Rosacea and Its Comorbidities: What Patients Need to Know
As research continues to uncover potential links between rosacea and various systemic conditions, patients are increasingly turning to their dermatologists for clarity. From cardiovascular disease to depression and gastrointestinal (GI) issues,the associations are intriguing but far from definitive.
“The co-occurrence of rosacea and systemic disease is far from definitive, and the majority of patients presenting with rosacea do not have an associated comorbidity,” says Hilary Baldwin, MD, director of the Acne Treatment & Research Center in Brooklyn, New York. “My job as a dermatologist is to diagnose and treat the rosacea, uncover any potential comorbidities, and refer back to the primary care giver,” she adds. “The last thing that I want to do is to panic the patient during the visit. This is particularly significant in our current medical climate in which obtaining appointments with primary care physicians — or finding one if currently without — is met with unacceptable delays.”
Baldwin,a former president of the American Acne & Rosacea Society,co-authored a 2018 review of rosacea comorbidities and their common physiologic pathways. This review, along with a 2017 update by the National Rosacea Society Expert Commitee, found the most robust data supporting associations with cardiovascular and GI comorbidities. However, Baldwin emphasizes that a comorbidity in a patient with rosacea “does not indicate any type of cause and affect. It simply means that the diseases are present together. There are numerous diseases that have been found to co-exist with rosacea.”
Recent studies have highlighted additional connections. According to Richard Gallo, MD, PhD, professor and chair of Dermatology at the University of California, San Diego, and senior author of the 2017 National Rosacea Society update, dyslipidemia, inflammatory bowel disease, and depression are among the most frequently reported comorbidities. “These seem to come up most frequently,” Gallo notes.A 2024 study also found an association between rosacea and the development of melanoma in White individuals. “That study needs some validation, but I think it’s something to keep an eye on,” he adds.
Despite these findings, the exact mechanisms linking rosacea to these conditions remain unclear. What is certain, though, is the importance of a collaborative approach between dermatologists and primary care providers to ensure comprehensive patient care.
Key Rosacea Comorbidities at a Glance
Table of Contents
| Comorbidity | Evidence Level | Notes |
|————————–|——————–|—————————————————————————|
| Cardiovascular Disease | Strong | Supported by multiple studies; no causal relationship established. |
| Gastrointestinal Issues | Strong | Includes inflammatory bowel disease; further research needed. |
| Depression | Emerging | strongest evidence among neurologic comorbidities. |
| Melanoma | Preliminary | 2024 study suggests association in White individuals; requires validation.|
For patients living with rosacea, understanding these potential links is crucial. However, as Baldwin and Gallo both stress, the presence of a comorbidity does not imply causation. Instead, it underscores the need for a holistic approach to health, where dermatologists and primary care providers work together to address both skin and systemic concerns.
If you or a loved one are managing rosacea, consider discussing these findings with your healthcare provider. Staying informed and proactive is the best way to navigate the complexities of this chronic condition.
Rosacea: A Potential Early Indicator of Systemic Diseases?
Rosacea, a chronic skin condition characterized by facial redness and inflammation, may be more than just a cosmetic concern. Emerging research suggests it might very well be an early indicator of systemic diseases, including cardiovascular, gastrointestinal (GI), and neurological conditions.Though, identifying and treating rosacea as a precursor to these diseases remains a challenge in clinical settings.
The Link Between Rosacea and Systemic Inflammation
Dr. Richard Gallo, a leading dermatologist, explains that rosacea is linked to the innate immune system and the nervous system. “Some of the genes that we find in the skin of patients with rosacea link the innate immune system and the nervous system to being part of the trigger,” he said. This connection suggests that facial rosacea could be a manifestation of systemic abnormalities.
As an example, Gallo and his colleagues have identified an abundance of the peptide LL-37 in the facial skin of rosacea patients. LL-37, known for its antimicrobial and proinflammatory properties, is also found in psoriasis. Recent studies in mouse models have shown that LL-37 can directly cause the buildup of atherosclerotic plaques, hinting at a potential link between rosacea and cardiovascular disease.
Comorbidities and Clinical Management
Dr.Julie C. Harper, a dermatologist and editor of the Rosacea Review newsletter, emphasizes the importance of reviewing systems in rosacea patients. “Every patient with rosacea that I see completes a review of systems, which should flag any comorbidities that are already present,” she told Medscape Medical News. Depression and anxiety are frequently reported alongside rosacea, making it reasonable to ensure patients have a primary care provider to monitor cardiovascular risk factors.
However, Harper cautions that there isn’t enough evidence to recommend routine screening for neurological, GI, or cardiovascular diseases in all rosacea patients. “We really don’t have enough evidence to suggest that all rosacea patients need to be screened additionally for these conditions at this time,” she said.
