Clinical-demographic profile, aggravating factors, comorbidities, and quality of life in patients with Rosacea: a Brazilian multicenter study (GBPER: Brazilian Research and Studies Group on Rosacea)

Bonamigo, Renan Rangel; Barea, Paula; Peruzzo, Juliano; Boza, Juliana; Miot, Hélio Amante; Bagatin, Edileia; Almeida, Luiz Maurício Costa; Milano, Giovanni Indelicato; Lima, Carla Wanderley Gayoso de; Vidal, Linácia Freitas; Picosse, Fabíola Rosa; Afonso, Bruna Manuella de Figueiredo; Oliveira, Clivia Maria Moraes de

doi:10.1016/j.abd.2025.501160

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Original Article • An. Bras. Dermatol. 100 (05) • 2025 • https://doi.org/10.1016/j.abd.2025.501160 linkcopy

Clinical-demographic profile, aggravating factors, comorbidities, and quality of life in patients with Rosacea: a Brazilian multicenter study (GBPER: Brazilian Research and Studies Group on Rosacea)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background Rosacea is the most prevalent chronic vascular-inflammatory dermatosis of the face. Its pathogenesis includes genetic and environmental factors, neurovascular alterations, and innate immunity. Many triggering and aggravating factors, as well as systemic comorbidities, have been associated with the disease, but there are few studies on its epidemiology in Brazil.

Objectives To describe the profile of patients with rosacea treated at referral centers, as well as to investigate the presence of comorbidities, dietary aspects, worsening factors, and quality of life.

Methods Cross-sectional and multicenter Brazilian study. Clinical and demographic data, disease severity, triggering and/or aggravating factors, diet, comorbidities, and impact on quality of life were evaluated.

Results 258 patients were included, predominantly women, between 35 and 65 years old and phototypes III, IV and II. The clinical picture ranged from mild to moderate in 89% of cases and quality of life was reasonable to slightly affected in 58% of cases. Aggravating factors for rosacea were reported by 96% of patients, with climate exposure, alcoholic beverages, and emotional changes being the most frequent. Among the foods mentioned as aggravating factors (28%), pepper, other condiments and hot beverages were the most frequently reported. Comorbidities were reported by 89% of the participants, with emphasis on endocrine (48%), psychiatric (35%), cardiovascular (31%) and gastrointestinal (28%) diseases.

Study limitations Uncontrolled study, including patients undergoing dermatological treatment.

Conclusions This study establishes that the profile of Brazilian patients with rosacea corroborates that described in the literature, with the presence of the disease in higher phototypes being relevant. Pepper and other condiments and hot beverages were important aggravating factors, and the presence of various comorbidities was reported by most of the patients.

Keywords
Acneiform eruptions; Classification; Epidemiology; Facial dermatoses; Rosacea

Variable	Values
Age (years)a	51.3 ± 14.4
Body Mass Index (kg/m²)a	26.9 ± 5.7
Overweight (BMI > 25 < 30 kg/m²)b	100 (39.21%)
Obesity (BMI ≥ 30 kg/m²)b	72 (27.9%)
Time to diagnosis (year)a	8.0 ± 8.6
Total duration of disease (years)a	11.1 ± 9.2
Sex b
Female	179 (69.4%)
Male	79 (30.6%)
Phototype b
I	7 (2.7%)
II	61 (23.7%)
III	119 (46.3%)
IV	66 (25.7%)
V	4 (1.6%)
Self-reported ancestry b
European	215 (83.3%)
African-American	18 (7.0%)
Eastern-Asian	2 (0.8%)
Indigenous	23 (8.9%)
Level of schooling b
Did not attend	4 (1.6%)
Kindergarten	25 (9.7%)
Elementary School	50 (19.4%)
High School	61 (23.6%)
Higher Education	118 (45.7%)
Family history of rosaceab	83 (32.3%)
Medications in use b	185 (71.7%)
Anti-hypertensives	80 (31.0%)
Antidepressants	50 (19.4%)
Antidiabetics	45 (17.4%)
Lipid-lowering agents	38 (14.8%)
Levothyroxine	29 (11.3%)
Oral contraceptives	25 (9.7%)
Proton-pump inhibitor	22 (8.6%)
Antiplatelet agents	10 (3.9%)
Vasodilators	7 (2.7%)
Othersc	87 (47%)
Treatments used for rosacea b
Topical	167 (64.7%)
Azelaic acid	82 (31.8%)
Ivermectin	91 (35.3%)
Metronidazole	87 (33.7%)
Oral	78 (30.2%)
Cyclins	71 (27.5%)
Isotretinoin	19 (7.4%)
Laser / pulsed light	55 (21.3%)

