For me acupuncture has always been part of some kind of ancient mythology. Humans are controlled by a brain that has complex neurological pathways to all corners of their bodies. Can inserting fine needles in to the so-called meridians along energy flows in these pathways help your rosacea ? If you are looking for hard evidence as proof, well then the answer to this question is plainly no.

A lot of intellectual effort has been invested in trying to obtain hard evidence that acupuncture is effective. Good evidence of the sort that is considered generally convincing has been hard to come by. My reading of the research suggests that the likely benefits of acupuncture can be attributed to the placebo effect and that you might also expect some relief from some forms of pain.

A trip around the online rosacea boards finds only a couple of relevant posts;

From The Rosacea Forum user: eastwest, 14 months of acupuncture;

It’s now been 14 months of regularly going to acupuncture and being on the herbal therapy. I have been very disciplined about all of this and have rarely missed a day of taking the herbs that the TCM doctor gives to me and rarely miss a week of acupuncture. When I started this, I was going to acupuncture twice a week and that lasted for 6 months (I think). After the 6 month point, I started going once a week.

My rosacea is now at the point where most days I can’t even feel having it. There is a tiny tinge of redness on the corners of my cheeks, but it’s very minor. My face is cool to the touch most of the time. I told the acupuncturist the other day that I am glad that I continue to get better all of the time but how it has been a bit frustrating that it has taken so long. She said that it took the body many many years to get into this state and because of that it will take some time to get balanced again. In my case it took about 35 years to get out of whack. She says that I have shown very very good patience and that I am doing very well for it.

From Rosacea Support Community: Re: acupuncture

i tried accupuncture for rosacea for about 8 mos & it really had no effect on the rosacea, but did improve my overall quality of life.

From Rosacea Support Community member: phlika29, Re: acupuncture

This is something I have tried. A few years ago I went to a number of sessions which did have quite a major effect both positive and negative. Negatives-during each session I had a major flush which really took it out of me. Positives- after the sessions my flushing would completely alter and tended to be confined to my nose. Long term effects were negligible for me and only lasted whilst I continued regular treatments. I stopped due to the intense flushing whilst the needles were in.

From Rosacea Support Community member: bubblensqueek, Re: acupuncture

My Chinese doctor said I need 12 once a week sessions and probably can go down to once every two weeks after that. An acupuncture treatment with her is always followed by accupressure. you should give it a try. Just make sure you find someone who knows what she/he is doing.

The following recently published paper teases us with a mention of rosacea. How indeed does acupuncture relate to modern dermatology ? This Rosacea News post was inspired by this abstract being published – the authors ask “what can we learn from the ancients with regard to their use of acupuncture as part of a holistic system of medicine, and how does this relate to the practice of modern dermatology?”

I hope that holistic medicine does have something to offer rosacea, but so far that benefit is elusive.

Acupuncture in dermatology: an historical perspective., Int J Dermatol. 2009 Jun;48(6):648-52, Tan EK, Millington GW, Levell NJ.

Classical acupuncture focuses primarily on treating the person, and secondarily treating the illness. The “symptoms” are regarded as “branch” expressions of a “root” (constitutional) imbalance. Different root imbalances can produce the same symptoms. Five patients with eczema, for example, may reveal five distinct root imbalances and would all be treated very differently. Because acupuncture treats the whole person, it has something to offer almost every condition. In many cases, acupuncture aims to bring about a complete cure; in others, it aims to manage the problem.

Acupuncture remains a substantial part of the traditional Chinese medicine, which is used to treat many conditions including acne, alopecia, dermatitis, pruritus, psoriasis, rosacea, systemic lupus erythematosus, urticaria, herpes zoster, chicken pox, impetigo, leprosy, vitiligo, and tinea.

This review introduces the historical context of acupuncture within Chinese medicine and how it relates to skin disease. Specifically, a key question is, what can we learn from the ancients with regard to their use of acupuncture as part of a holistic system of medicine, and how does this relate to the practice of modern dermatology?

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A few newspapers have picked up this Question & Answer article where rosacea sufferers are encouraged to try Epsom salts (magnesium sulfate) or Milk of Magnesia on their skin.

