Dr. Wu published a paper in 2006 on treating rosacea with herbs. This paper highlighted the properties and potential rosacea treatment modalities of licorice, feverfew, green tea, oatmeal, lavender, chamomile, tea tree oil and camphor oil. This just published paper concentrates more on the anti-inflammatory properties of several natural products and reviews the evidence supporting their use in inflammatory skin conditions.

Many rosacea sufferers want to treat their symptoms with natural therapies. This pursuit can be tricky as many natural ingredients are not easily obtained in a useable form. In the end it is sometimes just down to using commercial preparations that contain the active ingredient – and hopefully at the same time no other potentially irritating components. Another option is to try natural ingredients using a homemade mix.

Colloidal Oatmeal

We know from a recent rosacea news article that colloidal oatmeal (Avena sativa) has interesting cleansing, moisturizing, buffering, soothing, protecting and anti-inflammatory properties.

This paper especially highlights one of the active phytochemicals found in colloidal oatmeal – avenanthramides. These have been shown to have strong anti-inflammatory effects. At a concentration of 3%, avanthramides have a similar effect to hydrocortisone 1%.

suggested products: Linda Sy Mild Oatmeal Facial Cleanser, aveeno anti-itch.

Feverfew

Feverfew (Tanacetum parthenium) has a long history as a natural medicine and has potent anti-inflammatory, antioxidant and anti-irritant properties.

One point that I didn’t pick up on when previously writing about aveeno ultra calming with feverfew is that feverfew contains parthenolides which are highly irritating. Thus if you are interested in trying feverfew topically, be sure to look for products that contain Feverfew PFE (Parthenolide-free extract) – such as Aveeno for eg..

Studies show that Feverfew PFE is able to reduce UV induced redness and is beneficial for individuals with sensitive skin; offering improvement in facial redness, blotchiness, overall irritation and the feeling of rough skin and shaving irritation.

The paper cites a 2005 AAD Poster session that states that feverfew has greater inhibitory effect compared to other botanical compounds including green, black and white tea, echinacea, licorice, chamomile and aloe vera by factors of 35 to 1000-fold.

I had missed noting the (7!) posters sessions in 2005 that dealt with Feverfew PFE, but did highlight a more recent session from the 2008 AAD meeting that targeted rosacea more directly ; see Facial tolerance of a feverfew-PFE containing daily moisturizer regimen in mild to moderate rosacea patient.

suggested products: aveeno ultra calming with feverfew

Licorice

The active ingredients in licorice are well known to rosacea sufferers, epescially since the Eucerin Redness Relief range was introduced by Beiersdorf.  The two main actives from licorice are glabridin and licochalcone A which both have anti-irritant and anti-inflammatory properties. The paper cites studies that show that a lotion containing licochalcone A showed improvements in facial redness for those with and without rosacea, shaving induced irritation and UV induced redness.

From Anti-inflammatory Herbs

The dose of licorice is 5 to 15 g daily of cut or powdered roots and should contain 200 to 600 mg of glycyrrhizin. Licorice use is contraindicated in patients with high blood pressure, cardiac diseases, or liver cirrhosis.

suggested products: eucerin redness relief.

Aloe Vera

The active ingredients of interest in Aloe Vera are salicyclic acid, magnesium lactate and gel polysaccharides. Typical properties include aloe vera’s anti-inflammatory, analgesic, antipruritic (see AAD: pruritus), wound healing and anti-oxidant effects.

In clinical trials a 0.5% aloe vera cream was found to statistically improve psoriatic plaques (a symptom of psoriasis) and in other case reports is was found to be effective in reducing burning itching, and scarring that resulted from radiation dermatitis.

suggested products: pure aloe vera gel kept in the refrigerator.

Chamomile

Chamomile is a member of the daisy family – Matricaria recutita. The paper mentions properties of the volatile oil of chamomile as being able to inhibit cyclooxygenase and lipoxeygenase as well as the flavonoids pigenin, luteolin and quercetin which inhibit histamine release.

