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Rosacea

Rosacea (pronounced rose-ay-sha) is a chronic skin disorder which first appears as a mild redness of the skin that looks like sunburn but the redness doesn’t disappear. It then worsens and acne-like bumps appear which can eventually cause a bulbous nose. The skin can feel tight and dry, and flushing can feel hot, burning and uncomfortable. Rosacea usually appears on the face (cheeks, nose, chin and forehead).

Rosacea usually appears between the ages 35 and 45 years. (Ref. FC Powell)

Rosacea is primarily a disorder of the facial blood vessels. Facial skin contains hundreds of blood vessels of different shapes and sizes and with rosacea, where the facial skin becomes easily flushed, the underlying facial blood vessels don’t behave as they should.

What is couperose?
Couperose is broken capillaries which cause the skin on your face appear red or pinkish and it can feel tight and irritated, like rosacea.
It is mild compared to rosacea.

Rosacea Facts

Rosacea isn’t contagious or infectious, the rosiness or blushing effect is actually caused by enlarged blood vessels under the skin and these blood vessels fail to function like normal ones. Rosacea sufferers may also develop pimples and have dry, burning and gritty sensations in the eyes. A thickening of the skin, caused by enlarged sebaceous glands, can also lead to the nose becoming larger and disfigured (bulbous).1,2

  • There are approximately 45 million rosacea sufferers worldwide.3
  • Fair skinned adults are more likely to get rosacea than darker skinned folks.
  • Rosacea can occur at any age, however it’s more common in middle-aged women.

 

How to prevent rosacea

In the rosacea management plan you’ll find out how to look after your skin condition and minimise discomfort. The Rosacea Management Plan details factors that can exacerbate rosacea. After the management plan comes the Rosacea Treatment Plan. This program shows you how to improve your health and clear up your skin condition from the inside out. Rosacea is said to be irreversible once it becomes chronic but I believe any stage of rosacea can be eliminated or at least minimised and controlled with the right health program. This program is divided into five steps.

The supplemental advice in the Rosacea Treatment Plan is designed for adults. If you have a child with rosacea, you can read this section however you should follow the ‘Children’s Clear Skin Program’ (Chapter 16 in The Healthy Skin Diet) or at least implement a daily exercise routine for your child.

 

What causes rosacea?

To understand rosacea better, it’s important to look at the functional and structural changes that occur in the blood vessels of rosacea sufferers.

Normal blood vessels perform these important functions to keep the skin healthy:

  • Facial blood vessels deliver essential nutrients and oxygen to the skin. Just like the postman delivers letters to your home each day, your blood vessels transport and deposit vitamins, minerals, fats and oxygen to your outer layer throughout the day (and night) so your skin can function properly.
  • Facial blood vessels remove waste products that have been produced by facial skin cells. Just as you put out your household garbage each week for collection by the local garbage men, your facial skin cells also put out their garbage daily and the bloodstream takes these waste products away for removal from the body.
  • Facial blood vessels help to regulate internal body temperature. If your body’s internal temperature gets too high it triggers the blood vessels to dilate. This expansion of the vessels allows an increase in blood flow, which releases large amounts of heat from the skin’s surface. This helps the internal body temperature to normalise and afterwards, healthy blood vessels return to their regular size.5

 

The abnormal functioning of facial blood vessels in rosacea sufferers:

  • Rosacea blood vessels expand (dilate) when exposed to ordinary substances that normal blood vessels do not respond to.
  • Rosacea blood vessels can expand wider than normal blood vessels.
  • Rosacea blood vessels can continue to dilate for abnormally long periods of time.

All three of these changes cause an abnormal increase in blood flow to facial skin and this results in facial flushing.6 In rosacea, the functional changes occur first and if these functional changes are left untreated then more serious structural changes may eventually occur.

 

The normal structure of facial blood vessels:

Blood vessels are hollow tubes which transport blood that is rich in nutrients and oxygen from the heart to the body’s outermost organ — the skin.

  • Facial blood vessels contain vascular smooth muscle cells and endothelial cells which work to control blood flow and change the blood vessel diameter.

