<<Disclaimer: Verify this information before applying it to your situation.>> 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