Topical chamomile is mostly used for the treatment of atopic dermatitis and skin irritation. One study found that the anti-inflammatory effect of topical chamomile was approximately 60% as effective as 0.25% hydrocortisone.

From Anti-inflammatory Herbs

The recommended dose of Matricaria recutita flowers is 3 g three times daily; Matricaria is available as an infusion, a fluid extract, and a tincture (1:5). Allergic hypersensitivity to this herb may occur in rare cases, and the herb can irritate the eyes if applied near them

Turmeric

Circumin is the active compound in Turmeric, and is responsible for the yellow pigment. Circumin has anti-oxidant, anti-inflammatory and chemoprotective properties that means it is is suitable for topcial inflammatory conditions and wound healing. Sadly, even though circumin improves epithelialization and wound contraction, the colour and odour limits its applicability to topicals, especially those applied to the face.

From Anti-inflammatory Herbs

According to Commission E in Germany (the German authority on evaluating herbal preparations), the recommended dose is 1.5 to 3 g of cut root daily; preparations of Curcuma longa are infusion powders, tinctures (1:5), and fluid extracts. The use of curcumin is contraindicated in bile duct obstruction because it enhances the secretion of bile.

Finally, here is the abstract of the paper that inspired this article.

Anti-inflammatory ingredients, Wu J., J Drugs Dermatol. 2008 Jul;7(7 Suppl):s13-6., University of Southern California-Los Angeles, Los Angeles, CA, USA.

There is a growing public awareness and concern among individuals regarding the condition of their skin, with a concomitant desire to use natural products to treat skin conditions. The increased interest in these products has spurred scientific and clinical studies evaluating the composition and clinical usefulness of natural products in the treatment of inflammatory skin dermatoses.

There are numerous natural ingredients that have been demonstrated to possess anti-inflammatory properties that make formulations containing these ingredients attractive treatment options.

This article summarizes the active ingredients, anti-inflammatory properties, clinical effects, and therapeutic potential of colloidal oatmeal, feverfew, licorice, aloe vera, chamomile, and turmeric. Potential therapeutic indications include erythema induced by ultraviolet light, rosacea, atopic dermatitis, sensitive and irritated skin, drug-induced skin eruptions, and psoriasis. These products may be particularly well suited as alternatives to pharmacologic therapies in chronic conditions for which long-term use is required.

Over to you: what related products have you tried ? please leave us all a comment below.

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• golden chamomile
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• US Pharmacist: Anti-inflammatory Herbs discussed here.

Colloidal Oatmeal is a versatile and multi-functional compound. This paper details the history and chemistry of colloidal oatmeal and shows how its’ chemical polymorphism leads to many useful clinical properties. Of most interest to rosacea sufferers are the cleansing, moisturizing, buffering, soothing, protecting and anti-inflammatory properties. Colloidal Oatmeal may well be the dream ingredient for rosacea friendly products.

The following table summarizes the paper’s detailing of the components of colloidal oatmeal and the corresponding clinical benefits obtained.

Colloidal Oatmeal is defined as a product made from grinding and processing whole oat grain with strict requirements on the particle size and fat content. The small particle size and the way that it disperses in water means that when it deposits on the skin it forms an occlusive barrier.

The paper lists references to colloidal oatmeal being used as a therapy for swimmer’s itch, chickenpox, poison ivy, oak and sumac, insect bites, winter itch, atopic dermatitis, dry skin, allergic or irritant dermatitis, ichthyosis – as well as prickly heat, hives, sunburn and rashes.

Colloidal oatmeal: history, chemistry and clinical properties, J Drugs Dermatol. 2007 Feb;6(2):167-70, Kurtz ES, Wallo W., Johnson & Johnson Consumer Products Company, Scientific Affairs Department, Skillman, NJ 08558, USA.

