Characterization and Analysis of the Skin Microbiota in Rosacea: A Case–Control Study



The efficacy of antibiotics in rosacea treatment suggests a role for microorganisms in its pathophysiology. Growing concern over the adverse effects of antibiotic use presents a need for targeted antimicrobial treatment in rosacea.


We performed a case–control study to investigate the skin microbiota in patients with rosacea compared to controls matched by age, sex, and race.


Nineteen participants with rosacea, erythematotelangiectatic, papulopustular, or both, were matched to 19 rosacea-free controls. DNA was extracted from skin swabs of the nose and bilateral cheeks of participants. Sequencing of the V3V4 region of the bacterial 16S ribosomal RNA gene was performed using Illumina MiSeq and analyzed using QIIME/MetaStats 2.0 software.


Compared with controls, skin microbiota in erythematotelangiectatic rosacea was depleted in Roseomonas mucosa (p = 0.004). Papulopustular rosacea was enriched in Campylobacter ureolyticus (p = 0.001), Corynebacterium kroppenstedtii (p = 0.008), and the oral flora Prevotella intermedia (p = 0.001). The highest relative abundance of C. kroppenstedtii was observed in patients with both erythematotelangiectatic and papulopustular rosacea (19.2%), followed by papulopustular (5.06%) and erythematotelangiectatic (1.21%) rosacea. C. kroppenstedtii was also associated with more extensive disease, with the highest relative abundance in rosacea affecting both the cheeks and nose (2.82%), followed by rosacea sparing the nose (1.93%), and controls (0.19%).


The skin microbiota in individuals with rosacea displays changes from that of healthy skin, suggesting that further studies examining a potential role for the skin microbiota in the pathophysiology of rosacea may be warranted.

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Corresponding author

Correspondence to Anna L. Chien.

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Research reported in this publication was supported by the National Rosacea Society and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health, under R01AR064297 and AR068280 to Luis A. Garza.

Conflict of interest

Anna L. Chien participated in Galderma’s Rosacea Medical Advisory Board Meeting in 2017. Sewon Kang is an advisory board member of Almirall and has received an honorarium. The participation was not in relation to the current article. Barbara M. Rainer, Katherine G. Thompson, Corina Antonescu, Liliana Florea, Emmanuel F. Mongodin, Jonathan Bui, Helena B. Pasieka, Alexander H. Fischer, and Luis A. Garza have no conflicts of interest that are directly relevant to the content of this article.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Johns Hopkins Institutional Review Board and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all participants included in the study.

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Rainer, B.M., Thompson, K.G., Antonescu, C. et al. Characterization and Analysis of the Skin Microbiota in Rosacea: A Case–Control Study. Am J Clin Dermatol 21, 139–147 (2020).

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