Skin Bacteria Thrives in Rosacea Patients

Written by on October 18, 2010 in Papules & Pustules, What Causes Rosacea? with 9 Comments

Staphylococcus epidermidis bacteria

This just published abstract has two interesting findings.

Firstly the majority of pustules from a group of rosacea sufferers contained a growth of a skin bacteria called Staphylococcus epidermidis, whereas normal skin from the same side of the face as the pustule did not.

Secondly a significant difference was found between the growth of Staphylococcus epidermidis in the eyelid margin of a group of rosacea sufferers compared to similar people who did not have rosacea.

So the researchers were able to prove that this bacteria was more prevalent in the pustules of rosacea and in the eyelids of people who suffer from facial rosacea lesions.

Staphylococcus epidermidis is part of the normal flora of human skin. It has been found to be resistant some types of antibiotics but is not normally considered pathogenic (capable of causing an infection).

I look forward to more research that will further establish the relative importance of this bacteria Staphylococcus epidermidis, the bacteria Bacillus oleronius found in demodex mites as well as any link to overgrowth of stomach bacteria.

Why not throw Propionibacterium acne in to the mix as well – I say!

Before we get too excited about this finding we also need to remember that in recent times the anti-inflammatory and other non-antibiotic properties of systemic antibiotics have been shown to be important factors in the successful treatment of rosacea symptoms by antibiotics.

Staphylococcus epidermidis: A possible role in the pustules of rosacea, J Am Acad Dermatol. 2010 Oct 11.

Whitfeld M, Gunasingam N, Leow LJ, Shirato K, Preda V., Department of Dermatology, St Vincent’s Hospital, Darlinghurst, Sydney, Australia; Skin and Cancer Foundation of Australia, Darlinghurst, Sydney, Australia.

BACKGROUND: Rosacea is a common skin and ocular disease. Cutaneous rosacea is characterized by facial flushing, telangiectasia, papules, and pustules. It is generally regarded as inflammatory in nature. We believed that the role of bacteria as a contributory factor in pustular and ocular rosacea needed to be revisited.

OBJECTIVES: We sought to ascertain whether there is an increase in the bacteria isolated from the (1) pustules of rosacea; and (2) eyelid margins of persons with cutaneous pustular rosacea.

METHODS: Bacterial swabs were taken and cultured from an incised rosacea pustule, the ipsilateral cheek skin, and the eyelid margin of 15 patients with pustular rosacea. Swabs were also taken from the cheek skin and ipsilateral eyelid margin of 15 matched control subjects.

RESULTS: A pure growth of Staphylococcus epidermidis was isolated from a pustule of 9 of 15 patients with pustular rosacea, and no pure growth of S epidermidis was isolated from their ipsilateral cheek skin. This was a highly statistically significant increase (P = .0003). A pure growth of S epidermidis was isolated from the eyelid margins of 4 of 15 patients with pustular rosacea, and no pure growth was isolated from the eyelids of age- and sex-matched control subjects. This was a statistically significant increase (P = .05).

LIMITATIONS: This study focuses on the microbial basis of rosacea.

CONCLUSION: Our findings suggest S epidermidis may play a role in pustular and ocular rosacea.

Ipsilateral means “from the same side”, basically a fancy way of saying that they tested the rosacea pustule itself and some skin near the pustule on the same side of the face as the pustule.

Cutaneous means of the skin, ie. facial rosacea as opposed to ocular rosacea.

[update Feb 2010:] The full text of this article is now available online: Staphylococcus epidermidis: A possible role in the pustules of rosacea.


This study differs from other studies looking at the role of bacteria in a pathologic processes by using the patients’ own skin as the control. It has demonstrated a highly statistically significant (P = .0003) increase in the pure growth of a bacteria, namely S epidermidis (usually regarded as a commensal) from a pustule when it is compared with the mixed bacterial growth found from the skin adjacent to the same pustule. It is noteworthy that we did not find a pure growth of any other bacteria. This result suggests that S epidermidis is likely to be an integral part of the disease process in pustular rosacea and may play a role in ocular rosacea.

