by the evidence presented. 2 Instead, demonstrating that a specific inhibitor of a presumed biomarker inhibits the disease or finding that the presumed biomarker is genetically linked to the disease would be stronger evidence of causal association. Therefore, identification of biomarkers on the basis of changes in their levels in diseased skin does not necessarily mean they are good targets for future intervention.…”