Imagine that vascular smooth muscle cells and endothelial cells are like nightclub bouncers. A bouncer acts as a regulator, usually increasing the flow of people through the door when the club is empty but restricting the amount of patrons who flow into the club when the space reaches their legal capacity. Likewise, normal blood vessels in the skin should dilate (increase blood flow to your skin) and constrict (which reduces blood flow to the skin) on cue, to meet the body’s demands and maintain good health.7

 

However, the abnormal structural changes in the facial blood vessels of rosacea sufferers are as follows:

  • Rosacea facial blood vessels may become permanently dilated from dysfunctional endothelial cells — like a balloon that has been blown up and let out so many times that it eventually fails to deflate back to its original size.
  • Damage may occur to vascular smooth muscle.
  • New blood vessels may branch out from existing blood vessels (angiogenesis) and more blood vessels near the surface of your skin will make your skin appear red.8

You don’t have to fully understand the structural and functional changes in rosacea to be able to treat your condition; you just need to remember things that make your condition worse so you can limit your exposure to them. This is important because you can help to prevent your blood vessel functional changes from becoming permanent structural changes (FYI: structural changes are bad news so you want to treat this condition as early as possible).

Let’s identify factors that can aggravate rosacea if you already have it. This will vary from person to person. See if you can identify some of your facial flushing triggers from this list:

 

 Rosacea can be aggravated by:

allergies (triggering histamine release)

alcohol

anxiety and worry

dairy products

embarrassment

exposure to sunlight

extreme temperatures

foods containing histamine

hot drinks

illness

laughing, crying

physical activity*

poor diet and lifestyle

saunas or hot baths

sudden temperature changes

sunshine

some medications (such as topical steroids)

spicy and hot foods

skin-care products

stress, inability to cope

vitamin and mineral deficiencies

windy weather

 

* Although physical activity aggravates rosacea, exercise should not be avoided as it’s an important part of recovery.

 

Rosacea Treatment Plan

Step one: Limit histamine reactions

Because the redness of rosacea is created by enlarged blood vessels under the skin, we’ll look very closely at histamine foods and their ability to enlarge blood vessels.

Read and fill in the following questionnaire to identify whether you have a histamine/amine sensitivity.

 

 

If you scored 20 or above then you may have an amine sensitivity. If you scored over 30 then you are highly likely to have amine sensitivity. However, even if you scored lower, I believe all people with rosacea should limit their intake of histamine-containing foods to prevent the progression of rosacea.

Histamine can trigger facial flushing in rosacea sufferers. There are two ways you can be exposed to histamine:

  • First, histamine is released within the body when exposed to stress or an allergen (an allergen causes an allergic histamine reaction such as redness or swelling).
  • Second, histamine is naturally found in many delicious foods and drinks such as wine, cheese and chocolate. Let’s look at these two points in more detail.

    Histamine release and rosacea

    When you have an allergic response, the substance you’ve come into contact with stimulates the release of antibodies, which then attach to your mast cells and cause histamine to be released.9 For example, you might be allergic to the yellow food colouring tartrazine, found in the packaged dessert you just ate, so your body goes into panic mode and releases the antibodies that attach to mast cells. Then histamine is freed into your bloodstream, which causes your skin to itch and flush with redness.

    Histamine/allergic symptoms include:

    • itchy nose, sneezing and increased mucus production;
    • watery or burning sensation in eyes;
    • skin rashes or hives;
    • congested sinuses;
    • headache or migraine;
    • wheeze in lungs or spasms;
    • stomach cramps,
    • diarrhoea;
    • skin itchiness;
    • skin flushing/redness, or rosacea.

     

    Histamines are able to cause such havoc in your body because they are present in almost all body tissues,waiting for a trigger to release them into the bloodstream. Histamine is stored in the skin, lungs, intestinal lining,mast cells and basophils.

    • The release of histamine can be triggered by anything your body deems an allergen,

    such as drugs, chemicals, inhaled particles such as pollen, insect venom and some foods.

    • Histamine release can also be triggered by stress.

     

    Histamines in foods and drinks

    As mentioned earlier, histamine is naturally found in many foods and drinks, in varying amounts. Large amounts can be found in chocolate, cheese, wine, spicy food and beer which is why they’re more likely to cause a reaction than other histamine-containing foods.

    • Histamine has the ability to signal to your body to enlarge the blood vessels and allow maximum blood flow, which leads to a facial flush.
    • Headaches can be caused by histamine-containing chocolate because histamine causes the blood vessels in the brain to dilate and this increases pressure in the head.
     
