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Fungus and Rosacea


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Conidiophores of Aspergillus, image courtesy of Wikimedia Commons

Bacteria has been implicated in rosacea with a huge amount of clinical papers on this subject. Demodex is now without a doubt linked to a significant number of rosacea cases. We have papers indicating treatment for one particular protozoa improves rosacea, however virus has not been ruled out in rosacea, nor archea has been ruled out in rosacea. The human microbiome includes the skin which contains a number of different microbes.

"The prevalence of fungal infections has been steadily increasing which is in part highly attributable to a growing immunocompromised population as well as an increase in worldwide travel." [8]

Fungus and Rosacea

Fungus has not been ruled completely out in its connection with rosacea and has been one theory on what causes rosacea at least in some cases, and should be ruled out. 

For example, the Cleveland Clinic reports, "Other theories suggest that the condition is caused by microscopic skin mites, fungus, psychological factors, or a malfunction of the connective tissue under the skin." [bold added]

Seborrheic Dermatitis, a co-existing condition with rosacea at times, has been associated with fungus, particularly Malassezia yeast, and is some cases responds well to antifungal treatments. [7]

Candida albicans (a fungus or yeast) and rosacea have been linked in a few research papers. One report said that a “patient was treated with intermittent pulses of itraconazole for the candidasis and doxycycline initially before being substituted with isotretinoin 6 months later for the rosacea.” and the outcome was that “the patient’s candidiasis responded well and has been in remission for 3 months while his rosacea continues to improve.”[1] Antibiotic resistance and bacterial overgrowth are other complications of long term antibiotic treatment for rosacea. Walter Last dubs this 'antibiotic syndrome.' [2] "The use of invasive devices and broad spectrum antibiotics has increased the rate of candidal superinfections." [3]

One report said, "These findings suggest that S. salivarius K12 may inhibit the invasion process of C. albicans into the mucous surfaces or its adhesion to denture acrylic resins by mechanisms not associated with the antimicrobial bacteriocin activity. S. salivarius K12 may be useful as a probiotic as a protective tool for oral care especially with regards to candidiasis." [4]

Candida Albicans And Rosacea
Chronic Mucocutaneous Candidiasis (CMC) in Demodectic Rosacea

"CMC was diagnosed in our patient despite poor clinical features. Sequencing of the genome revealed STAT1GOF mutation. This mutation affects production of IL-17, an important cytokine in mucocutaneous defense against Candida. The association with mycobacterial adenitis is rare and continues to be poorly understood. The presence of atypical rosacea in this setting is suggestive of this entity. Antifungal therapy and prevention of complications are necessary to reduce the morbidity and mortality associated with this condition." [5] [bold added]

"Researchers found that the risk for rosacea, as well as the skin disorders atopic eczema and onychomycosis (toenail fungus), increased with the presence of systemic low-grade inflammation – a chronic condition that may not cause visible symptoms yet contributes to the pathogenesis of many noncommunicable diseases, including atherosclerosis, type 2 diabetes, metabolic syndrome and others." [bold added] [6]

Fungal Infection Activates Inflammasomes

"As part of the innate immune system, inflammasomes play an important role in the induction of inflammatory cascades and coordination of host defenses, both via the activation and secretion of pro-inflammatory cytokines and the induction of a specialized form of immune-stimulatory programmed cell death termed pyroptosis. Traditionally, inflammasomes have mainly been studied in professional innate immune cells such as macrophages. More recently, however, several studies described various epithelial inflammasomes and highlighted their crucial role as a first line of defense. Since epithelial cells line important barrier tissues such as the intestines, their inflammasomes are optimally positioned to recognize invading microbes at the first point of interaction." [9]

"Inflammasomes are important sentinels of an organism's innate immune defense system," said corresponding author and founding member of the inflammasome field Thirumala-Devi Kanneganti, Ph.D., of the St. Jude Immunology department. "Our prior work showed that fungal pathogens activate the inflammasome, but the exact mechanism of action for inflammasome engagement was unknown." [10]

