Exposome factors and concomitant systemic pathology in the pathophysiology of rosacea

Background. Rosacea is a chronic, relapsing dermatological disease that affects the skin of the face. Rosacea is characterized by the occurrence of erythema, papules, telangiectasia, edema, pustules, or a combination of these manifestations. Currently, rosacea is considered a multifactorial disease with a wide range of exogenous and endogenous triggers.

Objective. Purpose of the study: analysis of Russian-language and foreign scientific publications on the influence of trigger factors and concomitant systemic pathology on rosacea.

Materials and methods. During this study, a search and analysis of domestic and foreign literary sources was carried out using electronic databases PubMed, Elibrary, CyberLeninka, ScienceDirect in the field of dermatovenerology, containing information on the etiopathogenesis of rosacea, trigger factors, and concomitant pathologies affecting the disease.

Results. Unfavorable trigger factors for rosacea are pharmacological, immunological, infectious, climatic, thermal and nutritional. Skin with rosacea is most sensitive to temperature changes, especially heat. Various factors play a role in the development of rosacea, including disruption of the protective function of the epidermis, inflammation induced by cathelicidin antimicrobial peptides, changes in vascular reactivity, enhanced innate immunity, neurogenic inflammation, angiogenesis, fibrosis, and hypercolonization by Demodex mites. It is assumed that rosacea is not limited only to the skin, but may be associated with various systemic disorders, such as pathologies of the gastrointestinal tract, cardiovascular diseases, neurological disorders, and endocrinopathies.

Conclusion. Identifying and eliminating triggers is critical to successfully treating and preventing this disease.

1. Searle T., Al-Niaimi F., Ali F. R. Rosacea. Br J Hosp Med (Lond). 2021; 2 (82): 1-8. DOI: 10.12968/hmed.2020.0417.

2. Ayupova K. R., Yusupova L. A. Current state of the problem of rosacea. Lechaschi Vrach. 2022; 5-6: 30-33. DOI: 10.51793/OS.2022.25.6.005. (In Russ.)

3. Wollina U. Is rosacea a systemic disease? ClinDermatol. 2019; 6 (37): 629-635. DOI: 10.1016/j.clindermatol.2019.07.032.

4. Rodrigues-Braz D., Zhao M., Yesilirmak N., et al. Cutaneous and ocular rosacea: Common and specific physiopathogenic mechanisms and study models. Mol Vis. 2021; 27 (13): 323-353.

5. Na-Young Kang С., Shah M., Tan J. Rosacea: An Update in Diagnosis, Classification and Management. Skin Therapy Lett. 2021; 4 (26): 1-8.

6. Yang X., Cai M. New Insights into the Mutual Promotion of Rosacea, Anxiety, and Depression from Neuroendocrine Immune Aspects. Clin Cosmet Investig Dermatol. 2023;. 16 (29): 1363-1371. DOI: 10.2147/CCID.S413237.

7. Matushevskaya Yu. I. New aspects of the pathogenesis of rosacea. Effectivnaya farmakoterapiya. 2022; 31: 52-58. DOI: 10.33978/2307-3586-2022-18-31-52-58. (In Russ.)

8. Zuuren E. J., Arents B. W., Linden M. M., et. al. Rosacea: New Concepts in Classification and Treatment. Am J ClinDermatol. 2021; 4 (22): 457-465. DOI: 10.1007/s40257-021-00595-7.

9. Daou H., Paradiso M., Hennessy K., et. al. Rosacea and the Microbiome: A Systematic Review. Dermatol Ther (Heidelb). 2021; 1 (11): 1-12. DOI: 10.1007/s13555-020-00460-1.

10. Dall'Oglio F., Fusto C., Micali G. Intrafamilial Transmission of Rosacea Spanning Six Generations: A Retrospective Observational Study. J Clin AesthetDermatol. 2022; 2 (15): 35-39.

