Rosacea generally occurs without an obvious explanation.
The link of rosacea to the gastrointestinal tract is very clear since it is associated with Crohn's disease, liver disease, chronic pancreatitis and Helicobacter pylori infection in the stomach. In 2008, it was discovered that rosacea is associated with small intestinal bacterial overgrowth (SIBO).
Dr. Weinstock and the Specialists in Gastroenterology in Creve Coeur have investigated the association of SIBO with various syndromes and diseases. It has been shown that SIBO is a major contributing factor to irritable bowel syndrome, restless legs syndrome and rosacea of the skin and/or eyes. Furthermore, treatment of SIBO often improves symptoms of these disorders. The lactulose breath test diagnoses the presence of SIBO.
The 2008 study by Italian investigators found that SIBO was present in 52 of 113 (46%) consecutive rosacea patients. The FDA-approved antibiotic rifaximin (Xifaxan®) was given to 28 of these 52 patients. Of these 28 patients, 20 (71%) experienced clearing of their rosacea lesions and 6 (21%) had significant improvement in their overall rosacea symptoms.
In contrast, 18 of 20 patients (90%) treated with placebo had no improvement of their rosacea and 2 experienced worsened rosacea symptoms. Subsequent treatment of placebo patients with rifaximin led to lesion healing in 17 of 20 patients (85%) and improvement in 2 of 20 patients (10%). Rifaximin did not help rosacea in the patients who did not have SIBO. These results are especially encouraging in light of the fact that many of these patients failed other rosacea treatments. Rifaximin is not absorbed from the gastrointestinal tract, has a low probability of bacterial antibiotic resistance and causes few side effects.
The results of our own study of rosacea echoed the results of the study above. Read Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of its Eradication. On this page: Dr. Weinstock explaining rosacea and the skin-gut link and photos of rosacea patients who have responded to SIBO therapy. If you are interested in getting the breath test for SIBO then please contact us and we will mail the kit to your home. If the results show SIBO is present then you will be offered an office visit to discuss and receive treatment. If the results are negative you will continue to work with your dermatologist and/or ophthalmologist.