     

    Histamine-rich foods and drinks

    Histamine-releasing foods, which cause a histamine reaction in the body

    anchovies, sardines, tuna

    avocado

    beer, brandy, liqueur, port, rum, sherry

    canned foods

    cheese

    chocolate, cocoa powder/drinks

    ciders, cider vinegar, vinegar

    cola soft drinks

    eggplant

    fermented drinks

    fermented foods/yoghurt/soy sauce

    coloured fish (not white-fleshed fish)

    jams and preserves

    cooked meats, processed meats

    sour cream

    spinach

    mushrooms, champignons

    tomatoes, tomato juice and sauce

    wines, especially red wine

    yeast extract

    oranges, orange juice

    gherkin

    olives (ref.10)

    alcohol

    bananas

    certain nuts

    chocolate

    eggs

    fish

    milk/dairy products

    papaya/pawpaw

    pineapple

    shellfish

    strawberries

    tomatoes (ref.11)

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Amine-free foods

     Amine-free foods

    most vegetables

    lentils, beans

    peas

    pears

    apples

    custard apples

    mangos

    apricots

    peaches

    rhubarb

    berries

    cherries

    currants

    guava

    lychees

    nectarines

    pomegranate

    rockmelon

    watermelon

    freshly cooked beef*

    skinless chicken*

    lamb, veal*

    rabbit*

    fresh white fish*

    soy milk, tofu

    carob

    lemonade

    decaffeinated coffee

    coffee, tea

    peppermint tea

    garlic

    shallots

    herbs

    vanilla

    arrowroot

    barley

    buckwheat

    cornflour

    malt

    rice, rice flour

    rolled oats

    rye

    wheat

    polenta

    honey

    maple syrup

    sunflower oil

    cashews (ref.12)

     

    If you want to drink alcohol for a special occasion your best choices would be gin, vodka or whisky as they don’t contain amines (although they can still cause a histamine reaction). You can drink them with soda or mineral water (but not lemon squash, tonic water or any other mixer). However, you really should avoid alcohol until your condition improves.

    Histamines may not be the initial cause of your rosacea but they usually play a role in exacerbating the problem. In a properly functioning body, the liver helps to safely remove histamines by a process called sulfation, and people with rosacea may have poor sulfation ability. When sulfation and other liver detoxification reactions are overburdened, histamine is not removed from the body fast enough and problems such as vasodilation may be the result.

     

    Amines and sulfation

    Sulfation in the liver sounds a bit confusing but whenever I explain liver detoxification I liken it to a horse race around a race track. Histamine is the race horse that is travelling along the blood vessels and it needs to be sternly guided to the finish line for safe removal from the body. Now histamine ‘race horses’ can’t find the finish line all by themselves — horses just aren’t that disciplined on their own — they need ‘jockeys’ to steer them in the right direction. In your body, sulphur is the jockey that can ride histamine horses safely to the finish line. When sulphur is available in the body, histamine is quickly removed from the blood stream, so only the appropriate amount of blood vessel dilation can occur.

     

    You can improve sulfation (and histamine removal from the bloodstream) by including sulphur-rich foods such as garlic, onion and cabbage in your diet. Sulphurcontaining amino acids (methionine, cysteine and taurine) are found in protein-rich foods such as chicken. All of the other detoxification pathways need support to take the burden off the sulfation pathway in the liver, so also take the other liver ‘jockeys’— omega-3, glycine, magnesium, B vitamins, selenium and vitamin C.

     

    • Poor sulfation (not enough jockeys) in the liver detoxification (race track) can

    make you more susceptible to environmental illness, rheumatoid arthritis and

    nervous system problems such as Parkinson’s disease and motor neuron disease.

     

    FAQ

    Q ‘I get awful facial flushing, especially in summer. What can I do to quickly relieve the flush?’

    A People with severe rosacea produce a lot of body heat so they feel hot and uncomfortable much of the time. If you are having a facial flush or experiencing excessive heat, try the following:

    • Suck on an ice cube.
    • Wet your skin with cold water or fill a plastic bag with ice cubes and hold next to

    the skin.

    • During a flush if you have no ice cubes or access to cold water, you can visualise

    bathing in a swimming pool filled with ice cubes. This works because studies

    have shown that the brain can’t tell the difference between what is real and

    what is vividly imagined.13 Picture bathing with ice cubes floating around you,

    even pretend to shiver and you will cool down in no time.

     

    FAQ

    Q ‘I have rosacea and my skin gets itchy all the time. Is there anything I can do to get some relief?’

