Can rosacea exacerbate hormonal disorders?

Rosacea is a dermatosis initially caused by a significant dilation of the facial blood vessels (telangiectasias), which makes them more visible, especially on lighter skin tones. These manifestations are accompanied by a diffuse redness on the face, as well as skin hypersensitivity, burning sensations, and sometimes hot flashes. It's important to know that rosacea is a chronic condition, meaning it operates in flare-ups. Symptoms may thus regress, or even disappear, for several weeks, before returning. There are several forms of rosacea, each presenting different clinical signs:

• Vascular Rosacea: Also known as telangiectasia, it is characterized by facial redness, which can be intermittent (erythema) or permanent (erythrosis). This often occurs on the cheeks, forehead, nose, and chin. Due to their dilation, the blood vessels on the skin's surface appear blue or red and are visible to the naked eye.

• Papulopustular Rosacea: In addition to the symptoms associated with rosacea, papulopustular rosacea, or acne rosacea, manifests through pustules and red bumps on the face. However, unlike acne, this form of rosacea does not result in blackheads. Papulopustular rosacea occurs following the invasion of the parasite Demodex in the sebaceous glands.

• Hypertrophic Rosacea: A rare form of the disease, it is characterized by dilated pores, skin thickening, or skin protrusions. Hypertrophic rosacea results from an increase in the volume of the sebaceous glands. The nose is particularly affected (rhinophyma) as this area contains a large portion of the sebaceous glands on the face.

• Ocular Rosacea: Characterized by inflammation in the eyes, particularly the eyelids, followed by tearing, irritation, and dryness of the eyes, ocular rosacea is believed to be caused by a malfunction of the Meibomian glands, the sebaceous glands located in the epidermis of the eyelids.

Is there a connection between rosacea and hormones? This question has been the focus of several recent research studies, but the results have not provided a clear answer. Indeed, data from 75,000 women with rosacea revealed that the majority of patients were postmenopausal and a minority were using a combined oral contraceptive treatment. This is a type of pill that includes both estrogen and progesterone, as opposed to so-called micro-dosed pills, which do not contain estrogen. Although the role of hormones in the etiology of rosacea has not been fully elucidated, this study suggests a hormonal influence in certain subtypes of rosacea.

Another study, contradicting the previous one, suggested that combined pills increase the risk of rosacea. Estrogens are implicated: they are believed to have a vasodilatory effect and promote the appearance of telangiectasias. While their exact mechanism of action is not known, researchers have reported an increased presence of estrogen receptors in areas affected by telangiectasias. This is also why women are more prone to spider angiomas during pregnancy, a period during which the level of estrogens in the body increases.

Thus, although they do not lead to the same results, studies suggest that hormonal fluctuations have an effect on rosacea flare-ups. However, the reverse has not been studied and no data suggests that rosacea exacerbates hormonal disorders.

• FOLDES E. G. Pharmaceutical impact of contraceptive pills on the skin. International Journal of Clinical Pharmacology, Therapy, and Toxicology (1988).

• BARBAROT S. & al. Unilateral Nevoid Telangiectasia Syndrome: A Rare but Benign Diagnosis. Journal of Vascular Medicine (2019).

• TOSTI A. & al. Hormonal Contraceptives and Dermatology. American Journal of Clinical Dermatology (2021).

• ALI F. & et al. Rosacea. British Journal of Hospital Medicine.(2021).