One can imagine that a bath with Epsom salts would be relaxing, but I’m not sure that it is a reliable rosacea treatment per se. One possible reason for any benefits might be the presence of sulfur in the form of the sulfate.

Milk of magnesia is a mildly alkaline suspension of magnesium hydroxide and has been known to be used topically for canker sores. Other `folk’ usage of topical milk of magnesia is for acne, seborrheic dermatitis, and oily skin.

Might there be something real in using these kind of easily available products topically ? That would be a great result for those looking for cheap treatments !

People’s Pharmacy

By Joe and Teresa Graedon

COLUMNISTS

Q. I read about using milk of magnesia for treating acne. My skin condition is called rosacea. It is a painfully embarrassing problem, and no one seems to know what causes it or how to cure it. (W.C. Fields was the most famous rosacea victim, and people sometimes assume a red nose is a result of drinking too much.)

The pharmaceutical products my dermatologist prescribed failed to clear up my red bumps. So I tried magnesium sulfate in the form of a warm compress soaked in an Epsom-salts solution. This worked beautifully, but nobody is making the rounds telling dermatologists about it.

A. Magnesium sulfate (Epsom salts) is an old-fashioned multipurpose remedy that is sold as a laxative and muscle soak. Why it might work for rosacea is a mystery, but some readers have gotten relief from their redness and breakouts with topical milk of magnesia (magnesium hydroxide).

Here is one testimonial: “I’m 52, and my acne (actually rosacea) is related to menopausal hormone changes. Since my mid-40s, I’ve tried many different prescription and OTC treatments. I like milk of magnesia the best, and it’s by far the least expensive. I put MoM on my face at bedtime, and by morning my skin looks better.”

User Comments

From LoisAnne on Sun May 10, 2009, Anyone ever had this experience? My derm’s wife has rosacea and he laughs and says that she claims milk of magnesia works best for her! I told him he should check out this forum and see what people are doing for rosacea. (and I am also going to try Milk of Magnesia) Oh….on the face, not internally!

From Strive, 4th May 2008, Milk of Magnesia or magnesium hydroxide. Several years ago I read that this is a good mask for folks with acne, etc. I think the information might have been in the Paula Begoun book. Recently, I came across a bottle in my closet and have been experimenting with it overnight with some pretty good results. Maybe it’s just the absorption of oil that is helping, since I also have seb derm. Some people apparently keep it on briefly before washing it off. Has anyone else tried it?

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We are seeing more and more newspaper health and beauty articles that relate to rosacea. Today the UK’s MailOnline has an intriguingly titled article – How waggling my feet has helped my red face. To save you the effort of reading all the way to the end, the feet waggling refers to an exercise the acupuncturist suggests “waggling them slowly up and down at the ankle for three minutes night and morning, to move the heat around my body.”

The article’s author Maggie Alderson lists a few treatments that she has settled on to get relief from her rosacea symptoms.

“The less I do to my face and the purer the gunk I don’t do it with, the better.”

“I left with a prescription for oral antibiotics, which he said were the only thing that would help.

As I’d rather have a sore, red face than take antibiotics on an open-ended schedule, I was no further ahead.”

It seems like Ms Alderson’s current regime can be summarise thus;

• I just use Liz Earle’s Superskin Moisturiser, which is the only one that seems to counteract the tissue paper dryness.
• Apart from this there are three things that seem to keep my pizza face – as we call it in the family – under relative control. The most radical is acupuncture. She has also prescribed foot exercises, waggling them slowly up and down at the ankle for three minutes night and morning, to move the heat around my body.
• Now I use an overpriced SPF15 tinted moisturiser under my foundation – and wear a hat. You feel like a plonker, but it’s not as embarrassing as having a face like a baboon’s bum.
• The final weapon in my rosacea armoury is yoga. It’s the one thing that makes me really relax and I find that between classes, it helps to keep life’s general anxiety level down.

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Natural Remedies for Rosacea?

The roles of complementary and alternative medications in the management of rosacea have yet to be established, so it’s hard to offer any “natural” remedies for the condition. Cucumber was mentioned as early as 1649 as a treatment for facial redness in a text on herbal remedies by Nicholas Culpepper, an English botanist and physician, but cucumber has not been studied scientifically. Some rosacea sufferers, especially those prone to frequent flushing, report benefit from relaxation and stress management techniques.

