Can rosacea exacerbate hormonal disorders?

Rosacea is a dermatosis initially triggered by a significant dilation of the facial blood vessels (telangiectasias), which makes them more visible, especially on lighter skin tones. A diffuse redness on the face accompanies these manifestations, along with skin hypersensitivity, burning sensations, and sometimes hot flushes. It is important to know that rosacea is a chronic condition, meaning it operates in flare-ups. Symptoms may thus regress, or even disappear, for several weeks, before returning. There are several forms of rosacea, each presenting different clinical signs:

• Vascular Rosacea: Also known as telangiectasia, it manifests as facial redness, which can be intermittent (erythema) or permanent (erythrosis). This often occurs on the cheeks, forehead, nose, and chin. Due to their dilation, the blood vessels on the skin's surface appear blue or red and are visible to the naked eye.

• Papulopustular Rosacea: In addition to the symptoms associated with rosacea, papulopustular rosacea, or acne-rosacea, manifests itself through pustules and red spots on the face. However, unlike acne, this form of rosacea does not result in blackheads. Papulopustular rosacea occurs following the invasion of the parasite Demodex in the sebaceous glands.

• Hypertrophic rosacea: a rare form of the disease, it is characterised by dilated pores, skin thickening or skin protrusions. Hypertrophic rosacea is a result of an increase in the volume of the sebaceous glands. The nose is particularly affected (rhinophyma) as this area contains a large proportion of the sebaceous glands in the face.

• Ocular Rosacea: Characterised by inflammation in the eyes, particularly the eyelids, followed by tearing, irritation, and dryness of the eyes, ocular rosacea is believed to be caused by a malfunction of the Meibomian glands, the sebaceous glands located in the epidermis of the eyelids.

Is there a connection between rosacea and hormones? This question has recently been the subject of several research studies, but the results obtained have not provided a clear answer. Indeed, data concerning 75,000 women suffering from rosacea revealed that the majority of patients were menopausal and a minority were using a combined oral contraceptive treatment. This is a type of pill that includes both oestrogens and progesterone, as opposed to so-called micro-dosed pills, which do not contain oestrogens. Although the role of hormones in the etiology of rosacea has not been fully elucidated, this study suggests a hormonal influence in certain subtypes of rosacea.

Another study, contradicting the previous one, has suggested that combined pills increase the risk of rosacea. Oestrogens are implicated: they are believed to have a vasodilatory effect and promote the appearance of telangiectasias. While their exact mechanism of action is not known, researchers have reported an increased presence of oestrogen receptors in areas affected by telangiectasias. This is also why women are more prone to spider angiomas during pregnancy, a period during which the level of oestrogens in the body increases.

Thus, although they do not lead to the same results, studies suggest that hormonal fluctuations have an effect on rosacea flare-ups. However, the reverse has not been studied and no data suggests that rosacea exacerbates hormonal disorders.

• FOLDES E. G. Pharmaceutical impact of contraceptive pills on the skin. International Journal of Clinical Pharmacology, Therapy and Toxicology (1988).

• BARBAROT S. & al. Unilateral Naevus Telangiectaticus Syndrome: A rare but benign diagnosis. Vascular Medicine Journal (2019).

• TOSTI A. & al. Hormonal Contraceptives and Dermatology. American Journal of Clinical Dermatology (2021).

• ALI F. & et al. Rosacea. British Journal of Hospital Medicine.(2021).