Incident rosacea and related dermatoses in estrogen-exposed females

Rosacea is a chronic inflammatory facial dermatosis that disproportionately affects women and may fluctuate during periods of hormonal transition. Fluctuations in estrogen levels across the female lifespan have been hypothesized to contribute to the development of inflammatory, pigmentary, and androgen-mediated dermatologic conditions. However, population-level data evaluating the association between estrogen exposure and incident rosacea across hormonally defined life stages remain limited. This study aimed to evaluate whether exogenous estrogen exposure is associated with differences in incident rosacea risk across premenopausal, perimenopausal, and postmenopausal women. A retrospective cohort study was conducted using the TriNetX Research Network. Female patients were stratified into premenopausal (18–43 years), perimenopausal (45–55 years), and postmenopausal (≥ 56 years) cohorts. Within each age stratum, estrogen-exposed patients, defined by documented estrogen-containing hormonal contraceptive use or hormone replacement therapy use, were propensity score-matched 1:1 to estrogen-unexposed controls. The primary outcome was incident rosacea (ICD-10 L71.x) within three years following the index event. Secondary outcomes included other/unspecified rosacea [L71.8, L71.9], perioral dermatitis [L71.0], and rhinophyma [L71.1]. Perioral dermatitis was included because of its recognized clinical and diagnostic overlap with rosacea. Time-to-event analyses were performed using Kaplan–Meier methods and Cox proportional hazards models. After matching, cohorts included 742,051 premenopausal, 54,248 perimenopausal, and 378,572 postmenopausal women per exposure group. Across all age groups, estrogen exposure was associated with a significantly lower recorded incidence of rosacea. Hazard ratios (HR) were 0.75 (95% CI 0.72–0.78; log-rank p < 0.001) in premenopausal women, 0.77 (95% CI 0.69–0.85; p < 0.001) in perimenopausal women, and 0.67 (95% CI 0.65–0.70; p < 0.001) in postmenopausal women. Similar associations were observed for other rosacea subtypes, perioral dermatitis, and rhinophyma across cohorts. Exogenous estrogen exposure was consistently associated with a lower recorded incidence of rosacea and related rosacea-spectrum facial dermatoses, including perioral dermatitis and rhinophyma, across age-defined female life stages. These findings underscore the importance of hormonal context in rosacea epidemiology and support further investigation into the relationship between estrogen exposure and inflammatory facial dermatoses.

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