Abstract: Oatmeal has been used for centuries as a soothing agent to relieve itch and irritation associated with various xerotic dermatoses. In 1945, a ready to use colloidal oatmeal, produced by finely grinding the oat and boiling it to extract the colloidal material, became available. Today, colloidal oatmeal is available in various dosage forms from powders for the bath to shampoos, shaving gels, and moisturizing creams. Currently, the use of colloidal oatmeal as a skin protectant is regulated by the U.S. Food and Drug Administration (FDA) according to the Over-The-Counter Final Monograph for Skin Protectant Drug Products issued in June 2003. Its preparation is also standardized by the United States Pharmacopeia.

…

Ellen S. Kurtz PhD and Warren Wallo are employees of Johnson & Johnson Consumer Companies, Inc, the manufacturer of Aveeno products. The preparation of this manuscript was sponsored in full by Johnson & Johnson Consumer Companies, Inc.

More Background and Links

Dr. Wu’s paper on treating rosacea with herbs had this to say about Oatmeal ;

The US Food and Drug Administration classifies colloidal oatmeal (the powder resulting from the grinding and processing of whole oat grain) as a skin protectant ingredient that “provides temporary skin protection and relieves minor skin irritation and itching due to poison oak, poison ivy, poison sumac, and insect bites.” The properties that make oatmeal useful for these itchy and allergic conditions, however, make it an especially efficacious ingredient for rosacea therapies

First, oatmeal is a potent antipruritic. The moisturizing properties of colloidal oatmeal alleviate itch due to dry skin. These properties, in turn, promote protection of barrier function, which is often impaired in rosacea patients. Oatmeal also works as a skin protectant and enhancer of barrier function as the proteins and polysaccharides bind to skin to provide a protective barrier, while proteins buffer both acids and bases.

Oatmeal has anti-inflammatory properties. A study by Saeed and associates reported that a 10% colloidal oatmeal suspension inhibited prostaglandin synthesis by as much as 85%. The magnitude of prostaglandin inhibition was similar to that reported with indomethacin.

Finally, oatmeal is an effective cleanser that contains saponins that absorb dirt, oil, and sebaceous secretions while hydrophilic and lipophilic components absorb and solubilize aqueous debris.

Dr. Linda Sy was inspired by rosacea support group members making their own cleansing masks with oatmeal and water. She wondered if she could use colloidal oatmeal as a basis for a gentle rosacea cleanser. An extra bonus would be that it could sop up flakes associated with seborrheic dermatitis. This cleanser is well liked by the members of rosacea support. I find it cleanses really well, but does leave a slight tight feeling – which can be relieved with a gentle moisturizer.

We also know that after as little as 1 week using a colloidal oatmeal lotion (containing colloidal oatmeal, oat extract, humectants and a skin protectant) patients can see relief from dry itchy or scaly skin.

Johnson & Johnson, who make the Aveeno (avena is latin for oats) and Active Naturals range of products has a page on Oatmeal from their Aveeno Professional Site.

Products

Tips: do you have any tips for Colloidal Oatmeal that you’d like to share ? please leave a comment below.

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This paper was sponsored by Johnson & Johnson, who make the Aveeno Active Naturals Ultra Calming range. J&J are attempting to target rosacea sufferers with their aveeno range that contains feverfew. Rosacea sufferers are difficult to target with cosmetics so it is encouraging to see large companies doing background research to create suitable products.

Poster Abstracts, American Academy of Dermatology 66th Annual Meeting, February 1–5, 2008, San Antonio, Texas. Supplement to the JAAD, Feb 2008, Volume 58, Number 2.

