SIBO Eradication Clears Rosacea (Rifaximin/Xifaxan): are you serious ?

This sort of abstract just make me shake my head. If you read quickly you will think that this abstract suggests that Small Intestinal Bacterial Overgrowth (SIBO) causes rosacea.

What this abstract is saying that is that rosacea sufferers seem to have a higher incidence of SIBO than non rosacea sufferers. The secondary result is that eliminating SIBO clears rosacea.

Well that is no surprise ! Antibiotics interrupt the inflammatory pathway that causes the papules and pustules of rosacea. We all know that.

What would be interesting to explore further would be what causes the SIBO. Could that cause point back to something triggering papules and pustules ?

If you view the AbstractPlus you will see that SIBO has been linked by the same team to Scleroderma, abnormalities in acromegaly, and IBS.

Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of Its Eradication,

Clin Gastroenterol Hepatol. 2008 May 2, Parodi A, Paolino S, Greco A, Drago F, Mansi C, Rebora A, Parodi AU, Savarino V.

Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy.


CONCLUSIONS: This study demonstrated that rosacea patients have a significantly higher SIBO prevalence than controls.

Moreover, eradication of SIBO induced an almost complete regression of their cutaneous lesions and maintained this excellent result for at least 9 months.

Extended Conclusion:

(continues) In fact in 78% of our patients, skin lesions fully cleared an in 17.7% improved greatly 1 month after interrupting rifaximin therapy.

Moreover, all rosacea patients who remained unchanged with placebo treatment and were switched to the antibiotic arm showed the same dramatic improvement of their lesions.

Last, rosacea was kept in remission in 96% patients followed for at least 9 months, and this remarkable finding contrasts with the frequent relapse observed with th traditional therapies.


How SIBO might lead to skin lesions is unclear.

However, other associations between SIBO and extraintestinal diseases, such as fibromyalgia and NASH, have an unclear pathogenesis.

The clearance of cutaneous lesions in almost all rosacea patients after its eradication strongly suggests that SIBO plays a significant pathogenetic role in rosacea, especially in its papulopustular component.

Although the underlying mechanisms linking SIBO to the cutaneous lesions of rosacea need to be elucidated, we believe that our findings represent paramount progress in the clinical management of those frustrated patients.

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[Update]: there is a thread over a the forum SIBO diet/treatment, where Artist mentions that Rifaximin doesn’t leave the gut so doesn’t directly have any systemic effect on the skin. This leads to the question of what inflammation has it stopped or pathway has it blocked and what can we prove that this means ? How might that be related to digestion in general and rosacea specifically ?

On a related note Seth Kendall speculates in his paper Remission of rosacea induced by reduction of gut transit time, that

“It is possible that intestinal bacteria are capable of plasma kallikrein–kinin activation and that flushing symptoms and the development of other characteristic features of rosacea result from frequent episodes of neurogenic inflammation caused by bradykinin-induced hypersensitization of facial afferent neurones.”

[Update 2]: I have a scanned copy of the Clin Gastroenterol Hepatol paper. If you would like to read it, please email me –

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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113 Reader Comments

  1. Irene Fletcher says:

    I am a believer about disease beginning in the mouth after having these two teeth extracted and I feel so much better now. I have developed Type II Diabetes in the last 4 years and probably did have it earlier than that but wasn’t diagnosed. The Rosacea preceded the diabetes. Remember that Type II starts with severe bouts of hypoglycemia so be sure to watch that. I have two first cousins that now have been diagnosed with Type II when they went to the Dr. with symptoms of hypoglycemia. They are both quite thin and I was as well in the beginning of it. When blood sugar is too high it does cause the rosy cheeks to show up, because you get really warm is why and start to sweat.

  2. Maureen says:

    I am in total agreement with you about any forms of sugar,rather it be breads bagels white sugar or any fruits that are naturally high in their own natural state.There are high sugar fruits and low ones. The same goes for vegs. starchie one and low ones.I juiced carrots one time only drank about 1/4th. of a glass, within about 5-mins. my stomach was killing me and I wanted to vomit.Well I never juiced carrots again nor do I hardly eat them unless they are eaten at the end of a meal after I have had enough protein.
    Iam so happy to hear that some are getting better after the Hydrogen Breath test I really need to do this also.
    Saw my new Derma Dr. yesterday and told him when i gave up all Wheat and Dairy products that it really helped with all the burning in the face and just helped the rosacea in so many ways but it takes time. After doing this for so many years I do sneak it in my diet once in a while but boy do I pay for it Even the Dr. yesterday said my rosacea really looks good, other than the visible blood vessels I now have on my cheeks.He did say he has never heard any one say this before. I am not afraid to tell any Dr. what has helped me, Proboicts, digestive enzymes, Hydrochloric acid,and eliminating sugar the best you can helps tremendously.
    I have all plans on checking this out for I have lived with this all my life and do at times have IBS.Thanks everyone for all your comments. Were all going to get rid of this someday you gotto believe that. Sorry this is so long.

