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Thanks to everyone who took time to respond to my request for
information on the effect of a gluten-free diet on rosacea. If you
recall, I asked people to let me know when they got it, how bad it got,
and how fast it resolved itself (if indeed it did). Eleven people with
rosacea responded, plus a couple more with helpful suggestions on
therapies to try.

First, I did a little net-surfing to get a thumbnail description of
rosacea. Basically, what I got from the reading is that rosacea
generally appears on the nose, chin, cheeks and forehead. It's
characterized by redness which comes and goes, but inevitably worsens
over time to include pimples, some hard and red (papules) and some
pus-filled (pustules). It doesn't usually include the blackheads and
whiteheads of garden-variety acne. The skin can get very dry and scaly.
Eventually the dilated blood vessels become visible as red lines. The
worst cases have swelling along with redness and can form bumps of
thickened skin especially on the nose, called rhinophyma. The eyes can
become involved, with symptoms of tearing, feeling like there's
"something in my eye," etc., and can progress to "corneal complications"
-- i.e. vision damage or even blindness.

I did not find itching described as a symptom of "classic" rosacea,
although several of the people who told me that was one of their
symptoms said they had been officially diagnosed with rosacea by a
dermatologist. Perhaps I'm not looking at the right sources. I
understand it is a recognized symptom of DH, however.

Typical age of onset of rosacea is between 30 and 50 though it can
appear earlier or later. More women get rosacea, but men are more likely
to progress to the most severe stage. Topical steriod creams are not
helpful and can be harmful; long-term antibiotic therapy (i.e., for the
rest of your life) is usually prescribed; tetracycline is most often
mentioned. The standard line is that the condition is progressive
without treatment, controllable, but ultimately not curable.

W.C. Fields may be the most well-known rosacea sufferer. Because he was
an alcoholic, people with rosacea are often unfairly assumed to be
alcohol abusers, but there is no causal link between the two, although
alcohol can prompt or aggravate a flare-up.

Officially, the cause of rosacea is unknown. It appears more often in
people prone to blushing or flushing, leading to speculation that it is
linked with a vascular disorder, as people who have it are also
apparently more prone than the general population to suffer from
migraines.

Current strategies for coping with rosacea consist of identifying
individual "tripwires"  -- things that cause flushing -- that can
aggravate the condition or produce flare-ups. The National Rosacea
Society's (http://www.rosacea.org) survey of more than 400 patients
revealed these as the most common: sun exposure for 61 percent of the
respondents; stress for 60 percent; hot weather for 53 percent; alcohol
for 45 percent; spicy foods for 43 percent; exercise for 39 percent;
wind for 38 percent; hot baths, cold weather and hot drinks for 37, 36
and 36 percent, respectively; and skin-care products for 24 percent.

Of my 11 respondents, 8 had been diagnosed with rosacea (three of these
had also had other diagnoses in addition to rosacea over the years,
including seborrheic dermatitis and DH). Three apparently were self
diagnosed.

Five called themselves celiacs (four of these specifically said they had
been diagnosed as such). Two had been diagnosed with irritable bowel
syndrome and one with eosinophilic gastroenteritis (and *not* CD). One
described herself as gluten intolerant, one described skin and joint
problems but couldn't say if she was celiac, and one did not give a
diagnosis.  All said they were gluten-free at this point.

Eight of the eleven had noticed improvement in their rosacea after going
gluten-free. Most said it took a while to notice an improvement, from 1
to 6 months, although one noticed the chin/eyebrow rash part of her
problem went away in two weeks.  One said a year after going GF the
rosacea had almost completely disappeared, and one said he noticed
improvement in 3-6 months and now is normal in skintone almost 4 years
later. Improvement ranged from complete disappearance of the rosacea to
redness "just about disappeared" to "95% back to normal".

When gluten is consumed problems seem to appear pretty quickly again,
however. One said "my nose is the bellweather." Another said she has
problems within the week after eating gluten. Another said her skin will
react in a couple of days but it then takes weeks to clear up after she
goes GF again.

However, of the four diagnosed celiacs, only two improved. One who did
not said she contracted rosacea after her celiac diagnosis (and going
gluten-free), and the other said he suffers from chronic rosacea despite
being gluten free for 25 years.

The respondent with skin and joint problems said soy seems to be the
main offender in her battle with rosacea, especially soy lecithin, and
she suspects seed and nut oils (such as sesame, flax and now almond) as
well. One gluten-intolerant person whose skin cleared up after going
gluten-free said she noticed yeast in her diet produces the same red
nose and ugly veining, so she has eliminated it as well. Another
gluten-intolerant person said she had (lesser )skin problems appear
after consuming quantities of rice, and suspects she is intolerant to
that as well.

