Rosacea – not limited to the skin

Rosacea literally means “red as a rose” in Latin. It is the name for a chronic skin condition that is accompanied by an increase and decrease in disease symptoms over many years. Light-skinned people are more likely to be affected by it.

Rosacea can be recognized by redness in the face, skin inflammations, eye complaints and skin thickening of the nose (popularly known as the sour nose), the forehead or the chin. The condition was once thought to be limited to the skin and eyes, but today we know it goes deeper than just the skin. There is strong evidence that rosacea is associated with so-called systemic disorders.

A recent study examined the systemic conditions associated with rosacea. These conditions vary greatly. Below is a list:

• allergies (airborne and food)
• lung diseases
• intestinal disorders (e.g. Irritable bowel syndrome (IBS), celiac disease)
• hypertension
• hormonal imbalance
• type-1 diabetes mellitus
• cardiovascular disorders
• rheumatism
• anxiety disorders and depression

The more severe and the longer the duration of rosacea, the higher the risk of these conditions.

As a dermatologist, I am often asked if nutrition can play a role. The answer to that is yes. Rosacea can be triggered by a whole range of foods.

• hot coffee and tea
• alcohol (mainly white wine and liqueur)
• capsaicin in spices (cayenne pepperand red pepper)
• Cinnamon aldehyde-containing foods:
  • cinnamon
• tomatoes
• chocolate
• citrus
• eggplant
• avocado
• vinegar
• banana
• curry
• plums
• raisins
• soy
• spinach
• dairy products

Besides nutrition, what else could trigger it?

Rosacea, of course, is not just caused by certain foods. Certain weather conditions, such as cold or hot weather, ultraviolet light, wind, physical exertion or emotions can also give rise to the condition.

You should also pay attention to cosmetics, certain irritating substances such as soap, perfume, shaving foam, chemical sunscreen filters, menthol, facial cleansing wipes, peeling products.

Drugs such as Corticosteroids, Doxorubicin, Infliximab, Interferon, Nifedipine, Nitroglycerin, Prostaglandin E, and Rifampicin can also enhance rosacea predisposition.

There is a lot to read about possible cellular mechanisms, both innate and acquired immune cells, but skin cells, vascular cells (endothelial cells) and neurology may also be involved in rosacea.

New insight: rosacea and systemic diseases

While delving into the countless studies into the causes of rosacea, I came across a study that provided me with a lot of insight. It concerned a genetic study (Aponte JL, 2018) of more than 73,000 individuals, in which the findings caught my attention. In the participants with rosacea, abnormalities were found at 7 different locations in the chromosomes in the coding for, among others, IL-13, PSMB9, HERC-OCA2, RS1805007 and NRX3-DIO2. These discoveries indicate that rosacea goes deeper than just superficial skin conditions and may be associated with systemic disorders.

Specifically, this means the following.

• Overexpression of IL-13:
  • more asthma, allergic rhinitis, intestinal complaints
• PSMB9:
  • rheumatism, heart failure, myocardial infarction, neurodegenerative diseases: parkinson, alzheimer’s, ALS and upregulation of various pro-inflammatory cytokines: IL-8, Nitrite Oxide (NO), TNF-alpha, IL-beta, adhesion molecules, prostaglandins.
• HERC-OCA2 encodes melanin in pigment cells.

Although these terms may seem a bit strange, let me clarify them. All these genes are involved in systemic diseases such as allergies (in the air, such as pollen or dust, and in food) but also intestinal disorders, cardiovascular diseases, neurological disorders, anxiety disorders and depression. Thus, there is a genetic predisposition to rosacea and the development of many systemic diseases.

Genetic predisposition to rosacea and systemic diseases.

It is unknown what the chances are that you will develop these systemic conditions and which of these conditions you will develop first. One bright spot is that with these new findings we are a step further because new or existing drugs may be applied in the fight against rosacea and related conditions.

Tips: what can you do against rosacea right now.

Try to avoid triggers in food as much as possible, even if it is sometimes difficult to resist that delicious piece of chocolate in your candy cabinet. One method that can help you with this is a food trigger diary. In addition to certain foods, it is also best not to use rough washcloths and/or cleaning brushes.
In addition, it is also strongly discouraged to use cosmetics with perfume, sodium lauryl sulfate, fruit acids, scrub or glycolic acid.

A mineral sunscreen will give you the least skin irritation, but make sure that it contains both titanium dioxide and zinc oxide. This combination provides broad ultraviolet coverage. Titanium dioxide protects you better from uvb rays and zinc oxide covers uva rays better. Read more here UVA and UVB.

A single study (Schlesinger TE, 2013) showed a beneficial effect of hyaluronic acid serum and reduction of rosacea complaints. Cream with niacinamide (Drealos ZD, 2005) or vitamin B3 also reduces inflammation in the skin in people with a mild to mild form of rosacea.

Literature:

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. Systemic comorbidities associated with rosacea: a multicentric retrospective observational study. Int J Dermatol. 2019;58(6):722-728.

Rainer BM, Kang S, Chien AL. Rosacea: Epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017;9(1):e1361574

Rainer BM, Fischer AH, Luz Felipe da Silva D, Kang S, Chien AL. Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study. J Am Acad Dermatol. 2015 Oct;73(4):604-8.

Weiss E, Katta R. Diet and rosacea: the role of dietary change in the management of rosacea. Dermatol Pract Concept. 2017;7(4):31–37

While you are here

Dermatitis perioralis is a rash most commonly seen in women between the ages of 16 and 45. But also in children aged between 7 months and 13 years. The skin condition consists of small inflammatory papules and pimples and/or red/pink scaly areas around the mouth or eyes. Read more about this: Dermatitis perioralis