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Sunlight and vitamin D, do they trigger rosacea?

Posted on: July 23, 2013   by  John Cannell, MD

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Vitamin D may make rosacea worse according to researchers in Turkey.

Rosacea is a chronic condition characterized by facial redness and occasional pimples. It typically begins as redness on the central face across the cheeks, nose, or forehead. In some cases, additional symptoms, such as swelling of superficial blood vessels on the face, small red bumps and pustules, red gritty eyes, burning and stinging sensations, and in some advanced cases, a red lobulated nose is seen.  It affects 3% of the US population over the age of 30.

Eighty-one percent of patients with rosacea report that sun exposure makes it worse. Of the many environmental triggers that exacerbate the condition, sun exposure is actually the most common. This may be because patients with rosacea have elevated levels of the antimicrobial peptide, cathelicidin, in the affected skin. Vitamin D increases cathelicidin, which may explain why sun exposure is a common environmental trigger, though researchers don’t know for sure.

Overgrowth of a dysfunctional intestinal flora or abnormal intestinal microbiome may play a role in causing the disease. Recently a trial of rifaximin, a non-absorbable antibiotic that treats intestinal overgrowth but does not leave the digestive tract, showed a 96% response rate; meaning, that almost all of the participant’s reported an improvement with this treatment.

What about vitamin D levels in people with rosacea? Recently, scientists in Turkey discovered that rosacea patients had statistically significantly higher 25(OH)D levels than controls.

Ekiz O, Balta I, Sen BB, Dikilitaş MC, Ozuğuz P, Rifaioğlu EN. Vitamin D status in patients with rosacea. Cutan Ocul Toxicol. 2013 May 28.

The mean vitamin D levels in the 41 rosacea patients was 21 ng/ml compared to 18 ng/ml in 32 controls (p=0.047). However, the prevalence of vitamin D levels <20 ng/ml was 37% in the rosacea patients and 28% in healthy controls, which was not significantly different (p=0.34).

The authors concluded:

“Patients with rosacea have relatively high serum vitamin D levels compared to control groups. The result of our study suggests that increased vitamin D levels may lead to the development of rosacea. To confirm status of vitamin D levels in patients with rosacea, larger epidemiological studies are needed.”

While this type of study and their findings are hardly convincing, it does raise some questions. Particularly since sun exposure makes the condition worse.

We know sunlight and sunburn makes rosacea worse, so does supplemental vitamin D do the same? Any readers have any anecdotes in this realm?

24 Responses to Sunlight and vitamin D, do they trigger rosacea?

  1. Rita and Misty

    Dr. Cannell~~I really need to preface my comments here with the statement: “I am not a physician nor am I a healthcare professional.”

    I do have some musings on rosacea, though.

    First, let me say: there is no doubt in my mind that sun exposure may trigger a bout of rosacea. I have witnessed this first hand. I have also witnessed sun exposure no longer trigger that same rosacea response once iodine was added to the diet, even though the 25(OH)D level of this person is quite high. 🙂

    My thoughts are this: the rosacea trigger (sorry if this isn’t correct medical terminology) is encouraged in an acidic body.

    In my opinion, an alkalized body will not be prone to rosacea, regardless of sun exposure or 25(OH)D level.

    Now, I know many are going to disagree with my next statement, as Iodine has been implicated as a rosacea trigger. Please humor me though….

    Iodine is an excellent alkalizing agent. And it will help keep us healthy; it will balance thyroid function, clear arteries, control glucose levels, prevent PCOS and breast cancer, keep our metabolism humming, help with our overall mood, and aid vitamin d in its function.

    In other words, I consider Iodine to be a vitamin d co-factor (I’m not a doctor or scientific researcher…only someone addicted to nutritional things…).

    I think that we are all severely deficient in Iodine. I have taken 50 mg of Iodoral for 1.5 years now, and I am the healthier for this. (I recently told a fellow VDC member I was taking 75 mg–I apologize, I added incorrectly…but 50 mg is still substantial).

    My daily protocol includes:

    D3
    Vitamin C
    B-Complex
    Magnesium
    Boron
    Zinc
    K
    Iodine
    Selenium
    Melatonin

    Be well,
    Rita

  2. Rita and Misty

    (my point being that separately, high levels of either d and iodine may exacerbate rosacea…or low levels of either may exacerbate rosacea, BUT–optimal levels of both D and Iodine will help the body stay healthy–and it will then not be prone to rosacea)

  3. Jks1

    I am 60 and always in the sun. I too developed roseca mainly on my nose.I started regularly eating organic live sauerkraut and kinche daily and since then, over a year now, I have completely eliminated any pimples on my nose!

