Rosacea natural treatment vitamins herbs supplements by Ray Sahelian, M.D. Acne Rosacea treatment with diet

Rosacea is a common chronic skin disorder which occurs most commonly in middle-aged individuals. Skin manifestations include transient or persistent facial redness, appearance of tiny blood vessels near the skin surface, swelling, papules and pustules that are usually confined to the central portion of the face. Complications include ocular rosacea. Acne rosacea is a common skin disorder which affects adults women more than men. Rosacea affects about 14 million Americans.

Subscribe to a FREE Supplement Research Update newsletter. Twice a month you will receive an email with a review of several studies on various supplements and natural medicine topics, including rosacea and acne rosacea, and their practical interpretation by Dr. Sahelian.

Causes of Rosacea
Little is known about the cause of rosacea. Genetic, environmental, dietary, vascular, inflammatory factors and microorganisms such as Demodex folliculorum and Helicobacter pylori have been considered. Triggers include heat, alcohol, spicy foods and embarrassment which can worsen the condition.
   Biochemically, overproduction of two inflammatory proteins lead to excessive levels of a third protein that causes rosacea symptoms. A high amount of SCTE (stratum corneum tryptic enzymes) and too much cathelicidin leads to the abnormal peptides that cause the symptoms of rosacea. Research will determine whether the levels of these proteins can be manipulated through food, supplements, or medicines.

Severe exacerbation of rosacea induced by cinnamon supplements.
J Drugs Dermatol. 2008 Jun; Campbell TM, Neems R, Moore J. Rush University Medical Center, Chicago, IL 60612, USA.
The authors report a case of a 68-year-old Caucasian female with type 2 diabetes mellitus who experienced an acute exacerbation of her rosacea 2 weeks after self-initiating cinnamon oil pills to lower her blood sugar levels. The use of cinnamon has commonly produced cutaneous side effects of irritant or allergic contact dermatitis and been reported to have vasodilatory effects. Yet, there are no reports of cinnamon use triggering a rosacea exacerbation in the literature.

Natural treatment for rosacea
Little is known regarding natural rosacea treatment. My guess is that eating a low inflammatory diet could be helpful consisting of fish and vegetables and low sugar intake. Perhaps taking Fish-Oil supplements could help.

Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation.
J Cosmet Dermatol. 2008 Mar; Berardesca E, Cameli N, Cavallotti C, Levy JL, Piérard GE, de Paoli Ambrosi G. San Gallicano Dermatological Institute, Rome, Italy.
This study aims to evaluate a topical treatment based on silymarin / methylsulfonilmethane (S-MSM) to improve erythematous-telangiectactic rosacea. Forty-six patients affected by stage I-III rosacea entered this double-blind, placebo-controlled study. Subjects were treated for 1 month. A statistically significant improvement was observed in many clinical and instrumental parameters investigated. In particular, improvement of skin redness, papules, itching, hydration, and skin color occurred. The combination of silymarin and S-MSM can be useful in managing symptoms and condition of rosacea skin, especially in the rosacea subtype 1 erythemato-telangiectatic phase. The action can be considered multicentric and multiphase because of the direct modulating action on cytokines and angiokines normally involved and up-regulated in the case of such skin condition. See MSM for more information. MSM creams are available over the counter.

Rosacea treatment
Topical metronidazole and azelaic acid have been demonstrated to be effective treatments for rosacea. Severe or persistent cases may be treated with oral metronidazole, tetracyclines or isotretinoin. Topical camphor oil has also been tried.
   Metronidazole was the first topical agent approved by the U.S. Food and Drug Administration for the treatment of rosacea. Several controlled studies have confirmed the efficacy and safety of topical metronidazole 0.75% gel, lotion and cream and 1% cream for rosacea. At present, little data exists regarding the use of combination topical therapy in rosacea management, although anecdotal evidence and preliminary studies suggest at least some additive benefit when topical metronidazole is used in combination with sulfacetamide 10% /sulfur 5%.  
   There is evidence that topical metronidazole and azelaic acid are effective for rosacea. There is some evidence that oral metronidazole and tetracycline are effective. More well-designed, randomized controlled trials are required to provide better evidence of the efficacy and safety of other rosacea therapies.

Rosacea medication
Oracea (doxycycline, USP, CollaGenex) became available in 2006 for the treatment of inflammatory lesions (papules and pustules) of rosacea in adult patients.

Ocular Rosacea
Rosacea can cause a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small inflamed bumps. The eyes may become bloodshot and eyelashes sometimes fall out. The rosacea ophthalmic signs are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis.

Signs of rosacea - Diagnosis of rosacea
Erythema, papules, pustules and telangiectases, the main clinical signs of rosacea and are located on the face. Eiagnosis of rosacea might be confusing since the signs are similar to other illnesses. Other skin conditions of medical conditions to consider include acne vulgaris, erysipelas, seborrhoeic and contact eczema as well as systemic diseases like lupus erythematosus, dermatomyositis, scleroderma, sarcoidosis and leukemia.

