Rosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut–Skin Axis of Rosacea

Abstract

Rosacea is a chronic inflammatory disease with complicated pathophysiology that involves genetic and environmental elements and dysregulation of innate and adaptive immunity, neurovascular responses, microbiome colonization or infection, resulting in recurrent inflammation. Rosacea has been reported associated with various gastrointestinal diseases including inflammatory bowel disease, celiac disease, irritable bowel syndrome, gastroesophageal reflux disease, Helicobacter pylori (HP) infection, and small intestine bacterial overgrowth (SIBO). The link may involve common predisposing genetic, microbiota, and immunological factors, comprising the theory of the gut–skin axis. Although the evidence is still controversial, interestingly, medications for eradicating SIBO and HP provided an effective and prolonged therapeutic response in rosacea, and conventional therapy for which is usually disappointing because of frequent relapses. In this article, we review the current evidence and discuss probable mechanisms of the association between rosacea and gastrointestinal comorbidities.

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

“…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.…”

“…Dear Editor , Rosacea is a chronic inflammatory disease that primarily affects young and middle‐aged white women 1 . 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. 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.…”

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…”