    I found it interesting in the article that a faulty gut bacteria was detected in roseca cases. It seems to be the factor I had! I do not take Vit D supplements either since my tested level was around 50.

    Jim

  4. pf

    Sunlight is a major trigger for my rosacea. I have slightly low vitamin D levels which I have been working on correcting. While supplementing with vitamin D, my rosacea continued to worsen. Recently, I came to realize that I also had signs of low vitamin A. Since incorporating pre-formed vitamin A into my daily vitamin regimen along with vitamin D and co-factors, my rosacea has been much better. This summer for the first time in years, I can expose my face briefly to sunshine without provoking a ugly rash. For me, and perhaps others, my guess is that it’s not that vitamin D is causing rosacea, so much as the delicate balance between vitamin A and D is off. BTW, I have always eaten orange veggies without having any impact on my vitamin A status. Preformed is essential for me.

  5. seriousgreta

    I have had rosacea for probably 12 years. At the beginning of this period, my guess is that my vitamin D levels were well below 30. About two years ago, I figured out that I could control it by using a high SPF sunscreen and something called Prosacea. However, after working my vitamin D level up to 47, my rosacea has calmed considerably; almost to the point of non-existence .. I no longer have to be coated in sunscreen and I use the ointment once in awhile.

    I think the Turkish study didn’t look at enough factors; big problem with many studies.

    It’s all about ‘balance’ and achieving balance is different for everyone. Vitamin D, dietary acidity, iodine, vitamin A are all probably involved. I think the key to my ‘balance’ just happened to be raising my vitamin D, but it makes perfect sense that other people got results doing other things.

  6. John

    I believe that roseaca and also chloasma (pregnancy mask) are a result of your body trying to make MORE vitamin D in a shorter amount of time than usual because your body is starving for it. Your skin is in hyperdrive because you usually maintain low levels of vitamin D. Flood your system with high levels of D for 6 months!

  7. seriousgreta

    Hmm .. Very interesting idea, and it certainly could have been true for me. All kinds of ‘things’ were breaking down for me around the time the rosacea appeared, and I think everyone of them was related to my chronic vitamin D deficiency.

  8. Rita and Misty

    “The mean vitamin D levels in the 41 rosacea patients was 21 ng/ml compared to 18 ng/ml in 32 controls (p=0.047).”

    So, John, I wonder if there would be a U-shaped curve, with rosacea cases going down once the 25(OH)D level reached around 50 ng/ml?

    That would be interesting to discover….

    And, it would fit my particular case…and make my Iodine musings not as valid (I do still think iodine deficiency is a serious matter…but I’m open to the opinions of others, I think).

  9. IAW

    So last night I “googled” and found http://scarletnat.blogspot.com/2012/12/the-role-of-vitamin-d-in-rosaceafacial.htmllast. It seemed some people had great luck with just adding Vitamin D and others it seemed as though adding Vitamin D (pill form) made things worse. So I am more apt to believe that something, like “pf” or “Rita” or “serious Greta” said above in that there is a another vitamin or mineral (maybe the magnesium thing again) that these people are deficient on and that is why they get “backlash” when they try and take the Vitamin D.

  10. Rita and Misty

    Here’s the thing:

    When those deficient in vitamin d, who also have rosacea, add vitamin d3 supplements to their protocol, and their rosacea immediately gets worse, they STOP the vitamin d3, without giving their bodies a chance to reach an optimal 25(OH)D….

    Someone would have to have forbearance, and give it his/her body the chance to reach an optimal d level to test John’s theory.

  11. Rita and Misty

    Pregnant women might be a good test group for this, as they are more likely to put up with the temporary rosacea if convinced that d3 supplementation will be beneficial to their babies….

    Just a thought.

  12. IAW

    TO: Rita
    What I cannot understand is why do they initially get worse? You would think that each day they would get a little better or if not taking much extra Vitamin D, then not noticing a change. I could also understand that if someone said well I take 5000 iu a day of Vitamin D and my Rosacea is almost gone, then I would say take a little more Vitamin D and maybe it will entirely go away. I agree that they probably need the Vitamin D but am hard pressed to tell them to “persevere” when they are in physical pain. I know some of them only took 1000 iu’s and had “backlash” so I cannot really say that telling them to slowly increase their “D” might avoid this.

