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Just about everyone knows someone with rosacea. It’s a common skin condition that’s difficult to hide. Conditions affecting appearance can be devasting to self-esteem and self-acceptance. Whether it’s acne, rosacea, or a mole, these abnormalities can make a person feel that that’s all others see when looking at them. For that reason, billions of dollars are spent on improving appearance, and the vast majority of money is spent on topical solutions. But is rosacea just a skin issue? The truth is: beauty isn’t exactly skin-deep.

What is Rosacea?

According to the American Academy of Dermatology, [rosacea] “often begins with a tendency to blush or flush more easily than other people. The redness can slowly spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be red all the time.”

The National Rosacea Society (NRS) notes that “it typically begins any time after age 30 as flushing or redness on the cheeks, nose, chin, or forehead that may come and go.”

Some of the main signs and symptoms of rosacea, as indicated by the NRS, are:

  • Persistent redness – resembling a blush or sunburn
  • Skin thickening – most common on the nose
  • Flushing – with warmth or burning
  • Bumps and pimples – resembling acne
  • Visible blood vessels – on cheeks, nose, and other areas in the central face
  • Eye irritation – often watery or bloodshot, plus swollen, crusty, or scaley eyelids

Other signs and symptoms may include burning or stinging, a feeling of tightness, swelling or raised patches, dryness, roughness, or scaly skin. Sometimes the rosacea even spreads to the neck, chest, scalp, or ears.

While it may seem like a skin condition, is it really a surface or cosmetic issue? At The Wellness Way, we think differently.

The Swiss Watch and Rosacea

One of the primary teachings of The Wellness Way is that your body is made up of systems that are like the gears of a Swiss Watch. Like the gears of a Swiss Watch, each system of the body affects all the others. That’s why you can’t just look at rosacea as a skin condition. It’s much deeper than that.

A review study done by the National Rosacea Society Expert Committee found that those with rosacea also had a higher incidence of:

  • High blood pressure
  • High cholesterol
  • Coronary artery disease
  • Rheumatoid arthritis
  • Digestive conditions, including celiac disease, Crohn’s disease, ulcerative colitis, and irritable bowel syndrome (IBS)
  • Neurological conditions, including Parkinson’s disease, Alzheimer’s disease, and multiple sclerosis (MS)
  • Allergic conditions, including seasonal allergies and food allergies
  • Certain cancers, including thyroid cancer and basal cell skin cancer

Why are there connections between rosacea and these other conditions? Because of the common causes behind them. It goes back to rounding up the usual suspects: toxins, trauma, and thoughts.

The Three T’s and Rosacea

Rosacea doesn’t just come out of nowhere. It’s more of a symptom than a condition, which means rosacea just reflects another potentially unknown imbalance in the body. There’s always some kind of trigger behind an imbalance –often many triggers. It all goes back to the “Three T’s”: Trauma, Toxins, and Thoughts.

  • Trauma triggers might be a car accident, fall, or another traumatic physical trigger that sets off the stress response.
  • Toxins may include food allergies, medications, chemical exposure, bacterial infection or overgrowth, or even skin mites.
  • Thoughts may include chronic stress, which affects our thinking and keeps us in a continuous state of alarm and inflammation.

These stressors disrupt homeostasis (balance) in the body. The main places to look are the microbiome (gut), immune response, and hormone balance.

The Gut-Skin Connection

You may have heard of the gut-brain axis, but did you know there is a gut-skin axis? This emerging theory proposes that gut health affects skin health (and overall health) through interactions between the immune system, nervous system, and metabolism.

The interaction between the gut and immune system is particularly important, as gut dysbiosis disrupts the gut lining (as in “leaky gut”) and leads to systemic inflammation affecting other organ systems and tissues, including the skin.

When you have an imbalance or overgrowth of bacteria in the gut (dysbiosis), it can trigger an immune response. Small Intestinal Bacteria Overgrowth (SIBO), a common type of dysbiosis, and an overgrowth of H. pylori both have a connection to rosacea.

Dysbiosis in the gut can also lead to food allergies, which are (not surprisingly) also associated with inflammation and rosacea.

Mast Cells, Histamine, and Rosacea

Mast Cells are part of the body’s immune response. They are white blood cells that, when triggered by a stressor, release an inflammatory substance called histamine. Histamine is associated with allergies, hives, and an overresponsive immune system.

A study published in the Journal of Investigative Dermatology found that rosacea patients had higher numbers of mast cells in their skin compared to healthy controls. Mast cell enzymes called proteases were also higher in those with rosacea. These enzymes spread inflammation by recruiting other immune cells to the region, leading to an amplified immune response.

