Rosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut-Skin Axis of Rosacea

Adv Ther. 2021 Mar;38(3):1415-1424. doi: 10.1007/s12325-021-01624-x. Epub 2021 Jan 28.


Rosacea is a chronic inflammatory disease with complicated pathophysiology that involves genetic and environmental elements and dysregulation of innate and adaptive immunity, neurovascular responses, microbiome colonization or infection, resulting in recurrent inflammation. Rosacea has been reported associated with various gastrointestinal diseases including inflammatory bowel disease, celiac disease, irritable bowel syndrome, gastroesophageal reflux disease, Helicobacter pylori (HP) infection, and small intestine bacterial overgrowth (SIBO). The link may involve common predisposing genetic, microbiota, and immunological factors, comprising the theory of the gut-skin axis. Although the evidence is still controversial, interestingly, medications for eradicating SIBO and HP provided an effective and prolonged therapeutic response in rosacea, and conventional therapy for which is usually disappointing because of frequent relapses. In this article, we review the current evidence and discuss probable mechanisms of the association between rosacea and gastrointestinal comorbidities.

Keywords: Celiac disease; Gut–skin axis; Helicobacter pylori; Inflammatory bowel disease; Irritable bowel syndrome; Rosacea; Small intestine bacterial overgrowth.

Publication types

  • Review

MeSH terms

  • Comorbidity
  • Gastrointestinal Diseases* / epidemiology
  • Gastrointestinal Microbiome*
  • Helicobacter Infections* / complications
  • Helicobacter Infections* / drug therapy
  • Helicobacter Infections* / epidemiology
  • Humans
  • Rosacea* / drug therapy
  • Rosacea* / epidemiology