Acne Rosacea

Also indexed as: Rosacea

Acne rosacea is a chronic skin condition of the forehead, cheeks, nose, and chin that occurs mostly in middle-aged adults with fair skin. The cause of rosacea is unknown, but there is likely a genetic component. Severe, untreated rosacea can be disfiguring to the face.

Checklist for Acne Rosacea

Rating Nutritional Supplements Herbs
1Star Betaine hydrochloride
Digestive enzymes
Vitamin B-complex		 Burdock
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of acne rosacea? 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.

How is it treated? Rosacea is usually treated with topical or oral antibiotics, which are thought to have primarily an anti-inflammatory effect. Vitamin A-related medications used for acne vulgaris may also be prescribed.

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 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

Nutritional supplements that may be helpful: 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.5 6 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 vitamins7 8 9 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.10 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.11 In a preliminary trial, supplemental hydrochloric acid, along with vitamin B complex, improved some cases of rosacea in people with low stomach-acid production.12 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.13 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.14 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 about any side effects or interactions.

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.15 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 any side 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. 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].

6. 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.

7. Tulipan L. Acne rosacea: a vitamin B complex deficiency. Arch Dermatol Syphilol 1947;56:589.

8. Stillians AW. Pyridoxine in treatment of acne vulgaris. J Invest Dermatol 1946;7:150–1.

9. Johnson L, Eckardt R. Rosacea keratitis and conditions with vascularization of the cornea treated with riboflavin. Arch Ophthamol 1940;23:899–907.

10. Sherertz EF. Acneiform eruption due to “megadose” vitamins B6 and B12. Cutis 1991;48:119–20.

11. Johnson L, Eckardt R. Rosacea keratitis and conditions with vascularization of the cornea treated with riboflavin. Arch Ophthamol 1940;23:899–907.

12. Allison JR. The relation of hydrochloric acid and vitamin B complex deficiency in certain skin diseases. South Med J 1945;38:235–41.

13. Barba A, Rosa B, Angelini G, et al. Pancreatic exocrine function in rosacea. Dermatologica 1982;165:601–6.

14. Vienne MP, Ochando N, Borrel MT, et al. Retinaldehyde alleviates rosacea. Dermatology 1999;199 Suppl 1:53–6.

15. Hoffman D. The Herbal Handbook: A User’s Guide to Medical Herbalism. Rochester, VT: Healing Arts Press, 1988, 23–4.