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    No one really knows the cause of rosacea but there are many theories. "Rosacea is a skin disease with an obscure and complicated pathogenesis." [1]

    The current most popular theory is that rosacea is a disorder of the innate immune system. For over twenty years the vascular theory was held as the most promising. What is interesting is at the heart of the innate immune system theory is that this includes an overproduction of cathelicidin (a killer of microscopic organisms that is at the cellular level found in white blood cells and also found in cells on the skin) which is transported in the vascular system, so we have come full circle. Some consider the nervous system as the root cause of rosacea, and the list goes on with many other theories worth considering (the latest theory is the Trigeminal sensory malfunction theory) but a good place to start your research is our post on Theories Revisited

    End Notes

    [1] Dovepress
    Rosacea and Helicobacter pylori: links and risks
    Elizabeth Lazaridou, Chrysovalantis Korfitis, Christina Kemanetzi, Elena Sotiriou, Zoe Apalla, Efstratios Vakirlis, Christina Fotiadou, Aimilios Lallas, Demetrios Ioannides

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    • This question was asked and I am sharing my answer here as well.   Basically everyone has demodex mites and it has been thought that the mites have some sort of undisclosed symbiotic relationship, i.e., the mites eat sebum which helps the mites and helps the humans keep sebum stasis. One report states, "....Demodex mites were originally perceived to be commensals, having a symbiotic relationship with the human host." - See Jarmuda et al published in the Journal of Medical Microbiology (second article mentioned in this post). While this same report says that 'most human populations' have NOT been sampled for demodex mites the general belief is that demodex are common throughout humanity and pose no problem as a pathogen except in the case of demodectic rosacea as far as known.    A Russian study on the mites says, "Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte."  It is comparable to bacteria which humans have a relationship with, there is good bacteria and bad bacteria. The probiotic bacteria and the pathogen bacteria. The demodex mites usually pose no problem with the vast majority of humans since they are possibly on everyone. Why they become more numerous seems to be of more importance.    For some unknown reason the mites are in higher density in rosacea patients. We don't know if the rosacea cause this increase in mites or does the increase in mites cause the rosacea, the old chicken or egg conundrum? There is evidence that reducing the mite density count improves rosacea.  It is clear that the mites like human skin since they eat sebum.     Maybe the increase of sugar/carbohydrate in the diet increases sebum which in turn increases the mite population, and voila, the inflammation of rosacea?    I don't think all rosacea is demodectic. GUT Rosacea is a different variant, but may be connected or associated.  The list of systemic comorbidities with rosacea keeps growing. The gut microbiome is obviously connected with skin microbiome (see my post on this).  
    • Related Articles Epidemiological features of rosacea in Changsha, China: A population-based, cross-sectional study. J Dermatol. 2020 Mar 24;: Authors: Li J, Wang B, Deng Y, Shi W, Jian D, Liu F, Huang Y, Tang Y, Zhao Z, Huang X, Li J, Xie H Abstract Rosacea is a common chronic skin disorder of unknown etiology. While population prevalence rates range 0.2-22% in Europe and North America, prevalence in China is currently undetermined. We conducted a large population-based case-control study to determine the present epidemiological status of rosacea in China, involving 10 095 participants aged 0-100 years (mean age, 35.5 ± 19.1; 50.5% female). A census of rosacea among 15 communities in Changsha in south central China was conducted with skin examination by board-certified dermatologists. Rosacea was observed in 3.48% (95% confidence interval, 3.13-3.85%) of the study population. Subtype distribution was erythematotelangiectatic in 47.6%, papulopustular in 35.0% and phymatous in 17.4%. Family history was noted in 37.8% and ocular symptoms in 31.3%. Associations with rosacea were observed for melasma, hypertension, hyperthyroidism and breast cancer in females (P < 0.05), and also for hyperthyroidism and peptic ulcers in males (P < 0.05). Our results provide baseline information about epidemiological aspects of rosacea in China. PMID: 32207167 [PubMed - as supplied by publisher] {url} = URL to article
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