  13. Rita and Misty

    Dear IAW~~

    If I understand John’s premise: he is saying that he believes roseaca and also chloasma (pregnancy mask) are a result of the body trying to make MORE vitamin D in a shorter amount of time than usual because of depletion mode. His words: “Your skin is in hyperdrive because you usually maintain low levels of vitamin D. Flood your system with high levels of D for 6 months.”

    I am assuming John is referring to sunshine and increased rosacea. But perhaps the same holds true for oral supplementation of d3 and increased rosacea–until the body reaches repletion levels.

    I am of the school that dosage matters little. It is your 25(OH)D level that counts. In other words, 50 ng/ml–80 ng/ml for most people will be optimal. You must take the daily dose that will get you there, correct?

    BTW–I am awaiting the results of my July 25(OH)D, and I will share upon notification.

    Be well, be happy, etc.
    Rita

  14. Arthur

    I am 62 years old and have a mild case of rosaceaI for probably about 15 to 20 years to point where I noticed it. It affects mainly my left nasal bridge and cheek. It is clearly genetic as my father had it and my sister has it, as well as least two of my nephews who have had much worse, even severe, cases affecting them in their 20s and 30s. In my case, it is clearly affected by sun exposure and also by exercise, both which which bring out the redness and flair it so it spreads some. I have treated with a topical metronidazole cream which is very effective and only have to use occasionally for a day or two or occasionally a little longer. Since I have brought my Vitamin D levels up to the the 50 to 60 ng/dL range over the past 8 to 10 years the rosacea has improved to the point where I almost never need the cream. Based on my own limited experience, I believe that the Vitamin D levels may be a marker to sun exposure but not an independent risk factor in itself and that oral Vitamin D supplements may actually help the condition. But who knows?

  15. Rita and Misty

    Hi Arthur,

    8 years ago my 25(OH)D level was 32 ng/ml…and my face was perpetually red…reminiscent of sunburn….

    When my level reached 74 n/gml, the redness disappeared. However, I correlated this event with my iodine use, as I do believe iodine has an alkalizing effect on the body (others have informed me that iodine exacerbates rosacea).

    Perhaps oral d3 supplementation did help my condition.

    I can tell you that I don’t suffer from rosacea now; and additionally, I can sit outside in the sun all day without any sunscreen and I will never (ever) burn.

    Arthur–Welcome to the Member’s Blog!!!

  16. to9894

    I have rosacea and my vitamin D level is low. For myself I also believe that rosacea is caused by problems in the gut. When I gain weight and eat junk food, my rosacea becomes worse. I recently read a comment from someone who took Florastor (Saccharomyces boulardii lyo) which is a probiotic, and this person said it cleared her rosacea. My plan is to increase my vitamin D levels with supplementation and improve what I’m eating and look into the Florastor. I also suspect gluten, dairy, sugar, bad fats, simple carbs, and foods high in salicylates to be my problem. Sometimes I also think it’s the additional ingredients in a vitamin D supplement that can cause problems.

  17. John

    Yes, I was referring to UV sunlight exposure. Using vitamin D as a marker is important. Exposure to UV increases vitamin D but it also affects sulfur and nitric oxide. Sometimes vitamin D has a direct beneficial effect and other times it may be a secondary one. However it seems certain good things linked to your health increase with higher levels of vitamin D.

  18. Rita and Misty

    Absolutely, John, I would agree with you: certain good things linked to your health do increase with higher levels of vitamin D. I’m counting on one of those things being a stronger immune system.

    Be well,
    Pollyanna

  19. Rita and Misty

    @John, My musings on vitamin d helping to build a stronger immune system led to my having a discussion with several AIDS/HIV researchers I know here at my institution of employment.

    Did you know that apparently rosacea is commonly found in patients suffering from HIV infections?

    I thought that was quite interesting. But after some pause for thought it makes some sense now to me.

