Rosacea natural treatment vitamins herbs supplements, role of diet and foods, by Ray Sahelian, M.D.
February 13 2016

Rosacea is a common chronic skin disorder which occurs most commonly in those 30 years of age and older individuals, and more commonly in women. A family history of the disease is a risk factor, as is the very light skin phototype (Celtic skin type). Alcohol and coffee, often blamed, are not risk factors. Skin manifestations include transient or persistent facial redness, appearance of tiny blood vessels near the skin surface, swelling, papules and pustules that are usually confined to the central portion of the face. Acne rosacea is a common skin disorder which affects adults women more than men. This skin condition affects about 14 million Americans.

Natural treatment for rosacea
Little is known regarding natural rosacea treatment. My guess is that eating a low inflammatory diet could be helpful consisting of fish and vegetables and low sugar intake. Perhaps taking fish oil supplements could help. See also this
acne page for suggestions.
   Wash your face with lukewarm, rather than hot, water. Reduce or avoid the use of soap since they are alkaline and they increase the pH of the skin. The use of makeup does not seem to make it worse.

Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation.
J Cosmet Dermatol. 2008.
This study aims to evaluate a topical treatment based on silymarin / methylsulfonilmethane (S-MSM) to improve erythematous-telangiectactic rosacea. Forty-six patients affected by stage I-III rosacea entered this double-blind, placebo-controlled study. Subjects were treated for 1 month. A statistically significant improvement was observed in many clinical and instrumental parameters investigated. In particular, improvement of skin redness, papules, itching, hydration, and skin color occurred. The combination of silymarin and S-MSM can be useful in managing symptoms and condition of rosacea skin, especially in the rosacea subtype 1 erythemato-telangiectatic phase. The action can be considered multicentric and multiphase because of the direct modulating action on cytokines and angiokines normally involved and up-regulated in the case of such skin condition. MSM creams are available over the counter.

J Drugs Dermatol. 2013. Efficacy and tolerability of low molecular weight hyaluronic acid sodium salt 0.2% cream in rosacea. Improvement was noted in measured clinical parameters with use of topical low molecular weight hyaluronic acid. Topical low molecular weight hyaluronic acid is another option that may be considered for the treatment of rosacea in the adult population. Compliance and tolerance were excellent.

I realize it's not practical for you to give personal medical recommendations, but was curious if you have come across anything in the literature regarding supplements, topical or otherwise, effective in the treatment of rosacea? I would be grateful for your feedback or suggestions for where I might direct my research.
   We'll keep looking for natural ways to treat rosacea. It is difficult to treat.

I have followed your career since my wife and I heard you at a book review at the La Quinta Hotel, La Quinta, California some years ago. I would like to call your attention to a problem I had recently with taking l arginine in quantity (6 g per day) over several months, I came down with rosacea, which cleared up when I stopped taking it and with standard treatment by a dermatologist. I have read stories by body builders of their faces getting "rough" when taking large doses of l arginine and wonder if they have undiagnosed rosacea. Keep up the good work.
   Thanks, this is the first we have heard of any potential reaction to arginine leading to rosacea.

I noticed on your site someone stating that they had rosacea symptoms after taking L-Arginine. The same happened to me recently. I believe L-Arginine has properties that promote the release of nitric oxide. Maybe there's a connection. The reaction to the L-Arginine happened within two days. When I stopped, the symptoms began to subside. I believe I fall into the category of people more susceptible to rosacea. I believe I may have the H. Pylori bacteria based on symptoms I have had for an extended period of time. I'm scheduling an appointment to get a test to confirm this. I bring it up because there's some evidence of a connection between H. Pylori bacteria and rosacea. Apparently L-arginine is an essential requirement for growth of H. Pylori. I noticed too on one of the websites I reviewed that the H. Pylori affects the normal process of L-arginine converting to L-ornithine. I don't understand the connections, but all these connections sure seems coincidental with the rosacea reaction I had to taking the L-arginine. I will let you know if the treatment of the H. Pylori also cures the rosacea symptoms.
   Thanks for sharing.

Dr. Perricone has an alpha lipoic acid face activator for rosacea, does it really help?
   I have not seen any studies with the alpha lipoic acid cream by Dr. Perricone for the treatment of rosacea, so I don't know.