Dahl et al also isolated S epidermidis from the rosacea pustules of all 4 of his reported patients with rosacea, although the possible role of this bacteria in rosacea has not been further reported. He did, however, note that the bacteria he cultured produced different proteins when cultured at different temperatures.

Although these data suggest that S epidermidis might have a role in the formation of the pustules, we cannot rule out that the substrate cutaneous environment in the pustules of patients with rosacea favors the growth of S epidermidis.

Doxycycline is thought to act in rosacea mainly via its anti-inflammatory action. This research has shown that S epidermidis may play a role in pustular and ocular rosacea, therefore examining the antibiotic sensitivities of this organism may help us to understand why other antibiotics may also be effective in some cases.

The temperature of the skin is known to be increased in persons with rosacea. It is likely that this is the result of the long history of flushing and the development of altered dermal vasculature, which increases blood flow to areas affected by rosacea. Increased temperature of the face has been shown to occur in settings of both exercise and consumption of hot drinks and alcohol. As pustules do not precede the erythematous change, we believe this increase in vascularity and the temperature of the skin may represent an important step in stimulating the usually commensal organism S epidermidisto behave as a pathogenic organism, leading to development of papulopustular rosacea.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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9 Reader Comments

  1. Doug says:

    Very Interesting! Maybe Rosacea is due to an infection and/or bacteria.

  2. Mike T says:

    Maybe these normal inhabitants of the skin prefer to congregate in the areas suggested.

    I bet there is plentiful food and warmth in these pustules when compared
    to “normal” skin.

    The best they can do is probably prove that this common bacteria is aggravating the persons Rosacea, e.g. possibly by a byproduct during food conversion.

    Until then, this study only suggests that pustule rich skin makes for prime real estate.

  3. Doug says:

    so how do we kill the bacteria?

  4. Terri says:

    I was diagnosed with rosacea years ago and was told by the dermatologist that the only way to keep it at bay was to constantly be on antibiotics to kill the bacteria. Of course, my system would build up an immunity to antibiotics. Rather than risk that in case of a “real” illness, I chose to live with it. Using Metrogel helped for many years, until I built up an immunity to that, too.

  5. As to killing this bacteria Staphylococcus epidermidis, or indeed whether it is involved at all in the way rosacea progresses – well that is an open question for now.

    I wouldn’t be surprised if future research found that even the so called low dose antibiotics have an effect on bacteria like Staphylococcus epidermidis, perhaps indirectly.

    The common thought is that antibiotics work in rosacea primarily by interrupting the inflammatory pathway that lead to the papules and pustules of rosacea. How this idea relates to normal skin bacteria such as Staphylococcus epidermidis and Propionibacterium acne is still to be discovered.

  6. stylin4u says:

    I have suffered with rosacea for many many years to the point where i wouldnt go out in public during an outbreak. I have used many prescribed regimens that never really worked. Almost two years ago, i discovered a product line that alleviates all my symptoms and i have not had an outbreak since i started using it.. Mind you, if i stop using it, i am certain of an out break. It consists of a cleanser, moisturizer and sterile water. And! i can use my cosmetics over it with no problems.

    • What is this cleanser, moisturizer and sterile water ?

      • Millie says:

        The name of the product line is Avene from Pierre Fabre Laboratories …I use the Eau Thermale for sensitive ans rosacea prone skin. I cannot begin to tell you how i feel about having my life back. My rosacea was extreme until i came upon Avene.

  7. Dee says:

    I have an outbreak at the moment.It is so itchy and painfull.I have been given such conflicting information on how to treat my skin.I am confused about the best ways to clean and moisturise my face including how to dry it off. (Hand towel/face towel) ????. My dermatologist has suggested we try vitamin A tablets.Any information or thoughts would be greatly appreciated.

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