  3. Hammer says:

    Hi Maureen,
    I enjoyed reading your post.

    I have also eliminated dairy and all sugars (complex and simple: starches including grains, cereals, starchy vegetables like potatoes and carrots..etc.)

    However I believe that by doing this, one’s blood sugar is also highly influenced…

    Regarding probiotics, adding these to my diet worsens my symptoms significantly. I find that when I consume either kefir, sauekraut, fermented milk, my face worsens (alot) a few days later.

    Other foods that worsen my symptoms: honey, maple syrup, milk, cashew nuts, high intake of fruits…others are not so obvious (large quantities of rice also does it).

    Irene—> Dr. Perricone mentions that calorie restriction helps in clearing acnee. I have found this to be my case as well.

    Could it be that since you have some teeth removed, you eat less? (to avoid pain)

  4. Al says:

    Rifaximin results.

    OK – so a follow-up to my last post is in order.

    As previously noted, several days after my course of meds I began to clear up, and shortly after that I was completely clear ( and still am ) except for one horizontal crack in the center of my chin where the fold is. This lesion is about 1/4″ long and just a crack in width. It tends to almost heal at night but opens up the next day. It seems to have a deep pustule that keeps erupting and I’ve tried everything to rid myself of it. Noit unsightly – just bothers the heck out of me that I am 99.9 % there and can’t nail this one last challenge.

    I have followed a fairly common test procedure for Demodex at home ( not difficult ) and came up negative. However, I will try again later this week and will report any change in outcome. I have read that Apple Cider Vinegar is helpful ( as it is for broken bones, outboard motors that won’t start and plugging leaks in oil pipes on the ocean floor ) and so have started drinking 3 oz in 16 oz of water with a little honey to nake it palatable, Ick . . . But I’m doing it twice a day and hope I don’t go blind.

    All in all however, I’m 100% satisfied with my $50 expenditure for Rifazimin. I cannot be sure that it is responsible for my recovery – but I really didn’t change anything else. For what it costs – I think most of you should try it and report back in 30 days any improvement. I’m only one voice, and that does not make a very scientific test – just hearsay and there’s already enough of that going around.

  5. Al says:

    Please excuse my many typos – it’s late and I didn’t proof read – or perhaps I am going blind.

    Good luck all!

  6. Liz says:

    @Stuart and @Dave H.

    You guys are not crazy. I came down with the same problem as you (gastritis) about a year ago after my bank account and heart were broken by various people. I spent a lot of time lying on the floor and not eating, and at the end of this period I was showing the beginning signs of ulcers. Sharp pain, bloated feeling, etc.

    I overcame it with some antacids.

    However, one year later, as I finished my summer intensive classes last week (including skipping lots of meals), I began to get the same symptoms, simultaneously developing what I suspect is my first full-blown case of rosacea. To this I would like to add that I have been living in China for the last 5 months and since I came here my intestines have not known a day of peace.

    So for what one woman’s opinion is worth, absolutely there is a correlation between gastro-intestinal health and rosacea. Not sure I understand it, but the evidence is there. Take it for what it’s worth.

  7. Hammer says:


    Has your condition been holding up? Still 99% clear of rosacea or has some of it come back since?


  8. Al says:

    Yup – Pretty much as clear as I’ve ever been. A pustule once in a while but tiny. I did notice that after three weeks away on my boat in the islands here in the Northwest even my color returned to 100% normal which is very confusing. Perhaps just relaxing? or lots of salt water? or too much beer. One will never know.

  9. Doug says:

    Or lots of sun/vitamin D!

  10. Hammer says:

    Hi all,

    I hesitate very much in taking antibiotics, however after reading the above posts (and trying many diets + fasts, and still experiencing my symptoms) I decided to try 10 days of Riflaximin.

