Another paper investigating the link between Small Intestine Bacteria Overgrowth and rosacea symptoms has recently been published.

Many of the results in this 2013 letter to the editor of JAAD confirm early discoveries from the 2008 paper from Clin Gastroenterol Hepatol.

The earlier paper concluded that ;

• 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.

Now this 2013 published paper is offering some more results and thoughts on the subsequent importance of the results.

2013 Article Results

• After therapy with rifaximin, complete resolution of cutaneous lesions in 78% of the patients with SIBO was observed.
• Of the patients with SIBO, 28 were treated with rifaximin: 46% reported cleared or markedly improved rosacea, 25% reported moderately improved rosacea, and 11% reported mildly improved rosacea.
• All 4 patients with ocular rosacea and SIBO reported marked improvement
• Rosacea was unchanged in 18% of patients

Study Comments

The introductory paragraph offers the following comment on how the authors think SIBO and rosacea may be related.

SIBO may alter immunity and trigger rosacea by increasing tumor necrosis factor-alfa or other cytokines, suppressing interleukin-17, and stimulating the T helper 1-mediated immune response.

Furthermore, gut bacteria have been shown to mimic immunogens associated with extraintestinal disease (ie, multiple sclerosis).

Article Abstract

Rosacea and small intestinal bacterial overgrowth: Prevalence and response to rifaximin

Journal of the American Academy of Dermatology, Volume 68, Issue 5 , Pages 875-876, May 2013

Leonard B. Weinstock, MD, Martin Steinhoff, MD, PhD

This work was previously presented at the American College of Gastroenterology Annual Scientific Meeting and Postgraduate Course in Washington, DC, October 28-November 2, 2011.

A new pathogenic mechanism [for rosacea] was recently suggested after a relationship was observed in a study where 46% of prospective patients with rosacea had small intestinal bacterial overgrowth (SIBO).

After therapy with rifaximin, a nonabsorbed, gut-active antibiotic, complete resolution of cutaneous lesions in 78% of the patients with SIBO was observed

Future Studies Needed

The authors recognise that more research is required to further confirm the efficacy of rifaximin.

The suggested future research would find rosacea sufferers who test positive to SIBO with the lactulose breath test and then are blind tested with rifaximin or placebo.

If the active participants were significantly improved compared to placebo participants then the usefulness of the nonabsorbed, gut-active antibiotic rifaximin would be confirmed.

Study Sponsor

The study was partly funded by Salix Pharmaceuticals, who hold a US Patent for rifaximin and market it under the brand name Xifaxan.

Related Large Clinical Trial

A large randomized clinical trial titled Rifaximin Treatment of Papulopustular Rosacea is due to start shortly. (NCT01359228) will study 100 patients in two groups – the active group to receive a dosage of Xifaxan 550mg, 3 times a day for 14 days – and the inactive arm to receive placebo (and then cross over).

This proposed clinical study is sponsored by University of California, San Francisco.

Related Articles

• Treating Intestinal Bacteria with Xifaxan May Improve Rosacea
• SIBO Eradication Clears Rosacea (Rifaximin/Xifaxan): are you serious ?
• Gut Bacteria and Xifaxan get some press coverage
• SIBO rosacea link at the Rosacea Forum
• Rosacea Support Community: SIBO diet/treatment
• New Rosacea Treatments – get them while they’re hot
• MedlinePlus: Rifaximin