Rosacea: Should natural treatments be considered?

Rosacea is a chronic dermatosis, causing inflammation of the skin. Its causes are still poorly understood, however, recent research has identified certain triggering factors. Among them, we can notably mention heat, sunlight, colonisation by parasites, stress, consumption of certain foods, or even a genetic predisposition. Indeed, it has been established that about 30% of people suffering from rosacea have family history of this condition. Rosacea causes symptoms of varying severity, depending on its stage and degree of management. Generally, four subtypes of rosacea are distinguished.

• Vascular rosacea or couperose : this form of rosacea is the most common but also the most benign. Individuals affected by this subtype often experience hot flushes and are prone to redness, referred to as erythrosis.

• Papulopustular rosacea : more debilitating, this form of rosacea is characterised by the presence of red spots, or even pustules, in addition to redness. Papulopustular rosacea is also accompanied by feelings of tightness and sensations of burning and discomfort.

• Hypertrophic rosacea : this rare but severe form of rosacea is characterised by the dilation of skin pores on the nose, or rhinophyma, and a thickening of the skin. This skin thickening is sometimes associated with papulopustules and can extend to the rest of the face.

• Ocular rosacea : Finally, it sometimes happens that rosacea affects the eyes. They then become red and particularly prone to conjunctivitis and a constant dryness. The eyelids can also be affected and show signs of redness.

At the first signs of rosacea, it is crucial to alert a dermatologist so that they can prescribe a suitable treatment to prevent the rosacea from worsening and progressing to more severe forms.

Whilst rosacea can never be completely cured, various treatments are available to improve the skin's appearance by reducing redness and pustules. The options vary depending on the severity of the symptoms and the subtype of the disease. Among the most common treatments are anti-inflammatory gels, oral antibiotics, and surgical procedures (laser, dermabrasion...). Additionally, when rosacea is at an early stage, there are natural solutions for rosacea that can help to reduce the appearance of redness and telangiectasias.

Liquorice.

Liquorice is a plant known for being particularly rich in flavonoids and saponins (glabridin, glycyrrhizic acid, glycyrrhizin, licochalcone and liquiritigenin). These compounds are endowed with anti-inflammatory properties. Research has shown that liquorice can inhibit the production of superoxide anions and the activity of cyclooxygenase, an enzyme involved in the pathogenesis of rosacea and catalysing the oxidation of arachidonic acid into prostaglandins in the body.

A study has particularly focused on the effect of a gel containing 2% liquorice on skin affected by atopic dermatitis. After daily applications for two weeks, the scientists observed a reduction in erythema scores, oedema and itching. Considering that rosacea is also characterised by sensitive skin, erythema and inflammation, it is reasonable to assume that liquorice is an excellent candidate for combating this skin condition.

Chamomile.

Chamomile contains a unique combination of saponins, phenylpropanoic acids, and flavonoids. Thanks to this complex composition, this plant significantly enhances the permeability of the vascular wall as well as the mechanical resistance of the capillaries. This helps to curb the excessive dilation of blood vessels, a key element in rosacea.

Among the studies conducted on the effect of chamomile on rosacea, one can mention a double-blind clinical trial comparing the efficacy of a 1% chamomile cream to that of a placebo. For 12 weeks, 125 patients suffering from rosacea applied the chamomile-based cream twice a day, while 121 others used the placebo. At the end of the experiment, the patients using the 1% chamomile cream observed a significant improvement in the severity of the erythema and the overall severity of the rosacea compared to baseline values and the placebo.

Aloe vera.

Aloe vera is highly valued in cosmetics and has numerous beneficial effects on the skin. Its properties are well-documented and have yielded excellent results in various studies. Anti-inflammatory, antioxidant, analgesic, antipruritic... Although the aloe plant is composed of more than 99% water, the remaining solid composition is complex and rich in active compounds such as enzymes, polysaccharides, fat-soluble vitamins, minerals and flavonoids.

Furthermore, aloe vera contains anthraquinones, which are structurally similar to tetracyclines, antibiotics regularly prescribed for rosacea. In addition, several case reports have noted an improvement in itching, burning, and even scarring associated with dermatitis following the application of an aloe vera gel. This natural ingredient notably works by reducing vasodilation and the permeability of the vascular wall, and plays a significant role in inflammatory skin conditions. Considering all these factors, aloe vera extract is a good alternative for soothing skin affected by rosacea.

Green tea.

The leaves and buds of the tea plant contain a significant number of antioxidant, anti-inflammatory, and photoprotective polyphenols known as catechins. From a mechanistic perspective, these molecules inhibit nitric oxide synthase, an enzymatic system catalysing the production of nitric oxide, a free radical. Furthermore, catechins downregulate the activity of lipoxygenase, which catalyses the oxidation of fatty acids, and cyclooxygenase, thereby achieving both antioxidant and anti-inflammatory effects.

Some studies also demonstrate that green tea extract has a beneficial effect on rosacea by suppressing the expression of the vascular endothelial growth factor and the hypoxia-induced factor (HIF-1), thereby inhibiting the angiogenic process of rosacea.

The yuzu.

Citrus fruits are well-known for their nutritional virtues and health benefits. The consumption of yuzu is widespread in Asian countries, particularly in Korea and Japan. This fruit is very rich in antioxidants and it has been demonstrated that it has a anti-inflammatory effect on the skin. Indeed, the limonene found in yuzu reduces the production of reactive oxygen species and the activity of the nuclear factor NF-κB, involved in the immune response and cellular stress response.

Furthermore, a study conducted in 2018 demonstrated that yuzu extract has a suppressive effect on certain pro-inflammatory mediators involved in the pathophysiology of rosacea such as LL-37 and KLK5. This study concluded that yuzu extract can help to normalise the innate immune system response in patients with rosacea and contribute to improving the symptoms of this skin condition.

Colloidal Oatmeal.

Colloidal oatmeal has been used for centuries as a soothing agent to alleviate itching and irritation associated with various dermatoses. The scientific community believes that avenanthramides found in oats are responsible for its beneficial effects, particularly its anti-inflammatory and anti-itch properties. Avenanthramides work by reducing the activity of NF-kB in keratinocytes and decreasing the production of pro-inflammatory cytokines.

Several studies have focused on the effects of colloidal oatmeal in cases of atopic dermatitis and have shown that this natural ingredient helps to soothe the skin and reduce redness. Considering the many similarities between rosacea and atopic dermatitis (redness, inflammation, itching...), it can be hypothesised that the benefits of oatmeal can extend to skin affected by rosacea.

Please note : this list is not exhaustive. Other natural treatments have been studied and have proven to have an effect on rosacea. Examples include turmeric, quassia amara, wormwood, tormentil, and yarrow.

• BERSON D. & al. Botanicals and Anti-Inflammatories: Natural Ingredients for Rosacea. Seminars in Cutaneous Medicine and Surgery (2011).

• TAN J. & al. Rosacea: New Concepts in Classification and Treatment. American Journal of Clinical Dermatology (2021).

• DANCIU C. & al. Recent Developments in the Treatment of Rosacea through Natural Substances. Pharmaceuticals (2024).