    I consulted an MD (who is also a microbiologist), showed him the Riflaximin / Rosacea research and asked if he could ideally:

    1- Have me do a breath test to help determine methane or hydrogen in my gut, thus finding out if an antibiotic will be useful or not.

    2- Should ‘1’ be unable to acheive (doctor said he wasnt aware or the procedure or how to proceed with the breath test), then to simply prescribe Riflaximin for 10 days since it is non-systemic and very poorly absorbed by the body (therefore relatively safe) in any event.

    To which the doctor promptly informed me that Riflaximin was not available in Canada (because no company here had asked or requested to make it available here).

    Which leaves me, in my eyes, with the option of ordering on the web.

    To which I wish to exercise high caution, since I dont want nor like to play with antibiotics, and in the event that I do (like now), I want to make sure I am getting the real thing, and not some lookalike (therefore falsifying my potential results and perhaps my health).

    I dont mind to pay more to get the real thing. Actually, I only want the real thing.

    Is there anyone here in the US or Europe who could perhaps give me any insights as to how I could proceed with giving Riflaximin a try?? As I live in Canada (Montreal) and not available here unfortunately.


    I contacted Salix Pharmaceuticals, whih is the company who manufactures Xifaxan, which is the brand name of riflaximin.

    They however only sell in the US and Europe.

  11. Hammer says:

    Hi again,

    Could those of you who tried Riflaximin for 10 days (as indicated by the study) inform me about the dosage details?

    The study mentions 1200mg per day for 10 days.

    – Is this taken in one dose? Or spread out throught the day?

    – With or outside of meals?

    – Morning of evening?

    Thanks again,


  12. Al says:


    I took three pills a day – and don’t recall when I took them. I’ll see if I can find my old prescription – it’ll tell me.


  13. dil says:

    Hi i have suffered from acne rosacea since i was about 16 years old and im 36 years old now …. so nearly half my life.
    I have tried various diets ,creams and biotics over the years with little effect.
    I live in Australia and would now like to Try Rifaximin but it is not approved here in Australia and was wondering if anyone knew of any reliable /legit websites to order from ?
    Has anyone ordered online and recieved the real deal if so what was the website?
    I got a script from my dodtor for rifaximin as some websites request a script but i am still worried that i will recieve a fake or not recieve it at all.
    Also like someone else stated here in the forum what is the dose ?(1200mg a day for 10 days only? ) , with foods , do you need a repeat course after the 10 day course at all?
    any info would be great

  14. Hammer says:

    I would also be interested. I am experiencing the same issue….

    – Not available in Canada,

    – Want to order online but want to me 110% sure of what I am buying,

    – Proper dosage and posology?

    Thanks again to anyone that can provide information,


  15. John says:

    If metronidazole(Flagyl) works by killing gut bacteria that produce methane, why do some rosacea patients improve with topical metronidazole ointment applied to the face??

  16. Jeff says:

    is this true?

  17. A says:

    My experience with rifaximin as an attempted treatment for papulopustular rosacea:

    After I discovered the information about the allegedly uplifting results others had seen with this drug – in despair of the disfiguring consequences we are all too familiar with – I spent my last money on a trip to Barcelona, Spain, where rifaximin is produced and sold under the brand name Spiraxin – available for purchase in any pharmacy without prescription from a doctor. I actually took 1200 mg/day for two weeks, not just ten days. When taking my first dose, my rosacea was worse than ever, pretty much. Well, long story short, aften five days I noticed improvement, on day ten I was CLEAR! Since then (three weeks post-treatment), my skin has been so much better, with only the occasional little pustule or papule if I eat unhealthy as a little reminder to struggle with – I now have cleaner skin than most people my age (I`m 19):) SIBO was obviously my problem, and fortunately the bacteria reacted positively to the drug – thank you, life! How long it will take before I experience complete remission is unknown, but I`m at least hoping for a few months – rifaximin does not trigger resistant bacterial colonies in your gut and can be used repeatedly with approximately the same effect over and over again. Just remember to take probiotic supplement between courses. I`ll keep you updated whenever something remarkable happens, enjoying a renewed self-esteem and life quality in the meantime.

    So, for others, try it; you have everything to gain and nothing to lose. I love and empathize with you all, stay strong and don`t give up no matter how troubling rosacea can be to how we judge ourselves. We are beautiful xanthochroids regardless.

  18. D. Beales says:

    None of what the medical community does in relation to rosacea seems to make much scientific sense to me. Treatment is empiric, a fancy word for “educated guess.”

