Integrative concepts of rosacea pathophysiology, clinical presentation and new therapeutics

Holmes, Anna; Steinhoff, Martin

doi:10.1111/exd.13143

Cited by 145 publications

(189 citation statements)

References 106 publications

(162 reference statements)

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“…[2,3] Increased levels of Demodex mites and associated bacteria (bacillus), antimicrobial peptides (eg cathelicidin/LL37), host immune variables (eg Tolllike receptor (TLR)-2) and nutrients (eg vitamin D3) are reported to alter the innate immune response and cause chronic inflammation and the facial skin sensitivity in rosacea. [2,3] In addition, the recent studies suggest significant associations between the severity of rosacea and systemic comorbidities (eg cardiovascular, allergic, respiratory, metabolic and gastrointestinal diseases) that are linked with chronic inflammation. [4,5] Rosacea and its reported comorbidities share involvement with barrier tissues that are colonized with a wide variety of microflora that constitute the microbiome.…”

Section: Backg Rou N Dmentioning

confidence: 99%

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Characterization of the facial microbiome in twins discordant for rosacea

Zaidi

Spaunhurst

Sprockett

et al. 2018

Experimental Dermatology

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Previously, we determined that genetic and environmental factors contributed equally towards rosacea in twins. To assess an environmental factor, we characterized the malar cheek bacterial microbiome from twins discordant for rosacea. We found no significant difference in facial microbiome alpha and beta diversity between related twins discordant for rosacea. However, the relative percentage abundance of Gordonia and Geobacillus, low-abundant genera, was positively and negatively associated with rosacea severity, respectively. Our data demonstrate a significant correlation between facial microbiome and severity of rosacea in genetically matched twins and importantly that overall microbiome composition is largely unchanged. | BACKG ROU N DRosacea is a chronic inflammatory disease of the facial skin and eyes that affects ~16 million individuals in the United States alone.Although its aetiology is unknown, we previously determined that both genetic and environmental factors contribute equally towards disease using identical (monozygotic) and fraternal (dizygotic) twins. [1] Previous studies have implicated microbial colonization and the cognate immune response as the critical driver of rosacea. [2,3] Increased levels of Demodex mites and associated bacteria (bacillus), antimicrobial peptides (eg cathelicidin/LL37), host immune variables (eg Tolllike receptor (TLR)-2) and nutrients (eg vitamin D3) are reported to alter the innate immune response and cause chronic inflammation and the facial skin sensitivity in rosacea. [2,3] In addition, the recent studies suggest significant associations between the severity of rosacea and systemic comorbidities (eg cardiovascular, allergic, respiratory, metabolic and gastrointestinal diseases) that are linked with chronic inflammation. [4,5] Rosacea and its reported comorbidities share involvement with barrier tissues that are colonized with a wide variety of microflora that constitute the microbiome. | QUE S TION ADDRE SS EDThe beneficial use of therapeutic drugs for rosacea including oral and topical antibiotics, sulphur compounds and ivermectin that alter the facial microbiome, [6] suggests that altering the resident skin microbiome may play a role in the disease. However, no conclusive evidence has been established.Microbial dysbiosis could be one of the factors associated with the pathogenesis of rosacea as well as its comorbidities. Harnessing the genetic and environmental control inherent in a twin study, we performed next-generation sequencing of the 16S rRNA gene to evaluate the hypothesis that facial bacterial microbiome dysbiosis will associate with the severity of rosacea in twins discordant for rosacea. | E XPERIMENTAL DE S I G NSee Appendix S1. | RE SULTS | Comparable overall facial skin microbiome composition across subjectsWe estimated the relative percentage abundance (RPA) of facial bacterial microbiome at the phylum level in twins with and without rosacea. The top four abundant phyla were Firmicutes (mean ± SD; 42.98% ± 1.05%), Proteobacteria (39.29% ± 1...

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Section: Backg Rou N Dmentioning

confidence: 99%

“…One of the most important extrinsic ageing factors is sunlight, particularly exposure to ultraviolet (UV) B irradiation, which is a major cause of skin photoageing. [1,2] Exposure of keratinocytes to UVB radiation activates various cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1α…”

Section: Backg Rou N Dmentioning

confidence: 99%

Characterization of the facial microbiome in twins discordant for rosacea

Zaidi

Spaunhurst

Sprockett

et al. 2018

Experimental Dermatology

View full text Add to dashboard Cite

show abstract

“…14 Treatment for flushing and erythema may involve oral drugs with vasoconstriction properties including adrenergic antagonists including mirtazapine (alpha blocker), propranolol (beta blocker) or carvedilol (both alpha and beta blocker). 2 These are used at low doses to avoid adverse effects such as hypotension, somnolence, fatigue and bronchospasm. They should be prescribed under specialist supervision, and careful monitoring is required.…”

Section: Specific Treatmentsmentioning

confidence: 99%

“…Microbes that are part of the normal skin flora, and specifically in the pilo-sebaceous unit -including Demodex mites and Staphylococcus epidermidis -may also play a role as triggers of rosacea. 2,3 Symptoms are initially transient. This is followed by persistent erythema due to repeated vasodilation, then telangiectasia and skin inflammation in the form of papules, pustules, lymphoedema and fibrosis.…”

Section: Introductionmentioning

confidence: 99%