    A If you’re feeling itchy try the following:

    • Fill a plastic bag with ice cubes and hold next to the skin.
    • Add 1⁄4 cup of bicarb of soda to a lukewarm bath and soak in it (refer to bath

    recipes on page 188).

    • Immediately after bathing, before the skin is totally dry, gently dab sensitive

    skin moisturiser or ointment on the affected areas.

    • Take a supplement containing quercetin and vitamin C (see step five).

     

    Step two: Exercise

    Exercise is essential for eliminating rosacea. I found this out the hard way ...

    My own personal experience is with mild rosacea. It wasn’t so bad because luckily I found a way to get rid of it before it had a chance to get worse. The first signs of rosacea began to appear twelve years ago; my chin was always red and I had to camouflage it with make-up, but my skin colour suddenly improved after I took dairy products out of my diet.

    I had a skin prick test and blood test for allergies and intolerances and modified my diet slightly so I enjoyed having a clear complexion for a while. However a few years later, even without having dairy in my diet, I started getting facial flushing.

    If the gas heater was on in winter I would flush. I was also overly sensitive to the summer heat and I couldn’t splash my face with warm water in the morning without my face being pink for the rest of the day. I also got patchy, red flushing during and after exercise. This was embarrassing so I used to apply make-up before going to the gym, just so I wouldn’t look like a blushing beetroot. Not that I ever exercised much! As I’ve mentioned before, I just never liked exercise; it always fatigued me and sometimes brought on cold and flu symptoms so I’d feel rotten for a whole week. However whenever I did stick to an exercise routine my rosacea would magically disappear. Then I would find another excuse to ditch the regime and my rosacea would soon return. So I did some extra research to see if this was a common reaction.

    The Rosacea Support Group website states that ‘Many rosaceans have noted that moderate (not strenuous) exercise seems to help alleviate their rosacea symptoms’.

    Other specialists have also said that many sufferers find the same success with exercise, which could be due to increased sympathetic constrictor tone to the facial blood vessels.15

    Other scientific reasons why exercise can improve rosacea:

    • Moderate exercise burns up the body’s lipid stores, which potentially leaves less fat available for the inflammatory response. However, excessive exercise, such as running a marathon, does the opposite and promotes inflammation in the body.(16)
    • Moderate exercise decreases blood levels of arachidonic acid (AA).17 AA from meat and dairy can be used to make inflammation in the body so it’s important to reduce AA levels by exercising and avoiding dairy if you suffer from rosacea.
    • Exercise enhances the amount of anti-inflammatory endorphins in the bloodstream.
    • Excess glucose in the blood can damage blood vessels and exercise reduces blood glucose levels.

    Regular exercise also improves blood circulation and good circulation is vital for healthy skin. An efficiently pumping circulatory system is necessary to carry nutrients and oxygen to your skin. If you have poor circulation, your skin literally becomes starved of nutrients because you are giving it an inadequate supply of essential fatty acids, antioxidants and oxygen.

     

    How does skin that is starved of nutrients survive?

    Think about it ... skin that lacks oxygen and nutrients will rot and die (as is the case with gangrene). So when your blood supply is sluggish or hampered in some way, the skin needs extra blood vessels to supply more nutrient-rich blood and it needs wider blood vessels to allow more flow with less effort.

    Poor circulation also means there is an inefficient removal of bodily wastes such as industrial toxins, pollution, dead cells and chemicals. Increased waste and skin cell turnover can cause the facial oil glands to become blocked and enlarged. This can eventually lead to nose and skin disfigurement seen in chronic rosacea.

     

    Exercise tips for rosacea

    • Initially when you exercise, you will get flushing and feel uncomfortable but bear with it as this reaction will eventually disappear.
    • If possible, exercise in air-conditioning or go swimming to avoid negative symptoms.
    • Exercise and sweat for at least fifteen minutes a day. However, keep your routines moderate and under one hour until your rosacea has cleared up.

    Step three: Promote good intestinal health

    Rosacea may also be exacerbated by poor gastrointestinal tract health and intestinal permeability. Ideally, your intestines should only allow tiny particles (that have been extracted from properly digested foods) to enter the bloodstream. These microscopic amino acids, glucose, vitamins, minerals and fatty acids are small enough to pass through a healthy gut wall while the larger particles stay in the intestines then pass through to the colon for removal in the faeces.

