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Digestion and Rosacea

How probiotics, prebiotics, digestive health and stress influence rosacea.

For those who remember the cantankerous comedian W.C. Fields, frequently appearing on the tipsy side in vaudeville sketches and movies, his red, bulbous nose is often one of the first recollections that come to mind—along with his famous line, "...my little chickadee." This signature appearance, used to great effect in his various roles, is thought to be the result of rosacea, a chronic, inflammatory skin condition affecting up to 14 million in the United States, and many more worldwide. The red, bulbous nose is but one manifestation of the condition, typically appearing in men much more than women. The more common symptoms of rosacea—the flushed redness of the face; accentuated small blood vessels and capillaries visible around the nose, chin and cheeks; bumpy papules or acne-like pustules; and at times dry, red, itchy eyes—can all appear in a range of severity, most commonly in adults 30–60 years of age, and more often in women upon entering menopause.

What causes rosacea is still largely unknown, but advances are being made in our understanding of the molecular pathways involved. For those interested in safe natural solutions, new research that reveals the connections between digestive health and rosacea is particularly promising. These studies include findings on how digestive supplements in the form of probiotics and prebiotics influence ongoing interactions between our immune systems and digestive systems. Research continues into ways to treat rosacea and at least manage the appearance of the skin affected, pointing to the use of such supplements as a means to quell the inflammatory processes that underlie inflammatory skin conditions.

Diet and Stages of Rosacea

Rosacea can manifest in phases. An individual may blush easily, with the area around the nose flushing red from blood vessels dilating close to the skin's surface. Redness that persists in this manner may be a sign of pre-rosacea. The progression of this red flushing, with swelling and the visible appearance of capillaries under the skin (telangiectasia) may be an indication of what is called vascular rosacea. Skin sensitivity may increase in the area affected, and the condition can be confused with seborrheic dermatitis, which sometimes produces flaky, irritated skin and oily dandruff.

Inflammatory rosacea describes cases where the condition has progressed to the point where persistent papules and pustules, and swollen, sensitive skin, sometimes involving the eyelids and around the eyes (ocular rosacea) occur. The red, bulbous nose (rhinophyma), again, most common in men, is the result of the sebaceous glands of the nose enlarging, causing swelling and thickening of the tissues around the nose, telangiectasia, and skin sensitivity. Thickening of tissues on the cheeks, forehead, and chin may also be seen in some cases of rosacea.

Interviews with patients have yielded a list of potential triggers that cause flare-ups and a worsening of their condition. Of the 1066 patients surveyed by the National Rosacea Society 81% found exposure to the sun the most common triggering factor, with emotional stress coming in a close second at 79%, and hot weather, 75%, a close third. However, the cumulative effect of dietary influences was also significant. Alcohol consumption and spicy foods were reported by a large percentage of those interviewed as triggers, 52% and 45%, respectively. Other foods figured as common triggers but for much less of this population of rosacea sufferers. Dairy products were found to be trigger foods in 8%, certain vegetables 9%, certain fruits 13%, and marinated meats 10%. Such polling cannot replace the research necessary to identify underlying causes, but it may provide some guidance for coping with the condition.

Of the foods that patients in this survey found to be a trigger, the consumption of liver is interesting for its value as a source of iron in the diet. A three-ounce serving of beef or chicken liver supplies 7.5 mg or 7.3 mg, respectively, nearly meeting the Recommended Daily Allowance for non-vegetarian and post-menopausal women of 8 mg/day. Iron is also a nutrient assimilated from spinach, kidney, soy and lima beans, raisins, and prunes. Each of these has been described by rosacea patients as a possible trigger to their flare-ups. Iron that is misplaced or misused in the body increases systemic oxidative stress, decreases antioxidant capacity, and contributes to expression of ferritin, an iron-storage protein found in high concentrations in rosacea lesions. Excess or misplaced iron can be a risk factor in a large number of conditions that include rosacea, as well as supporting infection from bacteria, fungi and some viruses.

