A new study from South Korea links the use of acid suppressants – proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), widely used therapies for treatment of acid-related gastrointestinal diseases such as peptic ulcer disease, heartburn, gastroesophageal reflux disease (GERD) and others – and increased risk of rosacea, according to a recent report in the Journal of Korean Medical Science.1
Using data from the Korean National Health Insurance Service-National Sample Cohort, a national database of approximately 1 million Koreans, the researchers identified 3,460 individuals who were prescribed PPIs or H2RAs for 90 days or more. Of these, 692 were diagnosed with rosacea for the first time at least one year after use of the treatments. The other 2,768 were of similar age, sex, index date and household income to the rosacea patients, and served as a control group for comparison.
Longer use of acid suppressants was significantly associated with greater risk of rosacea, the investigators found. Use of the suppressants for more than 30 days increased the risk by 43%, whereas use for more than 120 days was associated with a 68% greater risk, even after adjustment for possible confounding factors.
Moreover, the risk of developing rosacea increased when the daily dose increased, with those taking the highest cumulative daily dose of acid suppressants being more than twice as likely to have rosacea.
Other factors significantly associated with risk of rosacea among those using acid suppressants included residing in a rural area, as well as comorbidities including cancer, thyroid disease and depression, individually or in combination. Sun exposure has long been recognized as contributing to the development or exacerbation of rosacea, and the investigators speculated that the higher frequency of sun exposure experienced by rural residents resulted in the greater incidence of rosacea.
The investigators noted that alteration of the pH of the gut has been associated with altered composition of gut microbiota, which is important as the acidic barrier renders the stomach unfavorable for bacterial survival, according to studies.2,3 A reduction in gastric acidity could potentially lead to increased susceptibility to infections and other complications, including inflammatory skin diseases, they said; conversely, improvement of skin inflammation after taking oral prebiotics and probiotics also suggests a relationship between the skin and gut microbiomes. Further study would be useful, they noted, as separate analysis for H2RA and PPI, which have different mechanisms for suppressing gastric acidity, could reveal different results for each.
References
1. Kim JH, Min J, Jo YW, Kwon J-W, Her Y. Association between acid-suppressive drugs and risk of rosacea: retrospective study using Korean National Health Insurance Service- National Sample Cohort. J Korean Med Sci 2023;4;38:e402. doi.org/10.3346/ jkms.2023.38.e402.
2. Nam JH, Yun Y, Kim HS, Kim HN, Jung HJ, Chang Y, et al. Rosacea and its association with enteral microbiota in Korean females. Exp Dermatol 2018;27(1):37-42.
3. Chen YJ, Lee WH, Ho HJ, Tseng CH, Wu CY. An altered fecal microbial profiling in rosacea patients compared to matched controls. J Formos Med Assoc 2021;120(1 Pt 1):256-64.