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Rosacea tied to physical and psychological comorbidities.

Rosacea is significantly associated with a range of comorbidities including depression, hypertension, and cardiovascular disease, according to a review of 29 studies.

The recognition of rosacea as an inflammatory condition similar to psoriasis suggests that, as with psoriasis, rosacea may be associated with a range of systemic diseases, but data on such an association are limited, wrote Roger Haber, MD, from the department of dermatology at Saint George Hospital University Medical Center, Beirut, Lebanon.

In a systematic review published in the Journal of the American Academy of Dermatology, Dr. Haber and his colleague, Maria El Gemayel, MD, from the department of internal medicine at Hotel Dieu de France University Hospital, Beirut, analyzed data from 14 case-control studies, 8 cross-sectional studies, and 7 cohort studies published from 1965 to 2017.

"To the best of our knowledge, our study is the first review analyzing available data regarding the diseases associated with rosacea," they said.

Overall, the most common comorbidities associated with rosacea were depression (reported in 117,848 patients), hypertension (18,176 patients), cardiovascular disease (9,739 patients), anxiety disorder (9,079 patients), dyslipidemia (7,004 patients), diabetes mellitus (6,306 patients), and migraine (6,136 patients). All associations were statistically significant.

Psychological problems significantly associated with rosacea include depression and anxiety, which may be related to similar inflammatory pathways among these conditions, the researchers noted.

Cardiovascular disease risk factors significantly associated with rosacea included coronary artery disease, cardiovascular disease, peripheral artery disease, heart failure, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome. The association with coronary artery disease remained significant after adjusting for multiple variables, as has been shown with psoriasis, which supports consideration of rosacea as an independent risk factor for CAD, the researchers said.

In terms of gastrointestinal comorbidities, the studies reviewed found an association between rosacea and several GI disorders, including celiac disease, Crohn's disease, and ulcerative colitis, and Helicobacter pylori infection, they wrote. Although the current data do not imply causality, clinicians should screen rosacea patients for GI disorders, they noted.

The link between rosacea and migraine may stem from the similar vascular abnormalities and triggers common to both conditions, such as stress and alcohol, the researchers added.

The review does not establish causality between rosacea and any of the comorbidities examined in part because of the inclusion of observational studies, the researchers noted. "It is also possible that the observed association with rosacea is explained by shared environmental or lifestyle factors rather than by a common genetic disposition or pathophysiologic pathways," they said. Controlled and prospective studies are needed to better identify associations, but general physicians and dermatologists who recognize the potential risk of comorbidities in rosacea patients may be better able to manage and treat them, they added.

The researchers had no financial conflicts to disclose. There was no funding source for the study.

SOURCE: Haber R et al. J Am Acad Dermatol. 2018 April; 78(4):786-92.

By Heidi Splete


Commentary by Dr. Harper / I interpret the possible link between rosacea and this very long list of physical and psychological comorbidities with interest but with a great deal of caution. I personally need more information before I follow the authors' recommendations of calculating body mass index, and checking a fasting lipid panel, fasting glucose, or hemaglobin Alc at least once in rosacea patients older than 45 years. Additionally, asking about symptoms of Parkinson's disease, glioma, and multiple sclerosis in a rosacea patient seems over the top at this point. If a rosacea patient does not already suffer from anxiety before those questions, they probably will after. Don't misunderstand. This is an important area of research, but a cause-and-effect relationship cannot be concluded from these types of studies and we should be very careful how we translate them into our clinical practice.

So we stay tuned. Rosacea is a chronic inflammatory condition. Some of the inflammatory pathways and mediators in rosacea pathogenesis are also at work in other chronic inflammatory conditions. It is therefore plausible that these conditions might overlap and coexist. Is the common thread inflammation? Is the inflammation a result of common environmental or lifestyle factors? We do not know.

For now, it makes sense to treat and reduce the inflammation of rosacea. We should perform a review of systems annually and help to coordinate care with primary care providers when appropriate. Flagging all rosacea patients for additional screening or counseling is not warranted based on the data available at this time.
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Author:Splete, Heidi
Publication:Dermatology News
Date:Jul 1, 2018
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