    I think the reason the medical communty is so stumped about how to treat rosacea is that it is *all* caused by infection, and because it is caused by multiple pathogens and our ability to test for same in cases where infection is not rampant is so limited, we are left with the scattershot approach of trying antibiotic after antibiotic until something works.

    Carbohydrates n the diet are correlated to bacterial overgrowth. Strict carbohydrate limitation may help, but some experts think it only has success *after* whatever pathogen has been brought under control.

    Some diets I’m aware of that accomplish this are the Paleolithic Diet, and the Specific Carbohydrate Diet. Both are medically controversial.

    I am discouraged that no one followed up on their progress over the long-term.

  19. Hammer says:

    Maybe once a year or so, my face is dramatically more clear.

    Whatever caused this to happen, has made me realize that my face and body can heal very quickly, when the different factors are in place.

    This being said, I completed a full 7 day (168 hours) water fast (no food no cheating, only spring water).

    If rosacea is related to diet, then I should of seen a better skin, which unfortunately did not materialize.

    I attempted strict zero carb (only skinless chicken and boiled eggs) for a week…nothing.

    Gluten free for 6 months…nothing.

    Large quantities of digestive enzymes and hydrochloric acid…nothing.

    Exaggerated amounts of Essential fatty acids…nothing.

    Whatever causes my face to heal once a year, I would like to find out.
    Difficult to trace…

    I controlled and experimented for stress, which doesnt seem to be the answer either…

    All of my blood chemistry, urine, stool, hair, and saliva tests are excellent.

    Except for this:

    – Very low cholesterol (even if dietary intake is high)
    – Very low body temperature (thyroid is ok, tested 3 times)



  20. Hammer says:

    Sorry, also forgot to add:

    Low blood sugar

  21. Al says:

    And Sexual Abstinence. Tried that for 24 hours and showed no marked improvement.

  22. Al says:

    So, D. Beales – here is an update. I am still clear. Not 100% mind you, as I have one persistent little spot off to one side . . . . but better than I had ever hoped for. I may invest another couple of weeks to see if this one spot persists, then will try Riflaximin again and see if that wraps ‘er up.

  23. D. Beales says:

    Al, are you saying you took rifaximin & it cleared you almost entirely? Now you’re considering attemtping a second course of it? Thanks for the follow-up. I am in great need of it. As my husband recently tested positive in a hydrogen breath test and has GI ulceration, it’s my theory that we are both infected with the same bug but are manifesting it differently. I am going to propose that we *both* go on rifaximin, and possibly my son as well, so we don’t continually pass it back and forth. It they haven’t even been able to fully understand SIBO, I’m fairly certain they also know little about its transmissibility.

    Hammer, I have meibomian gland disease, whch is strongly associated with rosacea. Are you aware that “low cholesterol” (if by way of that you mean your HDL cholesterol is in the higher range) may actually be a problem? I will try to explain in layman’s terms…

    There is new evidence that the body can produce a “defective” kind of HDL chlesterol, i.e. HDL is not the “good” cholesterol, as medical science has assumed for decades. Recently, meibomian gland disease has been identified in one study to be a possible marker for HDL-related disease and cardiovascular risk.

    My theory, but this is only a theory and the evidence to support it is indirect at best, is that infection drives cholesterol dysfunction, which is why diet and exercise don’t control it in some people.

    Here are some articles to think about. I have dozens of articles on a related theme around periodontal disease, which has been linked not only to rosacea, but heart disease, diabetes, and cancer, for for this purpose I’ll provide 3 related to the paragraph above.

    The problem seems to be that no one is looking at the big picture, which IMO is infection. Just because we cannot identify it in laboratory analysis doesn’t mean it isn’t there. It means out testing methods are inadequate. For example, when I recently had a serious flare of periodoontal disease, a CRP and CBC came back completely normal. Anectdotal, I realize, but I’m a researcher and a scientist, and what that tells me is that our tersting methods are not sufficiently sensitive.

    1. Am J Ophthalmol. 2010 Sep;150(3):371-375.e1. Epub 2010 Jul 8.

    Association of dyslipidemia in moderate to severe meibomian gland dysfunction.

    Dao AH, Spindle JD, Harp BA, Jacob A, Chuang AZ, Yee RW.

    University of Texas Medical School at Houston, Department of Ophthalmology and
    Visual Sciences, Houston, TX 77030, USA.

