The role of the gut-skin axis in the pathogenesis of rosacea
DOI:
https://doi.org/10.12775/QS.2026.61.73044Keywords
Rosacea, gut-skin axis, Gut microbiota, diet, dysbiosis, SIBO, H.pylori, short-chain fatty acids, ProbioticsAbstract
BACKGROUND AND AIM
Rosacea is a chronic inflammatory skin condition affecting the central facial region, characterized by erythema, papulopustules, telangiectasia, and flushing. The aetiology of this disease is multifactorial, involving immune dysregulation, neurovascular instability, and environmental triggers. The aim of this narrative review was to analyze the role of the gut-skin axis in the pathogenesis of rosacea, with particular emphasis on gut microbiota, immune mechanisms, and the potential of dietary and microbiome-targeted therapeutic interventions.
MATERIAL AND METHODS
A narrative review of current scientific literature was conducted using the MEDLINE (PubMed) database. Original studies, systematic reviews, meta-analyses, and randomized controlled trials published primarily between 2007 and 2025 were included, using search terms including "rosacea," "gut-skin axis," "gut microbiota," "dysbiosis," "SIBO," "Helicobacter pylori," "short-chain fatty acids," "diet," and "probiotics."
RESULTS
Dysbiosis, reduced SCFA production, and increased intestinal permeability promote systemic inflammation and cutaneous immune activation in rosacea. A significant association between rosacea and gastrointestinal disorders, particularly SIBO and H. pylori infection, was confirmed. SIBO eradication with rifaximin achieved lesion resolution in 78% of rosacea patients. Mediterranean dietary patterns demonstrated protective effects.
CONCLUSIONS
The gut-skin axis is a significant component of rosacea pathogenesis. Dietary modification, probiotic supplementation, and targeted eradication of SIBO and H. pylori represent promising adjunctive therapeutic strategies. Further randomized controlled trials are required.
References
1. Skin color: a practical guide to dermatologic diagnosis and treatment. Springer, New York, NY; 2013:21-36.
2. Dermatologia współczesna Vol. 2 L. Rudnicka, M. Olszewska, A. Rakowska, M. Sar-Pomian Chapter 67 Rosacea Pages 26-29
3. Powell FC. Clinical practice: rosacea. N Engl J Med. 2005;352(8):793-803. doi:10.1056/NEJMcp041894
4. Crawford GH, Pelle MT, James WD. Rosacea: I -etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. 2004;51(3):327-341. doi:10.1016/j.jaad.2004.03.030
5. van Zuuren EJ. Rosacea. N Engl J Med. 2017;377(18):1754-1764. doi:10.1056/NEJMcp1506630
6. Gallo RL, Granstein RD, Kang S, Mannis M, Steinhoff M, Tan J, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea
7. Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148-155. doi:10.1016/j.jaad.2017.08.037 Buhl T, Sulk M, Nowak P, Buddenkotte J, McDonald I, Aubert J, et al. Molecular and morphological characterization of inflammatory infiltrate in rosacea reveals activation
8. of Th1/Th17 pathways. J Invest Dermatol. 2015;135(9):2198-2208. doi:10.1038/jid.2015.141Schwab VD, Sulk M, Seeliger S, Nowak P, Aubert J, Mess C, et al. Neurovascular and neuroimmune aspects in the pathophysiology of rosacea. J Investig Dermatol Symp
9. Proc. 2011;15(1):53-62. doi:10.1038/jidsymp.2011.6 Zhu W, Hamblin MR, Wen X. Role of the skin microbiota and intestinal microbiome in
rosacea. Front Microbiol. 2023;14:1106253. doi:10.3389/fmicb.2023.1106253
10. Yamasaki K, Di Nardo A, Bardan A, Murakami M, Ohtake T, Coda A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nat Med. 2007;13(8):975-980. doi:10.1038/nm1616
11. Aldrich N, Gerstenblith M, Fu P, et al. Genetic vs environmental factors that correlate with rosacea: a cohort-based survey of twins. JAMA Dermatol. 2015;151(11):1213- 1219. doi:10.1001/jamadermatol.2015.2230
12. Daou H, Paradiso M, Hennessy K, Seminario-Vidal L. Rosacea and the microbiome: a systematic review. Dermatol Ther (Heidelb). 2021;11(1):1-12. doi:10.1007/s13555- 020-00460-1
13. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514. doi:10.1038/nrgastro.2014.66
14. Cummings JH, Pomare EW, Branch WJ, Naylor CP, Macfarlane GT. Short chain fatty acids in human large intestine, portal, hepatic and venous blood. Gut. 1987;28(10):1221-1227. doi:10.1136/gut.28.10.1221
15. Park JS, Lee EJ, Lee JC, Kim WK, Kim HS. Anti-inflammatory effects of short chain fatty acids in IFN-γ-stimulated RAW 264.7 murine macrophage cells: involvement of NF-κB and ERK signaling pathways. Int Immunopharmacol. 2007;7(1):70-77. doi:10.1016/j.intimp.2006.08.015
16. Peng L, Li ZR, Green RS, Holzman IR, Lin J. Butyrate enhances the intestinal barrier by facilitating tight junction assembly via activation of AMP-activated protein kinase in Caco-2 cell monolayers. J Nutr. 2009;139(9):1619-1625. doi:10.3945/jn.109.104638
17. Chen Y, Shi Y, Chen Y, Li Y, Zhang Y. Gut microbiota dysbiosis in rosacea: a potential role in disease pathogenesis. Front Microbiol. 2021;12:686304. doi:10.3389/fmicb.2021.686304
18. Gałęcka M. Dysbioza jelitowa. Wydawnictwo Lekarskie PZWL; 2021
19. Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature. 2012;486(7402):207-214. doi:10.1038/nature11234
20. Saleem MM, Masood S, Rahmatullah MM, Imdad IA, Sange AMA, Nasr D. Gut microbiota dysbiosis and its role in the development of irritable bowel syndrome. Cureus. 2023;15(5):e39786. doi:10.7759/cureus.39786
21. Yu J, Duan Y, Zhang M, Li Q, Cao M, Song W, et al. Effect of combined probiotics and doxycycline therapy on the gut-skin axis in rosacea. Front Microbiol. 2022;13:1034258. doi:10.3389/fmicb.2022.1034258
22. Manzhalii E, Hornuss D, Stremmel W. Intestinal-borne dermatoses significantly improved by oral application of Escherichia coli Nissle 1917. World J Gastroenterol. 2016;22(23):5415-5421. doi:10.3748/wjg.v22.i23.5415
23. Li M, Fu J, Wei J, Wan M, Li L, Kong M, et al. Correlations between gut microbiota and serum metabolomics in patients with neurogenic rosacea. Front Microbiol. 2023;14:1125973. doi:10.3389/fmicb.2023.1125973
24. Szczeklik A, Gajewski P, eds. Interna Szczeklika. Medycyna Praktyczna; 2023.
25. Keikha M, Sahebkar A, Yamaoka Y, Karbalaei M. Helicobacter pylori CagA status and gastric mucosa-associated lymphoid tissue lymphoma: a systematic review and meta- analysis. J Health Popul Nutr. 2022;41:2. doi:10.1186/s41043-021-00280-9
26. Gravina AG, Federico A, Ruocco E, Lo Schiavo A, Masarone M, Tuccillo C, et al. Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea. United European Gastroenterol J. 2015;3(1):17-24. doi:10.1177/2050640614559262
27. Frydrych ZL, Chwarścianek N, Błaszak K, Czajkowski R. The potential role of Helicobacter pylori and other gut dysbiosis factors in the development of rosacea. Clin Dermatol Rev. 2022;6(2):75-80. doi: 10.5603/fd.96224
28. Manfredini M, Barbieri M, Milandri M, Longo C. Probiotics and diet in rosacea: current evidence and future perspectives. Biomolecules. 2025;15(3):411. doi:10.3390/biom15030411
29. Chen P, Yang Z, Fan Z, Wang B, Tang Y, Xiao Y, et al. Associations of adherence to Mediterranean-like diet pattern with incident rosacea: a prospective cohort study of government employees in China. Front Nutr. 2023;10:1092781. doi:10.3389/fnut.2023.1092781
30. Parodi A, Paolino S, Greco A, Drago F, Mansi C, Rebora A, et al. Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clin Gastroenterol Hepatol. 2008;6(7):759-764. doi:10.1016/j.cgh.2008.02.054
31. Antybiotykoterapia praktyczna. Dzierżanowska D., wydanie VI, s. 210.
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Copyright (c) 2026 Martyna Zielnik, Katarzyna Stróżna , Olga Błażowska, Alicja Jurewicz, Oliwia Gutowska, Weronika Nowak, Wiktoria Kostuch, Łukasz Kowalewski, Maria Styczyńska, Amir Naziri
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