Rosacea

What is Rosacea?

Rosacea is a common, chronic inflammatory skin disease that causes recurrent flushing, redness, visible blood vessels, bumps or pustules on the nose, cheeks, chin and forehead.^[1] It affects about 5% of the population and has no cure, but treatment can help manage it.^{[2, 3]}

Common symptoms

Rosacea is usually grouped into four subtypes that can overlap and change over time: erythematotelangiectatic (redness and visible vessels), papulopustular (bumps and pustules), phymatous (thickened skin, such as an enlarged nose) and ocular (eye involvement).^[1]

• Flushing or blushing easily
• Persistent redness in the center of the face
• Small visible blood vessels
• Acne-like bumps and pustules, without blackheads
• Burning, stinging or itching
• Dry, red, gritty or light-sensitive eyes, which affect many people with rosacea^[1]

Causes and risk factors

The exact cause is unknown. Current understanding points to a mix of genetic and environmental factors, with inflammatory pathways in the skin playing a central part.^{[2, 3]} Nerve and blood vessel reactivity, and the innate immune system, are also thought to contribute.^[4]

Common triggers include sun, heat, cold and wind, hot or spicy food, alcohol, stress, exercise and some skin products.^[2] Researchers have also looked at gut bacteria and Helicobacter pylori infection. The evidence is mixed, and studies of diet show no clear causal link.^{[5, 6]}

How it is diagnosed and treated conventionally

Rosacea is diagnosed by a clinician from the pattern of signs on the face and the history, and other conditions that look similar are ruled out.^[2] Daily sunscreen, moisturizer, mild cleansers and avoiding personal triggers form the base of care. Topical options include medicines that narrow blood vessels for flushing and ivermectin, metronidazole or azelaic acid for bumps and pustules. Oral options include low-dose doxycycline, isotretinoin in severe cases, and in some patients beta blockers for flushing.^[2]

A systematic review of 43 trials found several topical and oral treatments reduced inflammatory lesion counts.^[7] Light and laser treatment can help with visible vessels and redness.^[4] A referral is recommended for thickened skin changes and for eye involvement.^[2]

Why Rosacea calls for a whole-person approach

Rosacea is not only a skin-surface problem. The immune system, blood vessels, nerves, the gut and emotional health all appear to take part, and each can affect the others.

Care that helps with triggers, stress and wellbeing is therefore a reasonable addition to dermatology treatment, though research has not shown that it changes the disease.

Inflammation and the skin's immune response

Rosacea is considered a disorder of inflammation, with pathways involving cathelicidin and inflammasome complexes central to current theories.^[3] Many common triggers are thought to act on these pathways.^[3]

Blood vessels and nerve reactivity

Flushing and visible vessels reflect a neurovascular component, where nerve signals and blood vessels respond strongly to heat, emotion and other triggers.^[4]

Gut health

Small intestinal bacterial overgrowth, H. pylori infection and gut bacteria imbalance have been linked to rosacea, though how they act is not clear.^[6] A review of studies reported better results when H. pylori was treated in people who tested positive, but other studies found no clear change in severity, so this remains debated.^[5]

Stress, mood and quality of life

A meta-analysis found that people with rosacea had higher risks of developing depression and anxiety in cohort studies, although adjusted analyses of cross-sectional and case-control studies showed no significant association.^[8] Rosacea lowers quality of life, and a meta-analysis of 52 studies found that treatment improved quality-of-life scores.^[9] Stigma may add stress that in turn worsens symptoms.^[9]

Acupuncture for Rosacea

What the research shows

The research on acupuncture for rosacea is very limited. A PubMed search found no systematic reviews and no completed randomized trials. The published reports are case studies. In one, a woman with erythematotelangiectatic rosacea had acupuncture three times a week and reported improvement and no relapse for 6 months.^[10] A single case cannot show that acupuncture caused the change or that it works for others.

A clinical trial protocol exists for a related bloodletting-style technique in redness-dominant rosacea, but the protocol itself reports no results.^[11]

How acupuncture may work

The case report measured blood flow around the nose with laser Doppler and suggested acupuncture might redistribute local microcirculation.^[10] This is one proposed explanation from a single patient, not an established mechanism.

