Understanding Rosacea: Could It Be an Autoimmune Condition?

Is rosacea an autoimmune disease? Explore its links to conditions like type 1 diabetes, symptoms, treatments, and immune system involvement.

The National Rosacea Society (NRS) estimates that around 16 million people in the United States and as many as 415 million worldwide have rosacea. This makes it one of the most common skin conditions in the country, but yet we don’t completely understand what causes it. 

Understanding Rosacea: Could It Be an Autoimmune Condition?

Despite the clear differences between rosacea and autoimmune conditions, the belief that rosacea is an autoimmune disorder persists. This misconception likely stems from the fact that rosacea shares some similarities with autoimmune conditions, such as the presence of inflammation and the potential for flare-ups. However, the underlying mechanisms and triggers for rosacea are distinct from true autoimmune disorders. 

According to the National Rosacea Society

“...recent studies have found associations between rosacea and increased risk for a growing number of potentially serious systemic diseases, suggesting that rosacea may be an outcome of systemic inflammation. Although causal relationships have not been determined, these have included cardiovascular disease, gastrointestinal disease, neurological and autoimmune diseases and certain cancers.”

What Is Rosacea?

Rosacea is a chronic, inflammatory skin condition that primarily affects the face, causing redness, visible blood vessels, and sometimes small, pus-filled acne-like bumps. Though experts don’t know exactly what causes rosacea, current research indicates that potential causes include: 

  • Defects in the neurovascular system
  • Immune system dysfunction 
  • Presence of microbes and Demodex mites
  • Genetic predisposition

Unlike autoimmune conditions, rosacea is not caused by the body's immune system attacking its own healthy cells and tissues. Since those with rosacea often show higher levels of certain inflammatory markers and immune system activity, researchers think that immune system dysfunction may indeed contribute to flare-ups. 

Common Triggers and Risk Factors

According to the American Academy of Dermatology (AAD), rosacea patients tend to have sensitive skin that is easily triggered. Identifying individual triggers that worsen the symptoms of rosacea is important to controlling flare-ups. Although everyone has their own trigger(s), the most common triggers include sun exposure, emotional stress, weather, spicy food, alcohol, and skincare products.

In addition to medical therapy, identifying and avoiding individual triggers can go a long way in helping control rosacea flares. The National Rosacea Society is an excellent resource and support for helping identify your individual triggers. 

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH), those most at-risk for the condition include: 

  • middle-aged and older adults 
  • fair skin who tend to flush or blush easily
  • Northern or Eastern European descent
  • primarily women (though it’s typically worse in men)

Exploring the Link Between Rosacea and Autoimmune Disorders

What Does “Autoimmune Condition” Mean?

This condition occurs when the immune system acts overzealous, mistakenly viewing its own healthy tissues as a threat and attacking them. 

As a result, traditional autoimmune diseases like lupus erythematosus are characterized by widespread inflammation. Although rosacea does appear to involve immune system activity, it’s not clear yet whether the condition directly causes the body to attack its own healthy cells. 

Studies on the Link Between Rosacea and Conditions Like Type 1 Diabetes and Celiac Disease

In a large 2016 study of over 6,700 Danish patients with rosacea began the interest in the immune system. Researchers found women with rosacea to have a significantly higher risk of several autoimmune conditions, including: 

  • 2.6x greater risk of type 1 diabetes.
  • 2x greater risk of celiac disease.
  • 2.4x greater risk of rheumatoid arthritis.
  • 1.7x higher risk of multiple sclerosis. 

Interestingly, researchers only found a small association between men with rosacea and rheumatoid arthritis. 

Though this study suggests a strong link between autoimmune dysfunction and rosacea, more research is needed before drawing any conclusions. 

Genetics and Rosacea

Scientists have found that genes could play a role in the development of rosacea. One study on twins found identical twins are more likely to have rosacea than fraternal twins. It found genes and environmental factors like sun exposure equally played a role in the development of rosacea. 

