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Jacob P Thyssen - One of the best experts on this subject based on the ideXlab platform.
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incidence and prevalence of rosacea a systematic review and meta analysis
British Journal of Dermatology, 2018Co-Authors: Lise Gether, Alexander Egeberg, Line E K Overgaard, Jacob P ThyssenAbstract:Background The exact prevalence and incidence of rosacea remain unknown, although it is a common condition associated with severe noncutaneous diseases. Objectives To perform a systematic review of the published literature to examine the global incidence and prevalence of rosacea. Methods A systematic review of population-based and dermatological outpatient studies reporting the incidence and/or prevalence of rosacea was performed using three electronic medical databases: PubMed, Embase and Web of Science. Data were extracted and a proportion meta-analysis was performed to obtain pooled proportions. Results In total 32 studies were included examining a total of 41 populations with 26 519 836 individuals. Twenty-two populations were from Europe, three from Africa, four from Asia, nine from North America and three from South America. The pooled proportion of individuals with rosacea was 5·46% [95% confidence interval (CI) 4·91-6·04] in the general population and 2·39% (95% CI 1·56-3·39) among dermatological outpatients. Self-reported rosacea gave higher prevalence estimates than rosacea diagnosed by clinical examination, suggesting a low specificity of questionnaires based on symptoms. Rosacea affected both women (5·41%, 95% CI 3·85-7·23) and men (3·90%, 95% CI 3·04-4·87), and mostly those aged 45-60 years. Conclusions We estimated the global prevalence of rosacea based on published data and found that 5·46% of the adult population is affected. However, the prevalence of rosacea depended on the diagnostic method, with higher estimates in questionnaire studies of rosacea symptoms and lower estimates in health registries with International Classification of Diseases codes.
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prevalence and risk of migraine in patients with rosacea a population based cohort study
Journal of The American Academy of Dermatology, 2017Co-Authors: Alexander Egeberg, Gunnar H Gislason, Messoud Ashina, David Gaist, Jacob P ThyssenAbstract:Background Rosacea features increased neurovascular reactivity; migraine is a complex neurologic disorder characterized by recurrent episodes of headache associated with nausea and increased sensitivity to light and sound. Objective We evaluated the prevalence and risk of new-onset migraine in patients with rosacea. Methods All Danish individuals 18 years of age or older were linked in nationwide registers. Adjusted hazard ratios (HRs) were estimated by Cox regression. Results In the total cohort (n = 4,361,688), there were 49,475 patients with rosacea. Baseline prevalence of migraine was 7.3% and 12.1% in the reference population and in patients with rosacea, respectively. The fully adjusted HR of migraine was 1.31 (95% confidence interval 1.23-1.39) for patients with rosacea. Patients with phymatous rosacea (n = 594) had no increased risk of migraine (adjusted HR 0.45; 95% confidence interval 0.11-1.80), whereas patients with ocular rosacea (n = 6977) had a 69% increased risk (adjusted HR 1.69; 95% confidence interval 1.43-1.99). Notably, the risk was higher among patients age 50 years or older than in younger individuals, and the risk was only significant among women. Limitations We were unable to distinguish between migraine subtypes. Conclusion We found a significantly higher prevalence and risk of incident migraine especially in female patients with rosacea. These data add to the accumulating evidence for a link between rosacea and the central nervous system.
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rosacea and gastrointestinal disorders a population based cohort study
British Journal of Dermatology, 2017Co-Authors: Alexander Egeberg, Leonard B Weinstock, Erik P Thyssen, Gunnar H Gislason, Jacob P ThyssenAbstract:Background Rosacea is a common inflammatory facial skin condition. Recent genetic and epidemiologic studies have suggested pathogenic links between rosacea and gastrointestinal disorders, but data are limited. Objectives The objective was to investigate the association between rosacea and celiac disease (CeD), Crohn's disease (CD), ulcerative colitis (UC), Helicobactor pylori (HP) infection, small intestinal bacterial overgrowth (SIBO), and irritable bowel syndrome (IBS), respectively. Methods We performed a nationwide cohort study. A total of 49,475 patients with rosacea, and 4,312,213 general population controls were identified using nationwide administrative registers. We established the prevalence of the aforementioned disorders, and used Cox regression to obtain hazard ratios (HRs) of the risk of new-onset CeD, CD, UC, HP infection, SIBO, and IBS, respectively, in patients with rosacea. Results The prevalence of CeD, CD, UC, HP infection, SIBO, and IBS, respectively, was higher among patients with rosacea when compared to the control subjects. Adjusted HRs revealed significant associations between rosacea and CeD (HR 1.46, 1.11-1.93), CD (HR 1.45, 1.19-1.77), UC (HR 1.19, 1.02-1.39), and IBS (HR 1.34, 1.19-1.50) respectively, but not HP infection (HR 1.04, 0.96-1.13) or SIBO (HR 0.71, 0.18-1.86). Conclusions Rosacea is associated with certain gastrointestinal diseases, but the possible pathogenic link is unknown. Gastrointestinal complaints in patients with rosacea should warrant clinical suspicion of disease. This article is protected by copyright. All rights reserved.