What treatment involves

Treatment uses fine, sterile, single-use needles at points on the face, body and limbs chosen for the individual, usually left in place for about 20 to 40 minutes. A course of several visits is usual, with reassessment. Because rosacea skin is easily irritated, facial needling is typically gentle, and needles are not placed on broken, infected or inflamed skin.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or soreness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell the practitioner first if you have a bleeding disorder, take blood thinners, or are pregnant.

Ayurvedic medicine for Rosacea

The Ayurvedic view

Ayurveda does not have a single classical name for rosacea. Facial redness with heat, burning and bumps is traditionally understood as an excess of Pitta, the principle linked with heat and inflammation, often with blood and digestion described as involved. These are traditional categories used to plan care, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Cooling diet and routine, such as limiting very spicy, hot and fermented foods and alcohol, which overlap with common rosacea triggers
• Regular meals and sleep, and stress-calming practices
• Cooling herbal preparations applied to the skin, where the skin is intact and not irritated
• Herbs such as turmeric, prescribed by a qualified practitioner

Panchakarma purging or bloodletting procedures are not appropriate during pregnancy, acute illness or frailty, and heating therapies are generally unsuitable for flushing skin. A herbal preparation applied to the skin (transdermal medication therapy) may be considered. Ayurvedic products vary in quality, and one study of products bought online found detectable lead, mercury or arsenic in about one fifth of them, so sourcing matters.^[13]

What the research shows

We found no clinical trials or systematic reviews of Ayurvedic treatment for rosacea, so the evidence is none. Turmeric (Curcuma) has been studied in several skin conditions, and one systematic review noted it may help prevent facial redness such as rosacea and flushing, but that review drew on a small number of studies across many skin problems and called for more human trials.^[14]

Herbal medicine for Rosacea

Herbs and formulas that have been studied

Research covers two groups: traditional Chinese medicine used together with standard rosacea treatment, and plant extracts applied to the skin. The topical plant extracts studied include licochalcone (from licorice), silymarin (milk thistle), a Chrysanthellum indicum extract and quassia extract.^[15]

What the research shows

The evidence is limited. A meta-analysis of 13 randomized trials (1,348 people) found that adding traditional Chinese medicine to standard treatment gave better symptom scores, quality-of-life scores and recurrence rates than standard treatment alone. The authors advised caution because the evidence was uncertain and the studies were of low quality.^[16]

A systematic review of six studies of topical polyphenols found they may reduce redness and bumps, but the studies had significant methodological limitations.^[15] A review of natural ingredients concluded that more research is needed to know their benefit in rosacea.^[17]

Safety and herb-drug interactions

Herbs can interact with medicines. A literature review described serious interactions, including bleeding with blood thinners and changed drug levels with St. John's wort.^[18] Tell us about all medicines you take, including doxycycline, isotretinoin and other prescriptions, and about pregnancy, breastfeeding, and liver or kidney disease.

In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[13] Herbs should come from tested sources and be prescribed individually. Rosacea skin is sensitive, and some products meant to help can make it worse, so patch testing and caution with new products is sensible.^[17]

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes rosacea as heat in the Lung and Stomach channels, sometimes with damp-heat or blood stasis. Ayurveda describes aggravated Pitta in the blood. Researchers studying rosacea measure things that loosely parallel these ideas: inflammatory signaling, blood vessel and nerve reactivity, and gut microbial balance.^{[3, 4, 6]}

No study has shown that a TCM pattern or a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for rosacea is complementary. Keep your dermatologist or primary care physician, continue prescribed creams and medicines, and do not stop or change them without your prescriber. We do not diagnose rosacea, so facial redness that is new or changing should be evaluated first.^[2]

Please bring your diagnosis, a list of current medicines and skin products, and any eye care instructions. Eye symptoms need an eye specialist's care.^[2]

When to seek urgent medical care

Some symptoms need prompt medical attention.^[1]

• Eye pain, light sensitivity, blurred vision or a sudden red eye
• Facial swelling with fever, or painful hot skin that spreads quickly
• Skin that is thickening or changing shape, or a sore that does not heal
• Rash with fever, blistering or sores in the mouth or eyes
• Severe low mood, hopelessness or thoughts of self-harm

If any of these occur, call 911 or go to the nearest emergency department. For thoughts of self-harm, call or text 988, the Suicide and Crisis Lifeline.