Rosacea Research studies
Helicobacter pylori and rosacea.
East Mediterr Health J. 2003 Jan-Mar;9(1-2):167-71.
Recent reports have suggested an increased prevalence of Helicobacter pylori infection in patients with rosacea, with some evidence of dermatological improvement in patients treated with antibiotics for this infection. Our study investigates the prevalence of H. pylori infection in rosacea patients in Kerman. Serological examination was done for 29 patients with classical identification of rosacea using the enzyme-linked immunosorbent assay IgG antibody method. Comparison of antibody titres with those of a control group revealed that the prevalence of positive serological tests for H. pylori was significantly higher in the test group. This supports the suggestion of some form of relationship between rosacea and H. pylori infection, though further investigations with larger sample sizes are required for a definite conclusion.

Reactive oxygen species and rosacea.
Cutis. 2004 Sep;74(3 Suppl):17-20, 32-4.
Although the fundamental pathogenesis of rosacea remains unknown, inflammation is a central process in this disorder. Recent evidence suggests that this inflammation is associated with the generation of reactive oxygen species (ROS) that are released by inflammatory cells such as neutrophils. In vitro studies suggest that certain core therapies for rosacea, including metronidazole and the tetracyclines, show antioxidant effects, and this may be one aspect of their mechanism of action.

Ultraviolet light and rosacea.
Cutis. 2004 Sep;74(3 Suppl):13-6, 32-4.
The general consensus among clinicians is that rosacea is a photoaggravated disorder. Pathophysiologic processes induced by UV radiation, which are processes similar to those seen in photoaging, contribute to the signs and symptoms of rosacea. Because of the purported role of solar radiation, clinicians may want to use photosensitizing antibiotics with discretion in patients with rosacea. In addition to topical and oral therapy for rosacea, clinicians should recommend that patients use sunscreens or sunblocks (inorganic chemicals such as zinc oxide or titanium dioxide).

Rosacea and the pilosebaceous follicle.
Cutis. 2004 Sep;74(3 Suppl):9-12, 32-4.
The pathophysiology of rosacea remains unknown. A leading theory suggests a vascular basis; however, clinical observations and histopathologic studies suggest that inflammation of the pilosebaceous follicle may be central to the pathogenesis of rosacea. Demodex folliculorum is a frequently seen commensal in the follicles of facial skin. According to evidence from biopsies of the skin surface, individuals with rosacea have a higher density of this parasite. This increased mite density may play a role in the pathophysiology of rosacea by triggering inflammatory or specific immune reactions, mechanically blocking the follicles, or acting as a vector for bacteria. Ongoing research has shown that bacteria from patients with rosacea may behave differently at the higher skin temperature that may be present in patients with rosacea. Another group has isolated bacteria from the Demodex mites; these bacteria may play a pathogenic role in papulopustular rosacea by facilitating follicular-based inflammatory changes.

Rosacea: a clinicopathological approach.
Dermatology. 2004;209(3):177-82.
There are few reports of the histological changes in rosacea, and little attempt has been made to correlate such changes with clinical findings. In the present study, we describe in detail the histopathological features of rosacea in a large number of patients and simultaneously investigate the aetiopathogenesis of the disease based on the comparative assessment of epidemiological, clinical and histological findings. The study included 73 patients with rosacea. A skin biopsy with a 4-mm punch was performed in each case. All biopsy specimens included subcutaneous tissue. In 10 randomly selected patients, facial biopsy specimens were obtained from both involved and uninvolved (non-lesional) skin. Demodex mite presence was estimated semi-quantitatively under light microscopy. Patients with self-reported gastro-intestinal symptoms were submitted to upper gastro-intestinal endoscopy, and a rapid urease test was performed. Serological antibodies, IgG and IgA, against Helicobacter pylori were also detected. The patients had a broad clinical spectrum of lesions. No specific histological features associated with either erythematous-telangiectatic or papulopustular clinical forms were noticed. Histological examination showed that there is no histological pattern unique to rosacea. Three different types of granulomas were observed: small palisaded ones around altered collagen and other granulomas of elastolytic and non-specific epithelioid type, all coexisting in 5 cases. The deep dermis and subcutis were frequently involved. Comparative study in 10 rosacea patients between lesional and non-lesional skin biopsies revealed almost the same histological changes to the latter biopsies, to a lesser degree though. Rosacea seems to be a reaction pattern to which a variety of pathogenetic routes may lead.

Treatment of human Demodex folliculorum by camphor oil and metronidazole.
J Egypt Soc Parasitol. 2004 Apr;34(1):107-16.
A total of 15 females suffering from erythematotelangiectatic rosacea and 12 females free from other dermatological lesions were selected. Demodex folliculorum infestation density in both patients and control were evaluated by non-invasive skin surface biopsies. Five facial sites were selected. The daily topical application of 1/3 diluted camphor oil with glycerol and 500 mg metronidazole orally were given for fifteen days. The results were very successful with no clinical side effects.

