Background: Rosacea, a common chronic inflammatory skin disorder, has a poorly understood pathogenesis. Growing evidence suggests that patients with rosacea have a higher risk of metabolic syndrome (MetS). However, few studies have investigated the association between metabolic status and rosacea. Therefore, we aimed to assess the metabolic abnormalities are associated with an increased risk of rosacea using the National Health Check-ups (NHC) database of Korea. 
Methods: Data came from 2,806,617 cohort participants identified from 2006 to 2015. Cox Proportional Hazards Regression were used to estimate multivariable adjusted hazard rations (HR) and 95% confidence intervals (Cis) for rosacea risk. Metabolic abnormalities considered included: elevated blood pressure (>130/85 mm Hg), hyperglycemia, hypertriglycemia (>150 mg/dL), hypo-HDL cholesterolemia (<40 mg/dL for men and <50 mg/dL for women), and high waist circumference (> 90cm for men and >85cm for women). 
Results: During follow-up, 5,589 participants were diagnosed with rosacea. Compared to metabolically healthy participants, metabolically unhealthy participants had increased risk of rosacea development. Hypertension (hazard ratio 1.20; 95% confidence interval 1.20-1.21), hyperglycemia (hazard ratio 1.38; 95% confidence interval 1.38-1.39), hypertriglycemia (hazard ratio 1.06; 95% confidence interval 1.06-1.07), hypo-HDL cholesterolemia (hazard ratio 1.51, 95% confidence interval 1.50-1.52), and increased waist curcumference (hazard ratio 1.33, 95% confidence interval 1.32-1.33) significantly increased the risk of rosacea. 
Conclusion: Collectively, this study indicates that patients with hypertension, hyperglycemia, dyslipidemia and high waist circumference may be at increased risk for rosacea. However, further studies are needed to evaluate whether the control of metabolic parameters can lower the incidence of rosacea.

Implications of metabolic status on the incidence of rosacea : a Korean nationwide population-based cohort study