Bumpy Ride

The redness and pimples of rosacea can cause embarrassment and distress.

by Lisa James

May 2011

Life is full of simple pleasures: a day at the beach, a glass of wine with friends, a spicy bowl of curry. But these pleasures can become problems when they trigger rosacea, a condition marked by facial flushing and roughness estimated to affect more than 16 million people.

Rosacea’s visible nature can lead to feelings of awkwardness. “Rosacea affects a person’s self-esteem and may lead to social withdrawal,” says Jeanette Jacknin, MD, holistic dermatologist and author of Smart Medicine for Your Skin (Avery/Penguin, www.drjacknin.com). In a survey by the National Rosacea Society (NRS, www.rosacea.org), nearly 76% of the respondents said that rosacea hurt their self-confidence.

Visible Impact

Rosacea’s emotional impact is heightened by the fact that it affects the nose and central face. (The chest, ears, neck or scalp can also be affected.) Persistent redness and bumps may be accompanied by the appearance of fine blood vessels and the skin may itch, swell or feel dry. “A bulbous red nose may develop slowly if the condition is untreated,” says Jacknin; the prominent nose of W.C. Fields was caused by this condition, called rhinophyma.

Up to 50% of patients develop ocular rosacea, marked by burning, gritty eyes and recurring styes, infections that cause red bumps to form on the eyelids. Jacknin says eye problems can come before or after skin symptoms develop, or occur on their own. Ocular rosacea can damage the cornea, causing blurry vision.

Rosacea, which runs in families, occurs most often in fair-skinned people. “I don’t think I’ve ever see people with real dark skin having rosacea,” says Alan Dattner, MD, founder of www.holisticdermatology.com in New Rochelle, New York and a founding member of the American Academy of Dermatology’s Task Force for Nutrition and the Evaluation of Alternative Medicine.

Rosacea tends to occur in cycles of remissions and flareups sparked by triggers such as heat and sun exposure. Hot drinks and spicy foods can also set off an outbreak; other common triggers include alcohol, tomatoes, citrus fruits and chocolate. “Anything that stimulates blood coming to the face is a possible trigger,” explains Dattner. “It’s a vicious cycle: Someone gets embarrassed, they flush, they become embarrassed about their rosacea, they flush some more.”

Scientists are studying why rosacea develops. Microbes, food allergies, an over-reactive immune system and glitches in the interaction between nerves and blood vessels have all been implicated. Studies have found a potential link between ocular rosacea and bacteria associated with Demodex mites, normal skin inhabitants that are more abundant in rosacea patients (Ophthalmology 5/10).

The number of factors helps explain why each patient experiences rosacea differently. “It’s like a lock and key. The same substance may cause a reaction in one person and not another,” says Dattner. He tells people to check their facial reactions with a hand mirror “so they can figure out ways to avoid making the rosacea worse.”

Cooling the Burn

The first step in controlling rosacea is to avoid anything that triggers a flareup. Jacknin suggests wearing sunscreen with a sun protection factor (SPF) of at least 15 every day, even when indoors, and a hat when outside. Avoid extremes of heat and humidity; this means no hot baths or showers and avoiding hot tubs, steam rooms and saunas.

Exercise is as important for people with rosacea as for anyone else but “take care not to become overheated or flushed, or to sweat profusely,” Jacknin cautions. Early morning or late evening workouts can help you avoid the worst heat of the day.

Proper skin care is crucial. Use lukewarm water and a very mild soap or cleanser, and don’t scrub; blot the skin dry with a soft towel. Jacknin says to use only fragrance-free, hypoallergenic, water-based cosmetics. If you have ocular rosacea, take particular care of your eyelids. The NRS recommends cleaning them twice a day with either plain water or baby shampoo on a wet washcloth.

Jacknin says that some people with rosacea report good results with either horse chestnut cream or rose-wax cream applied twice a day. For visible blood vessels, Jacknin suggests diluting essential oils of borage, rose, cypress, neroli or lemon in evening primrose or jojoba oil and applying the mixture sparingly to affected areas. (All topical therapies should be tested on small patches of skin first to check for irritation.)
Caring for rosacea from the outside isn’t enough; it’s essential to understand what’s going on inside. “You need to determine what’s off in your digestive system,” says Dattner. “If you have a lot of allergies to specific foods, eating those foods over and over again is going to keep producing inflammation.” This can lead to leaky gut syndrome, in which a damaged bowel lining allows irritants such as undigested food particles to pass into the bloodstream.

Finding a diet that’s less likely to set off your rosacea means determining which foods cause your symptoms and cutting them out of your diet. Jacknin also recommends avoiding animal and hydrogenated fats, junk food, refined sugars and artificial flavorings and preservatives.

Instead, Jacknin suggests eating more vegetables—especially the vitamin B12-rich dark-green varieties—fruits, whole grains and such lean sources of protein as fish and skinless chicken. Drinking at least eight glasses of filtered water daily helps flush toxins out of the body.

Jacknin recommends a number of supplements for rosacea including a high-quality multivitamin, preferably one based on whole foods; beta-carotene, 25,000 IU twice a day; vitamin B complex; vitamin C, 500 mg with bio­flavonoids, three times a day; zinc, 25 mg twice a day; flaxseed oil, 1,000 mg three times a day; acidophilus- and bifidus-based probiotics twice a day; and digestive enzymes. (Tailor a supplementation plan to your needs in consultation with a trained practitioner.)

Jacknin also suggests homeopathic remedies depending on your particular symptoms. For example Arsenicum album, 30x or 15c, is appropriate if the rash is dry, burning, flaky and scaly. A trained homeopath can help you in your search; find one through the National Center for Homeopathy: www.nationalcenterforhomeopathy.org, 703-548-7790.

The best way to keep rosacea from limiting your life is to keep looking for solutions. “Rosacea is a manifestation,” says Dattner. “It’s not just one cause, one problem.”

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