Poster Session P116, Facial tolerance of a feverfew-PFE containing daily moisturizer regimen in mild to moderate rosacea patients, Dara Miller, Johnson & Johnson Consumer & Personal Products Worldwide, Skillman, NJ, United States; Monya Sigler, PhD, Thomas J. Stephens & Associates, Inc., Carrollton, TX, United States; Warren Wallo, MS, Johnson & Johnson Consumer & Personal Products Worldwide, Skillman, NJ, United States

Rosacea is a disease that affects not only a patient’s physical appearance through the manifestation of erythema, telangiectasia, and rough skin, but it also has an effect on the emotional well-being of its sufferers, causing feelings of insecurity and embarrassment. Rosacea patients struggle to find daily skincare products that they can tolerate and that will not cause their symptoms to worsen. Feverfew-PFE (parthenolide-free extract) has been demonstrated through multiple in vitro and in vivo studies to reduce redness and irritation in sensitive skin patients, as well as calm and soothe the skin. A regimen of once a day use of a daily moisturizer with SPF 15 and a night moisturizer, both containing feverfew-PFE, was tested for its tolerance by patients with mild to moderate rosacea. A 4-week clinical study of a regimen of once daily application of a day moisturizer with SPF 15 and a night moisturizer was conducted on thirty female subjects with mild to moderate rosacea of subtype I (erythematotelangiectatic rosacea) or mild to moderate subtype II (papulopustular rosacea). Facial tolerance and product performance was assessed by investigator clinical evaluations and self-assessments at various time points over the course of the study. After 4 weeks of daily use of the feverfew-containing moisturizer regimen, study subjects exhibited statistically significant improvements versus baseline in their facial erythema, dryness, and roughness, as well as in the overall appearance of their skin as graded by the investigator. The investigator observed no statistically significant increases in facial irritation versus baseline. Study subjects did not perceive any significant increases in sensory irritation parameters, and self-assessments indicated that patients perceived improvements in their overall appearance and skin texture. In conclusion, a once a day regimen of a day and night moisturizer containing feverfew-PFE has been shown to be well tolerated by patients with mild to moderate rosacea and can be used to improve the overall appearance and texture of their skin.

Sponsored in full by Johnson & Johnson Consumer & Personal Products Worldwide.

Featured Products:

YOUR TURN: Some initial product reviews of the Aveeno Active Naturals are positive. Leave a comment below or discuss this product in the Moisturizers Forum at Rosacea Support.

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I had to cringe when I read this article – Golf for Women: First Annual Skin Care Awards. It promotes some fabulously expensive cosmetics. One would really hope that their exotic sounding ingredients actually work. Great to see that Aveeno Ultra-Calming Daily Moisturizer is in this list, and is only $14.

Dior L’Or De Vie La Crème ($320) has a very high concentration of Myobenol C, “an antioxidant that protects against UV rays and environmental stresses,” says Dr. Sadick. It’s extracted from the shoot of sauvignon grapevines.

Aveeno Ultra-Calming Daily Moisturizer SPF 15 ($14) “soothes tight, sunburnt skin and really improves my patients’ facial redness,” says Dr. Baumann. Feverfew, one of the ingredients, promises to prevent facial flushing and relieve acne.

Clinique CX Redness Relief Cream ($75) “is an effective, lightweight cream for rosacea sufferers,” says Dr. Airan. It contains caffeine, sucrose, tea extracts and algae to soothe red, blotchy skin.

Chanel Sublimage Essential Regenerating Cream ($350) “is rich, feels like liquid velvet on contact and smells wonderful,” says Dr. Pak. Vanilla Planifolia, its key ingredient, enhances skin tone and texture.

Kinerase Cream ($117) “contains the active ingredient kinetin, which locks in moisture,” says Dr. Waldorf. “It’s great as an under-eye cream, and the gentle formula is ideal for women with dry, sensitive skin.”

Editor’s Choice

Lancôme Platinéum Hydroxy-Calcium Re-Densifying & Strengthening Cream SPF 15 ($108) proves that calcium is good for more than bones. This cream contains hydroxy-calcium molecules to improve the skin’s strength.

Related Product:

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• Zia, ADERMA Septalibour, Clinique City Block, Ambre Solaire, Neutrogena Moisture Day Lotion Dermatological Formula

There is a lot of interest from rosacea sufferers in treating their rosacea with natural or herbal therapies and remedies. Many shy away from treatments like antibiotics and metrogel. So far the best collection of information about natural products I’ve found is a paper called Treatment of Rosacea with Herbal Ingredients. One of the herbs mentioned in that paper was Feverfew. Just to recap ;

From: treating rosacea with herbs

Feverfew (Tanacetum parthenium)

One of the primary active components of feverfew, parthenolide, inhibits serotonin release from platelets. Feverfew inhibits 5-lipoxygenase and cyclooxygenase, resulting in a reduction in human blood platelet aggregation.

