Many of my patients with rosacea are under the impression that it is a form of acne because rosacea can produce severely inflamed, sebum-filled lesions that resemble acne. It is also characterized by red inflamed cheeks and a bulbous nose giving its’ sufferers the unfortunate reputation of being heavy alcohol drinkers.  Recent research, though, has finally revealed the truth about the origin of rosacea.  My patients have been surprised to learn about these findings and I’d like to share them with you too.

Rosacea:  Skin Mites and Bacteria To Blame

Rosacea commonly affects about 3% of the population.  More than 14 million people in North America have the condition.  Most are likely women ages 30-50 with weakened immune systems.  The most common form of treatment has been an antibiotic even though a bacterial origin was never really found for the condition.  They just seemed to help.

Recently, though, researchers in Ireland [The potential role of Demodex folliculorum mites and bacteria in the induction of rosacea. Journal of Medical Microbiology, 2012 DOI] proved why antibiotics are an effective treatment for rosacea. The condition is actually caused by a type of bacteria that live inside tiny mites that burrow deep into the hair follicles of the skin. Called Demodex folliculorum, these tiny mites occur naturally within the hair follicles of the face.  They can increase with age and skin damage – especially following exposure to sunlight.

In people with rosacea, the amount of Demodex mites is higher than people who don’t have the condition. In the Irish research study, a certain type of bacteria – Bacillus oleronius – was discovered living inside these mites.  When the mites die, the bacteria are released into the skin.  These bacteria then produce certain molecules that provoke an immune-type reaction in rosacea patients.  This immune reaction causes the intense inflammatory flare-up and skin breakdown that is common to a rosacea breakout.

Researchers concluded that the best way to approach the treatment of rosacea is to use antibiotics that will specifically target these bacteria.   Controlling the Demodex mite population in facial skin is believed to help as well. More good news is that these bacteria are sensitive to the antibiotics typically used to treat rosacea – tetracycline, minocycline, or doxycycline.

Do You Have Rosacea?

Many people who experience facial redness come into my office wondering if they have rosacea.  As a dermatologist, here’s what I look for to determine a diagnosis of rosacea:

• Redness of the face – across the cheeks, chin, and tip of nose.  Face seems to blush/flush easily and may burn or sting.
• Many tiny spider-like veins (telangiectasias) across the face.
• Skin sores that resemble acne breakouts with oozing or crusting. Some can be sebum filled.
• Reddened, bulbous nose (rhinophyma).

How To Minimize Rosacea Flare-Ups

Rosacea is a chronic skin condition which (as of yet) cannot be cured even though antibiotic treatment is effective.  Here are some things you can do to minimize flare-ups:

• Limit sun and/or high wind exposure – use a good sunscreen.
• Avoid spicy foods, hot drinks, and alcohol – can stimulate outbreaks.
• Limit/avoid hot weather activity.  Wait until later in the day when the sun is down.
• Reduce stress – can aggravate outbreaks.

Natural Treatments for Rosacea

Although rosacea typically responds to antibiotics and some laser treatments, there are some more natural treatments that you may try as well.  They include:

• Chrysanthellum indicumcream.  Made from an extract of the herb chrysanthellum indicum, it is thought to strengthen the tiny capillaries in the skin.  In a study, results showed that after 12 weeks, the cream had significantly improved rosacea symptoms, like redness and swelling, compared to the placebo.
• Green tea cream.  Another study showed that rosacea symptoms improved after 4 weeks of using a facial cream infused with green tea extract.  Green tea is an antimicrobial agent that likely helped reduce the bacterial load.
• Licorice.  Topical application of the herb licorice reduced symptoms in 4-8 weeks.
• Digestive enzymes (probiotics) and B vitamins:  Studies have shown that after being given digestive enzymes, like probiotics, people with rosacea had improvement of their symptoms.   Rosacea is also associated with deficiencies of the B vitamin, riboflavin. Riboflavin helps decrease the number of mites in the skin.

I know from my rosacea patients that it can be a disheartening and embarrassing condition that may lead to social withdrawal.  The severe lesions that often accompany it can also be physically disfiguring if not treated.  If you feel you have rosacea symptoms, please see a dermatologist to explore your treatment options.

Stay Well,
Jay Brachfeld, M.D.
Natural Health News

Bacterial Cause Found for Skin Condition Rosacea, http://www.sciencedaily.com/releases/2012/08/120829195121.htm

Rosacea, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001882/

Rosacea – Natural Treatments to Consider, http://altmedicine.about.com/cs/treatments/a/Rosacea.htm