Microbiota in Rosacea
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Microbiota in Rosacea Hei Sung Kim1,2,3
© The Author(s) 2020
Abstract Rosacea is a complex facial skin condition associated with abnormal inflammation and vascular dysfunction. Next to the known trigger factors, the role of microbiota in the development and aggravation of rosacea continues to raise interest. Demodex folliculorum mites, Helicobacter pylori, Staphylococcus epidermidis, Chlamydia pneumoniae, and the Demodexassociated bacterium, Bacillus oleronius are microbes that have been linked with rosacea. However, the results of studies which assessed their involvement in the disease have been inconsistent and inconclusive. Microbiological research in many different disciplines exploded in recent years as methods to analyze complex microbial communities at the taxonomic and phylogenetic levels became available. Here, we provide an update on the microorganisms implicated in rosacea and review the potential pathogenic role of microbes in the development of rosacea.
Key Points
1 Introduction
Microbes have long been suspected to play a role in rosacea.
Rosacea is a chronic inflammatory skin disease affecting the central face. It was first described medically in the 14th century by Dr. Guy de Chauliac, a French surgeon [1]. The reported prevalence of rosacea is quite high and varies considerably between study populations [2] and geographical areas [3]. Rosacea is reported less frequently in people with highly pigmented skin than in those with a fair complexion, which is likely due to under-detection of the disease in individuals with a dark skin tone [3]. In a recent meta-analysis of studies of the general population (N = 26,519,836 individuals) and dermatology outpatients (N = 18,483), the pooled proportion of subjects with rosacea was 5.46% (estimated range 0.09–22.41%) in the general adult population and 2.39% (estimated range 0.00–23.14%) among dermatology outpatients [4]. Based on these findings, the National Rosacea Society (NRS) estimates that 415 million people suffer from rosacea worldwide [5]. Adults of 45–60 years of age are primarily affected, with no significant difference between women and men [4]. Although the pathophysiology of rosacea is poorly understood, the efficacy of antibiotics in rosacea treatment suggests that microbes are a pathogenic factor. All microorganisms (bacteria, viruses, fungi, and mites) present in/on the skin constitute the skin microbiota, including resident microorganisms (the core microbiota), which are symbionts, and transient microorganisms (the ‘tourists’), which arise from the environment and persist for hours to days before
Better understanding of the microbiota and its role in rosacea pathophysiology may help determine the impact of microbial dysbiosis and host reactivity in rosacea populations. Deeper knowledge of microbe–host interactions in rosacea will allow targeted patient care and aid the development of innovative therapies.
* Hei Sung Kim [email protected] 1
Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Mil
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