Abstract
COVID-19 can affect the skin, with rosacea flare-ups reported after infection or vaccination. This study compared rosacea patients with and without post-COVID-19 exacerbation to identify contributing factors. A customized electronic questionnaire was administered to rosacea patients, gathering COVID-19 infection/vaccination status, demographics, and rosacea features. Participants were classified by post-COVID-19 rosacea exacerbation vs none. Multivariable logistic regression identified risk factors. Finally, a total of 104 patients were analysed; 15.4% experienced rosacea exacerbation after COVID-19 vaccination and 28.8% after infection. Comorbidities such as metabolic diseases or allergic diseases were associated with a higher risk of rosacea exacerbation after vaccination or infection (OR = 11.083, 95% CI: 1.136-108.135). Burning and stinging symptoms predicted higher exacerbation risk after vaccination (OR = 8.978, 95% CI 1.968-40.969). Papulopustular rosacea was associated with lower risk (OR = 0.276, 95% CI: 0.066-1.160). Higher body mass index (BMI) was associated with lower exacerbation risk after vaccination (OR = 0.646, 95% CI 0.450-0.928) and infection (OR = 0.731, 95% CI: 0.572-0.933). Frequent rosacea episodes increased exacerbation risk after infection (OR = 8.288, 95% CI: 2.044-33.608). In conclusion, lower BMI was associated with higher risk of rosacea exacerbation after COVID-19 vaccination or infection. Patients with burning and stinging symptoms or a non-papulopustular subtype were more likely to experience exacerbation after vaccination.