Inflammation in the Gut and Rosacea

Other interesting connections between diet and rosacea have come to light from research into the causes of this affliction. Inflammatory gastrointestinal tract disorders have been associated with rosacea. It has been hypothesized that intestinal flora may influence the kallikrein-kinin system of proteins in the blood, which influence inflammation and blood pressure, as well as other processes, through the actions of the mediators bradykinin and kallidin, vasodilators that act on cell types throughout the body. This hypothesis is supported by evidence of the beneficial role probiotics and prebiotics play in modulating the flora that inhabit the human gut.

The Food and Agriculture, and the World Health Organizations of the United Nations define probiotics as "live microorganisms which when administered in adequate amounts confer a health benefit on the host." Prebiotics, in contrast, are defined by the International Scientific Association for Probiotics and Prebiotics as "non-digestible food ingredients that beneficially affect the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria that can improve the host health." In short, probiotics supplement the flora already active in the gut, while prebiotics nourish both native flora and any probiotic flora added by means of supplements.

Work has shown that in the healthy intestine, microorganisms, which vastly outnumber the eukaryotic cells of the host in a symbiotic relationship, communicate with the host's mucosal immune system embedded in the lining of the intestine. The inseparable nature of this relationship allows for proper digestion and efficient energy extraction from food, while maintaining vigilance against pathogenic bacteria. This beneficial effect extends far beyond the mucosal lining of the gut to influence systemic immunity and the inflammatory response. Immunomodulating effects include stimulation of immunity through promotion of antibody production, boosting pro-inflammatory cytokine expression, and enhancement of host defensin production, an antimicrobial peptide. Suppressive effects include down-regulating systemic inflammation, decreasing cytokine expression, cell proliferation, and increasing "cell death," the controlled elimination of unnecessary and redundant cells, or apoptosis.

Prebiotics are seen to exert similar systemic benefits beyond simply supporting the gut flora. Prebiotics selectively stimulate beneficial bacteria that generate, among other things, lactic and acetic acid, which in turn can be digested by other beneficial bacteria. This role is thought to help out-compete potential pathogens. Another benefit of prebiotic fermentation in the gut is the down-regulation of inflammatory markers.

Although not yet extensively well-documented, the direct effect of probiotics on inflammatory skin conditions is suggested by the many studies that show the direct effects they exert on systemic immunity and inflammatory responses. Atopic dermatitis is reduced in children whose mothers use probiotics during pregnancy. In the case of inflammatory skin disorders, probiotics are thought to regulate the types of immune system cells known as T cells and lymphocytes. Certain kinds of T cells become confounded in autoimmune diseases, where they start to fail to recognize and destroy the body's own cells and tissues. Effector lymphocytes are cells able to mount very specific immune functions, that are also believed to be influenced by the actions of probiotics in the diet.

Stress, Inflammation, and Rosacea

Another factor that must enter any discussion of inflammatory skin conditions, including rosacea, is the role stress plays. The skin, endocrine, nervous, digestive, and immune systems do not act in isolation of one another. Stress ramps up activity along both the hypothalamic-pituitary-adrenal and gut-brain axes. This has a significant overall effect in contributing to inflammation and the release of pro-inflammatory mediators.

Though the complexities of these various interactions are not always well understood, the effect each one has upon the others is coming to light and must be relevant to treatment options. In the case of rosacea, strategies to reduce emotional stress are likely to exert a positive influence in the management of this condition.

Making a deliberate effort to learn about and maintaine a healthy diet, being mindful of triggers to rosacea flare-ups, and including supplements beneficial to digestion and immunity are three natural, safe ways to relieve the stress that managing rosacea might generate. While there may not be a cure as yet for rosacea, treatment options that get closer to the heart of the problem are available.

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Digestion and Rosacea—Reference Documents and Further Reading

Principal Author: C. Lucida, DermaHarmony Science Editor
Date of Publication: 06/21/2010
Updated: 06/23/2010