Shaoling Zhang - One of the best experts on this subject based on the ideXlab platform.
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genome wide identification of lysin motif containing protein family genes in eight Rosaceae species and expression analysis in response to pathogenic fungus botryosphaeria dothidea in chinese white pear
BMC Genomics, 2020Co-Authors: Qiming Chen, Xin Qiao, Hao Yin, Shaoling ZhangAbstract:Lysin motif-containing proteins (LYP), which act as pattern-recognition receptors, play central roles in growth, node formation, and responses to biotic stresses. The sequence of Chinese white pear genome (cv. ‘Dangshansuli’) along with the seven other species of Rosaceae has already been reported. Although, in these fruit crops, there is still a lack of clarity regarding the LYP family genes and their evolutionary history. In the existing study, eight Rosaceae species i.e., Pyrus communis, Prunus persica, Fragaria vesca, Pyrus bretschneideri, Prunus avium, Prunus mume, Rubus occidentalis, and Malus × domestica were evaluated. Here, we determined a total of 124 LYP genes from the underlined Rosaceae species. While eighteen of the genes were from Chinese white pear, named as PbrLYPs. According to the LYPs structural characteristics and their phylogenetic analysis, those genes were classified into eight groups (group LYK1, LYK2, LYK3, LYK4/5, LYM1/3, LYM2, NFP, and WAKL). Dispersed duplication and whole-genome duplication (WGD) were found to be the most contributing factors of LYP family expansion in the Rosaceae species. More than half of the duplicated PbrLYP gene pairs were dated back to the ancient WGD (~ 140 million years ago (MYA)), and PbrLYP genes have experienced long-term purifying selection. The transcriptomic results indicated that the PbrLYP genes expression was tissue-specific. Most PbrLYP genes showed differential expression in leaves under fungal pathogen infection with two of them located in the plasmalemma. A comprehensive analysis identified 124 LYP genes in eight Rosaceae species. Our findings have provided insights into the functions and characteristics of the Rosaceae LYP genes and a guide for the identification of other candidate LYPs for further genetic improvements for pathogen-resistance in higher plants.
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Genome-wide characterization, evolution, and expression analysis of the leucine-rich repeat receptor-like protein kinase (LRR-RLK) gene family in Rosaceae genomes
BMC, 2017Co-Authors: Jiangmei Sun, Peng Wang, Shaoling ZhangAbstract:Abstract Background Leucine-rich repeat receptor-like protein kinase (LRR-RLK) is the largest gene family of receptor-like protein kinases (RLKs) and actively participates in regulating the growth, development, signal transduction, immunity, and stress responses of plants. However, the patterns of LRR-RLK gene family evolution in the five main Rosaceae species for which genome sequences are available have not yet been reported. In this study, we performed a comprehensive analysis of LRR-RLK genes for five Rosaceae species: Fragaria vesca (strawberry), Malus domestica (apple), Pyrus bretschneideri (Chinese white pear), Prunus mume (mei), and Prunus persica (peach), which contained 201, 244, 427, 267, and 258 LRR-RLK genes, respectively. Results All LRR-RLK genes were further grouped into 23 subfamilies based on the hidden Markov models approach. RLK-Pelle_LRR-XII-1, RLK-Pelle_LRR-XI-1, and RLK-Pelle_LRR-III were the three largest subfamilies. Synteny analysis indicated that there were 236 tandem duplicated genes in the five Rosaceae species, among which subfamilies XII-1 (82 genes) and XI-1 (80 genes) comprised 68.6%. Conclusions Our results indicate that tandem duplication made a large contribution to the expansion of the subfamilies. The gene expression, tissue-specific expression, and subcellular localization data revealed that LRR-RLK genes were differentially expressed in various organs and tissues, and the largest subfamily XI-1 was highly expressed in all five Rosaceae species, suggesting that LRR-RLKs play important roles in each stage of plant growth and development. Taken together, our results provide an overview of the LRR-RLK family in Rosaceae genomes and the basis for further functional studies