    PURPOSE: To determine whether meibomian gland disease, a major contributor to dry
    eye syndrome, is associated with dyslipidemia.
    DESIGN: Retrospective case-control study.
    METHODS: setting: Clinical practice. patient or study population: Sixty-six
    patients from January 2008 to July 2009 with moderate to severe meibomian gland
    disease whose serum lipid levels were obtained. We excluded patients who were
    already taking lipid-altering substances and patients with rheumatologic disease.
    We analyzed several parameters in prevalence of dyslipidemia (total cholesterol >
    200 mg/dL, low-density lipoprotein [LDL] > 130 mg/dL, high-density lipoprotein
    [HDL] 150 mg/dL) in MGD patients and compared
    these patients to the general population as reported by data from the National
    Health and Nutrition Examination Survey (NHANES). main outcome measure: The
    prevalence of dyslipidemia (elevated total cholesterol, elevated LDL, decreased
    HDL, or elevated triglycerides) in patients with moderate to severe MGD.
    RESULTS: Patients with moderate to severe MGD had a higher incidence of
    dyslipidemia with respect to elevated total cholesterol (>200 mg/dL), 67.4% to
    45.1% (P = .0012) when compared to population controls. There was a smaller
    number of MGD patients with low HDL (HDL 150 mg/dL), 15.2%, when compared to controls, 33.1%
    (P = .0049).
    CONCLUSIONS: Patients with moderate to severe MGD have a higher incidence of
    dyslipidemia with respect to elevated total cholesterol than the general
    population. Surprisingly, the component of total cholesterol that contributed
    most to this increase in total cholesterol came from elevated serum HDL levels.
    To our knowledge, elevated HDL has not been associated with any pathologic state.
    Patients with MGD had a statistically significant lower incidence of
    hypoalphalipoproteinemia (low HDL) than the general population. Patients with MGD
    also had a lower incidence of hypertriglyceridemia than the general population.

    PMID: 20619393 [PubMed – indexed for MEDLINE]

    2. N Engl J Med. 2011 Jan 13;364(2):127-35.

    Cholesterol efflux capacity, high-density lipoprotein function, and

    Khera AV, Cuchel M, de la Llera-Moya M, Rodrigues A, Burke MF, Jafri K, French
    BC, Phillips JA, Mucksavage ML, Wilensky RL, Mohler ER, Rothblat GH, Rader DJ.

    Cardiovascular Institute, University of Pennsylvania, Philadelphia, USA.

    Comment in:
    N Engl J Med. 2011 Jan 13;364(2):170-1.

    BACKGROUND: High-density lipoprotein (HDL) may provide cardiovascular protection
    by promoting reverse cholesterol transport from macrophages. We hypothesized that
    the capacity of HDL to accept cholesterol from macrophages would serve as a
    predictor of atherosclerotic burden.
    METHODS: We measured cholesterol efflux capacity in 203 healthy volunteers who
    underwent assessment of carotid artery intima-media thickness, 442 patients with
    angiographically confirmed coronary artery disease, and 351 patients without such
    angiographically confirmed disease. We quantified efflux capacity by using a
    validated ex vivo system that involved incubation of macrophages with
    apolipoprotein B-depleted serum from the study participants.
    RESULTS: The levels of HDL cholesterol and apolipoprotein A-I were significant
    determinants of cholesterol efflux capacity but accounted for less than 40% of
    the observed variation. An inverse relationship was noted between efflux capacity
    and carotid intima-media thickness both before and after adjustment for the HDL
    cholesterol level. Furthermore, efflux capacity was a strong inverse predictor of
    coronary disease status (adjusted odds ratio for coronary disease per 1-SD
    increase in efflux capacity, 0.70; 95% confidence interval [CI], 0.59 to 0.83;
    P<0.001). This relationship was attenuated, but remained significant, after
    additional adjustment for the HDL cholesterol level (odds ratio per 1-SD
    increase, 0.75; 95% CI, 0.63 to 0.90; P=0.002) or apolipoprotein A-I level (odds
    ratio per 1-SD increase, 0.74; 95% CI, 0.61 to 0.89; P=0.002). Additional studies
    showed enhanced efflux capacity in patients with the metabolic syndrome and low
    HDL cholesterol levels who were treated with pioglitazone, but not in patients
    with hypercholesterolemia who were treated with statins.
    CONCLUSIONS: Cholesterol efflux capacity from macrophages, a metric of HDL
    function, has a strong inverse association with both carotid intima-media
    thickness and the likelihood of angiographic coronary artery disease,
    independently of the HDL cholesterol level. (Funded by the National Heart, Lung,
    and Blood Institute and others.).