Self-care and dietary measures may also aid in the management of rosacea, but there are different forms of the disease, and each may require different treatments.

It is great to see more and more articles on rosacea in a publication like the New York Times. It is also encouraging that they have access to the best minds in rosacea research and treatment. Having said that, it is a bit discouraging to find an unsatisfying answer to such an important question. Surely there are good natural rosacea treatments out there somewhere ?

We do know that in this year’s AAD meeting in SFO, one presenter Dr. Downie suggested that natural ingredients do have a role in the treatment of rosacea. Dr. Downie suggested feverfew, green tea and licorice as worth investigating.

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This post-treatment therapy is in addition to some other recently published research that patients treated immediately after IPL with a LED device showed that their post-treatment redness subsided faster compared to not also being treated with LED.

We also know that 2% polyphenone in a hydrophilic cream has shown promise as a treatment for the papules and pustules of rosacea.

Topical polyphenolic antioxidants reduce the adverse effects of intense pulsed light therapy, J Cosmet Laser Ther. 2009 May 27:1-4, Freedman BM., Plastic Surgery Associates of Northern Virginia, McLean, Virginia, USA.

Background: Intense pulsed light therapy (IPL) has been associated with erythema and increased lipid peroxidation. Polyphenolic antioxidants have been shown to decrease inflammation and reduce oxidative stress in irradiated skin.

Objective: To determine whether the topical application of polyphenolic antioxidants to IPL-treated skin reduced the adverse effects of IPL exposure.

Methods: In a split-face study, 10 volunteers underwent three full-face IPL treatments (16 J/cm(2), 10ms, 560nm filter) spaced 3 weeks apart. A polyphenolic antioxidant solution was pneumatically applied to the left side of the face, beginning immediately before the first IPL treatment then weekly for six treatments. The lipid peroxide concentration, skin antioxidant level and skin moisture content were obtained before and after the study.

Results: Skin treated with IPL alone contained a significantly higher concentration of lipid peroxides when compared to skin treated with IPL plus polyphenolic antioxidants (p<0.05). Skin treated with IPL alone contained a significantly lower level of polyphenolic antioxidants and had a significantly lower moisture content (p<0.05).

Conclusions: In this study, the concurrent pneumatic topical application of polyphenolic antioxidants reduced lipid peroxidation and skin dehydration in IPL-treated skin. Polyphenolic antioxidants may confer a protective effect on facial skin and enhance the effects of IPL therapy.

Featured Product

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Many of these ingredients are already present in commercially available products. Rosacea sufferers can only benefit from more research into compatible ingredients and more choice in off the shelf preparations.

SYM S048, Treatment of Acne and Rosacea in Ethnic Patients, Jeanine B. Downie, M.D., FAAD, Director, image Dermatology P.C., Assistant Attending Mountainside and Overlook Hospitals, Montclair, New Jersey.

Disclosures: Johnson & Johnson, Allergan (Shareholder), Medicis, Galderma, Novartis, Intendis, Skin Medica, Stiefel, Merz.

Slide 14: Feverfew

• A number of the composite family
• Inhibits 5-lipoxygenase and cycloxygenase
• This results in a reduction in human blood platelet aggregation
• Inhibits release of the inflammatory markers from activated lymphocytes and reduces neutrophil chemotaxis
• As feverfew has immunomodulating properties, it may be a useful treatment for rosacea

(Baumann, LS. Dermatol. Therapy. 2007; 20: 330-342).

Slide 15: Green Tea

• The derivatives are epicatechin, epigallocatechin, epicatectin-3- gallate
• They possess well documented anticarcinogenic properties, anti-inflammatory and antioxidant capabilities
• Is photoprotective
• Reduces disruption of the skin barrier

(Baumann, LS. Dermatol Therapy. 2007; 330-342).

Slide 16: Licorice

• Glycyrrhizin-is one of the main ingredients in licorice
• It reduces inflammation, promotes mucous secretion, soothes irritation and stimulates adrenal gland activity
• The anti-inflammatory properties are due to the inhibition of superoxide anion production and cyclooxygenase activity
• It decreases erythema, edema and itching in statistically significant amounts

(Baumann, LS. Dermatol Therapy. 2007; 330-342).

