Serum Ischemia-modified albumin levels in mild to moderate rosacea: an exploratory case-control study

BACKGROUND: Rosacea is a chronic inflammatory dermatosis in which oxidative stress has been implicated as a pathogenic factor. Ischemia-modified albumin (IMA) is a serum biomarker of oxidative stress not previously evaluated in rosacea. OBJECTIVE: To explore serum IMA levels in rosacea patients versus healthy controls and examine associations with disease severity and clinical characteristics. METHODS: In this exploratory case-control study, 72 rosacea patients and 72 age- and sex-matched healthy controls were enrolled. Serum IMA was measured by the albumin cobalt-binding (ACB) colorimetric method with concurrent serum albumin measurement. Statistical analysis included between-group comparisons, Benjamini-Hochberg false discovery rate (FDR) correction, and multivariable linear regression. RESULTS: Mean serum IMA did not differ significantly between rosacea patients (0.72 ± 0.19 ABSU) and controls (0.74 ± 0.14 ABSU; mean difference -0.02 ABSU, 95% CI [-0.08, +0.04]; Cohen's d = 0.12; p = 0.32). Serum albumin was also comparable between groups (p = 0.50). Male patients showed higher IMA than females (0.81 ± 0.13 vs. 0.72 ± 0.17 ABSU; mean difference +0.09 ABSU, 95% CI [+0.01, +0.17]; Cohen's d = 0.55; p = 0.015). A weak positive correlation between persistent erythema severity and IMA was observed (Spearman's r = 0.24, 95% CI [+0.01, +0.45]; p = 0.045), which did not retain significance after FDR correction (p = 0.058). Multivariable regression revealed no independent predictor of IMA. CONCLUSION: erum IMA was not significantly elevated in rosacea. Exploratory findings suggest possible associations with male sex and erythema severity, warranting confirmation in larger phenotype-stratified studies.