Acne Rosacea, What You Need to Know

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Acne Rosacea
Overview

What you need to know
The redness on your cheeks, nose, and chin may be signs of acne rosacea. How can you calm it down and put your best face forward? According to research or other evidence, the following self-care steps may be helpful:
•Steer clear of irritants
•Flare-ups may occur from too much sun exposure, stress, exercise, spicy food, or alcohol, or from extreme (hot or cold) weather or bathing-water temperatures

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full acne rosacea article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About acne rosacea
Acne rosacea, now more accurately known just as rosacea, is a chronic skin condition of the forehead,cheeks, nose, and chin. It consists of flushing, which turns into red coloration from the dilation of thecapillaries and can lead to pustules that resemble acne.

Rosacea occurs mostly in middle-aged adults with fair skin. The cause of rosacea is unknown, but there islikely a genetic component. Severe, untreated rosacea can be disfiguring to the face.

An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

Symptoms
What are the symptoms?
The skin of the center of the face-typically on or surrounding the nose-is red and swollen, with acne-like blemishes. As the condition progresses, parts of the eye can become inflamed and the nose may enlarge.

Diet
Dietary changes that may be helpful
Alcohol may increase the reddening of the skin affected by rosacea, but alcohol is not the cause of this disease.1 Spicy foods and hot drinks have been reported anecdotally by rosacea sufferers to cause flare-ups,2 but no controlled research has evaluated these claims. One small, preliminary report suggested that fasting followed by a vegan diet (allowing no animal flesh foods, dairy products, or eggs) had only small and inconsistent effects on rosacea.3

Lifestyle
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.4

Supplements
Vitamins that may be helpful
In a double-blind study, supplementing with zinc (23 mg three times per day for three months) decreased the severity of rosacea by about 75%, whereas no improvement occurred in the placebo group. Mild gastrointestinal upset was reported by 12% of the people taking zinc, but no other significant side effects occurred.5 Long-term zinc supplementation should be accompanied by a copper supplement, in order to prevent zinc-induced copper deficiency.

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.6, 7 Azelaic acid cream is available by prescription only and should be used only under the supervision of the prescribing physician.

Preliminary reports in the 1940s claimed that rosacea improved with oral supplements or injections of B vitamins8, 9, 10 On the other hand, one report exists of rosacea-like symptoms in a patient taking 100 mg per day of vitamin B6 and 100 mcg per day of vitamin B12; these symptoms subsided when the supplements were discontinued.11 More research is needed to evaluate the potential benefits or hazards of B vitamins for rosacea.

Some people with rosacea have been reported to produce inadequate stomach acid.12 In a preliminary trial, supplemental hydrochloric acid, along with vitamin B complex, improved some cases of rosacea in people with low stomach-acid production.13 Similarly, improvement in rosacea has been reported anecdotally after supplementation with pancreatic digestive enzymes, and a controlled study found that rosacea patients produced less pancreatic lipase than healthy people.14 Controlled trials are needed to evaluate the effects of hydrochloric acid and digestive enzyme supplements in rosacea. Hydrochloric acid supplements should not be taken without the supervision of a healthcare practitioner.

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.15 Inflammation was improved in most participants, and blood vessel abnormalities responded in about half the people after six months. Controlled research is needed to confirm these effects. Retinaldehyde cream is available by prescription only and should be used only under the supervision of the prescribing physician.

Are there any side effects or interactions?
Refer to the individual supplement for information aboutany side effects or interactions.

Herbs
Herbs that may be helpful
Historically, tonic herbs, such as burdock, have been used in the treatment of skin conditions. These herbs are believed to have a cleansing action when taken internally.16 Burdock root tincture may be taken in 2 to 4 ml amounts per day. Dried root preparations in a capsule or tablet can be used at 1 to 2 grams three times per day. Many herbal preparations combine burdock root with other alterative herbs, such as yellow dock, red clover, or cleavers. In the treatment of acne rosacea, none of these herbs has been studied in scientific research.

Are there any side effects or interactions?
Refer to the individual herb for information about anyside effects or interactions.

References
1.Chalmers DA. Rosacea: recognition and management for the primary care provider. Nurse Pract 1997;22:18, 23-8,30 [review].
2.National Rosacea Society. Coping with rosacea: tips on lifestyle management for rosacea sufferers. Barrington, IL: National Rosacea Society, 1996.
3.Lithell H, Bruce A, Gustafsson IB, et al. A fasting and vegetarian diet treatment trial on chronic inflammatory disorders. Acta Derm Venereol 1983;63:397-403.
4.National Rosacea Society. Coping with rosacea: tips on lifestyle management for rosacea sufferers. Barrington, IL: National Rosacea Society, 1996.
5.Sharquie KE, Najim RA, Al-Salman HN. Oral zinc sulfate in the treatment of rosacea: a double-blind, placebo-controlled study. Int J Dermatol 2006;45:857-61.
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].
7.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.
8.Tulipan L. Acne rosacea: a vitamin B complex deficiency. Arch Dermatol Syphilol 1947;56:589.
9.Stillians AW. Pyridoxine in treatment of acne vulgaris. J Invest Dermatol 1946;7:150-1.
10.Johnson L, Eckardt R. Rosacea keratitis and conditions with vascularization of the cornea treated with riboflavin. Arch Ophthamol 1940;23:899-907.
11.Sherertz EF. Acneiform eruption due to "megadose" vitamins B6 and B12. Cutis 1991;48:119-20.
12.Johnson L, Eckardt R. Rosacea keratitis and conditions with vascularization of the cornea treated with riboflavin. Arch Ophthamol 1940;23:899-907.
13.Allison JR. The relation of hydrochloric acid and vitamin B complex deficiency in certain skin diseases. South Med J 1945;38:235-41.
14.Barba A, Rosa B, Angelini G, et al. Pancreatic exocrine function in rosacea. Dermatologica 1982;165:601-6.
15.Vienne MP, Ochando N, Borrel MT, et al. Retinaldehyde alleviates rosacea. Dermatology 1999;199 Suppl 1:53-6.
16.Hoffman D. The Herbal Handbook: A User's Guide to Medical Herbalism. Rochester, VT: Healing Arts Press, 1988, 23-4.