Clinical assessment scores (investigator)	Categories	n (%)
IGA-RSS	1	73 (29.4%)
	2	97 (39.1%)
	3	45 (18.1%)
	4	25 (10.1%)
	5	7 (2.8%)
	6	1 (0.4%)
RCS
Flushing	Absent	42 (16.3%)
	Mild	100 (38.8%)
	Moderate	93 (36.0%)
	Intense	23 (8.9%)
Erythema	Absent	67 (26%)
	Mild	122 (47.3%)
	Moderate	65 (25.2%)
	Intense	4 (1.6%)
Papules and Pustules	Absent	91 (35.3%)
	Mild	121 (46.9%)
	Moderate	43 (16.7%)
	Intense	3 (1.2%)
Telangiectasias	Absent	34 (13.2%)
	Mild	146 (56.6%)
	Moderate	71 (27.5%)
	Intense	7 (2.7%)
Burning or stinging	Absent	81 (31.4%)
	Mild	83 (32.2%)
	Moderate	73 (28.3%)
	Intense	21 (8.1%)
Plaques	Absent	219 (84.9%)
	Mild	22 (8.5%)
	Moderate	14 (5.4%)
	Intense	3 (1.2%)
Dry appearance	Absent	148 (57.4%)
	Mild	68 (26.4%)
	Moderate	40 (15.5%)
	Intense	2 (0.8%)
Edema	Absent	224 (87.2%)
	Mild	26 (10.1%)
	Moderate	5 (1.9%)
	Intense	2 (0.8%)
Ocular	Absent	151 (58.5%)
	Mild	76 (29.5%)
	Moderate	24 (9.3%)
	Intense	7 (2.7%)
Peripheral (extra-facial)	No	233 (90.7%)
	Cervical	12 (4.7%)
	Pre-auricular	1 (0.4%)
	Back	1 (0.4%)
	Scalp	3 (1.2%)
	Anterior thorax/neck	7 (2.7%)
Phymatous changes	Absent	200 (77.5%)
	Mild	23 (8.9%)
	Moderate	27 (10.5%)
	Intense	8 (3.1%)
Changes compatible with granulomatous rosacea	Absent	238 (92.2%)
	Mild	8 (3.1%)
	Moderate	11 (4.3%)
	Intense	1 (0.4%)
Erythematous telangiectatic	Absent	14 (5.4%)
	Mild	146 (56.6%)
	Moderate	89 (34.5%)
	Intense	9 (3.5%)
Papulopustular	Absent	96 (37.2%)
	Mild	119 (46.1%)
	Moderate	40 (15.5%)
	Intense	3 (1.2%)
Phymatous	Absent	197 (76.4%)
	Mild	26 (10.1%)
	Moderate	27 (10.5%)
	Intense	8 (3.1%)
Ocular	Absent	157 (60.9%)
	Mild	70 (27.1%)
	Moderate	23 (8.9%)
	Intense	8 (3.1%)
Overall patient assessment	Absent	8 (3.1%)
	Mild	129 (50.0%)
	Moderate	100 (38.8%)
	Intense	21 (8.1%)

Variables	Values
Domains ^a
Symptom	2.9 ± 0.8
Emotion	2.7 ± 1.1
Function	2.1 ± 1.0
General	2.6 ± 0.8
How has your rosacea been over the past four weeks? ^b
Bad	37 (14.5%)
Regular	110 (43.3%)
Good	80 (31.3%)
Very good	18 (7.0%)
Excellent	11 (4.3%)
How much does your rosacea influence your quality of life? ^b
Not at all	48 (18.7%)
A little	82 (31.9%)
Reasonably	68 (26.5%)
A lot	46 (17.9%)
Very much	13 (5.1%)

Factorsa	Values - n (%)
Sun exposure	196 (76.0%)
Emotional changes	169 (65.5%)
Heat	160 (62.0%)
Physical exercise	115 (44.6%)
Alcohol	110 (42.6%)
Wind	66 (25.6%)
Foods	72 (27.9%)
Pepper	39 (54.16%)b
Other condiments	9 (12.5%)b
Hot foods/beverages	6 (8.3%)b
Dairy products	6 (8.3%)b
Chocolate	6 (8.3%)b
Coffee	5 (6.9%)b
Wine	4 (5.6%)b
Fats/fried foods	4 (5.6%)b
Milk	4 (5.6%)b
Sugar	4 (5.6%)b
Sweets	3 (4.2%)b
Processed meats-preservatives	3 (4.2%)b
Crustaceans	3 (4.2%)b
Tomato paste/tomato	2 (2.8%)b
Mayonnaise	2 (2.8%)b
Ketchup	2 (2.8%)b
Ginger	2 (2.8%)b
Cinnamon	2 (2.8%)b
Others	14 (19.4%)b
No aggravating factors mentioned	10 (3.9%)

