Gut-Skin Connection: Role of Intestinal Biome in Rosacea

Abstract

Introduction: We hypothesized that gut flora may play a role in skin disorders either directly or through effects on the immune system and inflammatory response. To explore this theory, we performed a study in patients with rosacea comparing groups provided with standard of care treatment (SOC) to an experimental cohort (E) who received SOC and probiotics. Methods: 60 patients aged 30 to 59 years old diagnosed with rosacea and 10 healthy normal comparative subjects were identified. Patients with rosacea were randomly divided into 2 groups. The first group received SOC which included 7 days of oral antibiotics, vitamins, antihistamine, and topical permethrin. The second group (E) received SOC and a probiotic containing Bifidobacterium 50 x106 CFU three times a day and an immunomodulator Polioxidonium for 21 days. The following studies were performed before and after therapeutic intervention: stool culture, examination of the skin, and scrapings of their skin pustules for presence of the mite D. folliculorum. These 2 groups were also compared before starting the study to the normal control subjects. Standard statistical comparisons and analysis were made using statistical software. Results: There were 21 male and 39 female patients studied: 30 in SOC and 30 in E. The following clinical improvement was observed in the experimental versus control groups: complete skin remission 56.7% versus 28.3%, significant improvement 38.3% versus 33.7%, minimal improvement 5% versus 24.7% respectively. No improvement was seen in 0% of experimental group and 11.3% of control group (Table I). Compared to the normal subjects there was significantly fewer colony forming units of Lactobacilus and Bifidobacterium in the patients with rosacea pretreatment. In contrast, post therapy stool studies revealed a significant increase in CFU of these microorganisms in the experimental group but not in SOC group controls (Tables 2&3). Conclusion: Gut flora may play a role in the development and clinical course of rosacea and inflammatory acne. Probiotics might be a beneficial adjunct to treatment of these patients. Additional studies are warranted to explore further connections between the gut microbiome and skin diseases.216_A Figure 1. Clinical response to the therapy in patients with rosacea who received SOC therapy and E therapy216_B Figure 2. Indicators of gut biome in patients with rosacea before therapy and healthy controls216_C Figure 3. Indicators of gut flora in patient with rosacea after SOC and E therapy