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Systemic Cormorbidities in Rosacea

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Rosacea is associated with a number of other diseases, referred to as ‘systemic comorbidities’, which one study reports, “Clinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.” [1] The following is a growing list:

Autoimmune conditions [2]

Allergies (airborne, food, etc.)

Anxiety Disorder [3]

Alzheimer's Disease


Chronic rhinosinusitis (CRS) [4]


Cardiovascular diseases [3]

Depression/anxiety disorders [3]


Diabetes [3]

Dyslipidemia [3]

Female hormone imbalance [5] [10]

Gastroesophageal Reflux Disease (GERD) and other GI disorders [1]


Hair loss

Helicobacter pylori infection [3]

Hepatobiliary system disorders [1]

Hyperlipidemia [3]

Hypertension [6]

Inflammatory bowel disease (IBD)

HLA-DRA Locus [7]

Kidney Disease [8]

Low-grade inflammation

Mental Health Disorders [9]

Metabolic diseases [1]


Migraine [31]

Multiple sclerosis

Obesity [25]

Parkinson's disease

Psychiatric diseases [3]

Respiratory diseases [1]

Rheumatoid Arthritis [3]


Ulcerative Colitis [3]

Urogenital diseases [10]

The above list keeps growing. This complicates the theories on the cause of rosacea increasing the call for further research. For example, one study it was stated, "In this large study of patients with rosacea, atopic dermatitis, and psoriasis, we did not detect an increased 1-year risk of cardiovascular disease after adjusting for confounders." [11] 

Confounding Factors
Therefore, papers stating an association of rosacea with other diseases should all be taken with a grain of salt due to 'confounders' since another paper states, "Limitations included the accuracy of the published data, potential patient selection, and possible confounding factors. The true nature of the drawn correlations is uncertain, and causality cannot be established." [3] [bold font added for emphasis]

image courtesy of WikiMedia Commons

"In statistics, a confounder (also confounding variable, confounding factor or lurking variable) is a variable that influences both the dependent variable and independent variable causing a spurious association." Wikipedia

End Notes

[1] Int J Dermatol. 2018 Dec 21;:
Systemic comorbidities associated with rosacea: a multicentric retrospective observational study.

Aksoy B, Ekiz Ö, Unal E, Ozaydin Yavuz G, Gonul M, Kulcu Cakmak S, Polat M, Bilgic Ö, Baykal Selcuk L, Unal I, Karadag AS, Kilic A, Balta I, Kutlu Ö, Uzuncakmak TK, Gunduz K

[2] Dermatol Clin. 2018 Apr;36(2):115-122. doi: 10.1016/j.det.2017.11.006. Epub 2017 Nov 29.
Rosacea Comorbidities.
Vera N1, Patel NU2, Seminario-Vidal L3.

[3] J Am Acad Dermatol. 2018 Apr;78(4):786-792.e8. doi: 10.1016/j.jaad.2017.09.016. Epub 2017 Oct 26.
Comorbidities in rosacea: A systematic review and update.
Haber R1, El Gemayel M2.

[4] There may be a relationship between rosacea and chronic rhinosinusitis (CRS) as the following quote concludes: 

"Patients with rosacea and CRS manifested severe erythematotelangiectatic rosacea. There was enough evidence to suggest an association between rosacea and CRS. Clinical and radiological assessments of the paranasal sinuses are recommended."

Med Princ Pract 2014;23:511-516 (DOI:10.1159/000364905)
Rosacea and Chronic Rhinosinusitis: A Case-Controlled Study
Al-Balbeesi A.O. 
Department of Dermatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia

[5] "There is no research regarding hormones and their effect on rosacea," Dr. Bergfeld said. "However, it has been widely observed that rosacea is often aggravated at menopause and sometimes during mid-cycle."
Women May Need Added Therapy, Rosacea Review, NRS

[6] Cardiovascular Diseases and Rosacea

[7] "The HLA-DRA locus is associated with rosacea as well as with other inflammation-associated disorders, such as inflammatory bowel diseases including ulcerative colitis, Crohn’s disease, and celiac disease....Moreover, Spoendlin et al. found that an increased risk of rosacea was observed particularly during the period of increased gastrointestinal tract inflammation. Thus, the overlap in the genetic relevance of HLA-DRA between rosacea and inflammatory bowel diseases might imply a potential link between these disorders...Patients with rosacea have a higher risk of cardiovascular comorbidities including hypertension, dyslipidemia, and coronary artery disease than that seen in controls. Rosacea severity was also found to be dependent on the presence of cardiovascular comorbidities....In addition, the association between cardiovascular diseases and rosacea might also be explained by enhanced expression of the cathelicidin, which has been observed both in the course of atherosclerosis and rosacea. The GWAS by Chang et al. [20] also revealed that patients with rosacea shared a genetic locus with type 1 diabetes mellitus; this association was further confirmed by a population-based study as well....Patients with rosacea have a significantly increased risk of neurologic disorders such as migraine, depression, complex regional pain syndrome, and glioma...Recently, an increased interest has been shown in the potential associations between neurodegenerative diseases and rosacea....For example,...Parkinson’s disease...dementia, especially Alzheimer disease..."

Int J Mol Sci. 2016 Sep; 17(9): 1562.
Published online 2016 Sep 15. doi:  10.3390/ijms17091562, PMCID: PMC5037831

Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition
Yu Ri Woo, Ji Hong Lim, Dae Ho Cho, and Hyun Jeong Park, Chris Jackson, Academic Editor

[8] Study Finds Possible Link Between Kidney Disease and Rosacea, NRS

[9] Clin Exp Dermatol. 2019 Jan 31;:
The mental health burden in acne vulgaris and rosacea: an analysis of the US National Inpatient Sample.
Singam V, Rastogi S, Patel KR, Lee HH, Silverberg JI

[10] J Am Acad Dermatol. 2015 Aug 6;
Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: Results of a case-control study.
Rainer BM, Fischer AH, Luz Felipe da Silva D, Kang S, Chien AL

[11] Dermatol Ther (Heidelb). 2016 Dec;6(4):649-658. Epub 2016 Sep 22.
Cardiovascular Disease Outcomes Associated with Three Major Inflammatory Dermatologic Diseases: A Propensity-Matched Case Control Study.
Marshall VD, Moustafa F, Hawkins SD, Balkrishnan R, Feldman SR,




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