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genome wide identification and comparative analysis of the heat shock transcription factor family in chinese white pear pyrus bretschneideri and five other Rosaceae species
BMC Plant Biology, 2015Co-Authors: Xin Qiao, Hao Yin, Shaoling ZhangAbstract:Heat shock transcription factors (Hsfs), which act as important transcriptional regulatory proteins in eukaryotes, play a central role in controlling the expression of heat-responsive genes. At present, the genomes of Chinese white pear (‘Dangshansuli’) and five other Rosaceae fruit crops have been fully sequenced. However, information about the Hsfs gene family in these Rosaceae species is limited, and the evolutionary history of the Hsfs gene family also remains unresolved. In this study, 137 Hsf genes were identified from six Rosaceae species (Pyrus bretschneideri, Malus × domestica, Prunus persica, Fragaria vesca, Prunus mume, and Pyrus communis), 29 of which came from Chinese white pear, designated as PbHsf. Based on the structural characteristics and phylogenetic analysis of these sequences, the Hsf family genes could be classified into three main groups (classes A, B, and C). Segmental and dispersed duplications were the primary forces underlying Hsf gene family expansion in the Rosaceae. Most of the PbHsf duplicated gene pairs were dated back to the recent whole-genome duplication (WGD, 30–45 million years ago (MYA)). Purifying selection also played a critical role in the evolution of Hsf genes. Transcriptome data demonstrated that the expression levels of the PbHsf genes were widely different. Six PbHsf genes were upregulated in fruit under naturally increased temperature. A comprehensive analysis of Hsf genes was performed in six Rosaceae species, and 137 full length Hsf genes were identified. The results presented here will undoubtedly be useful for better understanding the complexity of the Hsf gene family and will facilitate functional characterization in future studies.
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transferability of newly developed pear ssr markers to other Rosaceae species
Plant Molecular Biology Reporter, 2013Co-Authors: Lian Fan, Lei Wang, Man Zhang, Qingzhong Liu, Yuping Song, Shaoling ZhangAbstract:A set of 120 simple sequence repeats (SSRs) was developed from the newly assembled pear sequence and evaluated for polymorphisms in seven genotypes of pear from different genetic backgrounds. Of these, 67 (55.8 %) primer pairs produced polymorphic amplifications. Together, the 67 SSRs detected 277 alleles with an average of 4.13 per locus. Sequencing of the amplification products from randomly picked loci NAUPy31a and NAUpy53a verified the presence of the SSR loci. When the 67 primer pairs were tested on 96 individual members of eight species in the Rosaceae family, 61.2 % (41/67) of the tested SSRs successfully amplified a PCR product in at least one of the Rosaceae genera. The transferability from pear to different species varied from 58.2 % (apple) to 11.9 % (cherry). The ratio of transferability also reflected the closer relationships within Maloideae over Prunoideae. Two pear SSR markers, NAUpy43c and NAUpy55k, could distinguish the 20 different apple genotypes thoroughly, and UPGMA cluster analysis grouped them into three groups at the similarity level of 0.56. The high level of polymorphism and good transferability of pear SSRs to Rosaceae species indicate their promise for application to future molecular screening, map construction, and comparative genomic studies among pears and other Rosaceae species.
Yongping Cai - One of the best experts on this subject based on the ideXlab platform.
