Lipidome and Microbiome Profile of the Eye in Rosacea

Rosacea is a common condition that has multiple subtypes that exhibit inflammation and
deficits in the skin/eye barrier function. Cutaneous rosacea is estimated to have an
incidence of 10-22% while the prevalence of ocular rosacea ranging from 6-72%. Although
rosacea is not an infection, antibiotics are widely used as first-line therapy due to their
anti-inflammatory and skin-barrier function supporting effects. The most common class of
antibiotics used are the tetracyclines, such as doxycycline and minocycline. With the
emergence of community acquired methicillin resistant Staphylococcus aureus (MRSA) as well as
macrolide resistant Streptococci and Staphylococci, there is growing concern for the
widespread use of antibiotics for non-infectious conditions.

The current clinical gap in practice is that there are few alternative therapies to
antibiotics and this is partly due to our lack of understanding of what leads to the impaired
skin/eye barrier and inflammation in rosacea. Few lipid-based studies have been performed in
rosacea but there is early evidence for the importance in the lipidome to rosacea. The sebum
in those with papulopustular rosacea was identified to have an abnormal profile to their
sebum with a deficiency in long chain saturated fatty acids6 that correlates with the
deficient skin barrier that is seen in rosacea. Treatment with minocycline was shown to
restore skin barrier function in papulopustular rosacea but no lipid profile related measures
were performed. Moreover, no studies have evaluated the role of other lipid mediators that
are closely associated with the skin barrier and inflammation such as the ceramides and the
eicosanoids.

The question that the investigators aim to address in this proposal is how the local lipid
mediator profiles of ceramides and eicosanoids are altered in cutaneous and ocular rosacea
and how antibiotics alter the lipidome. The investigators also seek to understand how the
microbiome is changed in those with and without rosacea, and how the microbiome is altered in
those with rosacea. Understanding how the lipidome is modulated in rosacea with antibiotic
treatment will serve as the first step in targeting therapies toward directly altering the
lipidome to reduce inflammation and ultimately reduce the use of antibiotics.

Inclusion Criteria for subjects:

- Aged 18 and older

- Subjects that meet one of the following criteria:

- Healthy subjects without an inflammatory facial rash or an inflammatory eye
condition

- Subjects diagnosed with ocular rosacea or cutaneous rosacea (papulopustular or
erythematotelangiectatic) by either a board-certified dermatologist or
ophthalmologist

Exclusion Criteria

- Those who are prisoners or cognitively impaired.

- Those who have had any change to their hormonal birth control regimen in the last 4
weeks

- Systemic antibiotic use in the last four weeks

- Allergy or known intolerance to tetracyclines

- Those who wear contact lenses

- Autoimmune disease such as lupus, dermatomyositis that has cutaneous involvement

- Those who are pregnant or may become pregnant