Another good place to start reading about these  complementary `naturally based’ therapies is the page treating rosacea with herbs.

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• Naturopathic Teatments for Rosacea

What are the best known naturopathic treatments for rosacea, and how well have they been shown to work ? Naturopathy is a medical philosophy that tries to improve our health by helping the body’s own ability to recover from illness and injury.

Those who practice naturopathic medicine promote a holistic approach to health and would steer away from synthetic treatments such as antibiotics and metronidazole for example.

If you ever wanted to get to the bottom of the mumbo jumbo that sometimes surrounds naturopathic treatments, then read on.

Herbs

There are now several products on the market to treat rosacea that promote their genesis in natural products. Additionally it may be possible to use some herbs in their natural form. Some of the commercially available products include the Aveeno Ultra Calming range that contains feverfew, and the Eucerin Redness Relief range that contains Licochalcone A, an extract of licorice. One other `naturally based’ topical worth considering is Rosacure which contains MSM and silymarin (Lady Thistle Extract). Although not a herb, colloidal oatmeal containing products from Aveeno are also based on a natural ingredients and my be useful in treating the itch of rosacea.

One herb that stands out (in theory at least) for me is arnica montana. This herb does have a long history of being used to treat swelling and bruising. If this can be extended to include the inflammation of rosacea then arnica might be worth exploring further. One other interesting approach is the Califlora and aloe vera based anti flushing protocol to control angiogenesis between IPL treatments.

It seems to me that products that are sourced from natural ingredients, that also have been tested and developed into commercial products, and are easily available; hold a lot of promise for rosacea sufferers.

Acupuncture

Although acupuncture has been a subject of active research since the late 20th century, accupuncture’s effects are not well understood. It is considered safe when administered by well trained practitioners using sterile needles, but probably like most of these sorts of therapies, needs more research.

See the following acupuncture thread over at the Rosacea Support Community for thoughts from other rosacea sufferers. It seems that acupuncture may be good for overall health, help you relax and might just help you cope with rosacea. Another thread at The Rosacea Forum from a member’s acupuncture trial is also worth reading, although there doesn’t seem to be a conclusion just yet.

Aromatherapy

Aromatherapy uses what are called essential oils and other aromatic compounds to affect one’s mood or health. Note that the `essential’ in essential oils only refers to the oils being concentrated from the plant they were extracted from. Thus the usage of `essential’ here should not be confused with uses of the term such as essential fatty acids for example.

According to wikipedia, the scientific evidence for aromatherapy is weak and could only be considered as mildly encouraging for a limited set of possible uses. Proponents of aromatherapy suggest that there are 2 main ways that the therapy works; firstly by the influence of the aroma on the brain, and secondly by the pharmacological effects of the essential oils.

Unlike acupuncture, aromatherapy is considered a largely Western treatment regime. The delivery of aromatherapy can be via aerial diffusion, inhalation or directly on the body. Many of the potentially interesting essential oils, like lavender oil, eucalyptus oil for eg. may also be useful as a topical treatment in their own right.

As aromatherapy preparations are often concentrated, dilution with a suitable solvent would be advised.

Homeopathy

Does homeopathy rise about the mumbo jumbo sounding statement of `treating like with like’ ?  Can it offer something useful for rosacea sufferers ? While the formal description of homeopathy; “an ill person can be treated using a substance that can produce, in a healthy person, symptoms similar to those of the illness” doesn’t sound too bad, sadly the research has never been able to escape the placebo effect. When you consider that many homeopathic remedies are diluted such that the active ingredient is undetectable in the diluent, it isn’t surprising that any benefits are hard to prove.

What about the Placebo Effect ?

For those not familiar with the placebo effect, it might be worth exploring that further here. When a new medication is trialled, researchers need to prove the efficacy of the medication when compared to placebo. The mind is a powerful influence in any treatment, especially when the patient has an expectation of improving. When trialists expect that they are receiving the active ingredient, but are only receiving the inactive placebo, and do perceive a benefit – this benefit is known as the placebo effect. Thus a blind study is more convincing; where trialists do not know if they are receiving an active ingredient, and the response can be measured objectively.

There are several theories about why the placebo effect exists. A disease may have its own natural cycle, or some people may be predisposed to the power of suggestion.