    PMCID: PMC3030449 [Available on 2011/7/1]
    PMID: 21226578 [PubMed – indexed for MEDLINE]

    3. N Engl J Med. 2011 Jan 13;364(2):170-1.

    HDL and cardiovascular-disease risk–time for a new approach?

    Heinecke J.

    Comment on:
    N Engl J Med. 2011 Jan 13;364(2):127-35.

    PMID: 21226584 [PubMed – indexed for MEDLINE]

  24. D. Beales says:

    I should also add that I too, like Hammer, have attempted many unsuccessful treatments, including:

    *Dr. Tseng’s demodex mite protocol (tea tree oil applied according to his published article in British Journal of Derm)
    *apple cider vinegar (could not keep it down)
    *sodium bicarbonate (could not keep it down)
    *HCL tablets
    *carbohydrate restriction
    *topically applied borax/hydrogen peroxide solution (helped the acne, not the redness, meibomian gland disease)
    *salicylate wash (also helped the acne but did nothing else)
    *immunosuppressive therapy
    *low-dose doxycycline
    *low-dose minocycline

    Nothing has helped.

  25. Hammer says:

    Thank you for the information D. Beales.

    I’ve been trying to research the significance and implications of low cholesterol levels.
    Reading on the subject…Alot of conflicting information.

    The book: Ignore the awkward by Dr. Ravnskov, relates with your evidence on abnormal cholesterol levels and infection as a factor.

    Here’s the average of 4 of my blood samples in the last 2 years (early 30s – male):

    Total: 2.89 mmol/L
    Tri: 0.66
    HDL: 0.92
    LDL: 1.76

    *** Are there any guidelines or places you can advise I research or educate myself further?

    The rosacea-bacterial overgrowth-infection link appears to be the answer. I can assure all that, at this point, I am not deficient or missing in any nutrients…

    Therefore if not diet, or lifestyle based (I experimented with different factors)….bacteria would seem like a better hypothesis.

    My experiments with very high intakes of fresh garlic along with other anti-microbial herbs yielded little results. But perhaps a stronger antibiotic (taken with probiotics) could be a solution.

    I prefer to avoid taking antibiotics, and since Riflaximin appears to work only when a particular bacteria is detected, how or where can an individual take a breath test to determine if the bacteria in question is present?

    (in Canada)

  26. D. Beales says:

    I don’t know of any one source that would give you what you’re looking for, Hammer. The medical community itself appears to just recently be recognizing the infection/cholesterol link, and it is *very* controversial as to whether cholesterol comes first and bacteria grow because they’re attractd to it, or vice versa. The only way you might get at this is to search using the terms you’re specifically interested in, but be prepared to read information at a very high level of understanding, and full text articles are not usually free.

    You should ask your doctor about hydrogen/methane breath tests. Show him/her articles relating SIBO to rosacea. They are also controversial, and the evidence within them is not considered to be strong.

  27. mrtlbbry says:


    I’m very interested in the potential link between SIBO and Rosacea. I was recently diagnosed with rosacea and have had terrible p+p’s for around a year now. I am 31 years old and never had problems with my skin before – even as a teenager.

    It took a while for a definitive diagnosis (misdiagnosed as acne and even a skin infection) and I have been prescribed both Erythromycin and Metronidazole topical treatment since diagnosis with little improvement. Flare ups are more regular but less severe.

    Like many I was interested in the SIBO link. I am especially curious as two recent blood tests have show that I have significantly raised Bilirubin (studies suggest raised serum bilirubin reliably predicted presence of SIBO). My GP is scratching her head as to what is causing the raised level and we’re awaiting advice from the local Gastro dept.

    @A (who purchased Rifaximin (Spiraxin) in Barcelona and have good results).

    I have a few of questions about your purchase.

    1. Did you buy your full dose from one pharmacy or did they have a limit on how many packets you bought?

    2. What was the pack size and cost of each pack? My research has shown Spiraxin is available in 12x200mg packs but you may have more accurate info.