In a recent study by Martin and associates, 45 days of treatment with 1% feverfew PFE (parthenolide-free extract) – Aveeno Daily Moisturizer Ultracalming, improved mild inflammatory acne by inhibiting the release of inflammatory markers from activated lymphocytes and reducing neutrophil chemotaxis. It is these immunomodulating properties that suggest feverfew PFE[TM] may be a useful treatment for rosacea.

Aveeno has released 3 products from their `Active Naturals Feverfew’ range ; Ultra-Calming Daily Moisturizer with SPF 15, Ultra-Calming Moisturizing Cream and Ultra-Calming Foaming Cleanser.

From: Active Naturals Feverfew

A calming and soothing solution for Sensitive Skin, Feverfew, a resilient flower related to chamomile, thrives in the harsh conditions of the Mediterranean mountain region. For centuries this hardy little flower has been cultivated for its medicinal value. AVEENO® scientists unlocked feverfew’s true potential by creating a unique way to process feverfew which retains the naturally active benefits of the ingredient to soothe and calm irritated skin.

Advancing the Science of Feverfew

Naturally calming feverfew found in AVEENO® is a patented skincare breakthrough and has been shown in preclinical testing to effectively deliver the broadest range of anti-oxidant and anti-inflammatory benefits compared with over 2,000 other natural ingredients. In addition to providing anti-oxidant activity, it calms and soothes compromised and assaulted skin. Feverfew is proven to reduce redness and irritation caused by internal and external aggressions.

From: ULTRA-CALMING DAILY MOISTURIZER WITH SPF 15

With naturally calming feverfew, a natural ingredient related to chamomile, this light, fast-absorbing moisturizer is clinically proven to visibly reduce facial redness and soothe irritation. It helps to actively manage dry, red uncomfortable skin. Ultra-Calming Daily Moisturizer also helps maintain healthy-looking skin and is shown in clinical studies to deliver visible skin improvements in as little as one week.

Use it daily to reduce redness, calm and soothe irritations, and diminish blotchiness for even-looking skin. It is gentle enough to use every day and safe enough for the most sensitive skin, even those with rosacea.

Additional Product Benefits Include: UVA/UVB sunscreens, oil-free, hypoallergenic, noncomedogenic

User Product Reviews:

mrsmcompton, on Aug 14, 2005 said:

A couple of weeks ago, I saw a comercial for Aveeno Ultra Calming Foaming Cleanser and it talked about removing the redness in your skin. Well, I have never really thought a lotion or cleanser would do anything for me, but decided I’d try this one and ohhhhhh am I so glad I did! In the first few days of using it, there was no change and I was discouraged, but by the end of the first week, I could see an amazing difference and didn’t need to even TRY to use the green cover stick. I used my normal make up and for the first time in a LONG time I didn’t see these big red cheeks staring back at me! I’m not saying this product will do miracles or even work for everyone, but it sure did help me! And for like 7 bucks at Walmart, it was sure worth a shot!

belcanto, on Mar 28, 2006, said:

I’ve been using Aveeno Ultra-Calming moiturizing cream. It seems to help a little, but it doesn’t moisturize quite enough at times. Others here have said that it made their redness worse, however.

