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Rosacea: Alternative Medical Approach

Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.
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Rosacea is an inflammatory skin condition that causes redness of the face and commonly affects middle-aged men and women.

Rosacea: Alternative Medical Approach
It is three times more common in women, but usually more severe in men. You may mistake some of its characteristics — small, red, pus-filled bumps or pustules — for acne. This is reason it is sometimes referred to as “acne rosacea” The difference between acne and rosacea is the fact that the red spots and pustules are dome-shaped rather than pointed and there are no blackheads, whiteheads, deep cysts, or lumps. Rosacea affects the cheeks, nose, chin and forehead - rarely, it involves the trunk and upper limbs. What Are the Symptoms of Rosacea?

 

  • The skin of the center of the face—typically on or surrounding the nose—is red and swollen, with acne-like blemishes.
  • Red, sore or 'gritty' eyelids are sometimes caused by rosacea.
  • Ocular manifestations may include many different eye problems and may precede skin involvement, thus delaying the diagnosis of rosacea.
  • Red eyelids
  • Rosacea may cause the nose to slowly enlarge. When rosacea is not treated, some people - especially men - may eventually get small knobby bumps on the nose. As more bumps appear, the nose looks swollen.
  • Facial burning/tingling
  • Visible veins on face (telangiectasia)
  • Rosacea is often accompanied by a red face due to flushing. Sometimes the affected skin is swollen and hot. Flushing and Rosacea
    Facial flushing can make symptoms worse and even cause flare-ups in patients whose rosacea had been under control. It is the chronic flushing in rosacea which causes the telangiectasia. Flushing can be triggered by many things, the most common being hot drinks, alcohol, spicy foods, stress, sunlight and extreme heat or cold. Other causes of flushing and telangiectasia (dilated superficial blood vessels) include heredity, exercise, emotions, hormones, cortisone medications and other rare skin diseases. Possible Causes of Rosacea
    The cause of rosacea is unknown, but many factors have been suspected of influencing it:
  • One theory is that primarily a blood vessel disorder causes vessels in the face to swell.
  • Gastric analysis of rosacea patients has led to the theory that it many sufferers produce inadequate stomach acid leading to hypochlorhydria (Hydrochloric acid deficiency)
  • Another is that the cause of rosacea is a chronic bacterial infection in the gastrointestinal system caused by a Helicobacter pylori infection.
  • Rosacea patients often have a reduced secretion of pancreatic lipase, an enzyme which aids in fat digestion
  • Some researchers have suggested that tiny mites (Demodex folliculorum) living in human hair follicles may play a role by clogging up sebaceous gland openings.
    Traditional Medical Treatments:
    Prescription medications used to treat rosacea include topical and oral antibiotics. The main topical drug, metronidazole (Metrogel®), is thought to have antibacterial and anti-inflammatory effects. The vitamin A-related medication tretinoin (Retin A®), which is used for acne vulgaris, may also be prescribed. The most commonly used oral antibiotic is tetracycline (Sumycin®). Not recommended:
    Cosmetics / Moisturizers Avoid oil-based facial creams. Use a water-based make-up and sunscreen. The skin may be very sensitive to local applications. Recommended Functional Medicine Lab Tests
  • Test for Food Allergies The incidence of migraine headaches and flushing accompanying rosacea points to some form of food intolerance.
  • Rule H. Pylori
  • Rule out HCL deficiency
  • Rule out tiny mites (Demodex folliculorum)