    But when the intestinal wall is unhealthy, it can develop larger than normal holes that allow the wrong-sized particles into your blood vessels. To get a clear idea of what I mean, picture that you’re in a kitchen, you’ve cooked some rice and you’re now using a strainer to drain the water from the rice. The rice ends up in the strainer and the liquid passes through. Imagine what would happen if the colander holes were too large: when you strained the rice, some of the grains would pass through—this is not ideal.

    When your gut lining is permeable, foreign particles pass though, enter your bloodstream and cause an immune system response. This basically means your body panics at the invasion and a cascade of histamines is released from your cells. And as you know, histamines cause blood vessel dilation.

    According to French researchers "Many dietary and hormonal factors are known to affect the severity of rosacea symptoms, several of which also modulate the activity of the enzyme intestinal alkaline phosphatase (IAP). The role of IAP in inhibiting an inflammatory response to intestinal bacteria suggests a mechanism by which intestinal pathologies may be linked to the skin inflammation characteristic of rosacea." (Journal abstract from ScienceDirect.)

    All rosacea sufferers should make sure they have good digestion and intestinal health. A probiotic supplement and chewing your food properly may help. See Chapter 3, ‘Guideline No. 1’, in The Healthy Skin Diet for more information.

     

    Step four: Take supplements that promote healthy blood flow

    These include natural antihistamine supplements (buffered vitamin C – magnesium ascorbate), omega-3 fish oil and chlorophyll.

     

    Vitamin C

    Vitamin C also has an antihistamine effect and is a well-known antioxidant.

    Dosage: Take 100mg of buffered vitamin C (magnesium ascorbate) twice a day

     

    Chlorophyll

    Chlorophyll is the green pigment in plants and chlorophyll supplements are useful for improving red blood cell health (such as Grants Liquid Chlorophyll or Swisse Double Strength Chlorophyll+ tablets – take 3-4 tablets daily). Read Chapter 3, ‘Guideline No. 1’, for more information as chlorophyll is an essential treatment specific for rosacea.

     

    Step six: Eat a healthy diet

    According to researchers from Florida, USA, "the belief that food aggravates rosacea has been accepted. Patients are counseled to avoid rosacea triggers and, thus, refrain from such items as spicy foods; alcoholic beverages; and hot, caffeinated drinks. The list of triggers can be more extensive and include fruits, marinated meats, and cheeses." (The Role of Diet in Acne and Rosacea article can be found here.)

    Remember to eat a healthy diet and limit your intake of amine-rich foods. If you are after a specific program with recipes, The Eczema Diet is a low-amine and low salicylate program with 80 recipes. Drink 1 ½ to 2 litres of filtered water daily.

     

    Aside from food, also remember to rest if you are feeling unwell. Relaxation and meditation may help as stress and tension can trigger facial flushing if you already have rosacea.

     

    Rosacea Treatment Plan: Key points to remember

    Limit histamines in your diet

    • Avoid alcohol, chocolate, cheese, oranges, spicy food and allergy foods.
    • Stress and anxiety also trigger histamine release so read Chapter 19, ‘Beauty breathing’ for effective relaxation techniques, or learn how to meditate.

    Exercise

    • Improve your circulation. Exercise for at least fifteen minutes every day, sweat

    and breathe deeply.

    • Exercise is the most essential step to improving your rosacea; without it, all

    other steps will only offer minor benefit.

    Promote good intestinal health

    • Take a probiotic supplement if necessary; chew your food properly; drink water.

    Take supplements that promote healthy blood flow

    • Take magnesium ascorbate (beffered vitamin C) and drink Green Water (chlorophyll)

    Eat a healthy diet

     

    This is an edited extract from The Healthy Skin Diet, Chapter 18 (Exisle Publishing).

     

    References
    Fischer, K., 2008, The Healthy Skin Diet, Chapter 18, Exisle Publishing, Australia.
    Whitehead, J. (2009). Intestinal alkaline phosphatase: the molecular link between rosacea and gastrointestinal disease?. Medical hypotheses, 73(6), 1019-1022.
    Keri, J. E., & Rosenblatt, A. E. (2008). The role of diet in acne and rosacea. J Clin Aesthet Dermatol, 1, 22-26.
    Powell, F. C. (2003). Rosacea. In European Handbook of Dermatological Treatments (pp. 467-473). Springer Berlin Heidelberg.