Naturally Treating Rosacea

More than 16 million people in the United States and 415 million worldwide have rosacea. Yet, most diagnoses come as a surprise. In a national survey, almost all participants diagnosed with rosacea knew little or nothing about its symptoms.¹What is rosacea? National Rosacea Society. Accessed June 10, 2024. https://www.rosacea.org

Facial flushing is common with rosacea and often accompanied by small, acne-like bumps on the nose, cheeks, and forehead.²Farshchian M, Daveluy S. Rosacea. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023. While flare-ups and periods of remission are typical, persistent redness is the most telling sign.³Sharma A, Kroumpouzos G, Kassir M, et al. Rosacea management: a comprehensive review. J Cosmet Dermatol. 2022;21(5):1895-1904. https://doi.org/10.1111/jocd.14816

There are four types of rosacea, and fair-skinned, middle-aged women are most susceptible. Many people have more than one kind⁴Paiva-Santos AC, Goncalves T, Peixoto D, et al. Rosacea topical treatment and care: from traditional to new drug delivery systems. Mol Pharmaceutics. 2023;20(8):3804-3828. https://pubs.acs.org/doi/10.1021/acs.molpharmaceut.3c00324:

1. Erythematotelangiectatic rosacea: Persistent redness at the center of the face that may include small, widened blood vessels
2. Papulopustular rosacea: Small, domed pimples with redness and swelling
3. Phymatous rosacea: Bumpy, swollen, and thickened skin around the nose
4. Ocular rosacea: Eyelid inflammation and photosensitivity with redness, tearing, and irritation

Hillary Abbott, ND, a dermatology, digestive health, and autoimmune disease specialist, says rosacea can be difficult to treat. “[Rosacea] is multifaceted, and the cause can vary for each patient. The first step toward successful treatment is identifying the underlying cause.”

Possible causes and common triggers

With numerous potential causes ranging from lifestyle choices and diet to genetics and environment, pinpointing rosacea’s source is often challenging. Microorganisms, neurovascular dysregulation, and immune reactivity may also be factors.²Farshchian M, Daveluy S. Rosacea. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023.

“For some patients, [rosacea] may be caused by an unhealthy balance of microbiota on the skin or in the gut; for others, it may be due to a deficiency in their innate immunity,” says Dr. Abbott. “Demodex mites are found in higher numbers on the skin of people who have rosacea and could be one of the causes. These mites carry a bacterium called Bacillus oleronius, which is thought to be why they cause skin inflammation.” Demodex mites live in human hair follicles, typically on the cheeks, eyelashes, forehead, sides of the nose, and ears. Present on skin and in the pores of almost everyone, Demodex mites are generally harmless. However, they can multiply rapidly in immunocompromised people and those with certain skin conditions.

Dr. Abbott notes the association between rosacea and small intestinal bacterial overgrowth (SIBO), H. pylori, and low stomach acid. “It is essential to identify and treat any underlying causes, such as dysbiosis, inflammatory bowel disease, SIBO, H. pylori, and hypochlorhydria,” she explains. She chooses natural treatments to correct immune dysregulation.

A rosacea flare may occur when the immune system overreacts, spurring chronic inflammation.⁵van Zuuren EJ, Arents BWM, van der Linden MMD, Vermeulen S, Fedorowicz Z, Tan J. Rosacea: new concepts in classification and treatment. Am J Clin Dermatol. 2021;22(4):457-465. https://doi.org/10.1007/s40257-021-00595-7 Common triggers include sun exposure, alcohol consumption, stress, spicy food, food allergies, and hot beverages.⁶Buddenkotte J, Steinhoff M. Recent advances in understanding and managing rosacea. F1000Res. 2018;7. https://doi.org/10.12688/f1000research.16537.1 According to a survey of more than 1,000 rosacea patients, sunlight, emotional stress, and hot weather cause the most trouble.⁷Rosacea triggers survey. National Rosacea Society. Accessed June 10, 2024. https://www.rosacea.org/patients/rosacea-triggers/rosacea-triggers-survey

Medical treatments

Although there is no cure for rosacea, conventional treatments include topical and oral prescription medications, light or laser therapy, and surgery.³Sharma A, Kroumpouzos G, Kassir M, et al. Rosacea management: a comprehensive review. J. Cosmet Dermatol. 2022;21(5):1895-1904. https://doi.org/10.1111/jocd.14816 “Azelaic acid gel may be a more natural and effective topical than Metrogel, a topical antibiotic used to treat rosacea,” notes Dr. Abbott.

Natural therapies

A natural approach to rosacea treatment combines diet and lifestyle improvements with natural remedies that target inflammation. “Conventional treatments may not have long-term efficacy,” Dr. Abbott says, “because they are not addressing the underlying cause of the condition. “It is important to support the immune system and assess potential nutrient deficiencies, such as zinc, copper, B vitamins, vitamin D, and omega–3s, which are key [for] immune health.” Avoid niacin (vitamin B3), as it can cause flushing and worsen symptoms.⁸Searle T, Ali FR, Carolides S, Al-Niaimi F. Rosacea and diet: what is new in 2021? J Clin Aesthet Dermatol. 2021;14(12):49-54.