    Alternative Documented Treatments
  • The administration of large doses of B-vitamins has been shown to be effective, riboflavin being the most important. While B-vitamins are important, some rosacea patients may be aggravated by large dosages of these nutrients.
  • HCL supplementation results in marked improvement in rosacea patients who have achlorhydria or hypochlorhydria.
  • Pancreatic or plant enzyme supplementation, especially when prepared with extra lipase, will improve this digestive weakness.
  • Azelaic acid is found naturally in wheat, rye, and barley and is used topically in a 20% strength cream. Controlled clinical trials have found this cream effective for mild to moderate acne, including rosacea.
  • A topical preparation of retinaldehyde (a prescription form of vitamin A) may be effective in treating people with mild rosacea. In a small, preliminary trial, women with rosacea used a retinaldehyde cream (0.05%) once daily for six months. Inflammation was improved in most participants, and blood vessel abnormalities responded in about half the people after six months. Lifestyle Changes That May Be Helpful
    Sun exposure, stress, excessive exercise, and extreme temperatures (hot or cold) of weather or bathing water may trigger flare-ups of rosacea, so avoiding these conditions is recommended. Factors That May Aggravate Rosacea include:
  • Hot foods or beverages
  • Spicy foods
  • Alcohol
  • Temperature extremes
  • Sunlight
  • Stress, anger or embarrassment
  • Strenuous exercise
  • Hot baths, saunas
  • Corticosteroids
  • Drugs that dilate blood vessels, such as some blood pressure medications
    Here are Other Suggestions for Preventing Flare-ups:
  • Wear sunscreen with a sun protection factor (SPF) of 15 or higher to protect your face from the sun.
  • Protect your face in the winter with a scarf or ski mask.
  • Avoid irritating your facial skin by rubbing or touching it too much.
  • Avoid facial products that contain alcohol or other skin irritants.
  • When using moisturizer with a topical medication, apply the moisturizer after the medication has dried.
  • Use products that are labeled noncomedogenic. These won't clog your oil and sweat gland openings (pores) as much.
  • Avoid overheating.
  • If you wear makeup, consider using green- or yellow-tinted pre-foundation creams and powders, because they're designed to counter skin redness.
  • Avoid alcohol.
  • Keep your face cool. Experts say you should avoid anything that causes flushing.
  • Keep a diary of flushing episodes and note associated foods, products, activities, medications or other triggering factors.
    References
    Allison JR. The relation of hydrochloric acid and vitamin B complex deficiency in certain skin diseases. South Med J 1945;38:235–41. Barba A, Rosa B, Angelini G, et al. Pancreatic exocrine function in rosacea. Dermatologica 1982;165:601–6. Graupe K, Cunliffe WJ, Gollnick HP, Zaumseil RP. Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports. Cutis 1996;57(1 Suppl):20–35 [review]. Bjerke R, Fyrand O, Graupe K. Double-blind comparison of azelaic acid 20% cream and its vehicle in treatment of papulo-pustular rosacea. Acta Derm Venereol 1999;79:456–9. Vienne MP, Ochando N, Borrel MT, et al. Retinaldehyde alleviates rosacea. Dermatology 1999;199 Suppl 1:53–6. Zaun H.Gastric function in patients with skin diseases. Analysis of electrogastrographical findings in 1282 dermatologic patients] Munch Med Wochenschr. 1972 Jan 7;114(1):33-7. Schulz U, Drunkenmolle R. [Correlations between disorders of gastric secretion and skin diseases] Z Gesamte Inn Med. 1971 May 1;26(9):Suppl:112 c Buechner SA Rosacea: an update.Dermatology. 2005;210(2):100-8. Zandi S, Shamsadini S, Zahedi MJ, Hyatbaksh M.Helicobacter pylori and rosacea. East Mediterr Health J. 2003 Jan-Mar;9(1-2):167-71. Aroni K, Tsagroni E, Lazaris AC, Patsouris E, Agapitos E. Rosacea: a clinicopathological approach. Dermatology. 2004;209(3):177-82. Diaz C, O'Callaghan CJ, Khan A, Ilchyshyn A. Rosacea: a cutaneous marker of Helicobacter pylori infection? Results of a pilot study. Acta Derm Venereol. 2003;83(4):282-6. Szlachcic A. The link between Helicobacter pylori infection and rosacea. J Eur Acad Dermatol Venereol. 2002 Jul;16(4):328-33. Forton F, Germaux MA, Brasseur T, De Liever A, Laporte M, Mathys C, Sass U, Stene JJ, Thibaut S, Tytgat M, Seys B.Demodicosis and rosacea: epidemiology and significance in daily dermatologic practice. J Am Acad Dermatol. 2005 Jan;52(1):74-87. el-Shazly AM, Ghaneum BM, Morsy TA, Aaty HE.The pathogenesis of Demodex folliculorum (hair follicular mites) in females with and without rosacea. J Egypt Soc Parasitol. 2001 Dec;31(3):867-75. Georgala S, Katoulis AC, Kylafis GD, Koumantaki-Mathioudaki E, Georgala C, Aroni K. Increased density of Demodex folliculorum and evidence of delayed hypersensitivity reaction in subjects with papulopustular rosacea. J Eur Acad Dermatol Venereol. 2001 Sep;15(5):441-4. Powell FC. Rosacea and the pilosebaceous follicle. Cutis. 2004 Sep;74(3 Suppl):9-12, 32-4. Vienne MP, Ochando N, Borrel MT, Gall Y, Lauze C, Dupuy P. Retinaldehyde alleviates rosacea. Dermatology. 1999;199 Suppl 1:53-6. Elewski BE, Fleischer AB Jr, Pariser DM A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in the topical treatment of papulopustular rosacea: results of a randomized trial. Arch Dermatol. 2003 Nov;139(11):1444-50. Dahl MV, Jarratt M, Kaplan D, Tuley MR, Baker MD.Once-daily topical metronidazole cream formulations in the treatment of the papules and pustules of rosacea. J Am Acad Dermatol. 2001 Nov;45(5):723-30. Written on April 10, 2005