In connection with the updated standard classification system for rosacea published late last year, the National Rosacea Society Expert Committee also published an article in the Journal of the American Academy of Dermatology commenting on rosacea comorbidities and future research.¹

Comorbidity is the occurrence of two disorders or illnesses in the same person, at the same time or one after another. The committee summarized the many recent studies that have found associations between rosacea and increased risk for cardiovascular disease, gastrointestinal dis- ease, autoimmune diseases and certain cancers, among a growing number of systemic diseases. Although it has not been determined whether these associations represent a cause-and-effect relationship, the committee noted that these findings may greatly increase the clinical significance of rosacea as evidence that the disorder may be an outcome of systemic inflammation continues to mount. 

“Well beyond its negative effects on emotional, social and occupational well- being, this provides further reason for people who suspect they may have rosacea to seek diagnosis and appropriate treatment,” said Dr. Sewon Kang, chairman of dermatology at Johns Hopkins School of Medicine and a member of the expert committee. 

In addition to comorbidities, the committee identified a number of areas where further research may be of particular value. Recent evidence suggests rosacea may appear often in individuals with darker skin types, and the updated standard criteria can be used to determine its prevalence in various ethnicities as well as populations worldwide. In addition, re- cent studies have found genetic factors that might affect the disease and may also be used to identify potential further co- morbidities. Data also suggests that the skin microbiome may play a role. 

The full pathophysiology of neurovascular dysregulation should be explored—from flushing and blushing, the interaction between the nervous and immune systems during neuroinflammation (flushing, erythema), the immune response (erythema, papules and pustules), through fibrosis—along with the potential role of adaptive immunity at the cellular level in certain phenotypes, the committee noted. Biomarkers should also be identified to confirm diagnosis and monitor progression or treatment results in clinical practice, and there is a need for therapy for ocular rosacea as well as continuing improvement in therapies for other phenotypes.

Reference

Gallo RL, Granstein RD, Kang S, et al. Rosacea comorbidities and future research: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol 2017 Nov 1. pii: S0190- 9622(17)32052-2. doi: 10.1016/j. jaad.2017.06.150. [Epub ahead of print]