Mark Gerold, MDCovenant Health Care

Saginaw, Michigan

I have no financial relationships to disclose.

Chronic condition

Involves facial redness, swelling, papules and pustules

Affects both sexes

3 times more common in women then men

Average onset age 30-50

More common in lighter complexion skin

Subtype 1: Facial redness

Subtype 2: Bumps and pimples

Subtype 3: Enlargement of the nose

Subtype 4: Eye irritation

Hormonal Diet◦ Low acid in stomach ◦ Irritating foods

Inflammation Parasite Enzyme Bacterial Overgrowth /Leaky Gut Stress Vitamin Deficiencies/Insufficiencies Mineral Deficiencies/Insufficiencies Allergies Autonomic Nervous System

INTERNAL AND EXTERNAL TREATMENT IS KEY

Diet

Lifestyle

Skin care

Worsens rosacea by increasing body temperature

Increases metabolism

Increases body temperature

Increases body metabolism which affects blood vessel reactivity

Blocks anti-inflammatory proteins

Eastern White Pine Extract has flavanols which reduce cortisol by 27 percent

L-Theanine: increases GABA and indirectly decreases cortisol◦ 25 mg per day

Pharma GABA from Lactobacillus reduces cortisol ◦ Blocks brain signal to adrenal glands to produce cortisol◦ GABA 500 mg every 8 hrs

Phosphadylserine decreases cortisol too ◦ Mechanism not known◦ 400-600 mg per day

◦ Reduce stress decreases cortisol also

Progesterone deficiencies or insufficiency cause lack of moisture to skin

Mechanism is not known

Overactive Thyroid can induce flushing

Close relationship between inflammatory conditions of the gut and body wide inflammation such as rosacea

Constipation worsens rosacea◦ Small study that showed if transit time improved,

severity of rosacea improved

As we age, stomach acid production falls

Use of antacids reduces acids

Proton pump inhibitors reduce acid

H pylori infection reduce acid

Consider adding Betaine (trimethylglycine)◦ 1 gram tab every 8 hrs, 30 min before meals

Some clients with rosacea have been reported to produce inadequate stomach acid

When betaine was supplemented with Vitamin B complex , some cases of rosacea improved◦ South Med J 1945; 38:235-41

◦ Dermatoligica 1982;165:601-6

An alkaline diet reduced rosacea over two months.◦ An alkaline diet triggers a slightly elevated pH

This allows the body to function optimally

Eat more fruits and vegetables

Avoid acid forming foods, grains, sugar, meats

Drink plenty of clean water

Avoid cooked fats, trans fats and fried foods

Avoid dairy foods

Alcohol Breads Cakes Coffee Cereal Crackers Grains Eggs Vinegar Eggs Nuts Seeds Sugar Tofu

Fresh fruit Vegetables Salad greens Sprouts Raw cider vinegar Lima beans Citrus fruits Millet Quinoa Berries

Ph Meter, check urine

Ph urine strips

AVOID :◦ Eggs

◦ Nuts

◦ Seeds

◦ Nightshades (tomatoes, potatoes, eggplants, and peppers and their spices )

◦ Fructose corn syrup

◦ Gluten products (wheat, rye, barley)

◦ Sweeteners including stevia

◦ Emulsifiers, thickeners and food additives

Derived from research indicated that autoimmune disease stems from intestinal permeability

The foods to avoid are the foods that have been shown to irritate the gut and increase intestinal permeability

Some clients embrace the diet forever

Others do it for a time and introduce foods gradually

Remove the foods that damage the gut

Replace with healing foods

Repair with specific supplements

Rebalance with probiotics

BONE BROTH

FERMENTED VEGETABLES ◦ Kimchi, kombucha

COCONUT PRODUCTS

SPROUTED SEEDS ◦ Chia seeds, hemp seeds, flaxseed

Probiotics 50 billions units daily

Digestive enzymes: 2 cap before each meal

Glutamine: 2-5 grams am and pm

Licorice Root: 500 mg every 12 hours

ROSACEA IS AN OXIDATIVE STRESS CONDITION Int. J Dermatol. 2004 Jul;43(7):494-7

This study showed higher oxidative species and lower amount of antioxidants in rosacea clients

29 test subjects

20 control subjects

High stratum corneum tryptic enzymes(SCTE) and high cathelicidin result high anti-microbial proteins that cause redness and pustules of rosacea

WU J, Journal of Drugs in Dermatology, 2006 Jan; 5(1):29-32◦ Licorice (Glycyrrhizin) 2% gel decreases significant

inflammation scores on skin over 2 weeks

◦ Feverfew (Tanacetum parthenium) inhibits 5-lipoxygenase and cycloxygenase

45 day study 1 % feverfew gel inhibited inflammatory markers from neutrophils and lymphocytes

