An Association Between Rosacea and Metabolic Syndrome?

Metabolic syndrome is a group of metabolic disorders, characterised by a significant waist circumference due to an excess of abdominal adipose tissue, high blood pressure, abnormal fasting blood sugar or insulin resistance, and dyslipidemia. However, studies have shown links between the rosacea and these metabolic disorders.

Relationship between diabetes and skin health.

A study conducted by Gursoy DOGAN on 47 individuals with rosacea and 50 control subjects revealed a significant increase in C-reactive proteins (CRP), a strong marker for the onset of diabetes, in patients with rosacea (4.86 mg/dL) compared to the control group (2.78 mg/dL). They also observed a positive correlation between rosacea and the occurrence of insulin resistance, a key phenomenon in diabetes, with 44.7% of patients with rosacea exhibiting insulin resistance compared to 10% in the control group.

By what mechanism?

Inflammation has been linked to an excessive response of the innate immune system due to increased activity of cathelicidin peptides. These can trigger angiogenesis and inflammatory responses by releasing IL-8. Stimulation of the cathelicidin-derived peptide induces the release of IL-1 via the P2X7 receptor. Similarly, the expression of the P2X7 receptor in peripheral blood monocytes has been associated with plasma levels of CRP and inflammatory cytokines in patients with type 2 diabetes. Indeed, the P2X7 receptor could be implicated in the pathological alterations of type 2 diabetes.

Association between rosacea and cardiovascular diseases and risks.

A Brazilian clinical trial conducted by Ibrahim ALTUN and Asli Akin BELLI on 40 patients with rosacea and 40 controls showed that individuals with rosacea had significantly higher epicardial fat thickness and carotid intima-media thickness volumes than the controls. Similarly, Nilgün ATAKAN and her colleagues found that certain cardiovascular risk factors, such as total cholesterol, LDL, CRP levels, and family history of cardiovascular diseases, were significantly higher in 60 patients with rosacea than in the controls (n = 50).

By what mechanism?

Inflammation caused by rosacea can induce structural changes in high-density lipoproteins (HDL), negatively impacting their ability to remove cholesterol, which could potentially lead to cardiovascular issues. Total cholesterol, low-density lipoproteins (LDL), and C-reactive protein can cause the formation of deposits on the artery walls, or atherosclerosis. Furthermore, the serum activity of paraoxonase-1 (PON1), an antioxidant enzyme associated with HDL and protecting LDL from oxidation, decreases in individuals with rosacea. Dyslipidemic patients and those suffering from hypertension have also shown lower PON1 activity.

Link between obesity and rosacea.

In a study conducted by Wen-Qing LI involving 89,886 participants over 14 years, 5,249 cases of rosacea were recorded. The researchers found that the risk of rosacea was higher in individuals with an increased body mass index. The risk ratio of rosacea was 1.48 for a BMI > 35 kg/m2 compared to a risk of 0.99 for a BMI < 21.0 kg/m2.

By what mechanism?

The chronic inflammatory state associated with obesity could be a key factor in the development of rosacea, and obesity could increase the expression of certain types of immune cells, such as IL-6 and TNF-α, which are involved in the onset of rosacea. Vascular changes could be another reason, as obesity can lead to abnormalities in vascular function and structure, which could result in the vasodilation seen in rosacea.

However, the subject is still a topic of debate among researchers. Moreover, having rosacea does not necessarily mean that one suffers from a metabolic disorder, and vice versa.