The prescription medications that were prescribed only seemed to make the problem worse! I am looking for references to a natural cure or treatment. It has been somewhat frustrating for me to find out that in the 21st Century there exists such a commonly occurring condition and not much is known about it's cause or treatment. It's interesting that it's a "middle-aged" disease ! I just simply stopped taking the antibiotics and topical gels that were prescribed to me because I believed that those items were actually aggravating my condition. So I turned to home remedies such as green tea cream, and compresses of Epsom Salts and even to aloe vera. The latter product actually dried up the inflammatory rash that was on my forehead for 4 months in just two applications. I haven't had an opportunity to apply any more but, with facial massage I've managed to nearly stop the inflammation and eliminate the rash which was like a beacon to others (in my mind). My hope is that the rash will disappear and not return but, my old faithful aloe vera plant came to my rescue once more, while conventional pharmacological medication failed me miserably !

Does a serrapeptase supplement help with rosacea?
   I have not seen such research nor had any feedback from anyone using it for this condition.

Zinc supplements not helpful
Int J Dermatol. 2012. Randomized, double-blind trial of 220 mg zinc sulfate twice daily in the treatment of rosacea. A 2006 article published in the International Journal of Dermatology reported that oral zinc sulfate 100 mg three times daily was associated with improvement in the severity of facial rosacea (Sharquie et al. 2006; 45: 857-861). The current study was undertaken to further assess the role of zinc in the management of rosacea. This was a randomized, double-blind trial of 220 mg of zinc sulfate twice daily for 90 days in patients with moderately severe facial rosacea at baseline. Subjects were recruited in the Upper Midwest USA between August 2006 and April 2008, and followed until July 2008. Forty-four subjects completed the trial (22 in each arm). Rosacea improved in both groups. There were no differences in magnitude of improvement based on rosacea severity scores between subjects receiving zinc sulfate and subjects receiving placebo (P=0.284). Serum zinc levels were higher in subjects receiving zinc. Oral zinc sulfate was not associated with greater improvement in rosacea severity compared with placebo in this study.

Causes of rosacea
Little is known about the cause of rosacea. Genetic, environmental, dietary, vascular, inflammatory factors and microorganisms such as Demodex folliculorum and Helicobacter pylori have been considered. Triggers include heat, stress, sun exposure and embarrassment which can worsen the condition. Having low antioxidant status in the body could make symptoms worse. Inflammation plays a critical role in the pathogenesis of this disorder. Some think intestinal bacterial overgrowth is a potential cause and one wonders whether the use of probiotics could be of benefit.
   Biochemically, overproduction of two inflammatory proteins lead to excessive levels of a third protein that causes rosacea symptoms. A high amount of SCTE (stratum corneum tryptic enzymes) and too much cathelicidin leads to the abnormal peptides that cause the symptoms. Research will determine whether the levels of these proteins can be manipulated through food, supplements, or medicines.

Rosacea in women is linked with an increased risk for a wide variety of autoimmune disorders including type 1 diabetes, celiac disease, multiple sclerosis, and rheumatoid arthritis.

Rosacea, a chronic skin condition that causes marked redness in the face, may be linked to an increased risk for Parkinson's disease.

The reason is half environmental and half genetic. On the environmental side, sun exposure is the key contributor. But obesity, alcohol and heart disease also appear to raise risk. If you have a strong family history of rosacea, more attention should be paid to environmental factors. Journal of the American Medical Association 2015.

Rosacea triggered by a vitamin B complex supplement. Actas Dermosifiliogr. 2011.

Rosacea fulminans triggered by high-dose vitamins B6 and B12.
J Eur Acad Dermatol Venereol. 2001.
Rosacea fulminans is a rare variant of rosacea conglobata that occurs almost exclusively in women well past adolescence. The aetiology is unknown, although immunological, hormonal, and vascular factors have been suggested. We report the case of a 17-year-old girl with rosacea fulminans that was temporally associated with daily ingestion of high-dose vitamin B supplements. The onset was sudden and cosmetically disabling. The eruption improved when the vitamin supplement was discontinued and a therapeutic regimen including isotretinoin and methylprednisolone was introduced. It seems appropriate to consider the possibility of such a vitamin B-triggered condition in cases of subjects presenting new or exacerbating facial eruptions. rosacea treatment.

Severe exacerbation of rosacea induced by cinnamon supplements.
J Drugs Dermatol. 2008. Rush University Medical Center, Chicago, IL, USA.
The authors report a case of a 68-year-old Caucasian female with type 2 diabetes mellitus who experienced an acute exacerbation of her rosacea 2 weeks after self-initiating cinnamon oil pills to lower her blood sugar levels. The use of cinnamon has commonly produced cutaneous side effects of irritant or allergic contact dermatitis and been reported to have vasodilatory effects. Yet, there are no reports of cinnamon use triggering a rosacea exacerbation in the literature.

