Rosacea - Naturopathic Approaches

Rosacea is a complex skin condition characterized by redness and flushing that could be transient or persistent. Although the causes of rosacea are unclear, there are a variety of contributing factors such as genetics, environmental factors, diet, microbes, and stress. Inflammation, blood vessel changes, and neural pathway variations are all involved in how rosacea develops and persists.^[1][2]

Specific stimuli for rosacea include stress, spicy and/or hot foods and drinks, alcohol, temperature changes, physical exercise, corticosteroids, UV radiation, chemicals, medications, hormonal fluctuations, and secondary local infection with Demodex mites.^[3] These stimuli lead to dilation of the blood vessels, formation of new blood vessels, and inflammatory changes in the skin.

Symptoms and Impact on Quality of Life

The central feature for a diagnosis of rosacea is diffuse redness around the nose and cheeks. The redness and flushing may be accompanied by red and purple blood vessels, and pustules similar to acne pimples.^[1][2] Women are more prone to developing rosacea, especially women of Caucasian descent in the Northern hemisphere.^[2] It is not specifically linked to a specific skin type; however, affected individuals do report dryness around the areas of the face where the redness occurs.^[2][4][5] Rosacea symptoms may lead to physical discomfort such as stinging, burning, and itchiness. In addition to the physical symptoms, the psychosocial impact of having a visible skin condition is a major aspect that must be addressed in rosacea patients. Embarrassment, anxiety, depression, and low self-esteem are commonly experienced by people affected not only by rosacea, but also by acne, psoriasis, and eczema.^[5][6] As such, patients experience a negative influence on their quality of life, but it’s possible that they do not always seek medical advice about the impacts this has on their quality of life.^[6]

Oftentimes, patients will turn to over-the-counter topical products and try out a variety of natural and complementary therapies to alleviate the symptoms of their rosacea such as dryness, burning, stinging, itching, and tightness.^[7][8] These patients also tend to use makeup to cover their facial redness and provide psychological comfort to patients as well. As with most (skin) conditions, patients desire quick and easy ways of dealing with their rosacea.

Conventional Treatment

Conventional treatment of rosacea includes the use of antibiotics, anti-inflammatories and other medications, lasers, electrosurgery, and the avoidance of triggers. Topical and oral antibiotics and antifungals are used to suppress inflammatory pustules and nodules. Antibiotics commonly used for rosacea usually display broad-spectrum activity which could have damaging effects on the skin when used long-term, especially since they disturb the body’s internal and external microbiome.^[7] These medications also help with the Demodex mites and the bacteria these mites harbour; these mites have been linked to rosacea in some cases; however, their specific role is still under debate.^[7] Electrosurgery and laser treatment help decrease the formation of new blood vessels and the release of inflammatory molecules. These treatments also help with collagen production and skin remodeling, i.e. how new skin is laid down by the body. Other conventional treatments include brimonidine gel to help with the redness, antihypertensives that can help constrict the blood vessels of the face, and the avoidance of potential triggers such as alcohol and spicy foods.^[4]

Conventional treatment shows good results in patients; however, relapse is common shortly after cessation of therapy.^[1] Furthermore, conventional treatment at the moment does not take into consideration the psychosocial effects of having rosacea, which may be a big contributing factor to the high relapse rate. Discussions on the adverse effects on quality of life and possible referrals to qualified professionals would be a prudent step in these cases.

Naturopathic Approaches to Rosacea

Naturopathic doctors take a holistic approach to rosacea (and other health concerns), taking into consideration the multifactorial nature of the condition as well as the interplay of different systems in the body. The skin, obviously, must be addressed with topical treatments for soothing and healing; however, one or more of hormones, diet, digestion, immunity, sleep, and stress must be addressed for a majority of rosacea patients as well.

Topical Treatments

Many women resort to purchasing a variety of skin-care products that will help minimize the appearance of redness, even resorting to harsh products that may cause further damage to the skin, especially in the long run. Azelaic acid, which has antibacterial and anti-inflammatory effects, has been shown to decrease redness and pustules in rosacea patients when applied as a cream twice daily for three months.^[9][10] Clinically, carrier oils such as jojoba, sweet almond, and camellia oil function well as moisturizers when used on their own, combined together, or mixed in with moisturizers.^[11] These oils are nourishing to the skin and good for all skin types—they are non-clogging and full of vitamins and minerals to moisturize, tone, and heal the skin. Essential oils for rosacea that may be diluted in these carrier oils include neroli, immortelle, and lavender. When combined appropriately, these plant oils can help with the redness, pimples, blood vessels, and discomfort associated with rosacea.^[11]

Zinc supplementation at a relatively low dose of 20 mg per day has been associated with a decreased severity of rosacea symptoms by approximately 75% over a period of three months.^[9][12] Zinc picolinate and zinc citrate may be better absorbed by the body, and long-term use of zinc should be preceded by a consultation with a qualified health-care professional.^[9] Antioxidants play an important role in our immune, vascular, and skin health. Vitamin C, green tea, and quercetin have clinically shown positive impacts on the severity in patients with rosacea.^[11] In addition to common food triggers, it is possible that people experiencing rosacea may also have other food sensitivities that are not commonly tested for in an allergy test. Rosacea patients may also have lowered stomach acid and digestive enzymes, gut dysbiosis, and inflammation in the digestive tract.^[9][13][14] Digestive support can be in the form of hydrochloric acid supplementation, digestive enzymes, probiotics, and/or a combination of herbs that help support stomach acid production and healing of the digestive tract.^[11] Herbs can be used in the form of tinctures, capsules, teas, and oils. Here are some herbs that have been clinically used successfully in rosacea patients:^[11][15]

• To stimulate stomach acid and digestive enzymes, herbs such as ginger, gentian, and globe artichoke can be used.
• To help with sleep and gas production in the digestive tract, herbs such as lemon balm, chamomile, and holy basil can be used.
• For hormonal support around menopause, herbs such as black cohosh and sage can be used.
• Adaptogenic herbs to help with stress management, immunity, and hormonal changes include ashwagandha, licorice, and rhodiola.

Stress Management

Stress management is a must for most health concerns. Our nervous system plays a crucial role in the development of many health conditions including rosacea.^[6] Stress can affect our sleep, hormones, microbiome, immunity, and even sleeping habits. The stress-management component can vary from implementing strategies such as deep-breathing, exercise, and hobbies to seeing a certified professional such as a psychologist or psychiatrist. In addition to the behavioural changes, the body’s resilience to stress can be supported with adaptogenic herbs, dietary changes and nutrient supplementation, and acupuncture.

Acupuncture is a great adjunct to topical and other internal treatments for rosacea. It can help decrease the frequency of outbreaks, help balance hormones, increase resilience to stress, and address digestive concerns. Local acupuncture close to the affected areas can help minimize the appearance of blood vessels and support collagen production.

Due to its multifactorial nature, rosacea must be treated from a place that addresses the underlying systems involved in the condition including the psychological aspects. There are a variety of naturopathic options that address rosacea from the inside out that may involve healing the gut, making dietary changes, supplementation, addressing hormonal imbalances, helping the skin heal, and increasing resilience to stress.