By Herbalist and Naturopath Vera Martins, a graduate of CNM (College of Naturopathic Medicine).

Rosacea is a common skin condition characterised by chronic inflammation and dilation of the facial blood vessels resulting in recurrent episodes of flushing and redness. As the condition progresses it becomes more severe and telangiectasia, i.e. visible blood vessels, may appear. If left untreated, papules (bumps) and postules (pimples) may develop, and in advanced cases the skin may thicken around the nose, a condition known as rhinophyma. The areas mainly affected are the cheeks, nose, forehead and chin, but the eyes may also be involved (ocular rosacea). It occurs mainly in adults aged 30-50, especially in those with fair skin, and it is three times more common in women than in men, but more severe in men ¹.

This condition can cause a great deal of discomfort and because it affects the face can undermine self-confidence. Although the cause of rosacea is poorly understood, some factors have been implicated: low stomach hydrochloric acid, low pancreatic lipase (a digestive enzyme that helps to digest fat), deficiency in B complex vitamins (particularly vitamin B3) and overgrowth of Demodex (a skin mite) ^2,3. Recent research has also shown that infection with the bacteria H. pylori is higher in rosacea skin and that eradication of infection leads to a significant improvement of skin symptoms ⁴.

Common treatments include a variety of antibiotics, which may ultimately disturb beneficial bacteria in the gut and exacerbate rosacea symptoms.

Fortunately, there are a number of helpful natural things that you can suggest to your clients who present with these symptoms: to keep away from alcohol (especially red wine), hot drinks, spicy food, and refined sugar. Instead, they should adopt a nutrient-rich anti-inflammatory diet, containing leafy green vegetables, good sources of omega-3 such as wild salmon and chia seeds, and detoxifying foods such as garlic, ginger, lemon and turmeric, and eat organically wherever possible. Keeping a food and lifestyle diary can be helpful to identify potential triggers.

Reestablishment of a healthy gut function is essential in rosacea. To support digestion and beneficial gut flora, a good source of probiotics (such as organic kefir, kombucha and sauerkraut) and a high quality anti-inflammatory omega-3 supplement should be taken daily. Stress levels, particularly at meal times, should be managed, as stress can disturb the gut ⁵.

From a naturopathic viewpoint, as always, the underlying problem should be addressed in order to achieve consistent relief. Rosacea needs to be addressed from both the inside and outside, through food, supplements, and herbal remedies. The key priority is to re-establish a healthy gut function. If a test for H. pylori proves positive, herbs such as licorice, ginger, turmeric, green tea and garlic can be taken as food and tinctures, as well as oregano oil, to reduce levels of H. pylori and to decrease inflammation ⁶.

Herbal extracts of pine bark and bilberry provide extra antioxidants and strengthen blood vessels. Further supplements to consider include complex B vitamins, HCl and pancreatic lipase.

Topically, creams containing the naturally occurring azelaic acid (derived from barley, rye and wheat), as well as niacinamide (a form of vitamin B3), can also benefit rosacea skin ^7,8. As a naturopathically trained herbalist, I can also prepare a bespoke cream, tailored to the skin’s needs, using herbs that research has shown can reduce symptoms of rosacea due to their anti-inflammatory and antioxidant properties: chrysanthellum, aloe vera, green tea, licorice, oatmeal and bilberry ^9–11. A good skincare routine should be adopted keeping the skin clean, hydrated, protected from sunlight, and from extreme temperatures. Skincare products containing steroids and alcohol should be avoided, giving preference to ones free of synthetic ingredients.

As well as tackling rosacea, these tips can also help your clients to adopt a healthier lifestyle achieving a better body and mind balance.

Please note that my tips apply to adults only, as the condition mainly affects them.

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Sources:

1. Two, A. M., Wu, W., Gallo, R. L. & Hata, T. R. Rosacea. J. Am. Acad. Dermatol. 72, 749–758 (2015).
2. Holford, P. & Savona, N. Solve your Skin Problems. (Piatkus Books, 2013).
3. Jarmuda, S. et al. Potential role of Demodex mites and bacteria in the induction of rosacea. J. Med. Microbiol. 61, 1504–10 (2012).
4. Gravina, A. et al. Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea. United Eur. Gastroenterol. J. 3, 17–24 (2015).
5. Chang, Y.-M., El-Zaatari, M. & Kao, J. Y. Does stress induce bowel dysfunction? Expert Rev. Gastroenterol. Hepatol. 1–3 (2014). doi:10.1586/17474124.2014.911659
6. Ayala, G., Escobedo-Hinojosa, W. I., de la Cruz-Herrera, C. F. & Romero, I. Exploring alternative treatments for Helicobacter pylori infection. World J. Gastroenterol. 20, 1450–69 (2014).
7. Draelos, Z. D., Ertel, K. & Berge, C. Niacinamide-containing facial moisturizer improves skin barrier and benefits subjects with rosacea. Cutis 76, 135–41 (2005).
8. Liu, R. H., Smith, M. K., Basta, S. A. & Farmer, E. R. Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials. Arch. Dermatol. 142, 1047–52 (2006).
9. Dawid-Pać, R. Medicinal plants used in treatment of inflammatory skin diseases. Postȩpy dermatologii i Alergol. 30, 170–7 (2013).
10. Rigopoulos, D. et al. Randomized placebo-controlled trial of a flavonoid-rich plant extract-based cream in the treatment of rosacea. J. Eur. Acad. Dermatol. Venereol. 19, 564–8 (2005).
11. Wu, J. Anti-inflammatory ingredients. J. Drugs Dermatol. 7, s13–6 (2008).