Rosacea: do microbes have some role in its causation? A cross-sectional study from North-East India


  • Bijayanti Devi Department of Dermatology, Venereology and Leprology, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Jantu Kumar Bhaumik Department of Dermatology, Venereology and Leprology, Indira Gandhi Memorial Hospital, Agartala, Tripura (West), India
  • Nandita Bhattacharjee Department of Dermatology, Venereology and Leprology, Regional Institute of Medical Sciences, Imphal, Manipur, India



Rosacea, Aggravating factors, Demodex folliculorum, Coagulase-negative Staphylococcus


Background: Rosacea is a common inflammatory disease affecting the centrofacial skin. The etiopathogenesis is unknown and the disease follows a chronic course. It causes great social discomfort and reduces quality of life.

Methods: A cross sectional study was conducted from October 2011 to September 2013 in the Department of Dermatology, Venereology and Leprology of Regional Institute of Medical Sciences in Imphal, Manipur and all the patients diagnosed with rosacea were included. A detailed history and clinical examination were done and recorded in a preset proforma. Potassium hydroxide mount of skin scrapings and Gram stain as well as culture from lesion and control were performed.

Results: A total of 72 patients were included with female predominance. The mean age of the patients was 31.64±9.623 years. Sun exposure (70.8%) was the commonest exacerbating factor followed by fried spicy food (69.4%). Persistent erythema was seen in most of the patients (97.2%) and ETR was the commonest subtype (65.3%). Associated ocular manifestations were present in 4.2% of patients. The prevalence of Demodex mite was found to be higher in lesional skin as compared to the control. Culture from both lesion and control showed predominant growth of coagulase-negative staphylococcus (87% and 78.3% respectively).

Conclusions: Rosacea is a multifactorial disorder with diverse clinical spectrum. Elimination of the triggering factors may help in controlling the flares and improve the quality of life.


Debersaques J. Historical notes on (acne) rosacea. Eur J Dermatol. 1995;5(1):16-22.

Spoendlin J, Voegel JJ, Jick SS, Meier CR. A study on the epidemiology of rosacea in the UK. Br J Dermatol. 2012;167:598-605.

Hsieh F, Lee JY, Hsu MM. Rosacea: an often overlooked or misdiagnosed disease. Dermatol Sinica. 2004;22:213-20.

Wilkin J, Dahl M, Detmar M, Drake L, Feinstein A, Odom R, Powell F. Standard classification of rosacea: report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol. 2002;46(4):584-7.

Powell FC. Rosacea. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D, eds. Rook’s Textbook of Dermatology. 9th ed. UK: Wiley- Blackwell; 2016: 91.1-91.19.

Berg M, Liden S. An epidemiological study of rosacea. Acta Derm Venereol. 1989;69:419-23.

Abram K, Silm H, Oona M. Prevalence of rosacea in an Estonian working population using a standard classification. Acta Derm Venereol. 2010;90:269-73.

Bhattarai S, Agrawal S, Rijal A. Clinico-epidemiological profile of rosacea at a tertiary care hospital in eastern Nepal. NJDVL. 2012;10(1):27-32.

Bae YI, Yun SJ, Lee JB, Kim SJ, Won YH, Lee SC. Clinical evaluation of 168 Korean patients with rosacea: the sun exposure correlates with the erythematotelangiectatic subtype. Ann Dermatol. 2009;21(3):243-9.

Lazaridou E, Apalla Z, Sotiraki S, Ziakas NG, Fotiadou C, Loannides D. Clinical and laboratory study of rosacea in northern Greece. J Eur Acad Dermatol Venereol. 2010;24(4):410-4.

Khaled A, Hammami H, Zeglaoui F, Tounsi J, Zermani R, Kamoun MR, et al. Rosacea: 244 Tunisian cases. Tunis Med. 2010;88(8):597-601.

Crawford GH, Pelle MT, James WD. Rosacea: I etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. 2004;51:327-41.

Litt JZ. Steroid-induced rosacea. Am Fam Physician. 1993;48:67-71.

Georgala S, Katoulis AC, Kylafis GD, Koumantaki-Mathioudaki E, Georgala C, Aroni K. Increased density of Demodex folliculorum and evidence of delayed hypersensitivity reaction in subjects with papulopustular rosacea. J Eur Acad Dermatol Venereol. 2001;15:441-4.

Rather PA, Hassan I. Human demodex mite: the versatile mite of dermatological importance. Indian J Dermatol. 2014;59:60–6.

Forton FM, De Maertelaer V. Papulopustular rosacea and rosacea‐like demodicosis: two phenotypes of the same disease? J Eur Acad Dermatol Venereol. 2018;32(6):1011-6.

Whitfeld M, Gunasingam N, Leow LJ, Shirato K, Preda V. Staphylococcus epidermidis: a possible role in the pustules of rosacea. J Am Acad Dermatol. 2011;64(1):49-52.






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