Rosacea by Ray Sahelian, M.D. Acne Rosacea treatment
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 we email a brief abstract of several studies on various supplements and natural medicine topics, including rosacea and acne rosacea, and their practical interpretation by D. 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.
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.
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%.
New 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 Update
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. METHODS: 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 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 some six or eight 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 NO.
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. We have not seen any studies with the alpha lipoic acid cream by
Dr. Perricone for the treatment of rosacea, so we don't know.
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.
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.
Other links
serrapeptase
supplement
5-htp for serotonin
enhancement
coq10 supplement
vinpocetine as
vasodilator
nattokinase suppleemnt
dmae methyl donor