A Clinico-Pathological Investigation of Rosacea with Particular Regard to Systemic Diseases

Background: Rosacea is a common skin disorder that predominantly affects fair skinned people, particularly of Celtic origin. It usually presents with erythema, telangiectasia, and papulo-pustular lesions on the face and chest and usually triggered by sun exposure. The finding of a positive anti-nuclear antibody (ANA) has been reported in rosacea, as a consequence, those rosacea patients may be mislabeled as lupus erythematosus, often with important consequences in terms of treatment, and presumed prognosis. There is a limited literature examining rosacea and its associations with the positivity of ANA and connective tissue diseases (CTD).
Objectives: This study investigated the relationship of different sub-types of rosacea with positivity of ANA test, musculo-skeletal systemic symptoms including myalgia, arthralgia and Raynaud’s phenomenon and CTD particularly lupus.
Method: This was principally an observational study, I investigated a large group of patients (169 patients) with different subtypes of rosacea, identified from the dermatology and rheumatology departments in Doncaster Hospitals (93 patients) and Leeds Hospitals (76 patients). All patients had ANA blood screening test and all required data about their rosacea, associated systemic symptoms and previous history of CTD were recorded in special proformas after patients read information leaflet sheet and signed participation consent form.
Results: The results showed no significant increase in the ANA positivity test (overall 13%), however, in patients without a history of CTD, the level of ANA positivity of both centres combined was (5.3%) which is similar to that reported in the general population; (One-sample Binomial test compared to null hypothesis proportion [5%] p=0.500). Around 15 - 20% of patients had one or more systemic symptoms. Arthralgia and myalgia had the same percentage as reported by the control group and in normal populations; however, Raynaud's phenomenon was slightly greater than reported in the control group and the general populations. There could be an inverse relationship between Raynaud's treatment with vasodilators and rosacea flushing symptom.
Conclusion: This study confirmed that there is no evidence that any particular clinical sub-type of rosacea is associated with increased positivity of ANA or has specific relationship with CTD. The study also did not find any specific relationship between rosacea and systemic symptoms.