A significant association exists between Demodex infestation and the development of rosacea. Demodex infestation is a vital risk factor for rosacea according to the time-to-event relationship, and the degree of infestation played a more important role than did the mite infestation rate in the development of rosacea. Arch Dermatol. 2010. Retrospective analysis of the association between Demodex infestation and rosacea. Department of Immunology and Pathogen Biology, Medical School of Xi'an Jiaotong University, No. 76 Yanta W. Road, Xi'an, China.

Helicobacter pylori and rosacea.
East Mediterr Health J. 2003.
Recent reports have suggested an increased prevalence of Helicobacter pylori infection in patients with rosacea, with some evidence of dermatological improvement in patients treated with antibiotics for this infection. Our study investigates the prevalence of H. pylori infection in rosacea patients in Kerman. Serological examination was done for 29 patients with classical identification of rosacea using the enzyme-linked immunosorbent assay IgG antibody method. Comparison of antibody titres with those of a control group revealed that the prevalence of positive serological tests for H. pylori was significantly higher in the test group. This supports the suggestion of some form of relationship between rosacea and H. pylori infection, though further investigations with larger sample sizes are required for a definite conclusion.

Rosacea treatment, traditional medical therapy, prescription medications
The topical vasoconstrictor of cutaneous vasculature, oxymetazoline hydrochloride cream 1%, reduces erythema.

Topical minocycline foam is another treatment showing promise for people with rosacea.

Azelaic acid foam, 15% (Finacea), approved by the FDA in 2015, provides a well-tolerated option.

Cochrane Database Syst Rev. 2015. Interventions for rosacea. There was high quality evidence to support the effectiveness of topical azelaic acid, topical ivermectin, brimonidine, doxycycline and isotretinoin for rosacea. Moderate quality evidence was available for topical metronidazole and oral tetracycline. There was low quality evidence for low dose minocycline, laser and intense pulsed light therapy and ciclosporin ophthalmic emulsion for ocular rosacea.

There is high-quality evidence that topical brimonidine, azelaic acid, and ivermectin, as well as oral doxycycline and isotretinoin, are associated with improvements in rosacea. Lower-quality evidence is available for topical metronidazole, oral tetracycline, laser and light-based therapy, and topical cyclosporine for ocular rosacea.

Topical metronidazole and azelaic acid have been demonstrated to be effective treatments. Severe or persistent cases may be treated with oral metronidazole, tetracyclines or isotretinoin. Topical camphor oil has also been tried.
   Metronidazole was the first topical agent approved by the U.S. Food and Drug Administration for the treatment of rosacea. Several controlled studies have confirmed the efficacy and safety of topical metronidazole 0.75% gel, lotion and cream and 1% cream for rosacea. At present, little data exists regarding the use of combination topical therapy in rosacea management, although anecdotal evidence and preliminary studies suggest at least some additive benefit when topical metronidazole is used in combination with sulfacetamide 10% /sulfur 5%.  
   There is evidence that topical metronidazole and azelaic acid are effective for rosacea. There is some evidence that oral metronidazole and tetracycline are effective. More well-designed, randomized controlled trials are required to provide better evidence of the efficacy and safety of other rosacea therapies.

The U.S. Food and Drug Administration in 2013 approved Mirvaso (brimonidine) for the treatment of the redness -- clinically known as erythema -- that is a hallmark of rosacea. The gel is made by Galderma Laboratories, of Fort Worth, Texas.

The FDA in 2015 approved Bayer HealthCare's Finacea (azelaic acid) Foam, 15 percent, for treatment of mild to moderate rosacea, Bayer said in a news release.

Skin Therapy Lett. 2014. Rosacea: an update on medical therapies. Rosacea is a common, chronic cutaneous condition that affects the face. Two topicals and one oral medication are currently approved for the treatment of rosacea, including azelaic acid, metronidazole, and sub-antimicrobial dose of doxycycline. Identification of subtypes can help guide treatment strategies. It is essential for psychosocial implications of rosacea to be considered and conservative management, such as nonpharmacologic routine skin care, must form an important part of the overall care. Recently, new insights into the pathophysiology of rosacea have led to the emergence of etiologically oriented treatments. Ivermectin, an acaricidal agent that has been shown to be effective against rosacea refractory to other therapies, is currently in Phase 3 trials. Brimonidine, which was US FDA approved last year and recently sanctioned by Health Canada, has filled an essential therapeutic void in the targeted treatment of diffuse facial erythema.