It’s normal for mast cells to release histamine. The problem is when we’re unable to break the histamine down, due to a lack of histamine-degrading enzymes, like diamine oxidase (DAO). Low levels of DAO (often due to dysbiosis) can cause histamine levels to rise, leading to a cascade of symptoms. Mast cells can also become unstable, which is where natural mast cell stabilizers (like the herb Albizia) can come in handy.

Skin Mites?

One potential trigger of mast cells is Demodex skin mites. While these organisms are common residents in human skin, an overgrowth may disrupt the skin’s microbiome, leading to symptoms. According to a review study published in the Journal of the American Academy of Dermatology, “Patients with rosacea had significantly higher prevalence and degrees of Demodex mite infestation than did control patients.”

The National Rosacea Society shared discoveries about Demodex and rosacea in their newsletter, Rosacea Review. They noted that while these mites are a normal part of the human microbiome, a genetic predisposition for a different skin type may cause Demodex to flourish in rosacea patients.

A Demodex infection may trigger a histamine response from mast cells. Or it may be that Demodex mites flourish when histamine and inflammation are already elevated.

Hormones and Rosacea

Another place to look when it comes to rosacea is the hormones, particularly changes in estrogen and cortisol production and thyroid disorders. As levels of certain anti-inflammatory, protective estrogens fall, it can lead to more issues with inflammatory disorders, including rosacea.

There is also an estrogen-histamine connection, as high levels of certain estrogens promotes histamine release. Mast cells have estradiol and progesterone receptors, so they can be provoked by high levels of those hormones.

The stress hormone cortisol is another one to check, as stress and anxiety also increase inflammation, which may lead to flares. A 2020 review study published in the Journal of European Academy and Dermatology and Venereology found that stress and lack of sleep contribute to a pro-inflammatory state, impacting skin health.

The researchers concluded, “Hormone dysregulation, malnutrition, and stress may contribute to inflammatory skin disorders, such as atopic dermatitis, psoriasis, acne, and rosacea.”

Rosacea is also associated with thyroid disorders, including thyroid autoimmunity and thyroid cancer. A 2021 investigation into thyroid blood tests and rosacea found that anti-TPO antibodies tended to increase with rosacea severity. Rosacea patients also tended to have larger thyroid nodules and abnormal growths compared to controls.

Of course, correlation does not mean causation, but when you’re dealing with rosacea, it’s a good idea to have your hormones thoroughly tested (going beyond TSH, and the standard medical panels).

The Wellness Way Approach to Rosacea

Since rosacea is a symptom rather than an isolated condition, Wellness Way docs will investigate the contributing factors to your specific case. It’s impossible to know what exactly is causing rosacea without testing. That’s why “We don’t guess; we test!” After listening to you share your health history and your current symptoms (even beyond the skin), our practitioners will determine where to start with testing. These tests could include food allergy testing, gut testing, hormone testing, and more. From there, it’s just a matter of removing the barriers to healing. Your body is designed to have clear, balanced skin. Contact a Wellness Way Clinic today to start your healing journey!

Resources:

  1. Rosacea: Overview (aad.org)
  2. All About Rosacea | Rosacea.org
  3. Rosacea comorbidities and future research: The 2017 update by the National Rosacea Society Expert Committee – PubMed (nih.gov)
  4. Rosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut–Skin Axis of Rosacea – PMC (nih.gov)
  5. Mast cells are key mediators of cathelicidin-initiated skin inflammation in rosacea – PubMed (nih.gov)
  6. Anti-allergic activity of standardized extract of Albizia lebbeck with reference to catechin as a phytomarker – PubMed (nih.gov)
  7. New Studies Discuss Significance of Demodex in Rosacea Care | Rosacea.org
  8. Estrogen effects in allergy and asthma – PMC (nih.gov)
  9. Role of female sex hormones, estradiol and progesterone, in mast cell behavior – PMC (nih.gov)
  10. Clinical and biological impact of the exposome on the skin – PubMed (nih.gov)
  11. ROSACEA IS ASSOCIATED WITH THYROID AUTOIMMUNITY: A CASE CONTROL STUDY – PubMed (nih.gov)
  12. Personal history of rosacea and risk of incident cancer among women in the US – PubMed (nih.gov)
  13. Investigation of thyroid blood tests and thyroid ultrasound findings of patients with rosacea – PubMed (nih.gov)
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