Green tea (Camellia sinensis)oral / topical contain catechins which are photoprotectiveto skin in face of UV light exposure

Chamomile (Matricaria recutita) contain terpenoids and flavanoids, they are anti-inflammatory

Tea tree oil (Melaleuca Alternifolia), be careful that it is diluted because if not increase risk of redness, dermatitis and systemic hypersensitivity

Camphor Oil (Cinnamonum Camphora)In a study by Morsey,

◦ Marked reduction of mite skin infestation in rosacea clients by camphor topical oil 25 percent

◦ Chrysanthellum cream

Academy of Dermatology and Venereology , 2005

Showed more effective skin redness reduction then placebo

Cinnamon induced rosacea outbreak

J Drugs Dermatol, 2008

Arginine in some clients increases risk for flare

H. pylori prevalence is higher in patients with rosacea◦ East Mediterr Health J. , 2003

Journal for General Microbiology, 2012 Demodex folliculorum mite (8 leg arachnid/spider)

that lives harmlessly on the face Increase in number as we age and with sun damage The number of these mites is 10 times higher in

clients with rosacea They mate in the dark / eggs are laid in the pores /

mites die Mite life cycle: 14 DAYS It is not the mite that is the trigger but the bacteria

Bacillus oleronius that triggers the immune skin response

This occurs when the mite dies and the bacteria leak into the skin tissues

Solution Kill time

100 % alcohol 4 minutes

50 % tea tree oil 15 minutes

100% tea tree oil 4 minutes

100% carraway oil 4 minutes

100% dill weed oil 14 minutes

CAUTION: CARRAWAY OIL AND DILL WEED OIL ARE TOXIC TO EYE

Cornea, 2007 Feb 26(2):136-43Br J Opthamol 2005, Nov;89(11):1468-73

50 % tea tree oil diluted macadamia oil can be used around the eyes and skin with care weekly

50 % tea tree oil shampoo can be used daily

Camphor oil with or without glycerol dilutions gave complete cure of mite with 100%, 75% and 50 % dilutions.

Camphor oil in 25-50 % decreased mite but not full eradication.

Cleansing the face every am and pm can decrease overall mite load on face

J Cosmet Dermatol, 2008 Mar; 7(1):8-14Silymarin/methylsufonilmethane (S-MSM) cream resulted in clinically

significant decreases in redness, papules and skin color in rosacea clients.

Mechanism: decreasing the immune system cytokines

Vitamin D produces over 200 antimicrobial peptides to fight infection

Optimal level 50-70 Vitamin D increases cathelicidin which

triggers the rosacea Rosacea clients have 25 percent higher

Vitamin D levels then clients without rosacea. It is possible that too much vitamin D may

trigger rosacea also ◦ Cutaneous and Ocular Toxicology, Feb 2014, Vol

33, Issue 1, 2014, pages 60-62

VITAMIN A prevents the activation of the SCTE enzyme and the inflammatory cycle

Dosing: Vitamin A 8000 units daily if client is a fertile female

If patient is using dual contraception, then vitamin D 25000 units every 12 hours can help some clients for 1-2 months and then lower dose switch can occur

Amide of Niacin (Vitamin B3) Mechanism:◦ Decreases histamine release◦ Decreases sebum production ◦ Decreases P acnes bacteria activity◦ Decreases vasoactive amines

◦ 79 percent of test subjects showed moderate or more improvement after 8 weeks of therapy

◦ Dose: 750 mg per day ◦ Cutis 77: 17-28, 2006

Topical Niacinamide◦ Stabilizes the epidermis

◦ Prevents moisture loss

◦ Decreases inflammation on skin surface

Zinc 23 mg every 8 hours decreased rosacea severity by 75 percent

Zinc accelerates skin healing

Zinc helps maintain Vitamin A levels in blood

Long term zinc user should take a copper supplement to prevent copper deficiency ◦ Int J Dermatol 2006; 45:857-61

Rosacea clients produce less lipase then healthy individuals

Supplementing with oral enzymes anecdotally has improved rosacea symptoms

Dermatologica 1982; 165:601-6

Vitamin C helps stabilize blood vessels

Lipo C encapsulated form 14-20 grams per day

Divided dosing: 4 grams orally every 6 hours

Others recommend a 3 -5 gram daily dosing

Hypothalamus set point for body temperature is lower in rosacea

Miscommunication between blood vessels and nerves

Normal subjects set point: 90 degrees F Rosacea subjects set point: 65 degrees F

Action◦ Increasing GABA and GABA receptor activity with

supplementation◦ Increase Serotonin in body naturally ◦ Reduce cortisol levels by stress reduction

Use fan Guided imagery Green tea ice cubes applied to face daily Spray mist on self when exercising Cucumber slice massage on face Spray lemon juice on face Apply coconut oil to face Zinc sunblock Vitamin E applied to face daily Hormone balance

THANK YOU