Acne rosacea, now more accurately know just as rosacea, is a chronic skin condition of the
forehead, cheeks, nose, and chin. It consists of flushing, which turns into red coloration
from the dilation of the capillaries and can lead to pustules that resemble acne.
Rosacea occurs mostly in middle-aged adults with fair skin. The cause of rosacea is
unknown, but there is likely a genetic component. Severe, untreated rosacea can be disfiguring
to the face.
Checklist for Acne
Rosacea
What are the symptoms of acne rosacea?
The skin of the center of the face—typically on or surrounding the nose—is red
and swollen, with acne-like blemishes. As the condition progresses, parts of the eye can
become inflamed and the nose may enlarge.
Medical treatments
Prescription medications used to treat rosacea include topical and oral antibiotics. The main topical drug, metronidazole (Metrogel®), is thought to have
antibacterial and anti-inflammatory effects. The vitamin A-related medication tretinoin (Retin A®), which is used for acne vulgaris, may
also be prescribed. The most commonly used oral antibiotic is tetracycline (Sumycin®).
Dietary changes that may be helpful
Alcohol may increase the reddening of the skin affected by rosacea, but alcohol is not the
cause of this disease.1 Spicy foods and hot drinks have been reported anecdotally
by rosacea sufferers to cause flare-ups,2 but no controlled research has evaluated
these claims. One small, preliminary report suggested that fasting followed by a vegan diet
(allowing no animal flesh foods, dairy products,
or eggs) had only small and inconsistent effects on
rosacea.3
Lifestyle changes that may be helpful
Sun exposure, stress, excessive exercise, and extreme temperatures (hot or cold) of weather
or bathing water may trigger flare-ups of rosacea, so avoiding these conditions is
recommended.4
Nutritional supplements that may be helpful
Azelaic acid is found naturally in wheat, rye, and barley and is used
topically in a 20% strength cream. Controlled clinical trials have found this cream effective
for mild to moderate acne, including rosacea.5 6 Azelaic acid cream is
available by prescription only and should be used only under the supervision of the
prescribing physician.
Preliminary reports in the 1940s claimed that rosacea improved with oral supplements or
injections of B vitamins7 8
9 On the other hand, one report exists of rosacea-like symptoms in a patient taking
100 mg per day of vitamin B6 and 100 mcg per day of vitamin B12; these symptoms subsided when the supplements
were discontinued.10 More research is needed to evaluate the potential benefits or
hazards of B vitamins for rosacea.
Some people with rosacea have been reported to produce inadequate stomach acid.11 In a preliminary trial, supplemental
hydrochloric acid, along with vitamin B complex, improved some cases of rosacea in people with
low stomach-acid production.12 Similarly, improvement in rosacea has been reported
anecdotally after supplementation with pancreatic digestive
enzymes, and a controlled study found that rosacea patients produced less pancreatic lipase than healthy people.13 Controlled trials are
needed to evaluate the effects of hydrochloric acid and digestive enzyme supplements in
rosacea. Hydrochloric acid supplements should not be taken without the supervision of a
healthcare practitioner.
A topical preparation of retinaldehyde (a prescription form of vitamin A) may be effective in treating people with mild rosacea.
In a small, preliminary trial, women with rosacea used a retinaldehyde cream (0.05%) once
daily for six months.14 Inflammation was improved in most participants, and blood
vessel abnormalities responded in about half the people after six months. Controlled research
is needed to confirm these effects. Retinaldehyde cream is available by prescription only and
should be used only under the supervision of the prescribing physician.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Historically, tonic herbs, such as burdock, have been
used in the treatment of skin conditions. These herbs are believed to have a cleansing action
when taken internally.15 Burdock root tincture may be taken in 2 to 4 ml amounts
per day. Dried root preparations in a capsule or tablet can be used at 1 to 2 grams three
times per day. Many herbal preparations combine burdock root with other alterative herbs, such
as yellow dock, red
clover, or cleavers. In the treatment of acne rosacea,
none of these herbs has been studied in scientific research.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
References
1. Chalmers DA. Rosacea: recognition and management for the primary care
provider. Nurse Pract 1997;22:18, 23–8,30 [review].
2. National Rosacea Society. Coping with rosacea: tips on lifestyle
management for rosacea sufferers. Barrington, IL: National Rosacea Society, 1996.
3. Lithell H, Bruce A, Gustafsson IB, et al. A fasting and vegetarian
diet treatment trial on chronic inflammatory disorders. Acta Derm Venereol
1983;63:397–403.
4. National Rosacea Society. Coping with rosacea: tips on lifestyle
management for rosacea sufferers. Barrington, IL: National Rosacea Society, 1996.
5. Graupe K, Cunliffe WJ, Gollnick HP, Zaumseil RP. Efficacy and safety
of topical azelaic acid (20 percent cream): an overview of results from European clinical
trials and experimental reports. Cutis 1996;57(1 Suppl):20–35 [review].
6. Bjerke R, Fyrand O, Graupe K. Double-blind comparison of azelaic acid
20% cream and its vehicle in treatment of papulo-pustular rosacea. Acta Derm Venereol
1999;79:456–9.
7. Tulipan L. Acne rosacea: a vitamin B complex deficiency. Arch
Dermatol Syphilol 1947;56:589.
8. Stillians AW. Pyridoxine in treatment of acne vulgaris. J Invest
Dermatol 1946;7:150–1.
9. Johnson L, Eckardt R. Rosacea keratitis and conditions with
vascularization of the cornea treated with riboflavin. Arch Ophthamol
1940;23:899–907.
10. Sherertz EF. Acneiform eruption due to “megadose”
vitamins B6 and B12. Cutis 1991;48:119–20.
11. Johnson L, Eckardt R. Rosacea keratitis and conditions with
vascularization of the cornea treated with riboflavin. Arch Ophthamol
1940;23:899–907.
12. Allison JR. The relation of hydrochloric acid and vitamin B complex
deficiency in certain skin diseases. South Med J 1945;38:235–41.
13. Barba A, Rosa B, Angelini G, et al. Pancreatic exocrine function in
rosacea. Dermatologica 1982;165:601–6.
14. Vienne MP, Ochando N, Borrel MT, et al. Retinaldehyde alleviates
rosacea. Dermatology 1999;199 Suppl 1:53–6.
15. Hoffman D. The Herbal Handbook: A User’s Guide to Medical
Herbalism. Rochester, VT: Healing Arts Press, 1988, 23–4.
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purposes only. It is based on scientific studies (human, animal, or in vitro),
clinical experience, or traditional usage as cited in each article. The results reported may
not necessarily occur in all individuals. For many of the conditions discussed, treatment with
prescription or over-the-counter medication is also available. Consult your doctor,
practitioner, and/or pharmacist for any health problem and before using any supplements or
before making any changes in prescribed medications. Information expires March 2005.
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