Rosacea is an inflammatory dermatologic condition affecting 13 million Americans. When limited to the central part of the face, lesions can include flushing, vascular congestion, increased vascularity, red and pustular lesions and thickening of the skin and/or nose. These are an embarrassing social problem. When it involves the eyes, however, it can be a disturbing problem and can result in visual disorders. Ocular rosacea includes blood vessels forming on the lid margin, fullness of the lid margin, clogging of the tear glands and corneal abrasions from flaking skin which affect the vision and can be difficult to treat.
Rosacea occurs without explanation in most patients but it has been associated with inflammatory bowel diseases, chronic liver disease, chronic pancreatitis, low stomach acid, stomach bacteria, and, most recently, with small intestinal bacterial overgrowth.
Current therapy includes use of topical medications and oral antibiotics including doxycycline.
A recent study demonstrated a prevalence of small intestinal bacterial overgrowth by breath testing in 52/113 (46%) consecutive rosacea patients. An antibiotic called Xifaxan which is not absorbed from the gastrointestinal tract was given to these patients. In 28 patients treated with Xifaxan, 20 cleared their lesions and 6 had significant improvement. In 20 treated with placebo, 18 stayed the same and 2 worsened after at 1 month. Later Xifaxan treatment of the 20 placebo patients led to healing of 17 patients and improvement in 2. Xifaxan treatment of the patients without bacterial overgrowth did not help the rosacea.
If you are interested in getting a breath test to see if you have bacterial overgrowth (which can also explain problems with gas and bowel movements), please call Dr. Leonard Weinstock’s office in Creve Coeur (314-99-0554 extension 5).