Despite being hard to prove, homeopathy is one of the most wide spread non conventional treatment approaches alongside Chinese medicine, herbal medicine and osteopathy.

There is a lot of discussion about the merits of homeopathy as treatment regime. One robust criticism of the whole approach that is worth a read Quackwatch: Homeopathy The Ultimate Fake. The author, Stephen Barrett, M.D. asserts that the FDA has not held homeopathic products to the same standards as other drugs and that at best the remedies are just placebos.

Nutrition

We all of course know that what we eat influences our health. Just how much does diet affect our rosacea though ?

Some foods are known to be common rosacea triggers. It can be quite complicated to understand one’s own allergies and food intolerances, especially if there are rosacea flareups related to intake of unknown foods. One good source for further reading is the resource page Dietary Influence.

Beyond some directly traceable intolerance to a particular food, what about a particular style of diet ? Rosacea Diets have been around for several years. Can avoiding processed foods or eating an alkaline diet help your rosacea ? Anecdotal reports suggest that this may be the case.

One paper that looks to be heading an an interesting direction is summarised here; could rosacea be caused by diet ?

Pursuing a whole foods, plant-based diet is also something worth considering when thinking about your general health and longevity. My belief is that we would all benefit from seeking the advice of a dietician for our rosacea and indeed for our general health and wellbeing. With so many chronic diseases having links to diet, it makes good sense to explore good nutrition with a dietician.

Physical Therapies

This sort of therapy includes hydrotherapy, physiotherapy, sports medicine and soft tissue manipulative therapy. While it might be hard to imagine how physical therapies can help rosacea, they may well improve your quality of life. We also know that moderate exercise may help your rosacea.

Psychological Counselling

There has been little direct research between the effects of stress and rosacea. It appears that emotional flushing in rosacea sufferers may be maintained by a combination of both cognitive and physiological factors. What comes first though ? does stress  make rosacea worse, or does rosacea induce its own stress, and feed off itself.

While we wait for more research, those who do suffer from anxiety or depression will likely benefit from meditation, relaxation, and stress management.

Another result from some recent research linking rosacea and flushing found that `The stress and fear of blushing can be mitigated by psychological intervention such as Cognitive Behavioural Therapy and Task Concentration Training.’ These are 2 more options that may be worth exploring to help rosacea sufferers copy with flushing and anxiety.

Over to you.

OK, so I have tried my best to outline the depth of naturopathic treatments and frame them with some relevance to treating rosacea. What successes can you report ? Do these sorts of treatments hold much promise for rosacea sufferers ?

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Vitamins A,C, E & B3 are found naturally in the skin and have been shown to have potent anti-inflammatory and anti-oxidant properties. They can be depleted by sunlight, smoking, pollution and other free radical stress. The number of products containing these vitamins has ballooned in recent years. Read on to see how the theory and background of these Vitamins might be good for you.

Vitamin E

Also known as alpha-tocopherol, Vitamin E is found in fresh vegetables, vegetable oils, cereals and nuts. The term Vitamin E is used to describe 8 naturally occurring molecules. The activity of these compounds is measured in terms of alpha-tocopherol equivalents. Vitamin E has been shown to be useful in photoprotection, atopic dermatitis and skin protection.

There is evidence to suggest that vitamin E is the most important physiologic barrier anti-oxidant in the stratum corneum – i.e. in the part of the skin that protects you from the elements, Vitamin E is thought to be the critical anti-oxidant agent. Topical Vitamin E can restore the levels in the skin that can become depleted due to the oxidative stress of the sun and other environmental insults.

This page from Paula Begoun seems to be pretty comprehensive about Vitamin E.

“A sampling of its substantiated capabilities when applied topically includes:

• Protects the epidermis from early stages of ultraviolet light damage
• Increases the efficacy of active sunscreen ingredients
• Reduces the formation of free radicals upon skin exposure to UVA rays and other sources of skin stress
• Prevents the peroxidation of fats, a leading source of cell membrane damage in the body
• Reduces transepidermal water loss from skin and strengthens the skin’s barrier function
• Protects the skin barrier’s oil (lipid) balance during the cleansing process
• Reduces the severity of sunburn
• Skin absorbs and maintains levels of topical vitamin E, prolonging its benefits between applications”

Vitamin C

Because humans lack the enzyme to produce Vitamin C (L-ascorbic acid), we need dietary sources to obtain it. Citrus fruits and leafy green vegetables are good sources. Topically, Vitamin C has potent anti-inflammatory and antioxidant properties and indeed acts synergistically to restore the regenerative effects of Vitamin E. Thus Vitamin E and Vitamin C are often combined in topical preparations.