Rosacea fulminans triggered by high-dose vitamins B6 and B12.
J Eur Acad Dermatol Venereol. 2001 Sep;15(5):484-5.
Rosacea fulminans is a rare variant of rosacea conglobata that occurs almost exclusively in women well past adolescence. The aetiology is unknown, although immunological, hormonal, and vascular factors have been suggested. We report the case of a 17-year-old girl with rosacea fulminans that was temporally associated with daily ingestion of high-dose vitamin B supplements. The onset was sudden and cosmetically disabling. The eruption improved when the vitamin supplement was discontinued and a therapeutic regimen including isotretinoin and methylprednisolone was introduced. It seems appropriate to consider the possibility of such a vitamin B-triggered condition in cases of subjects presenting new or exacerbating facial eruptions. rosacea treatment.

Since rosacea is a chronic disease and many patients find prescription therapies unsatisfactory, they frequently turn to herbal ingredients for relief of their persistent facial redness. The most useful and frequently used herbal compounds include licorice, feverfew, green tea, oatmeal, lavender, chamomile, tea tree oil, and camphor oil. The utility of most of these herbs is based on their purported anti-inflammatory properties. Some of these herbs have proven effects, many have potential benefits, and some may aggravate rosacea. D

Rosacea natural treatment questions
Q. I realize it's not practical for you to give personal medical recommendations, but was curious if you have come across anything in the literature regarding supplements, topical or otherwise, effective in the treatment of rosacea? I would be grateful for your feedback or suggestions for where I might direct my research.
   A. We'll keep looking for natural ways to treat rosacea. Rosacea is difficult to treat.

Q.  I have followed your career since my wife and I heard you at a book review at the La Quinta Hotel, La Quinta, California some years ago. I would like to call your attention to a problem I had recently with taking l Arginine in quantity (6 g per day) over several months, I came down with rosacea, which cleared up when I stopped taking it and with standard treatment by a dermatologist. I have read stories by body builders of their faces getting "rough" when taking large doses of l arginine and wonder if they have undiagnosed rosacea. Keep up the good work.
   A. Thanks, this is the first we have heard of any potential reaction to arginine leading to rosacea.

Q. I noticed on your site someone stating that they had rosacea symptoms after taking L-Arginine. The same happened to me recently. I believe L-Arginine has properties that promote the release of nitric oxide. Maybe there's a connection. The reaction to the L-Arginine happened within two days. When I stopped, the symptoms began to subside. I believe I fall into the category of people more susceptible to rosacea.
   A. Thanks for sharing.
      Q. One other connection I failed to mention is that I believe I may have the H. Pylori bacteria based on symptoms I have had for an extended period of time. I'm scheduling an appointment to get a test to confirm this. I bring it up because there's some evidence of a connection between H. Pylori bacteria and rosacea. Apparently L-arginine is an essential requirement for growth of H. Pylori. I noticed too on one of the websites I reviewed that the H. Pylori affects the normal process of L-arginine converting to L-ornithine. I don't understand the connections, but all these connections sure seems coincidental with the rosacea reaction I had to taking the L-arginine. I will let you know if the treatment of the H. Pylori also cures the rosacea symptoms.

Q. Dr. Perricone has an alpha lipoic acid face activator for rosacea, does it really help?
   A. I have not seen any studies with the alpha lipoic acid cream by Dr. Perricone for the treatment of rosacea, so I don't know.

Q. What's the best natural treatment for mild acne rosacea ? (metro-gel currently using)
   A. Eat more fish, take fish oil capsules, and reduce inflammatory foods such as simple carbohydrates. I am still searching for more natural rosacea treatment research.

Q. I haven't seen much in the literature about the treating of rosacea. The prescription medications that were prescribed only seemed to make the problem worse !
I am looking for references to a natural cure or treatment. It has been somewhat frustrating for me to find out that in the 21st Century there exists such a commonly occurring condition and not much is known about it's cause or treatment. It's interesting that it's a "middle-aged" disease ! I just simply stopped taking the antibiotics and topical gels that were prescribed to me because I believed that those items were actually aggravating my condition. So I turned to home remedies such as green tea cream, and compresses of Epsom Salts and even to aloe vera. The latter product actually dried up the inflammatory rash that was on my forehead for 4 months in just two applications. I haven't had an opportunity to apply any more but, with facial massage I've managed to nearly stop the inflammation and eliminate the rash which was like a beacon to others (in my mind). My hope is that the rash will disappear and not return but, my old faithful aloe vera plant came to my rescue once more, while conventional pharmacological medication failed me miserably !

Q. Does a serrapeptase supplement help with rosacea?
   A. I have not seen such research nor had any feedback from anyone using it for this condition.