    Here is a link to an old journal article which briefly handles the subject:

    http://std.sagepub.com/content/19/7/493.full.pdf

  20. IAW

    To: Rita
    I understand what John is saying. Here is an excerpt from http://www.rosaceagroup.org/The_Rosacea_Forum/showthread.php?20982-My-Vitamin-D3-Story/page2. “During my first 2 weeks of 1,000 IU, I was more red and flushy than normal. I couldn’t tolerate 2,000 IU at all. After 3 weeks at 1,000, other than a brief period of remission from oregano oil, my skin had not been better in literally 20 years. I’m approaching that point now with 3,000, getting better every day, keeping in mind that just 2 months ago I could not take even 2,000 without an extremely bad reaction. At every stage, I get worse before I get better. The reactions at each dose have also taken longer to get over than the previous dose, and I’m sure if I had started at 5,000 a few months ago, I would still be in very bad shape now. I plan to stay at 3,000 for several more months – I think I moved too quickly from 2 to 3.”
    So this would confirm what John said. I still think that maybe a vitamin or mineral might ease this problem of “getting worse before getting better” or at least possibly lesson the amount of time the problem is occurring. So besides the reference to Vitamin A above another person said Vitamin C may have helped and another said that Zinc supplements definitely helped while trying to transition to taking more Vitamin D. (I did note that Zinc is on your supplement list.)
    At http://www.ncbi.nlm.nih.gov/pubmed/16863527 you will find Oral zinc sulfate in the treatment of rosacea: a double-blind, placebo-controlled study.It’s CONCLUSION: Zinc sulfate was found to be a good option in the treatment of rosacea, as it was safe, effective and lacking important side-effects.

  21. Rita and Misty

    Yes, and interestingly enough, Zinc has quite a beneficial effect upon the immune system:

    http://jn.nutrition.org/content/130/5/1421S.full

    “n summary, evidence to date indicates that adequate amounts of zinc are essential to maintain the integrity of the immune system and that HIV-1–infected individuals are a population particularly susceptible to zinc deficiency”

    (we do a great deal of Aids/HIV research here)

  22. Rita and Misty

    When I by chance showed this blog to those in AIDS/HIV research here it generated some very interesting and fruitful discussion…..(btw–the website got rave compliments on its blog and graphics).

    Here is an interesting question generated by this blog.
    Is AIDS caused by vitamin d deficiency?
    http://www.laleva.org/eng/2011/10/is_aids_caused_by_a_vitamin_deficiency.html

  23. pheppel

    When I was diagnosed with rosacea I had vitamin D levels of 8 ng/ml despite frequent sun exposure. Now after supplementing with vitamin D, my vitamin D levels are 50 ng/ml and my rosacea is gone. Along with rosacea, my seasonal allergies disappeared and much of my arthritis pain disappeared. I think the anti-inflammatory effects of vitamin D reduce rosacea.

  24. Michael

    Hello all,
    This is my first post since joining last week. I have been following this site for approximately 4 years. My adult son and I began taking 5,000 UIs of Vitamin D3 daily way back then. Here are some of the changes:
    My son, now 42, had been suffering for over a decade with horrible large-flake dandruff with scalp pustules, scabs, and general psoriasis looking scalp flesh. After 6 months on Vitamin D3 5,000 UIs daily which gave him a level of 25(OH) of 55 (it was never measured before he started), his scalp began to show improvement and after about two years more his scalp had become totally irritation-free and normal.
    At the same time he also was suffering from severe Rosacea on both cheeks. Dozens of prescriptions failed to help it or the scalp. His forehead also was completely inflamed with seborreic dermatitis and was flaking heavily and was covered with pustules. He was not a pretty sight at all. Prescriptions galore had not improved any of his ailments, nor did any home remedies.
    After about the 2nd year on Vitamin D3, the Rosacea was noticeably clearing considerably and the forehead was better, but not getting cured as thoroughly as the other two areas. So…..I put him on an absolute no-soap regime about 3 months ago and we are beginning to see some more improvement on the forehead. The forehead flaking is minimal and the pustules are smaller and fewer, however, the skin is still discolored red. What an ordeal we have been through fighting his skin condition. I give full credit to the 5,000 UIs of Vitamin D3 daily, as recommended by Dr. Cannell, as the base cause of his miraculous improvement.
    I am a bit of a sun worshiper from way back. I even sun bath in winter at noon even when it is near freezing here in Seattle. In the decade preceding our starting on Vitamin D3, my son had become a recluse and would no longer go on daily walks with me (1-3 hours was typical). He had become sullen, cranky, unsocial and would only go out rarely and only after dark. His mood and isolation had reached crisis proportions. You probably have already guessed what happened when he started taking the Vitamin D3 5,000 daily. Within a WEEK he was starting to talk in sentences about things, instead of just disinterested grunts. At about week 2 he went on a walking excursion downtown in daylight. It was like he was reborn or pulled back from the brink.
    I have some other Vitamin D3 tales to share later.
    Michael

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