Vitamin C is used to as a treatment and to prevent photodamage, photoagine, hyperpigmentation and redness.

Studies have shown that Vitamin C and Vitamin E together have greater benefits compare to when used alone. Adding ferulic acid was also found to further double the photoprotective effect of the two Vitamins.

Retinol (Vitamin A)

Retinol is the naturally occuring form of Vitamin A and can easily penetrate the epidermis.

The biologic properties of retinoids include “antioxidant activity (via free radical scavenging), increased fibroblast proliferation, modulation of cellular differentiation and proliferation, increased collagen and hyaluronate, and decreased matrix metalloproteinase-mediated extracellular matrix degradation”.

Topical retinol has been found to be effect for treating photoaging – showing improvements in facial wrinkles and fine lines.

Unfortunately some rosacea sufferers have found topical Vitamin A derivatives to be too harsh for their sensitive skin.

Cherie Detrie, M.D., director of cosmetic dermatology at the University of Pennsylvania in Radnor, has said  “retinaldehyde offers rosacea patients who may have sensitive skin the benefits of retinoids with fewer side effects.”. A 1999 study found that that “retinaldehyde has beneficial effects on the vascular component of rosacea.”

"Niacinamide / Niacin / Vitamin B3

The term Vitamin B3 is used to describe both niacinamide and nicotinic acid (niacin). Niacinamide is found in meat, fish and wheat. Niacinamide has anti-inflammatory and skin-lightening properties and can decrease the production of sebum. Topical niacinamide can be used to treat dry skin, acne, photoaging, blistering, pigment disorders and would healing.

One study looked at the topical usage of 1-methylnicotinamide (MNA) 0.25% in treating rosacea. The response was good in 26% of patients and moderate in 50% of patients. Varying results have been discovered when assessing the effect of topical 2% niacinamide on sebum excretion and sebum levels in Japanese and white subjects.

A 2005 study found that Niacinamide – Containing Facial Moisturizer Improves Skin Barrier and Benefits Subjects With Rosacea. Also note that the formulation of 1% metrogel also contains niacinamide. A 2007 study also found that niacinamide and kinetin in combination worked well to provide anti-aging effects for asian skin.

If you are considering taking a B complex vitamin supplement, Dr. Sy warns us to avoid one that contains Niacin as that can cause flushing. Niacinamide is fine.

The Abstract

Following is the abstract and summary that motivated this article.

Topical vitamins, J Drugs Dermatol. 2008 Jul;7(7 Suppl):s2-6., Burgess C. ,The Center for Dermatology and Dermatologic Surgery, Washington, DC, USA.

Vitamins are a natural constituent of human skin and are part of a system of antioxidants that protect the skin from oxidative stress. There has been an increased interest in the use of natural antioxidants such as vitamins to help restore dermal antioxidant activity. Vitamins A, C, E, and B3 have been shown to have potent antioxidant and anti-inflammatory properties, but to achieve optimal effectiveness, products must be delivered in appropriate formulations. Products containing alpha-tocopherol (vitamin E), L-ascorbic acid (vitamin C), retinol (vitamin A), and niacinamide (vitamin B3), are effective for the treatment of photoaging. These compounds have also shown effectiveness in the treatment of inflammatory dermatoses, acne, and pigmentation disorders and wound healing. There is emerging evidence that combinations of vitamins have additive effects that provide enhanced efficacy compared with individual compounds.

Summary: Substantial data suggest that topical vitamins such as vitamin E, vitamin C, retinol, and niacinamide have beneficial effects on the skin including photoprotection, and protection from photoaging and inflammatory dermatoses. For effective dermal penetration and maximal therapeutic efficacy, stable product formulations are required. Although these products have substantial activity when used individually, it also appears that combinations of these compounds have promising additive effects.

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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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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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