Suedusty, on Jan 6, 2006 said:

I tried Aveeno Ultra Calming Moisturizing Cream on the right side of my face last evening. It caused my mildly red face to become bright red and very inflammed on the right side. I washed it off, put some zinc oxide on which calmed it down a bit.

polockhart, on Feb 4, 2007 said:

I have been trying both Aveeno and Eucerin lines of redness relief washes, sunscreens and moisturizers. So far I really like the Eucerin sensitive wash (have not broken into the Aveeno bottle yet), find the nighttime Eucerin fairly good, the Aveeno Ultra Calming Moisturizer with sunscreen (15) absolutely wonderful and the Ultra Calming Moisturizer really good. I just bought the Eucerin Sunscreen Moisturizer (30) but haven’t opened it yet. If I had to choose between the two brands, Aveeno would be the one. It can calm the worst redness very quickly, even if I have been out in the cold and wind and actually have swelling. It leaves my skin silky smooth.

ljclayer, on Dec 19, 2006 said:

Just wanted you all to know I have found a new cleanser (Aveeno Ultra Calming) that is working out well for me. I used to use Cetaphil Gentle Cleanser in a bottle but discovered (after using it for 3 years) that it does not remove the tinted Zinco. I had seen similar messages posted about Cetaphil, but I was hooked and did not think it did not remove my Zinco until I “cheated” and used an alcohol based toner a couple times and saw beige all over the cotton square. Yuk, made me wonder what else it did not take off or if it left too much stuff on my face…would that contribute to acne ? This Aveeno product is not drying and not oily and when I put it on my face it feels soothing.

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This study shows that a lotion based on colliodal oatmeal can really help those with dry itchy skin. After just 1 week, patients saw improvement in dryness, roughness, itchiness and scaling. Colloidal Oatmeal is also used in Linda Sy’s Mild Oatmeal Facial Cleanser and is well liked by many rosacea sufferers.

Alleviating itchy, extra dry skin with an oatmeal, skin protectant lotion, Judith Nebus, MBA, Warren Wallo, MS, Ellen Kurtz, PhD, Johnson & Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States

Maintaining stratum corneum function is important for proper skin hydration and for providing a protective environment against external aggressors. Colloidal oatmeal, humectants, and skin protectants are well-known ingredients used for proper skin care maintenance. These ingredients maintain the stratum corneum in various ways, by acting as occlusive agents, attracting water to the skin, or forming a protective barrier on the skin. Dry skin is more prevalent during the winter months but can persist all year, especially in areas of low humidity. When skin is extremely dry and irritated, there is excessive flaking of corneocytes and microfissures can occur in the stratum corneum, resulting in a high transepidermal water loss rate. At times skin can become so dry and irritated that there is an increase in mast cells and histamine levels causing chronic itch among patients.

A controlled clinical study was conducted to evaluate the effectiveness of a body lotion containing colloidal oatmeal, oat extract, humectants and a skin protectant in alleviating extra dry, itchy skin. Healthy female patients with chronic itch and extra dry skin on their lower legs were enrolled into the 2-week study. Patients applied the lotion to the lower leg area twice a day. Benefits of the lotion were assessed by clinical evaluations, instrumental measures, and self-assessments. Itch intensity was monitored daily through patient diaries.

Clinical evaluations demonstrated significant improvements (P < .05) in dryness, scaling, and skin roughness after only one 1-week use of the oatmeal, skin protectant lotion. In addition, adhesive skin samples showed a significant decrease (P < .05) in fine and coarse flaking. Transepidermal water loss values decreased over time. Most important, patients perceived significant improvements in itch intensity levels after only 1 week of use of the oatmeal, skin protectant lotion. This clinical study clearly demonstrated that this topical preparation containing oatmeal, oat extract, humectants, and a skin protectant was effective in both relieving itch and dry skin while improving stratum corneum function in patients with extra dry, itchy skin. Efficacy was demonstrated by clinical evaluations, instrumental methods, and patient itch diaries. This oatmeal, skin protectant lotion also was effective in restoring moisturization and textural benefits to the skin.

Author disclosure: All authors are employees of Johnson & Johnson Consumer Products Worldwide. 100% supported by Johnson & Johnson Consumer Products Worldwide.

Poster Discussion Session P508, American Academy of Dermatology, 64th Annual Meeting, March 3-7 2006, San Francisco.

Supplement to Journal of The American Academy of Dermatology, March 2006, Volume 54, Number 3.

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