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genome wide analysis suggests the relaxed purifying selection affect the evolution of wox genes in pyrus bretschneideri prunus persica prunus mume and fragaria vesca
Frontiers in Genetics, 2017Co-Authors: Yunpeng Cao, Yahui Han, Dandan Meng, Qing Jin, Yi Lin, Muhammad Abdullah, Yongping CaiAbstract:WUSCHEL-related homeobox (WOX) family is a large group of transcription factors (TFs) specifically found in plants. WOX TFs are known to play important role in plant development and are related to the appearance of evolutionary novelties. Although the roles of WOXs in Arabidopsis and rice have been well studied, however, little are known about the relationships among the main clades in the molecular evolution of these genes in Rosaceae. Here, we carried out a genome-wide analysis and identified 14, 10, 10 and 9 of WOX genes from four Rosaceae species (Fragaria vesca, Prunus persica, Prunus mume and Pyrus bretschneideri, respectively). According to evolutionary analysis, as well as amino acid sequences of their homodomains, these genes were divided into three clades with nine subgroups. Furthermore, due to the conserved structural patterns among these WOX genes, it was proposed that there should exist some highly conserved regions of microsynteny in the four Rosaceae species. Moreover, most of WOX gene pairs were presented with the conserved orientation among syntenic genome regions. In addition, although no significant positive selection was detected according to substitution models analysis using PMAL software, type I functional divergence was found among certain amino acids in WOX proteins. These results revealed that the relaxed purifying selection might be the main driving force during the evolution of WOX genes in the tested Rosaceae species. This study provides useful information for further research on evolution of the WOX genes in family Rosaceae.
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Genome-wide analysis suggests high level of microsynteny and purifying selection affect the evolution of EIN3/EIL family in Rosaceae
PeerJ Inc., 2017Co-Authors: Yunpeng Cao, Yahui Han, Dandan Meng, Qing Jin, Yi Lin, Yongping CaiAbstract:The ethylene-insensitive3/ethylene-insensitive3-like (EIN3/EIL) proteins are a type of nuclear-localized protein with DNA-binding activity in plants. Although the EIN3/EIL gene family has been studied in several plant species, little is known about comprehensive study of the EIN3/EIL gene family in Rosaceae. In this study, ten, five, four, and five EIN3/EIL genes were identified in the genomes of pear (Pyrus bretschneideri), mei (Prunus mume), peach (Prunus persica) and strawberry (Fragaria vesca), respectively. Twenty-eight chromosomal segments of EIL/EIN3 gene family were found in four Rosaceae species, and these segments could form seven orthologous or paralogous groups based on interspecies or intraspecies gene colinearity (microsynteny) analysis. Moreover, the highly conserved regions of microsynteny were found in four Rosaceae species. Subsequently it was found that both whole genome duplication and tandem duplication events significantly contributed to the EIL/EIN3 gene family expansion. Gene expression analysis of the EIL/EIN3 genes in the pear revealed subfunctionalization for several PbEIL genes derived from whole genome duplication. It is noteworthy that according to environmental selection pressure analysis, the strong purifying selection should dominate the maintenance of the EIL/EIN3 gene family in four Rosaceae species. These results provided useful information on Rosaceae EIL/EIN3 genes, as well as insights into the evolution of this gene family in four Rosaceae species. Furthermore, high level of microsynteny in the four Rosaceae plants suggested that a large-scale genome duplication event in the EIL/EIN3 gene family was predated to speciation
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Genome-Wide Analysis Suggests the Relaxed Purifying Selection Affect the Evolution of WOX Genes in Pyrus bretschneideri, Prunus persica, Prunus mume, and Fragaria vesca
Frontiers Media S.A., 2017Co-Authors: Yunpeng Cao, Yahui Han, Dandan Meng, Qing Jin, Yi Lin, Muhammad Abdullah, Yongping CaiAbstract:WUSCHEL-related homeobox (WOX) family is one of the largest group of transcription factors (TFs) specifically found in plant kingdom. WOX TFs play an important role in plant development processes and evolutionary novelties. Although the roles of WOXs in Arabidopsis and rice have been well-studied, however, little are known about the relationships among the main clades in the molecular evolution of these genes in Rosaceae. Here, we carried out a genome-wide analysis and identified 14, 10, 10, and 9 of WOX genes from four Rosaceae species (Fragaria vesca, Prunus persica, Prunus mume, and Pyrus bretschneideri, respectively). According to evolutionary analysis, as well as amino acid sequences of their homodomains, these genes were divided into three clades with nine subgroups. Furthermore, due to the conserved structural patterns among these WOX genes, it was proposed that there should exist some highly conserved regions of microsynteny in the four Rosaceae species. Moreover, most of WOX gene pairs were presented with the conserved orientation among syntenic genome regions. In addition, according to substitution models analysis using PMAL software, no significant positive selection was detected, but type I functional divergence was identified among certain amino acids in WOX protein. These results revealed that the relaxed purifying selection might be the main driving force during the evolution of WOX genes in the tested Rosaceae species. Our result will be useful for further precise research on evolution of the WOX genes in family Rosaceae
Anna L. Chien - One of the best experts on this subject based on the ideXlab platform.
