Gut-Skin Axis Revisited: A Nationwide Cohort Study on the Bi-directional Relationship Between Rosacea and Irritable Bowel Syndrome.
4 affiliations
- 1Department of Dermatology, Kangwon National University School of Medicine, Chuncheon, Korea.
- 2Department of Medical Statistics, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea.
- 3Department of Dermatology, Kangwon National University School of Medicine, Chuncheon, Korea. [email protected].
- 4Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea. [email protected].
Abstract
Background
The gut-skin axis has emerged as a key concept linking cutaneous and gastrointestinal inflammation. Although prior studies have reported an increased risk of irritable bowel syndrome (IBS) among patients with rosacea, the reverse association remains unclear.Objective
To examine the bidirectional association between rosacea and IBS using a nationwide cohort database, clarifying whether IBS increases the risk of rosacea as well as the reverse relationship.Methods
We conducted a retrospective cohort study using the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC), including adults aged ≥20 years from 2002 to 2013. Incident cases of rosacea and IBS were identified using International Classification of Diseases, 10th Revision codes and matched to controls by age, sex, and index year. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), controlling for sociodemographic and clinical covariates.Results
During follow-up, patients with rosacea showed a higher incidence of IBS than matched controls (56.3 vs. 36.9 per 1,000 person-years), with a significantly increased risk in the fully adjusted Cox model (aHR, 1.30; 95% CI, 1.11-1.52). Conversely, patients with IBS had a higher incidence of rosacea compared with matched controls (0.37 vs. 0.21 per 1,000 person-years), corresponding to an elevated adjusted risk (aHR, 1.61; 95% CI, 1.39-1.87). These bidirectional associations remained consistent across sensitivity and subgroup analyses.Conclusion
This nationwide study demonstrates a reciprocal relationship between rosacea and IBS, underscoring shared inflammatory and neuroimmune mechanisms underlying the gut-skin axis.
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BibTeX
@article{min2026gutskin,
title = {{Gut-Skin Axis Revisited: A Nationwide Cohort Study on the Bi-directional Relationship Between Rosacea and Irritable Bowel Syndrome.}},
author = {Joon-Hong Min and Young Woo Jo and Young Her and Jae-Woo Kwon},
journal = {Annals of dermatology},
year = {2026},
month = oct,
doi = {10.5021/ad.25.210},
url = {https://europepmc.org/article/MED/42845202},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Gut-Skin Axis Revisited: A Nationwide Cohort Study on the Bi-directional Relationship Between Rosacea and Irritable Bowel Syndrome.
AU - Joon-Hong Min
AU - Young Woo Jo
AU - Young Her
AU - Jae-Woo Kwon
PY - 2026
DA - 2026/10/01
JO - Annals of dermatology
DO - 10.5021/ad.25.210
UR - https://europepmc.org/article/MED/42845202
AB - Background The gut-skin axis has emerged as a key concept linking cutaneous and gastrointestinal inflammation. Although prior studies have reported an increased risk of irritable bowel syndrome (IBS) among patients with rosacea, the reverse association remains unclear.Objective To examine the bidirectional association between rosacea and IBS using a nationwide cohort database, clarifying whether IBS increases the risk of rosacea as well as the reverse relationship.Methods We conducted a retrospective cohort study using the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC), including adults aged ≥20 years from 2002 to 2013. Incident cases of rosacea and IBS were identified using International Classification of Diseases, 10th Revision codes and matched to controls by age, sex, and index year. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), controlling for sociodemographic and clinical covariates.Results During follow-up, patients with rosacea showed a higher incidence of IBS than matched controls (56.3 vs. 36.9 per 1,000 person-years), with a significantly increased risk in the fully adjusted Cox model (aHR, 1.30; 95% CI, 1.11-1.52). Conversely, patients with IBS had a higher incidence of rosacea compared with matched controls (0.37 vs. 0.21 per 1,000 person-years), corresponding to an elevated adjusted risk (aHR, 1.61; 95% CI, 1.39-1.87). These bidirectional associations remained consistent across sensitivity and subgroup analyses.Conclusion This nationwide study demonstrates a reciprocal relationship between rosacea and IBS, underscoring shared inflammatory and neuroimmune mechanisms underlying the gut-skin axis.
SN - 1013-9087
SN - 2005-3894
ER -