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Rosacea

 

Rosacea Introduction

Rosacea is a chronic inflammatory condition of the pilosebaceous (sweat) glands located in the face. It was once considered to be a form of acne, but recent study views chronic inflammation as its own dermatological condition. Rosacea is characterized by flushing, erythematous (red) papules, and pustules with telangiectasia (new blood vessel growth). It primarily affects middle age individuals with light skin. Rosacea is usually present in the central areas of the face, and is not typically found on other parts of the body, like acne. [1]

The cause of rosacea is unknown. There is speculation, however, that moderate and severe acne at a younger age may precede rosacea, and be an underlying determinant. Rosacea causes cosmetic changes to the skin surface. The skin surface loses its smooth appearance and becomes chronically inflamed. Tissues of the nose, forehead, ears, and chin will often have increased and irregular growth in the later stages of the disease. [2]

Rosacea is most common in individuals between the ages of 30 and 50 years old. It is rarely diagnosed in younger individuals. It primarily affects females, though males are more likely to get hypertrophy (increased growth) of the nose. Rosacea tends to affect individuals with lighter skin and has an affinity for the Celtic race and southern Italians. This condition rarely affects individuals of color. [3]

Rosacea Symptoms

In the early stages of rosacea individuals will experience an intermittent flushing (reddening) of the face. This flushing may be a response to alcohol, spicy foods, exercise, and hot liquids. Over time, the flushing that was once periodic becomes constant and small blood vessels begin to grow in the areas affected by flushing. The skin in this area then becomes inflamed with first papules appearing, then pustules. In the final stage, there is persistent redness, deep papules, and pustules with marked blood vessel growth. Later, other areas of the face such as the nose, chin, forehead, and ears may begin to increase in growth. In rare cases the eyes can be affected by rosacea. This can become as serous complication, as the growth of cataracts may significantly affect one’s vision. [4]

Rosacea Treatment

Conventional treatment of rosacea is focused on topical or oral antibiotics. The most common topical antibiotic treatments are 0.75% Metronidazole cream and erythromycin gel. Commonly prescribed forms of oral antibiotics include tetracycline and doxycycline. Patients with later stage disease that do not respond to antibiotics can be treated with oral isotretinoin (a vitamin A product). Surgery may also be recommended in cases of severe overgrowth of the nose. [5]

There very few alternative recommendations outlined in medical literature for the treatment of rosacea. Although, it has been suggested that rosacea’s treatment with nutraceuticals should focus on repairing the integrity of the skin and reducing inflammation in the individual. Again, the exact antecedent in the development of this condition is unknown, however, treatment options can also be directed at the hypothetical cause(s) for rosacea.

Supplements helpful for Rosacea

Azelaic acid

Azelaic acid is a naturally occurring substance. It is thought to possess certain antibiotic and anti-inflammatory properties. Azelaic acid has been proven effective in clinical studies at treating papulo-pustular rosacea, though no positive effect has been demonstrated on telangiectasia (blood vessels). In one study, a 15% azelaic acid cream was demonstrated to be as effective as 0.75% metronidazole gel at reducing redness, papules, and pustules. [6] In another double-blind study a 20% azelaic acid cream was compared to placebo. Those persons administered azelaic acid had significant decreases in lesions and redness. The only reported side effect was mild burning after application, which typically resolved after several applications. [7]

NADH

NADH is a biochemically active form of nicotinamide (Vitamin B3). It is used in energy metabolism (the production of ATP). It is also a potent anti-oxidant. NADH protects the integrity of cellular membranes located throughout the body from damage by free radicals. In one particular study, a 1% NADH ointment was applied daily to affected areas in individuals with rosacea. These patients had significant improvement in their overall symptoms with no accompanying side effects. [8] The result of this study may show NADH as a relevant topical treatment for rosacea, as compared to other notable topical applications.

Vitamin C

Vitamin C is one of the most potent and active anti-oxidants in the body. Being nutritive to the skin, it also promotes tissue integrity and tissue healing. Damage from free radicals may play a role in the development of rosacea. Vitamin C can be used both topically and orally for the treatment of rosacea. One study found that daily use of a 5% vitamin C (ascorbic acid) preparation reduced erythema (redness) in 75% of the participants with rosacea. [9]

Vitamin A

Vitamin A is another essential nutrient for skin health. It promotes cellular integrity and healing to epithelial cells (skin). Vitamin A is also considered a potent anti-oxidant, and anti-inflammatory agent. Studies conducted on this vitamin have shown this fat-soluble vitamin to be effective at treating rosacea. [10,11] This is thought to be caused by its anti-oxidant capabilities and the protective effects it exerts on skin cells.

Essential Fatty Acids

Essential fatty acids are anti-inflammatory in nature. Proper intake of omega 3 and omega 6 fatty acids will inhibit production of pro-inflammatory molecules. This may provide a significantly beneficial effect for individuals with rosacea because the condition is a chronic inflammatory disorder of the skin. Supplementing with essential fatty acids is also beneficial for the skin, as the constituents of these oils improves the integrity of the cell membranes. Sources of omega 3 fatty acids, include fish oils, flaxseed oil, and black currant seed oil. Sources of omega 6 fatty acids are borage oil, evening primrose oil, and sunflower oil.

References

[1] Beers M, Berkow R. Rosacea. Merck Manual 17th Ed.: 813-814.

[2] Fitzpatrick T et al. Rosacea. Color Atlas and Synopsis of Clinical Dermatology 3rd Ed. McGraw Hill New York: 12-15.

[3] Fitzpatrick T et al. Rosacea. Color Atlas and Synopsis of Clinical Dermatology 3rd Ed. McGraw Hill New York: 12-15.

[4] Fitzpatrick T et al. Rosacea. Color Atlas and Synopsis of Clinical Dermatology 3rd Ed. McGraw Hill New York: 12-15.

[5] Beers M, Berkow R. Rosacea. Merck Manual 17th Ed.: 813-814.

[6] Frampton JE and Wagstaff AJ. Azelaic acid 15% gel: in the treatment of papulopustular rosacea. Am J Clin Dermatol. 2004; 5(1): 57-64.

[7] Bjerke R, Fyrand O, and Graupe K. Double-blind comparison of azelaic acid 20% cream and its vehicle in treatment of papulo-pustular rosacea. Acta Derm Venereol. 1999 Nov; 79(6): 456-459.

[8] Wozniacka A et al. Topical application of NADH for the treatment of rosacea and contact dermatitis. Clin Exp Dermatol. 2003 Jan; 28(1): 61-63.

[9] Carlin Rb and Carlin CS. Topical Vitamin C preparation reduces erythema of rosacea. Cosmetic Dermatol. 2001 Feb: 35-38.

[10] Zouboulis CC. Retinoids—which dermatological indication will benefit in the near future? Skin Pharmacol Appl Skin Physio. 2001 Sept-Oct; 14(5): 303-315.

[11] Cohen AF and Tiemstra JD. Diagnosis and treatment of rosacea. J Am Board Fam Pract. 2002 May-Jun; 15(3): 214-217.