Candida (usually, C. albicans) is, as you know, a yeast. Yeasts are fungi, and to kill or control fungi you need an antifungal. Antibiotics do not kill yeast–in fact, they can at least indirectly promote their growth!

In other words, killing all sorts of bacteria, both good and bad, with the use of a broad spectrum antibiotic often “makes room” for the growth of yeasts like C. albicans.

That’s why it is always a good idea to take probiotics when you are taking an antibiotic (if not an antifungal), so that, to the extent you can, you do not enable the overgrowth of other organisms, like C. albicans.

Anyway, yes, it’s a good idea to stay away from sugars and simple carbs that easily break down into sugars. There is way too much of both in the modern diet. I doubt, however, that there is that much of a connection with rosacea, at least in my case, as I limit my intake of sugar and processed foods, and have for years.

Looking at the studies, ingesting it apparently increases the levels of the anti-inflammatory cytokine known as interleukin-10. (Whatever the heck that is.)

I have to find my lab coat, polish my glasses and paste on a pointy little beard in order to quote the following, so hold on a minute….

Ahem: “Rifaximin increases the expression of PXR and PXR-regulated genes involved in the metabolism and excretion of xenobiotics and antagonizes the effects of TNFα in intestinal epithelial cells.”

That’s from a December 2010 paper published in Biological Pharmacology, entitled “Pregnane-X-receptor mediates the anti-inflammatory activities of rifaximin on detoxification pathways in intestinal epithelial cells.”

Obviously, the quoted bit means f-all to most, including yours truly.

Nevertheless, the take-away is pretty clear: rifaximin interrupts the inflammatory processes that lead to typical rosacea symptoms. Hence its effectiveness, at least so long as you are taking it, and perhaps for awhile afterwards.

What causes the inflammation in the first place, to ask the big-money question?

Who knows. Probably numerous things, which are different for different people.

Me, I don’t know what I might be doing (if anything) that is causation linked. I think I’ll start by eliminating all the surmised possibles from my diet (including the usual “triggers”) and if the symptoms subside, I’ll start adding things back in, one at a time. (And if it doesn’t subside, at least I’ll know that diet isn’t a likely contributor to the problem.)

So goodbye, wine and spirits. Goodbye, all simple carbs, grains and gluten. Goodbye, hot peppers. Goodbye, hot soup. Been nice knowin’ ya.

Seriously, I always thought demodex mites were merely a(nother) symptom, not a cause, and I’ve never tried treating for them.

Causation seems unlikely to me, but stranger things are no doubt true.

Pete H

I am a mid-50′s, fair-skinned US male who has had type-II rosacea since at least his 20′s.

Through most of that time I have also suffered from acne vulgaris, which kept the rosacea from being diagnosed until telangiactases began to appear late in my 30s. I went through a course of accutane in my late 20s for my “regular acne,” which totally ceased being a problem for me only a couple of years ago. (I no longer get blackheads–just the papules and pustules of rosacea. I’d gladly trade one problem for the other, thank you very much.) I also have seborrhea, mainly in the eyebrows, which tends to be worst in the winter. Otherwise, my health is very good–I exercise regularly, eat well, etc.–although fairly minor, non-specific intestinal issues bother me on occasion (low-level nausea, looser than normal stools, etc.) I am probably a bit lactose intolerant, and stay away from milk products most of the time.

As for other rosacea treatments, not one of the typically-prescribed topicals (like metronidazole, azelaic acid, etc.) or oral tetracyclines (like doxycycline) work, period. The only things that do work–but only while taking them–are macrolides like azithromycin, and, of all things antibiotic, amoxicillin. (For me, amoxy works like a charm.)

OK. I took a hydrogen breath test, which I got after sending my GP the 2008 Italian study. It came back mildly positive for SIBO.

My doctor then prescribed Xifaxan 1200 mg/day for 10 days, just as in the study.

Immediately before starting the Xifaxan, I had finished a course of Amoxicillin, so I was clear to start. (After completing a course of Amoxy, the rosacea papules always reappear within a couple of days.)

Well, while taking the Xifaxan, I remained totally clear, until the ninth day of treatment, when one solitary papule appeared near my upper lip.

Unfortunately, that one uninvited guest was soon joined by scores of others for the usual party, all within three days of finishing the scrip. I am now nine days out from completing the treatment, and it is as if I never took it.

I was hoping for at least a few months of respite, but it was simply not to be.

My experience suggests the following, at least to me: given that the body plan of all life forms from planaria to humans is the same (a hollow tube), the skin and the gut are one and the same, just differently placed, and what affects one will likely also affect the other. This may help explain why Rifaximin works on rosacea, regardless of its not being adsorbed into the bloodstream. Rifaximin has anti-inflammatory characteristics, just like other antibiotics. No great surprise then, that it works at least to some extent on the symptoms of the condition.

It’s back to square one for me. Given that the etiology of rosacea is doubtless multifactorial, don’t let my story keep you from trying Rifaximin as a long-term prophylactic, if not a cure. It might work for you. Just don’t be too disappointed if it doesn’t, or doesn’t work beyond the time you take it.

You did not say if it helped with the GI problem or the face?? I will be seeing my GI Dr on Thursday with the lit in hand to show him. I have had the GI problems since my colon surgery about 4 or 5 yrs. I have Ocluar Rosacea, inflamed eyes and eye lids for around 5 mo. I am hoping to try xifaxamine to see if it will help both. Thanks, Fern

It just goes to show you that not everyone’s Rosacea has the same cause(s)…