Rosacea medication
Oracea (doxycycline, USP, CollaGenex) became available in 2006 for the treatment of inflammatory lesions (papules and pustules) of rosacea in adult patients.

Ocular rosacea
The visual condition can cause a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small inflamed bumps. The eyes may become bloodshot and eyelashes sometimes fall out. The rosacea ophthalmic signs are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis.

Signs and diagnosis
Erythema, papules, pustules and telangiectases, are the main clinical signs of rosacea and are located on the face. Diagnosis of rosacea might be confusing since the signs are similar to other illnesses. Other skin conditions of medical conditions to consider include acne vulgaris, erysipelas, seborrhoeic and contact eczema as well as systemic diseases like lupus erythematosus, dermatomyositis, scleroderma, sarcoidosis and leukemia.

Rosacea research studies
Reactive oxygen species and rosacea.
Cutis. 2004.
Although the fundamental pathogenesis of rosacea remains unknown, inflammation is a central process in this disorder. Recent evidence suggests that this inflammation is associated with the generation of reactive oxygen species (ROS) that are released by inflammatory cells such as neutrophils.

Ultraviolet light and rosacea.
Cutis. 2004.
The general consensus among clinicians is that rosacea is a photoaggravated disorder. Pathophysiologic processes induced by UV radiation, which are processes similar to those seen in photoaging, contribute to the signs and symptoms of rosacea. Because of the purported role of solar radiation, clinicians may want to use photosensitizing antibiotics with discretion in patients with rosacea. In addition to topical and oral therapy for rosacea, clinicians should recommend that patients use sunscreens or sunblocks (inorganic chemicals such as zinc oxide or titanium dioxide).

Rosacea and the pilosebaceous follicle.
Cutis. 2004.
The pathophysiology of rosacea remains unknown. A leading theory suggests a vascular basis; however, clinical observations and histopathologic studies suggest that inflammation of the pilosebaceous follicle may be central to the pathogenesis of rosacea. Demodex folliculorum is a frequently seen commensal in the follicles of facial skin. According to evidence from biopsies of the skin surface, individuals with rosacea have a higher density of this parasite. This increased mite density may play a role in the pathophysiology by triggering inflammatory or specific immune reactions, mechanically blocking the follicles, or acting as a vector for bacteria.

Rosacea: a clinicopathological approach.
Dermatology. 2004.
The study included 73 patients with rosacea. A skin biopsy with a 4-mm punch was performed in each case. All biopsy specimens included subcutaneous tissue. In 10 randomly selected patients, facial biopsy specimens were obtained from both involved and uninvolved (non-lesional) skin. Demodex mite presence was estimated semi-quantitatively under light microscopy. Patients with self-reported gastro-intestinal symptoms were submitted to upper gastro-intestinal endoscopy, and a rapid urease test was performed. Serological antibodies, IgG and IgA, against Helicobacter pylori were also detected. The patients had a broad clinical spectrum of lesions. No specific histological features associated with either erythematous-telangiectatic or papulopustular clinical forms were noticed. Histological examination showed that there is no histological pattern unique to rosacea. Three different types of granulomas were observed: small palisaded ones around altered collagen and other granulomas of elastolytic and non-specific epithelioid type, all coexisting in 5 cases. The deep dermis and subcutis were frequently involved. Comparative study in 10 rosacea patients between lesional and non-lesional skin biopsies revealed almost the same histological changes to the latter biopsies, to a lesser degree though. Rosacea seems to be a reaction pattern to which a variety of pathogenetic routes may lead.

Treatment of human Demodex folliculorum by camphor oil and metronidazole.
J Egypt Soc Parasitol. 2004.
A total of 15 females suffering from erythematotelangiectatic rosacea and 12 females free from other dermatological lesions were selected. Demodex folliculorum infestation density in both patients and control were evaluated by non-invasive skin surface biopsies. Five facial sites were selected. The daily topical application of 1/3 diluted camphor oil with glycerol and 500 mg metronidazole orally were given for fifteen days. The results were very successful with no clinical side effects.

Since rosacea is a chronic disease and many patients find prescription therapies unsatisfactory, they frequently turn to herbal ingredients for relief of their persistent facial redness. The most useful and frequently used herbal compounds include licorice, feverfew, green tea, oatmeal, lavender, chamomile, tea tree oil, and camphor oil. The utility of most of these herbs is based on their purported anti-inflammatory properties. Some of these herbs have proven effects, many have potential benefits, and some may aggravate rosacea.