Most consistently, rosacea has been found to be associated with an increased risk of inflammatory bowel diseases (IBD). This relationship is supported by two 2019 meta-analyses of observational studies and a nationwide cohort study in Denmark.[1][2][3] While the mechanisms underlying this connection are unclear, both disease states involve dysfunction of the immune system and chronic inflammation.[2]
Small intestinal bacterial overgrowth (SIBO) has been suggested by some, but not all, studies to be more common in people with rosacea. Despite these inconsistent findings, treatment of SIBO with the antibiotic rifaximin has been found in multiple trials to improve symptoms of rosacea, with effects persisting for months to years.[4][5][6]. Rifaximin acts locally in the gut, and is not thought to influence systemic inflammation, unlike the other antibiotics used in rosacea management.[6]
Rosacea may be associated with an increased risk of celiac disease, and this relationship is further supported by a genome-wide association study that found that rosacea and celiac disease share two genetic risk markers.[6]
While H. pylori infection has been suggested to contribute to rosacea, this is controversial and not strongly supported by the evidence. One meta-analysis of observational studies reported a small, but not statistically significant, positive association between rosacea and H. pylori infection, while another meta-analysis of observational studies and a nationwide cohort study did not find a significant relationship. Any improvement in rosacea symptoms following treatment for H. pylori infection could, in theory, be attributed to the anti-inflammatory effects of the antibiotics.[7][3][6]
References
- ^Han J, Liu T, Zhang M, Wang AThe relationship between inflammatory bowel disease and rosacea over the lifespan: A meta-analysis.Clin Res Hepatol Gastroenterol.(2019-Aug)
- ^Wang FY, Chi CCAssociation of rosacea with inflammatory bowel disease: A MOOSE-compliant meta-analysis.Medicine (Baltimore).(2019-Oct)
- ^Egeberg A, Weinstock LB, Thyssen EP, Gislason GH, Thyssen JPRosacea and gastrointestinal disorders: a population-based cohort study.Br J Dermatol.(2017-Jan)
- ^Andrea Parodi, Stefania Paolino, Alfredo Greco, Francesco Drago, Carlo Mansi, Alfredo Rebora, Aurora Parodi, Vincenzo SavarinoSmall intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradicationClin Gastroenterol Hepatol.(2008 Jul)
- ^Drago F, De Col E, Agnoletti AF, Schiavetti I, Savarino V, Rebora A, Paolino S, Cozzani E, Parodi AThe role of small intestinal bacterial overgrowth in rosacea: A 3-year follow-up.J Am Acad Dermatol.(2016-Sep)
- ^Wang FY, Chi CCRosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut-Skin Axis of Rosacea.Adv Ther.(2021-Mar)
- ^Jørgensen AR, Egeberg A, Gideonsson R, Weinstock LB, Thyssen EP, Thyssen JPRosacea is associated with Helicobacter pylori: a systematic review and meta-analysis.J Eur Acad Dermatol Venereol.(2017-Dec)