Other studies have examined people’s DNA to understand the genetic causes of rosacea, such as one of 73,000 people. Researchers found seven areas of DNA with links to rosacea. These include genes that affect skin color (SLC45A2 and HERC2-OCA2), the immune system (HLA-DMA/B), and inflammatory responses (IL13). 

Beyond genetics, other factors such as environment and lifestyle could also play a role in whether or not someone develops rosacea. 

How the Immune System Appears to Contribute to Rosacea

It’s easy to confuse autoimmune disease with innate immune system dysfunction. While rosacea may share some similarities with autoimmune conditions, it is not classified as an autoimmune disorder. 

Recent studies have focused on the innate immune system which appears to play an important role in causing rosacea. This part of the immune system is the body’s first defense against harmful bacteria, viruses, and other pathogens. Its response is inflammation. This protective process may be malfunctioning in individuals with rosacea.

The immune system can become overactive in people with rosacea, leading to long-term inflammation. Learning more about how the innate immune system works could help create treatments that reduce these inflammatory responses.

Effective Rosacea Treatments

Managing rosacea often involves a combination of topical medications, oral treatments, and lifestyle modifications. Topical therapies may include metronidazole, azelaic acid, or ivermectin, which can help reduce redness and inflammation. Oral medications, such as antibiotics, may also be prescribed for more severe cases. Additionally, patients can often find relief by avoiding known triggers, using gentle skincare products, and protecting their skin from sun exposure.

Medical Treatments: From Topicals to Oral Medications

Rosacea treatment typically involves a combination of anti-inflammatory topicals with oral medication when necessary. 

According to the American Academy of Dermatology, current treatments include: 

  • Prescription creams and gels with azelaic acid, ivermectin or metronidazole to reduce inflammation.
  • Topical medications like brimonidine or oxymetazoline to reduce redness 
  • Laser and intense pulsed light therapy to diminish visible blood vessels
  • Oral medications like low-dose doxycycline to minimize inflammation 
  • Prescription eyedrops for eye rosacea (ocular rosacea)
  • Surgical procedures or laser treatment for severe skin thickening of the nose (rhinophyma)

Lifestyle Adjustments to Manage Triggers

In addition to medication, treating rosacea also typically requires lifestyle changes such as:

  • Consistent sunscreen use: use at least SPF 30+ broad-spectrum sunscreen with zinc oxide or titanium dioxide
  • Sun avoidance: wear sunglasses, hats, and other protective clothing. Seek shade when available.
  • Avoid exposure to excessive heat: take lukewarm (not hot) showers/baths, and wear breathable clothing in the heat. 
  • Track personal rosacea triggers in a diary (see rosacea.org for a free printable Rosacea Diary)
  • Avoid trigger foods such as spicy food, hot drinks, and red wine. 
  • Choose gentle skincare products formulated for sensitive skin, specifically without irritants like sodium lauryl sulfate, menthol or camphor. 
  • Manage stress through relaxation techniques like mindfulness, meditation, breathwork, or yoga. 

Emerging Research on Targeted Therapies

Scientists continue to investigate new treatments to target specific immune system responses, including cromolyn sodium, a topical medication that stabilizes mast cells and immune cells involved in rosacea inflammation. Another treatment being explored is Erenumab. It’s an injectable antibody traditionally used to treat migraines that is being researched to target specific blood vessel pathways. 

Insights from Current Research and Future Directions

While the root cause of rosacea remains a mystery, scientists continue to uncover new insights about this common, chronic condition. Recent gene studies have identified specific DNA regions involved in both skin characteristics and immune system responses, suggesting that rosacea may develop via multiple biological pathways. 

Researchers are also particularly interested in the role of mast cells — or immune cells that trigger inflammation and blood cell changes in rosacea patients — as understanding these processes could lead to more effective, targeted treatments down the road. 

Worried About Rosacea? Work with a Piction Dermatologist

Whether you’re coping with persistent redness or concerned about rosacea’s connections to other health conditions, Piction’s board-certified dermatologists can help you create a personalized treatment plan through convenient telehealth consultations. 

Connect with the team today to receive expert guidance today. 

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