Treating Rosacea as a Systemic Condition
Dr. Harper notes that rosacea patients often exhibit an exaggerated inflammatory response to environmental and microbial triggers. “For example, the ingestion of some foods can trigger inflammation in rosacea,” she said. This observation raises questions about whether rosacea is one manifestation of a more widespread, systemic inflammatory condition.For now, the best approach is to manage the clinical findings effectively. “We do this by matching our treatments mechanistically to the clinical features that we see. This will almost always include anti-inflammatory medications,” Harper explained.
When to Refer Patients
dr. Hilary Baldwin highlights that patients already being treated for cardiovascular or GI disease “have little to gain” from pointing out the possible association with rosacea. “The patient who can benefit from my intervention is the one in whom the symptoms are new or as yet unexplored,” she said.
Baldwin shared a case where referral proved beneficial: a rosacea patient with bloating, excessive flatulence, and abdominal pain initially presumed to be lactose intolerance. “Dairy avoidance was unhelpful in controlling his symptoms,” she said. Referral to a gastroenterologist led to a diagnosis of small intestinal bacterial overgrowth (SIBO), and treatment with rifaximin resolved both his GI and cutaneous symptoms.
A Warning Sign, Not a Diagnosis
In asymptomatic patients, Gallo advises that the common comorbidities associated with rosacea are not severe enough to require immediate referral. “However, it’s a warning sign, so you want to alert the patient to think about these things, making sure they’re plugged into a doctor, making sure their doctor is aware of it,” he said. “Those are importent steps.”
| Key Points | Details |
|—————-|————-|
| Rosacea and Systemic Diseases | Potential link to cardiovascular, GI, and neurological conditions. |
| LL-37 Peptide | Found in rosacea and psoriasis; may contribute to atherosclerosis. |
| Clinical Management | Focus on anti-inflammatory treatments and monitoring comorbidities. |
| when to Refer | New or unexplored symptoms warrant further investigation.|
While rosacea may serve as a warning sign for systemic diseases,more research is needed to establish definitive connections. For now, dermatologists recommend a proactive approach to managing rosacea and monitoring patients for potential comorbidities.
For more insights on rosacea and its systemic implications, visit the Rosacea Review newsletter or explore the latest research on Medscape.Revolutionizing News Consumption: How AI Summarizers Are Changing the Game
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Editor’s Questions:
1. Dr. Harper, can you explain why you believe rosacea might be a sign of a systemic inflammatory condition?
2. Dr. Baldwin, coudl you share a specific case where referral led to a notable discovery for a rosacea patient?
3. Dr. Gallo, how do you approach discussing teh potential systemic implications of rosacea with asymptomatic patients?
Dr.harper’s Response:
“Rosacea patients often exhibit an exaggerated inflammatory response to environmental and microbial triggers. For example, the ingestion of some foods can trigger inflammation in rosacea. This suggests that rosacea may not be just a skin condition but one manifestation of a more widespread, systemic inflammatory process. While the exact mechanisms are still being studied, the connection between rosacea and other conditions like cardiovascular disease, gastrointestinal disorders, and even neurological diseases points to a broader inflammatory state. For now, our focus remains on effectively managing the clinical features of rosacea with anti-inflammatory treatments.”
Dr. Baldwin’s Response:
“I recall a case where a rosacea patient presented with bloating, excessive flatulence, and abdominal pain. Initially, we thought it was lactose intolerance, but dairy avoidance didn’t help. I referred the patient to a gastroenterologist, who diagnosed him with small intestinal bacterial overgrowth (SIBO). Treating the SIBO with rifaximin not only resolved his gastrointestinal symptoms but also substantially improved his rosacea. This case highlights the importance of considering systemic conditions in rosacea patients, especially when symptoms are new or unexplained.”
dr. gallo’s Response:
“When discussing rosacea with asymptomatic patients, I emphasize that the condition can be a warning sign rather than a definitive diagnosis of systemic disease.I advise them to stay informed and ensure they’re regularly seeing a primary care physician who is aware of their rosacea. While not every patient will need immediate referral, it’s crucial to monitor for potential comorbidities. For example, I might say, ‘Rosacea can sometimes be associated with other conditions, so it’s crucial to keep an eye on your overall health and address any new symptoms promptly.’”
Conclusion:
The interview underscores the evolving understanding of rosacea as more than just a skin condition. Dr. Harper highlights its potential as a sign of systemic inflammation, while Dr. Baldwin shares a compelling case where treating an underlying GI issue improved both rosacea and gastrointestinal symptoms.Dr. Gallo stresses the importance of awareness and monitoring in asymptomatic patients. Together,these insights emphasize the need for a holistic approach to managing rosacea and its potential systemic implications.