Preliminary research suggests rosacea may indicate low vitamin D levels.⁹Ekiz O, Balta I, Sen BB, Dikilitaş MC, Ozuğuz P, Rifaioğlu EN. Vitamin D status in patients with rosacea. Cutan Ocul Toxicol. 2014;33(1):60-62. https://doi.org/10.3109/15569527.2013.797907 In a double-blind, placebo-controlled study, 100 mg of zinc sulfate more effectively reduced rosacea symptoms than a placebo.¹⁰Sharquie KE, Najim RA, Al-Salman HN. Oral zinc sulfate in the treatment of rosacea: a double-blind, placebo-controlled study. Int J Dematol. 2006;45(7):857-61. https://doi.org/10.1111/j.1365-4632.2006.02944.x

Green tea is a potent antioxidant and anti-inflammatory that may also alleviate rosacea. Research suggests that topical application of the tea’s extract can ease redness and build a protective barrier.¹¹Pazyar N, Feily A, Kazerouni A. Green tea in dermatology. Skinmed. 2012;10(6):352-355. https://europepmc.org/article/med/23346663^,12Ferzli G, Patel M, Phrsai N, Brody N. Reduction of facial redness with resveratrol added to topical product containing green tea polyphenols and caffeine. J Drugs Dermatol. 2013;12(7):770-774.

Since direct sunlight is almost always a problem for people with rosacea, adequate protection (sunscreen, hat, umbrella) and limited exposure are essential. If anxiety is a trigger, exploring stress management techniques can help.

Probiotic-rich foods, like yogurt, miso, kimchi, and kefir, restore good bacteria in the gastrointestinal microbiome. “[When] the underlying cause is gut related,” says Dr. Abbott, “it may help to eat fermented foods or take probiotics with Bifidobacterium breve and Lactobacillus salivarius.” ¹³Sánchez-Pellicer P, Eguren-Michelena C, García-Gavín J, et al. Rosacea, microbiome and probiotics: the gut-skin axis. Front Microbiol. 2024;14:1323644. doi:10.3389/fmicb.2023.1323644

Dr. Abbott recommends avoiding products that irritate the skin and adopting a consistent routine with daily moisturization and a gentle cleanser to remove dead cells. Aloe vera, coconut oil, and citron oil soothe dryness, while calendula, golden chamomile, and kanuka honey offer all-natural relief.

Footnotes

• 1
  What is rosacea? National Rosacea Society. Accessed June 10, 2024. https://www.rosacea.org ↩︎
• 2
  Farshchian M, Daveluy S. Rosacea. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023. ↩︎
• 3
  Sharma A, Kroumpouzos G, Kassir M, et al. Rosacea management: a comprehensive review. J Cosmet Dermatol. 2022;21(5):1895-1904. https://doi.org/10.1111/jocd.14816 ↩︎
• 4
  Paiva-Santos AC, Goncalves T, Peixoto D, et al. Rosacea topical treatment and care: from traditional to new drug delivery systems. Mol Pharmaceutics. 2023;20(8):3804-3828. https://pubs.acs.org/doi/10.1021/acs.molpharmaceut.3c00324 ↩︎
• 5
  van Zuuren EJ, Arents BWM, van der Linden MMD, Vermeulen S, Fedorowicz Z, Tan J. Rosacea: new concepts in classification and treatment. Am J Clin Dermatol. 2021;22(4):457-465. https://doi.org/10.1007/s40257-021-00595-7 ↩︎
• 6
  Buddenkotte J, Steinhoff M. Recent advances in understanding and managing rosacea. F1000Res. 2018;7. https://doi.org/10.12688/f1000research.16537.1 ↩︎
• 7
  Rosacea triggers survey. National Rosacea Society. Accessed June 10, 2024. https://www.rosacea.org/patients/rosacea-triggers/rosacea-triggers-survey ↩︎
• 3
  Sharma A, Kroumpouzos G, Kassir M, et al. Rosacea management: a comprehensive review. J. Cosmet Dermatol. 2022;21(5):1895-1904. https://doi.org/10.1111/jocd.14816 ↩︎
• 8
  Searle T, Ali FR, Carolides S, Al-Niaimi F. Rosacea and diet: what is new in 2021? J Clin Aesthet Dermatol. 2021;14(12):49-54. ↩︎
• 9
  Ekiz O, Balta I, Sen BB, Dikilitaş MC, Ozuğuz P, Rifaioğlu EN. Vitamin D status in patients with rosacea. Cutan Ocul Toxicol. 2014;33(1):60-62. https://doi.org/10.3109/15569527.2013.797907 ↩︎
• 10
  Sharquie KE, Najim RA, Al-Salman HN. Oral zinc sulfate in the treatment of rosacea: a double-blind, placebo-controlled study. Int J Dematol. 2006;45(7):857-61. https://doi.org/10.1111/j.1365-4632.2006.02944.x ↩︎
• 11
  Pazyar N, Feily A, Kazerouni A. Green tea in dermatology. Skinmed. 2012;10(6):352-355. https://europepmc.org/article/med/23346663 ↩︎
• 12
  Ferzli G, Patel M, Phrsai N, Brody N. Reduction of facial redness with resveratrol added to topical product containing green tea polyphenols and caffeine. J Drugs Dermatol. 2013;12(7):770-774. ↩︎
• 13
  Sánchez-Pellicer P, Eguren-Michelena C, García-Gavín J, et al. Rosacea, microbiome and probiotics: the gut-skin axis. Front Microbiol. 2024;14:1323644. doi:10.3389/fmicb.2023.1323644 ↩︎