Rosacea and the Microbiome: A Systematic Review
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REVIEW
Rosacea and the Microbiome: A Systematic Review Hala Daou . Michela Paradiso . Kerry Hennessy . Lucia Seminario-Vidal
Received: September 23, 2020 Ó The Author(s) 2020
ABSTRACT Rosacea, a chronic inflammatory skin disease characterized by recurrent episodes of facial flushing, erythema, pustules, and telangiectasia, largely affects fair-skinned women over 30 years of age. Although a long-recognized entity, the exact pathophysiology of this disease is still debated. Current theories highlight the role of the cutaneous microbiome and its associated inflammatory effects in rosacea’s pathogenesis. However, microbiological reverberations are not limited to the skin, as recent studies have described the potential cutaneous effects of alterations in the gastrointestinal (GI) microbiome. Associations with additional GI pathologies, including small intestinal bacterial
overgrowth (SIBO), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD), have been investigated, as well as Helicobacter pylori infection. In an attempt to better understand and characterize these relationships, as well as current treatment options, we conducted a systematic review of the literature in PubMed, Cochrane, and Embase from their inception to August 6, 2020. We have synthesized the literature findings within three sections of this manuscript: the cutaneous microbiome, the gut microbiome, and therapeutic strategies. Future studies should focus on specific mechanisms linking GI pathology with rosacea manifestations and the role of enteral drugs in mitigating cutaneous symptoms.
Keywords: Rosacea; IBD; Microbiome; Inflammation; Immune dysregulation
H. Daou Morsani College of Medicine, University of South Florida, Tampa, FL, USA M. Paradiso Ohio State University College of Medicine, Columbus, OH, USA K. Hennessy L. Seminario-Vidal (&) Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL, USA e-mail: [email protected]
Dermatol Ther (Heidelb)
Key Summary Points Rosacea is a chronic inflammatory skin disease characterized by recurrent episodes of facial flushing, erythema, pustules, and telangiectasia, largely affecting fair-skinned women over 30 years of age Imbalances in cutaneous organisms including Cutibacterium acnes, Staphylococcus epidermidis, Bacillus oleronius, and Demodex folliculorum have been implicated in the pathogenesis of rosacea An association between rosacea and numerous inflammatory gastrointestinal disorders has been reported in the literature Treatments targeting the dysregulation of both the cutaneous and gastrointestinal microbiomes have proven efficacious Future therapies should target gastrointestinal inflammation and dysbiosis as a means to ameliorate global immune system dysregulation and the ensuing symptoms of rosacea that arise
DIGITAL FEATURES
ocular and phymatous involvement [1]. It is divided into four principal subtypes based on these clinical characteristics: erythematotelangiectatic rosacea (ETR), papulopustular rosacea (PPR), phymatous rosacea, and
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