One respondent who did not specifically say she has rosacea (her mother
does), has noticed symptoms of her many allergies/food intolerances
alleviated after removing mercury amalgam fillings from her mouth and
starting "sweat therapy" to remove toxins. Another suggested essential
fatty acid supplementation to the diet.

Not many respondents said how long they had had rosacea, so it is
difficult to draw conclusions about whether length of time with the
condition corresponds with how fast (or whether) it cleared up after
going gluten-free. However, one 65-year-old respondent said he had
lifelong trouble with the "Irish nose"; another said she had been
diagnosed with rosacea over 20 years ago as a teenager; both had
complete remission after going gluten-free.

Those with rosacea diagnoses have tried various medical remedies,
including metrogel/metrocream and 2% Flagyll in Dermabase (all of which
appear to be topical forms of metronidazole, an anti-bacterial and
anti-inflammatory drug); steroid injections, drying creams, moistening
creams, antibiotics and hydrocortisone.

Several said these things did not produce permanent improvement. One who
was helped by going GF (cracking and flaking completely gone, redness
"just about disappeared") still uses metrocream. One said metrogel
helped "sort of, sometimes" but was completely cured by going GF. One
who was not cured still uses Flagyll cream which he says helps control
it.

(As an aside, if anyone is interested in non-drug helps for rosacea
flareups: during my own most severe outbreaks of "red nose syndrome,"
when peeling was the worst, I went to bed every night with my face
coated with castor oil. It seems to help reduce -- though not eliminate
-- the redness dramatically, perhaps by controlling the peeling skin.
However, it hasn't been a cure.)

One respondent who was on long-term antibiotics (on and off for seven
years) believes it caused some of her gut problems along with the celiac
disease. Another said she refused to go on antibiotics because of
potential intestinal damage. Antibiotics like tetracycline can also
cause permanent pigmentation changes in the skin (perhaps because of
increased photo-sensitivity), and one respondent seemed to indicate this
had happened to her.

Since there is no officially recognized cause for rosacea, the question
in my mind is why use antibiotics, which are -- I think I'm correct here
-- specifically an antibacterial agent.

I did a Medline search (http://igm.nlm.nih.gov) on rosacea and turned up
several studies exploring a link between rosacea and Helicobacter
pylori, the bacterium implicated in stomach ulcers. "May Helicobacter
pylori be important for dermatologists?" (Dermatology 1995; 191(1):6-8)
makes the case for a link, and the abstract states "Rosacea has often
been linked with gastrointestinal disturbances." (Oral?) metronidazole
apparently is a drug of choice for Helicobacter pylori infection as
well.

However, a more recent study in the American Journal of Gastroenterology
(1998 Feb; 93(2):220-2) concludes differently. "There was no significant
difference in the seroprevalence of H. pylori infection between rosacea
patients and healthy subjects (26.7% vs 34.9%; p=0.40). Significantly
more patients with rosacea complained of indigestion (66.7% vs 32.6%;
p=0.001) and used antacids (60% vs 32.6%; p=0.01)."

Another couple of studies implicated bacteria-containing skin mites
called demodex folliculorum and demodex brevis (J Egypt Soc parasitol
1997 Apr: 27(1):183-95, and Dermatology 1997; 195(3):239-42). The second
study involved children, who apparently rarely have these mites, but
these children were suffering from a compromised immune system due to
leukemia or HIV infection. The immune system component I think would be
of interest to celiacs. Still another study found these mites in a
75-year-old man with rosacea and treated him successfully with
metronidazole, even though the authors noted that this drug is not known
to be miticidal. However, I don't know whether by successful treatment
they meant "cured" or "controlled."

The final and to me, most interesting study I am not scientifically
educated enough to fully decipher, so I hope someone on the list will
read the article (or the Medline abstract) and correct me if I've drawn
the wrong conclusions. In Histol Histopathol 1996 Jan; 11(1):111-5,
scientists studied tissue taken from rhinophyma rosacea sufferers.
"Since neuropeptides and their receptors are responsible for local blood
flow regulation," they analyzed the number of "vasoactive intestinal
peptide" receptors (VIP-R) found in slice biopsies. "In contrast to
controls, rhinophyma disclosed not only a more dense distribution of
VIP-R positive cells, but immunoreactive perivascular large cells." Am I
right in reading this as a link between peptides from a digestive source
and rosacea? Anybody care to comment?

Many thanks to everyone who took the time to share their experiences. In
conclusion, I think it would be worth it to me to try going GF to treat
this, with the understanding that I might not see results for several
months.

Good luck to you all,

Leslie Beachwood
Beaverton, OR