Comorbidities	n (%)
Gastrointestinal condition	71 (27.5%)
Crohn’s disease / URC	6 (2.3%)
Gastroesophageal reflux disease	32 (12.4%)
Gastritis/gastric ulcer	40 (15.5%)
Pancreatitis	1 (0.4%)
Bariatric surgery	1 (0.4%)
Lactose intolerance	5 (1.9%)
Irritable bowel syndrome	5 (1.9%)
Colitis	1 (0.4%)
Diverticulitis	1 (0.4%)
Gastric hernia	1 (0.4%)
Neurological disease	46 (17.8%)
Cerebrovascular accident	6 (2.3%)
Migraine	39 (15.1%)
Other neurological disease	3 (1.2%)
Psychiatric disease	89 (34.5%)
Depression	46 (17.9%)
Anxiety	67 (26.1%)
Social phobia	1 (0.4%)
OCD	1 (0.4%)
Panic syndrome	1 (0.4%)
Insomnia	2 (0.8%)
Autoimmune disease	38 (14.8%)
Psoriasis	14 (5.4%)
Lupus erythematosus	6 (2.3%)
Frontal fibrosing alopecia	4 (1.6%)
Rheumatoid Arthritis	3 (1.2%)
Vitiligo	2 (0.8%)
Scleroderma or systemic sclerosis	2 (0.8%)
Hashimoto’s disease	4 (1.5%)
Purpura and hidradenitis	1 (0.4%)
Purpura	1 (0.4%)
Pemphigus foliaceus	1 (0.4%)
Transverse myelitis	1 (0.4%)
Lupus, scleroderma and dermatomyositis	1 (0.4%)
Infectious disease	12 (4.7%)
HIV/AIDS	4 (1.5%)
Hepatitis B	3 (1.2%)
Chagas’ disease	1 (0.4%)
Leprosy	1 (0.4%)
Recurrent UTI	1 (0.4%)
Latent tuberculosis	1 (0.4%)
Chromomycosis	1 (0.4%)
Neoplastic disease	40 (15.6%)
Cutaneous BCC/SCC	23 (8.91%)
CIN 3	1 (0.4%)
Melanoma	7 (2.7%)
Larynx	1 (0.4%)
Thyroid	3 (1.16%)
Breast	5 (1.9%)
Ovarian teratoma	1 (0.4%)
Intestine / Rectum	1 (0.4%)
Prostate	2 (0.8%)
Endometrium	1 (0.4%)
Leukemia	1 (0.4%)
Cardiovascular diseases	81 (31.4%)
Arterial Hypertension	77 (29.8%)
Acute myocardial infarction	3 (1.2%)
Dyslipidemia	40 (15.5%)
Arrythmia / atrial fibrillation	7 (2.7%)
Cardiomegaly	1 (0.4%)
Heart failure	1 (0.4%)
Venous thrombosis	2 (0.8%)
Endocrine disease	123 (47.7%)
Diabetes mellitus	42 (16.3%)
Thyroid nodule	3 (1.2%)
Hypothyroidism	18 (7%)
Insulin resistance	3 (1.2%)
Osteoporosis	1 (0.4%)
Obesity	61 (23.6%)
Metabolic syndrome	42 (16.3%)
Liver disease	26 (10.07%)
Steatosis	22 (8.5%)
Liver thrombosis	1 (0.4%)
Post-hepatitis cirrhosis	1 (0.4%)
Drug-induced hepatitis	1 (0.4%)
Liver transplant	1 (0.4%)
Urological disease	21 (8.1%)
Renal lithiasis	15 (5.8%)
Glomerulonephritis ‒ transplant	1 (0.4%)
Prostatic hyperplasia	2 (0.8%)
Nephritis in childhood	1 (0.4%)
Renal cyst	1 (0.4%)
Pyelonephritis	1 (0.4%)

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[TFN1] ^a
Mean and standard deviation.

[TFN2] ^b
Absolute and percentage values.

[TFN3] ^c
Medications with less than 2% frequency.