    3. Are you still ‘clear’?


  28. deborah says:

    Hammer: OMG i have low cholesterol, low body temp and sometimes low blood sugar, and rosacea. weird. i can tell you that my rosacea was in a remissive state when I Attacked my candida yeast or SIBO as they call it here; bad bacteria is what I refer to it as. I began rosacea symptoms in my early 30’s having no idea what it was and then one day i was waiting for a dental appt and read a magazine and there it was on a page. So i went to a dermatologist and he said i will put u on tetracycline for life! So knowing how bad antibiotics can be long term I said i would try for a month and do a checkup – he convinced me to try one more month and my face was perfect, but I would not continue so i went off of them and proceeded to gain weight and become depressed and had no idea why. After a few years i found out that the antibiotic killed my “good” bateria and that I had an outrageous overblown yeast problem. So now (then) I am 210 pounds, and determined to get my life back. I bought a program online which killed the yeast ( Caproyl (coconut oil), physlium husk and bentonite. I also cut out most carbs – any white foods like flour potatoes rice etc and ate a few whole grains and lots of fruits and veggies, very little dairy and no meat (i am a vegetarian). So after two weeks of that I began to feel a little better and had some energy and started walking everyday, 10 min, then 15, then 30 and when i was doing 45 a day I had gone from a size 16 to a size 8, i started to ride a bike, a mile then 2 etc. and at about two months at 15 miles a day I was wearing sz 4 and 127 pounds; it took 9 months total and I looked and felt great and no rosacea! My skin was starting to tan a little and no pustules or very much redness at all. I did use sun screen before going outside (in Florida) and all in all I was doing very well. I kept the weight off for over a year and unfortunately was HBC while riding my bike and i have been on and off my diet and excersize program every since. It took me about a year to recover and i shot up to 165#. Now I am looking to get back into it, I can tell the yeast is back; sweet cravings, weight gain and depression. It is a hard uphil battle I can tell you, but it is doable. So for the record i beleive that there is a direct link to the sibo and rosacea. Another anecdotal thing to consider is that this diet is often called the celtic curse and what did the Irish eat for decades? potatoes! carbs in fact – so it is very possible that it effected their gut bateria and perhaps made a predisposition. Anyway I would love to try this antibiotic to kick start my program but i don’t have the money to go to a doctor for the prescription. Anyone know a way around it? thanks and good luck to everyone!

  29. Al says:

    Well, my single red spot has grown into a regular pustule and now has several friends and family on my chin. Just like before. So, back to the doc and just started a new course of Riflaximin ( Xifaxin actually ) today. They come in 200 mg pills so I am taking three in morning, three at night for a daily dose of 1200 MG for two weeks. Going to go for carpet bombing and hope for total obliteration this time. Once done, I may try Probiotics like Flora Q and see how long I stay symptom free. Any probiotic suggestions?

    BTW – Had my Cholesterol checked again ( I’m always high but have no other issues – my BP and pulse are low, weight is lowish, no history of heart disease, I exercise and eat very, very well etc . . . ) and my lipoprotein profile reads like a horror-book. 330 total, HDL = 60, LDL = 254 and a ratio of 5.5. Go figure.

    Anyways – we’ll see what happens in the days ahead.

  30. Emily says:

    I’m not nearly as knowledgeable about the rest of you as far as rosacea and mine is mild, but I wanted to throw this out: I have celiac disease, an auto immune disease which causes villous atrophy in the small intestine, and thus, poor vitamin absorption, malnourishment, and other digestive problems. Often, celiacs (and those with IBS and Crohn’s and other GI disease) have SIBO, and I did, diagnosed on hydrogen breath test.

    My understanding is not that I have a contagious ‘bug’, but that there is bacterial growth in the small intestine that shouldn’t be there, given the failure of my small intestine to work properly. SIBO causes celiac-like symptoms of malabsorption and villous atrophy, so it may be that the roscea isn’t liked to diet, per se, or cured by the Xifaxin which doesn’t leave the small intestine, but overall health. In other words, when I fixed my gut completely, my skin cleared. As a result of celiac and SIBO, I was a mess but had to treat both (with the gluten free diet and Xifaxin, after the GF diet didn’t get rid of my symptoms). Hydrochloric acid seem to work in brief spurts before SIBO, but it clearly doesn’t treat the infection. (Which makes sense, given how intractable gut infections are).

    I took Xifaxin for 2 weeks (1200 mg per day) and like the rest of you, my skin cleared up immediately. Those of you who write about this may want to consider whether you have gut problems that give rise to some sort of malnourishment/failure to absorb nutrients from your food that allows your skin to become inflamed. I’m pretty sure it’s worked like that for me.

