Acne Rosacea

Acne rosacea is a chronic skin disorder – nose and cheeks area abnormally red and may be covered with pimples similar to acne; relatively common in adults between ages 30 and 50; more common in women (3:1), but more severe in men.

• Many factors suspected; alcoholism, menopausal flushing, vasomotor neurosis, seborrheic diathesis, local infection, B-vitamin deficiencies, gastrointestinal disorders.

• Most cases – moderate to severe seborrhoea, but sebum production is not increased in many; vasomotor lability is prevalent; migraine three times more common than in controls.

The diagnostic summary of this condition is :

• Chronic acneiform eruption on the face of middle-aged and older adults associated with facial flushing and telangiectasia.

• The acneiform component is characterised by papules, pustules, and seborrhoea; the vascular component by erythema and telangiectasia; and the glandular component by hyperplasia of the soft tissue of the nose (rhinophyma).

• The primary involvement occurs over the flush areas of the cheeks and nose.

Therapeutic considerations

• Hypochlorhydria: Gastric analysis of rosacea patients indicates hypochlorhydria; psychological factors (worry, depression, stress) reduce gastric acidity; HCL supplements improve patients with achlorhydria or hypochlorhydria; decreased secretion of lipase (bicarbonate and chymotrypsin normal); pancreatic supplements benefit.

• Helicobacter pylori: high incidence of gastric H. pylori found in rosacea patients; flushing reaction in rosacea may be caused by gastrin or vasoactive intestinal peptides; some histologically positive patients are serologically negative; clinical success in treating rosacea with metribudazole and abatement of H. pylori isolates and serology after treatment provide evidence connecting rosacea with H. pylori.

• Food allergy: migraine headaches accompanying rosacea point to food intolerance, as does reflex flushing by vasodilator substances.

• B vitamins: large doses of B vitamins are quite effective, with riboflavin (vitamin B2) as key factor.

• - Mite Demodex folliculorum is considered a factor, but is a normal inhabitant of follicles; may account for more granulomatous response of some patients (researchers able to infect skin of B2 deficient rats with Demodex, but not skin of normal rats).
• - Some patients’ rosacea may be aggravated by large doses of these nutrients; inflammation and    exacerbations of acne related to B2, B6, and B12 are reported in European literature.

Therapeutic approach

Cause(s) undetermined; adequate treatment possible for most patients; control hypochlorhydria and food intolerance; support with B-complex and avoidance of vasodilating foods.

General recommendations

Nutrition

• Diet: high-protein diet (44% protein, 35% carbohydrate [CHO], 21% fat) decreases 5-alpha-reductase activity and increases cytochrome P-450 degradation of estradiol; high CHO diet (10% protein, 70% CHO, 20% fat) has opposite effect; limit foods high in iodine and milk (high hormone content); eliminate trans fatty acids and high-fat foods.

• Sugar: insulin, and chromium: insulin efficacy in treating acne suggests defective cutaneous tolerance and/or insulin insensitivity; acne patient’s skin glucose tolerance is significantly impaired – acne may be called ‘skin diabetes’; eliminate concentrated CHOs to minimize immunosuppression; high-chromium yeast improves glucose tolerance and may help acne.

• Vitamin A: retinal reduces sebum production and hyperkeratinization of sebaceous follicules. However, must be supervised by a medical practitioner.

• Zinc: involved in production of local hormones and retinal binding protein; wound healing, tissue regeneration, and immune function; absorption of zinc salts may affect results; requires 12 weeks to show good results; prefer zinc picolinate or monomethionine; zinc is essential to normal skin function.

• Vitamin E and selenium: vitamin E regulates retinal levels in humans; male acne patients have decreased red blood cell glutathione peroxidase, which normalizes with vitamin E and selenium; acne of men and women improves with this treatment- inhibits lipid peroxide formation – suggesting other free-radical quenchers.

• Pyridoxine: helpful for women with premenstrual acne due to effect on steroid hormone metabolism; B6 deficiency causes increased uptake and sensitivity to T; in some patients, thyroid therapy markedly improves.

• Panthothenic acid (PA): active in synthesis of cholesterol and steroids; high doses induce regression of lesions without side-effects.

• Miscellaneous factors: acne patients have elevated circulating endotoxins, which can elevate copper : zinc ratio and enhance tissue destruction via alternative complement pathway and fibrin formation.

Topical Treatments: The goal through this application is to reduce bacteria and inflammation.

• Tea tree oil (Melaleuca alternifolia): from leaves of small trees in New South Wales, Australia; antiseptic properties; ideal skin disinfectant; effective against wide range of organisms (including 27 of 32 strains of P.acnes); good penetration without skin irritation.  5-15% preparations.

• Calendula Soap daily cleansing with calendula soap.

• Comedo Extractor draining comedones using this extractor is useful.

Physical Medicine : sun or UV lamp.

• Diet : avoid coffee, alcohol, hot beverages, spicy foods, and any other food/drink causing flush; eliminate refined and/or concentrated sugars, trans fatty acids (milk, milk products, margarine, shortening, synthetically hydrogenated vegetable oils, fried foods); avoid foods high in iodized salt.

• Supplements:

• - B-complex
• - Pancreatic enzymes
• - Betaine HCL enzymes (but only under the supervision of a health professional)

For more information on this topic please call ICIM Medics on +353 45 844 819 or email us at info@icim.ie

Tags: Skin Conditions