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comparison of the skin microbiota in acne and rosacea
Experimental Dermatology, 2020Co-Authors: Katherine G. Thompson, Liliana Florea, Emmanuel F Mongodin, Corina Antonescu, Barbara M. Rainer, Sewon Kang, Anna L. ChienAbstract:Acne and rosacea, despite their similar clinical presentations, follow distinct clinical courses, suggesting that fundamental differences exist in their pathophysiology. We performed a case-control study profiling the skin microbiota in rosacea and acne patients compared to matched controls. Nineteen rosacea and eight acne patients were matched to controls by age +/- 5 years, sex and race. DNA was extracted from facial skin swabs. The V3V4 region of the bacterial 16S rRNA gene was sequenced using Illumina MiSeq and analysed using QIIME/Metastats 2.0 software. The mean relative abundance of Cutibacterium acnes in rosacea with inflammatory papules and pustules (20.454% +/-16.943%) was more similar to that of acne (19.055% +/-15.469%) than that of rosacea without inflammatory papules and pustules (30.419% +/-21.862%). C acnes (P = .048) and Serratia marcescens (P = .038) were significantly enriched in individuals with rosacea compared to acne. Investigating the differences between the skin microbiota in acne and rosacea can provide important clues towards understanding the disease progression in each condition.
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evidence based update on rosacea comorbidities and their common physiologic pathways
Journal of The American Academy of Dermatology, 2018Co-Authors: Anna D Holmes, Anna L. Chien, Hilary E Baldwin, Julia Spoendlin, Anne Lynn S ChangAbstract:Rosacea is a common chronic inflammatory disease affecting the facial skin whose etiology and pathophysiology are the subject of much investigation. Risk factors include genetic and environmental elements that may predispose individuals to localized inflammation and abnormal neurovascular responses to stimuli. Recent studies have introduced an array of systemic rosacea comorbidities, such as inflammatory bowel disease and neurologic conditions, that can be challenging to synthesize. We critically review the current data behind reported rosacea comorbidities and identify and highlight underrecognized physiologic mediators shared among rosacea and associated comorbidities. This information may be helpful in addressing patient questions about potential systemic implications of rosacea and can serve as a candidate platform for future research to understand rosacea and improve treatments.
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rosacea is associated with chronic systemic diseases in a skin severity dependent manner results of a case control study
Journal of The American Academy of Dermatology, 2015Co-Authors: Barbara M. Rainer, Alexander H. Fischer, Sewon Kang, Dimitre Luz Felipe Da Silva, Anna L. ChienAbstract:Background Rosacea is a common chronic inflammatory dermatosis of unclear origin. It has been associated with systemic comorbidities, but methodical studies addressing this association are lacking. Objective We evaluated: (1) the association between rosacea and systemic comorbidities; and (2) if the severity of rosacea is impacted by comorbidities. Methods This was a case-control study: patients with rosacea were matched (1:1) to rosacea-free control subjects by age, sex, and race. Relative risk estimates were calculated using logistic regression as odds ratios with 95% confidence intervals. Results Among 130 participants (65 patients/65 control subjects), we observed a significant association between rosacea and allergies (airborne, food), respiratory diseases, gastroesophageal reflux disease, other gastrointestinal diseases, hypertension, metabolic and urogenital diseases, and female hormone imbalance. Compared with mild rosacea, moderate to severe rosacea was significantly associated with hyperlipidemia, hypertension, metabolic diseases, cardiovascular diseases, and gastroesophageal reflux disease. Limitations This was a case-control study with moderate sample size. Associated medical conditions were self-reported and could not always be confirmed by medication use and medical records. Conclusions Rosacea is associated with numerous systemic comorbid diseases in a skin severity–dependent manner. Physicians should be aware of these associations to provide comprehensive care to patients with rosacea, especially to those with more severe disease.
Sewon Kang - One of the best experts on this subject based on the ideXlab platform.
