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Cause of rosacea continues to defy science. These patients tend to have a higher prevalence of GI problems. In addition, rosacea is associated with GI diseases with manifestations beyond the gut, e.g. inflammatory bowel disease and celiac disease. Stomach infection with Helicobacter pylori bacteria has also been observed.
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
The gut is the largest immune organ in the body and the gut bacteria are involved in education of the body’s immune system. Based on such data, gut has been implicated in the causation of rosacea via the gut-immune-skin-brain axis.
Study: Dr. Parody and colleagues from the University of Genoa, Italy wanted to examine the role of small intestinal bacterial overgrowth in the causation of rosacea. They also studied the effect of eradication of such abnormal bacterial patterns on clinical manifestations of rosacea.
Methods of rosacea-gut study:
- 113 patients and 60 healthy age-sex matched controls
- Presence of small intestinal bacterial overgrowth (SIBO) was diagnosed by lactulose breath test and glucose breath test.
- Patients with SIBO were given the rifaximin antibiotic that is not absorbed into the body and as such acts only in the gut.
- Patients without SIBO were also treated with the same gut-selective antibiotic.
Results of rosacea-gut study:
- 46 percent of rosacea patients had SIBO as compared to only 5% among healthy controls.
- Of the patients in whom SIBO was effectively eradicated, 71% of the patients totally cleared the rosacea lesions whereas 21% were greatly improved.
- In contrast, rosacea skin lesions in 90% of the patients in placebo group remained unchanged while the skin lesions worsened in the remaining 10 percent.
- Subsequently, patients in placebo group were also treated with the same gut-selective antibiotic. This resulted in complete clearing of rosacea lesions in 7% of these patients.
Conclusion of rosacea-gut study
The prevalence of SIBO is higher among rosacea patients as compared to healthy controls.
Healing of intestinal bacterial overgrowth results in complete or almost complete healing of rosacea skin lesions. These beneficial effects are maintained for at least 9 months.
Treatment with antibiotic was of no effect in patients who did not have SIBO.
Dr. Minocha’s comments
Abnormal stimulation of the immune system appears to be involved in rosacea. Such a stimulation may be due to a bacteria whether in the gut or on the skin. Results of this study using a gut selective antibiotic strongly link the gut and skin together in causation.
Antibiotics are part of our armamentarium to treat rosacea. Perhaps these act by healing the abnormal bacterial patterns in the gut. However, many of these broad spectrum antibiotics have risk for significant adverse events.
Stretching the argument further, probiotics have been used to effectively treat SIBO. Perhaps, we should use probiotics to treat rosacea. However, all probiotics are not created equal and the benefits in different disease states are strain specific.
Is It Leaky Gut or Leaky Gut Syndrome?
Limited data suggest that Lactobacillus casei Shirota as well as a blend of Lactobacillus casei, Lactobacillus plantarum, Streptococcus faecalis and Bifidobacterium brevis are effective in eradicating SIBO.
Some dermatologists are already following using probiotics as adjunct treatment of skin disorders like acne and rosacea.
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