Fungus and Demodex Mites

Fungus has been associated with demodex mites. [11]

Anti-Fungal Treatments (antimycotic medication)

Allylamines: terbinafine [7]
Amphotericin B
Benzylamines: butenafine [7]
Clotrimazole [7]
Hydroxypyrones: Ciclopirox [7]
Imidazoles: bifonazole, climbazole, cotrimoxazole, ketoconazole (topical 2%), miconazole [7]
Solanum chrysotrichum [7]
Steroids [7]
Triazoles: fluconazole [7]
lithium [7]
zinc pyrithione [7]

Et Cetera

More info on bacterial overgrowth and antibiotic resistance.

End Notes

[1] Autosomal Dominant Familial Chronic Mucocutaneous Candidiasis Associated with Acne Rosacea
HL Ee, HH Tan, SK Ng; Ann Acad Med Singapore 2005; 34:571-4 • Full Article

By Walter Last

[3] Candida sepsis following transcervical chorionic villi sampling.
A Paz, R Gonen, and I Potasman
Infectious Diseases, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Hafa, Israel

[4] Effect of Streptococcus salivarius K12 on the in vitro growth of Candida albicans and its protective effect on oral candidiasis model.
Ishijima SA, Hayama K, Burton JP, Reid G, Okada M, Matsushita Y, Abe S.
Appl Environ Microbiol. 2012 Jan 20.

[5] Ann Dermatol Venereol. 2019 Oct 30;:
Chronic mucocutaneous candidiasis with STAT1 gain-of-function mutation associated with herpes virus and mycobacterial infections.
Baghad B, Benhsaien I, El Fatoiki FZ, Migaud M, Puel A, Chiheb S, Bousfiha AA, Ailal F

[6] New Study Shows Rosacea Associated With Low-Grade Inflammation, NRS, 12/04/2017

[7] Cochrane Database Syst Rev. 2015 May; 2015(5): CD008138.
Topical antifungals for seborrhoeic dermatitis
Monitoring Editor: Enembe O Okokon,corresponding author Jos H Verbeek, Jani H Ruotsalainen, Olumuyiwa A Ojo, Victor Nyange Bakhoya, and Cochrane Skin Group

[8] Curr Dermatol Rep. 2020; 9(2): 152–165.
Published online 2020 Mar 5. doi: 10.1007/s13671-020-00295-1
PMCID: PMC7224073
New Developments in Bacterial, Viral, and Fungal Cutaneous Infections
Samuel Yeroushalmi, Joshua Yoseph Shirazi, Adam Friedman

[9] Inflammasome, Wikipedia

[10] Research reveals how a fungal infection activates inflammation, December 2, 2020, St. Jude Children's Research Hospital, Science Daily

[11] Fungus and Demodex Mites

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  • 6 years later...

Hey Brady! I just did a couple of papers on Candida. It seems to me that I have found plenty of evidence linking Candida to rosacea symptoms. They don't specifically state that Candida causes rosacea but they do describe rashes that are the same description of rosacea rash. There are also many different species of Candida and I'm looking into the possibility that one or some of the Candida species lead to the rosacea symptoms expressed in both Candida rash and rosacea diagnosis.
Also an interesting side note that I discovered is that I had sepsis 2.5 years ago and was hospitalized in the ICU. The ICU is notorious for Candida infections with the depleted immune function, broken barriers and obviously the presence of microbes. As soon as the antibiotics ended from the sepsis my symptoms (not just rosacea but all candidiasis symptoms) appeared and have been not only unresponsive to medication but worsened by it. Candida albicans is also the most common cause of sepsis and is found in a cats mouth (I had deep cat bites). Just some food for thought on the larger picture and connecting the dots.

Sent from my Nexus 5X using Tapatalk

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