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comparison of the skin microbiota in acne and rosacea
Experimental Dermatology, 2020Co-Authors: Katherine G. Thompson, Liliana Florea, Emmanuel F Mongodin, Corina Antonescu, Barbara M. Rainer, Sewon Kang, Anna L. ChienAbstract:Acne and rosacea, despite their similar clinical presentations, follow distinct clinical courses, suggesting that fundamental differences exist in their pathophysiology. We performed a case-control study profiling the skin microbiota in rosacea and acne patients compared to matched controls. Nineteen rosacea and eight acne patients were matched to controls by age +/- 5 years, sex and race. DNA was extracted from facial skin swabs. The V3V4 region of the bacterial 16S rRNA gene was sequenced using Illumina MiSeq and analysed using QIIME/Metastats 2.0 software. The mean relative abundance of Cutibacterium acnes in rosacea with inflammatory papules and pustules (20.454% +/-16.943%) was more similar to that of acne (19.055% +/-15.469%) than that of rosacea without inflammatory papules and pustules (30.419% +/-21.862%). C acnes (P = .048) and Serratia marcescens (P = .038) were significantly enriched in individuals with rosacea compared to acne. Investigating the differences between the skin microbiota in acne and rosacea can provide important clues towards understanding the disease progression in each condition.
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Characterization and Analysis of the Skin Microbiota in Rosacea: A Case-Control Study.
American Journal of Clinical Dermatology, 2019Co-Authors: Barbara M. Rainer, Katherine G. Thompson, Liliana Florea, Alexander H. Fischer, H. Pasieka, Emmanuel F Mongodin, Corina Antonescu, Luis A Garza, Sewon KangAbstract:The efficacy of antibiotics in rosacea treatment suggests a role for microorganisms in its pathophysiology. Growing concern over the adverse effects of antibiotic use presents a need for targeted antimicrobial treatment in rosacea. We performed a case–control study to investigate the skin microbiota in patients with rosacea compared to controls matched by age, sex, and race. Nineteen participants with rosacea, erythematotelangiectatic, papulopustular, or both, were matched to 19 rosacea-free controls. DNA was extracted from skin swabs of the nose and bilateral cheeks of participants. Sequencing of the V3V4 region of the bacterial 16S ribosomal RNA gene was performed using Illumina MiSeq and analyzed using QIIME/MetaStats 2.0 software. Compared with controls, skin microbiota in erythematotelangiectatic rosacea was depleted in Roseomonas mucosa (p = 0.004). Papulopustular rosacea was enriched in Campylobacter ureolyticus (p = 0.001), Corynebacterium kroppenstedtii (p = 0.008), and the oral flora Prevotella intermedia (p = 0.001). The highest relative abundance of C. kroppenstedtii was observed in patients with both erythematotelangiectatic and papulopustular rosacea (19.2%), followed by papulopustular (5.06%) and erythematotelangiectatic (1.21%) rosacea. C. kroppenstedtii was also associated with more extensive disease, with the highest relative abundance in rosacea affecting both the cheeks and nose (2.82%), followed by rosacea sparing the nose (1.93%), and controls (0.19%). The skin microbiota in individuals with rosacea displays changes from that of healthy skin, suggesting that further studies examining a potential role for the skin microbiota in the pathophysiology of rosacea may be warranted.
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rosacea is associated with chronic systemic diseases in a skin severity dependent manner results of a case control study
Journal of The American Academy of Dermatology, 2015Co-Authors: Barbara M. Rainer, Alexander H. Fischer, Sewon Kang, Dimitre Luz Felipe Da Silva, Anna L. ChienAbstract:Background Rosacea is a common chronic inflammatory dermatosis of unclear origin. It has been associated with systemic comorbidities, but methodical studies addressing this association are lacking. Objective We evaluated: (1) the association between rosacea and systemic comorbidities; and (2) if the severity of rosacea is impacted by comorbidities. Methods This was a case-control study: patients with rosacea were matched (1:1) to rosacea-free control subjects by age, sex, and race. Relative risk estimates were calculated using logistic regression as odds ratios with 95% confidence intervals. Results Among 130 participants (65 patients/65 control subjects), we observed a significant association between rosacea and allergies (airborne, food), respiratory diseases, gastroesophageal reflux disease, other gastrointestinal diseases, hypertension, metabolic and urogenital diseases, and female hormone imbalance. Compared with mild rosacea, moderate to severe rosacea was significantly associated with hyperlipidemia, hypertension, metabolic diseases, cardiovascular diseases, and gastroesophageal reflux disease. Limitations This was a case-control study with moderate sample size. Associated medical conditions were self-reported and could not always be confirmed by medication use and medical records. Conclusions Rosacea is associated with numerous systemic comorbid diseases in a skin severity–dependent manner. Physicians should be aware of these associations to provide comprehensive care to patients with rosacea, especially to those with more severe disease.
