How Your Gut Health Is Linked To Rosacea

I'm a big believer that a happy gut means better overall health, including skin health. Just like the skin, the gut has its own unique microbiome (the microorganisms in a particular environment), and if the microbiome gets disrupted, there are consequences not just for the digestive system, but for other organs as well. (Digestive Wellness, by Elizabeth Lipski, PhD, is a great book for those who want to learn about this stuff.) A report in the Journal of the American Academy of Dermatology indicates there may be a connection—and a solution—for patients with Small Intestine Bacterial Overgrowth (SIBO) and rosacea.

How Rosacea Is Connected To Gut Health

SIBO is exactly what the name describes: the small intestine becomes overpopulated with bacteria. But isn't bacteria good? Yes, but the large intestine normally carries the majority of bacteria, not the small intestine, and overgrowth is associated with diarrhea, constipation, and bloating. The causes of bacterial overgrowth are many, varied, and interconnected, but carbohydrates have been known to feed the bacterial overgrowth, as has alcohol. Rosacea, most commonly manifested as redness and bumps on the face and body, happens when the body's innate and adaptive immunity breaks down. It's also related to neurovascular changes, chronic inflammation, and bacterial infection. This bacterial infection is the connection we're looking for. In the study, 46% of prospective patients with rosacea had SIBO, and these patients were prescribed rifaximin, an antibiotic commonly used for traveler's diarrhea. After rifaximin, 78% of those patients saw an improvement in their rosacea (and of course, their digestive issues). That's a major improvement!

How This Changes My Practice

Although the reasons rosacea and SIBO are connected are still not totally clear, there is a connection in at least a subset of patients. And now, for any patient with moderate or worse rosacea, I am suggesting a SIBO breath test, which can be performed at home, or in many gastroenterologist’s offices. It's a non-invasive test, but does take a few hours. For the patients that come back SIBO positive, they are getting treated with rifaximin. The good news? Many of those patients are having improvements in their rosacea! The bad news? Not all patients with SIBO and rosacea get better rosacea-wise when they are treated. The world of gut health is incredibly complicated and interconnected, and the interactions between small intestine bacterial health and your skin are still being studied. More work needs to be done, but this is a promising step in offering hope to those who suffer from rosacea. And for me, further proof that we cannot ignore the rest of the body when we think about skin disease.  

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