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To the Editor: The pathophysiology of rosacea involves dysregulation of innate and adaptive immunity, neurovascular changes, chronic inflammation, and, possibly, infections. 1 A new pathogenic mechanism was recently suggested after a relationship was observed in a study where 46% of prospective patients with rosacea had small intestinal bacterial overgrowth (SIBO). 2 After therapy with rifaximin, a nonabsorbed, gut-active antibiotic, complete resolution of cutaneous lesions in 78% of the patients with SIBO was observed. SIBO may alter immunity and trigger rosacea by increasing tumor necrosis factoralfa or other cytokines, suppressing interleukin-17, and stimulating the T helper 1-mediated immune response. 3 Furthermore, gut bacteria have been shown to mimic immunogens associated with extraintestinal disease (ie, multiple sclerosis). 4 The aim of this pilot study was to determine the prevalence of SIBO in …