    Anyway, I wanted to throw those things out there because I’ve been shocked at the extent to which all these things have, in my experience, been related.

  31. Nancy says:

    I’ve been suffering from rosacea for the past six years and am being treated at a well respected hospital in San francisco, ca. My derm. Just prescribed xifanan 550 mg., 2x/day, and pretherin cream to kill skin mites. It’s only day 3 and I’m literally watching and waiting to see if I will have improvements with these new treatments. My face felt cool and soft after the first treatment with the cream but I have to do a second treatment 7 days later (tonight) and then observe to see if I get any more acne rosacea. I’m skeptical since my rosacea is difficult to control, but I’m hopeful.

  32. Kathleen says:

    Oh my gosh, the Dr’s have been of little help for me. This site is a God send. Have been on prilosec for 5 and a half years due to reflux from a hiatal hernia, was increased to twice a day for 3-4 mos last year due to voice problems ( LPR ). Developed allergies a year ago, much much worse, the past 6 mos, have dropped 12-14 pounds without trying since I can eat so few foods without reacting. GI said no connection between allergies and gut, suggested a probiotic or Neomycin, probiotic caused bloating, did not take the Neomycin for many reasons. GI thought I might have SIBO due to prilosec. Last year face/neck so red ! One dermatologist said nothing about rosacea, one last week said I had it and to use topical cream. This is all fitting together at long last. Have seen 2 acupunturists, a Holistic Nurse Practitioner, a Homeopath, 2 GI’s, 2 Dermatologists, in addition to primary care. It is sad that I have to do put the pieces together myself. Have spent hours and hours researching and just today decided to google rosacea again and was amazed at the connection with CIBO. Thanks for all the great explanations. Have a GI appt in a couple weeks, allergy next week—all she wants me to do it take meds, cannot tolerate zrytec or allegra, claritin does nothing. Went to a dietician who was no help at all. Am interested in histamine producing foods since I can only eat chicken, turkey, oatmeal, quinoa, cabbage, lentils, broccoli without reacting. Anyone else having food challenges ? Thanks again. I am a retired nurse so pretty familiar with navigating the system but the lack of help in this case is very sad.

  33. rich says:

    hey guys, i live in australia. does anyone know how i would go about getting a hydrogen breath test and get hold of some rifaximin. my gp knows nothing about either. cheers

  34. Hammer says:

    Sorry, I dont.
    (Im in Canada and dont know how to get either here neither).

  35. MARY says:

    my rosacea appeared at 78 yrs of age. I am fair skin but any sunscreen seems to irriate. So far I haven’t had any luck with trying elimanting various things in my diet.I saw article on rifaximin and tried it for 10 days. My insurance wouldn’t approve it so had to pay $240 myself. My redness, etc. seemed to improve for one month after two 200 mgs tablets of rifaximin for 10 days. Now, however, my redness, etc. is back. I wish I knew more about chances of help from repeating rifaximin as am on a fixed budget. Thanks

  36. Al says:


    Here it is, July 1st and on April 16th this year I took three Rifaximin in the morning, three at night for a daily dose of 1200 MG for two weeks. I also took NEWCHAPTER Organics Probiotic All-Flora pills ( 2 per day ) since then.

    I am 100% clear, no redness, no pustules and very, very pleased.

    I am hoping that this is the end of a long story for me. I strongly recommend that anyone try this simple approach if you possibly can.

    Good luck all.

  37. harry says:

    Hi, $240 for 10 day course of 2 tablets of 200 MG/day is very very expensive. You can get it for 1/3rd of the price in Malaysia or Thailand or Sri Lanka. For a 2 week period of 1200 MG per day (3 times x 400 MG tablet / per day), it would only cost you 100 USD. Pity that you guys have to shell out so much. If anyone is in need of the tablets, please let me know.

  38. rich says:

    harry, can you post it to australia?

  39. Troy says:

    Rich, apparently can prescribe it, they are in Five Dock Sydney. Hydrogen breath tests can be done at Stream In Box Hill, Vic, at Warringal hospital Heidelberg, Vic or at CDD in Sydney also.

  40. Francisco says:

    I’m have suffered from acne rosacea since i was about 16 years old and im 42 years old now, I have 4 days trying rifaximin 200mg (in Venezuela called Normix) my gastroenterologist recommended dose of 800mg daily, 400 mg at breakfast and dinner. I’m still awaiting a response from my dermatologist. comment on my experience later. Thank you.

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