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Rosacea is a multi-system chronic inflammatory skin disease, with four major
categories of presentation. Its pathogenesis is still poorly understood, though it
affects women in greater numbers and seems to be slowly increasing in prevalence.
 
The internal pharmaceutical treatment options available are far from satisfactory and much of the education around management relies on the avoidance of triggers. The truth is that rosacea can be managed naturally, for those who are passionate about supporting their health holistically. It’s not a quick fix but it is a process that will leave you in an altogether bettered and empowered state of health.
 
The types.
 
The four types of rosacea include Erythematotelangiectatic rosacea (ETR) where
flushing and redness are seen, often accompanied by small visible blood vessels,
dryness, burning and sensitivity. Papulopustular rosacea (PPR) where pimple-like
bumps accompany the redness and skin often appear oilier or combination.
Phymatous rosacea where skin thickens, mostly on and around the nose and more commonly experienced by men.
Finally ocular rosacea which involves redness, sensitivity and visible capillaries in and around the eyes. It’s also important to note that pre-onset rosacea can be apparent for years before a full presentation is seen, flushing can start as early as childhood and can include symptoms such as prolonged redness after intensive exercise. It’s helpful to have preventative measure in place for those with pre-onset rosacea, this includes skin barrier support, UV protection and gut health support.
 
The triggers. 
 
Rosacea triggers differ from person to person, the lists can look extensive, the ones that I see to be more commonly problematic are wine, spicy food and prolonged UV exposure. It’s just about observing what yours
are and working around them while your skin doesn’t tolerate those factors.
The most common of the four rosacea subtypes is ETR, followed by PPR. Key
difference between these two presentations is that ETR more commonly presents
with flushing as part of the symptom picture, while PPR is more diffuse redness with vesicles, and a small mite known as the demodex mite is associated with the PPR presentation.
The demodex mite infiltrates hair follicles bringing with it bacteria that
cause the pustules to form, while also further activating the immune system.
Demodex mites are also a big part of ocular rosacea and treatment that focus on an antimicrobial solution such as dilute tea tree or iodine, applied to the eyelid and
upper lash line overnight have positive results.
 
All rosacea is characterised by increased skin inflammation, vascular dysfunction
and a compromised skin barrier. A compromised skin barrier allows for activation of the underlying immune cells, that intern mount inflammatory attacks when foreign invading substances are present, this includes chemicals, UV and microbes such as the demodex mites and bacteria. There is an increased number of mast cells and macrophage immune cells in the stratum corneum of rosacea sufferers, compared to healthy skin. Mast cells release inflammatory factors called prostaglandins, leukotrienes and histamine when they are activated. The consequences of mast cell activation are the symptoms of a rosacea flare.
Rosacea sufferers have an increased level of antimicrobial peptide called cathelicidin and an over-expression of Kallikrein Related Peptidase 7, which causes inflammation and a thinning of the skin barrier. These factors are known to be the main stimulus of rosacea skin symptoms and why rosacea is classified as an autoimmune disorder. We can see a picture of dysregulated immune activation and inflammation along with skin barrier dysfunction as the cornerstones of rosacea.
Stress, digestive health issues and immune dysfunction are the focus areas when
approaching holistic rosacea healing. This is because food allergies and sensitivities activate mast cells and add to immune dysfunction. Stress and oxidative stress are inflammatory and stir up immune dysfunction, while any negative changes in the gut microbiome and integrity of the gut lining can lead to immune dysfunction.  Those who suffer from rosacea do have a genetic predisposition, however the expression of those genes comes down to the above factors, along with skin barrier function.
 
Rosacea has been linked to low stomach acid and low digestive enzymes, two
issues that predispose you to food allergies and microbiome changes. Small
intestinal bacterial overgrowth, a leading cause of IBS has been linked to rosacea as has H.pylori, a bacterial infection that affects the stomach and small intestine.
Psychological stress and anxiety have been seen to increase vascular dysfunction
and those suffering with rosacea often also experience a worsening of these
symptoms due to the skin condition.
 
The treatment.
 
Holistic personalised rosacea treatment is different person to person, so it’s about
identifying your own areas of weakness and focusing on resolving those. If you have digestive symptoms of any kind, testing to ascertain the cause and treating it will be vital. If you have allergy symptoms such as allergic rhinitis, chronic sinus issues, eczema or dermatitis, asthma or other types of allergy reactions, food allergy testing would be useful in identifying personal triggers of mast cell activation and histamine release. If you know or suspect you are stressed or anxious, then supplements and lifestyle modifications that support the nervous system are indicated. Due to the need for a holistic health assessment of your personal rosacea drivers, it is helpful to have the support of a practitioner on your rosacea healing journey. To get you started, here are a few generalised recommendations for internal rosacea support.
 
Diet
 
- Aside from things like alcohol and UV that you may notice as short-term triggers,
avoiding gluten and cow dairy (except butter) decreases immune activation and
inflammation for many rosacea sufferers.
 
Supplements
 
- L-theanine, CBD or herbal medicines focused on stress and anxiety support where necessary.
- Vitamin B2 supplements for papulopustular rosacea (decreases demodex
proliferation).
- Vascular integrity support, such as pycogenol and or citrus bioflavonoids such as hesperidin and rutin.
- Omega-3 essential fatty acids to decrease inflammation and support skin hydration.
 
Skincare
 
- Products aimed at healing and protecting the skin barrier while reducing
inflammation are a must.
Talk to your skin specialist for recommendations specific to your skin.
 
Written by Elissa Roy.
Naturopathic Skin, Digestive and Hormone Specialist
BHSc Nat
Master of Applied Sciences (Traditional Chinese Medicine) -currently undertaking
0410777146
info@naturopathicskinspecialist.com
https://www.naturopathicskinspecialist.com/

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