11. Kim H. B., Na E. Y., Yun S. J., et. al. The Effect of Capsaicin on Neuroinflammatory Mediators of Rosacea. Ann Dermatol. 2022; 4 (34): 261-269. DOI: 10.5021/ad.21.223.

12. Guertler A., Volsky A., Eijkenboom Q., et. al. Dietary Patterns in Acne and Rosacea Patients-A Controlled Study and Comprehensive Analysis. Nutrients. 2023; 20 (15): 4405. DOI: 10.3390/nu15204405.

13. Maggioni D., Cimicata A., Praticò A., et. al. Preliminary Clinical Evaluation of a Topical Product for Reducing Slight Rosacea Imperfections. Clin Cosmet Investig Dermatol. 2020; 13: 299-308. DOI: 10.2147/CCID.S240784.

14. Rainer B. M., Kang S., Chien A. L. Rosacea: Epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017; 1 (9): 1361574. DOI: 10.1080/19381980.2017.1361574.

15. McCoy W. H. "Shedding Light" on How Ultraviolet Radiation Triggers Rosacea. J Invest Dermatol. 2020; 3 (140): 521-523. DOI: 10.1016/j.jid.2019.09.008.

16. Morgado-Carrasco D., Granger C., Trullas C., et. al. Impact of ultraviolet radiation and exposome on rosacea: Key role of photoprotection in optimizing treatment. J Cosmet Dermatol. 2021; 11 (20): 3415-3421. DOI: 10.1111/jocd.14020.

17. Luo X., Zhou N., Wu L., et al. Development of an animal model for rosacea like skin lesions caused by Demodex. Exp Ther Med. 2022; 4 (24): 618. DOI: 10.3892/etm.2022.11555.

18. Kim H. S. Microbiota in Rosacea. Am J Clin Dermatol. 2020; 21: 25-35. DOI: 10.1007/s40257-020-00546-8.

19. Wang F., Chi Ch. Rosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut-Skin Axis of Rosacea. Adv Ther. 2021; 3 (38) 1415-1424. DOI: 10.1007/s12325-021-01624-x.

20. Perlamutrov Yu. N., Olkhovskaya K. B., Aivazova T. V. Modern view on the etiopathogenesis of rosacea, the role of diet and intestinal microbiome in the course of the disease. Dermatovenerologiya. Kosmetologiya. 2022; 2 (8): 99-110. (In Russ.)

21. Zhu W., Hamblin M. R., Wen X. Role of the skin microbiota and intestinal microbiome in rosacea. Front Microbiol. 2023; 14 (10): 1108661. DOI: 10.3389/fmicb.2023.1108661.

22. Pektas S. D., Cinar N., Pektas G., et. al. Thiol/disulfide homeostasis and its relationship with insulin resistance in patients with rosacea. J Cosmet Dermatol. 2022; 6 (21): 2655-2661. DOI: 10.1111/jocd.14477.

23. Wienholtz N. K., Christensen C. E., Haugaard J. H., et. al. Cohort profile: COpenhagenROsaceaCOhort (COROCO) and COpenhagenMIgraineCOhort (COMICO). BMJ Open. 2020; 8 (10): 039445.

24. Choi D., Cho S., Choi S., et. al. Association of Rosacea With Cardiovascular Disease: A Retrospective Cohort Study. J Am Heart Assoc. 2021; 19 (10): 020671. DOI: 10.1161/JAHA.120.020671.

25. Schaller M., Almeida L. M., Bewley A., et. al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSaceaCOnsensus 2019 panel. Br J Dermatol. 2020; 5 (182): 1269-1276. DOI: 10.1111/bjd.18420.

26. Kovaleva Yu. S., Reshetova S. V., Nikolaeva M. G. Emphasis on azelaic acid in topical therapy of rosacea. Klinicheskaya dermatologiya i venerologiya. 2021; 20 (5): 103-108. DOI: 10.17116/klinderma202120051103. (In Russ.)