SIBO rosacea link

[brasileirao]

This is the best threat I have ever read on this board. I have recently been diagnosted with gastritis and LPR (Silent reflux) and recently have been experiencing IBS like symptoms. Most were caused by stress, mainly my father passing away and other things taking place in my life. My skin started to worsen when the gut issues started to creep up and now I'm realizing more and more that I need to stop stressing so that my gut can heal. I also found out I have lactose intolorence along with glutten which I have stopped eating for 2 weeks now. (it will take a while for my gut to replenish) I'm also taking 15 billion pill of pro biotic but my main focus now is to stop stressing so that I can heal. Regardless of how my face looks now, I know that the stress is a huge factor on my gut and thus making my Rosacea worse.

BTW- is this threat a sticky? If not, it should be. Some brilliant information on here. Just simply amazing.

p.s. I also believe that I have low stomach acid but my stupid doctor game me PPI. I think the PPI is doing more harm then good but right now I have to stick with it. I'm going to see him again in Feb and hope I can get tested for SIBO and do a round to check how much acid my stomach is producing.

I'll report back.

[Brady Barrows]

philfaebuckie,

I have added your post here to my post on SIBO and Rosacea.

[JBDMD]

The link between rosacea and SIBO is real.

I'm new to this group, and my compliments. Very thoughtful postings.

First, I am a doctor. Secondly, I had sudden onset rosacea about a year ago. I recently developed IBS as well. I started doing research, and I don't mean reading blogs, but reading actual scientific literature. There is huge support for the connection between Small Intestine Bacterial Overgrowth (SIBO) and rosacea. There is also a link between overall carbohydrate sensitivity and rosacea.
I started a severe carbohydrate restriction diet (find out what that really is, not what you think it is: read Gary Taubes "Why We Get Fat")
and a course of Flagyl. Astonishing results with the rosacea and the bowel issues within days. There is another new antibiotic, but it is way expensive. I can't give advice here, but if I could, I'd say go with the Flagyl before the expensive stuff.
Here's the most definitive article I've seen, actually the abstract:

Well, the post to the article was going here, but, unfortunately the site won't allow links to scientific literature. One big demerit.

The article is "Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication.": Parodi, A et al. Clinical Gastroenterology and Hepatology, 2008, Jul 6 (7): 759-64. The abstract is in Pub Med. Google it. Sorry I couldn't give you the actual link.

Trust me, in the world of medical research, unless these guys are lying, this is an over the top result. I don't know why after four years it isn't standard treatment. Probably because dermatologists don't read GI literature, and GI doctors don't treat rosacea.


Just remember, for years, ulcers were thought to be a result of stress. An article just like this came out showing it was from a bacteria, Heliobacter pylori, and overnight, treatment of ulcers changed. This study is a game changer too. Print it out. Take it to your doctor. Don't go in saying "I did my research and this is what I found, and what I want. It pisses us off when you do that.) DEMAND a trial of Flagyll (One gram, twice a day, first day, then 250mg three times a day for seven days. Generic Flaygyl (metronidizole is $10 at Walgreens.) Good luck and clear skin. If it works for you, spread the word.

[Melissa W]

Thank you JBDMD for sharing this info. You couldn't post the link because you are a new member.
Is this the abstract?

Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication.

Parodi A, Paolino S, Greco A, Drago F, Mansi C, Rebora A, Parodi A, Savarino V.
Source

Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy.

Abstract

BACKGROUND & AIMS:

To better understand the role of small intestinal bacterial overgrowth (SIBO) in rosacea, we aimed to assess the presence of SIBO in patients with rosacea and the clinical effectiveness of its eradication.
METHODS:

We enrolled 113 consecutive rosacea ambulatory patients (31 M/82 F; mean age, 52 +/- 15 years) and 60 healthy controls who were sex- and age-matched. Patients and controls underwent lactulose and glucose breath tests (BTs) to assess the presence of SIBO. Patients positive for SIBO were randomized to receive rifaximin therapy (1200 mg/day for 10 days) or placebo. A group of patients with negative BTs were also treated with rifaximin. Eradication was assessed 1 month after the end of therapy. Two dermatologists, unblinded on therapy, evaluated rosacea patients before and after treatment on the basis of an objective scale.
RESULTS:

The prevalence of SIBO was higher in patients than controls (52/113 vs 3/60, P < .001). After eradication, cutaneous lesions cleared in 20 of 28 and greatly improved in 6 of 28 patients, whereas patients treated with placebo remained unchanged (18/20) or worsened (2/20) (P < .001). Placebo patients were subsequently switched to rifaximin therapy, and SIBO was eradicated in 17 of 20 cases. Fifteen had a complete resolution of rosacea. After antibiotic therapy, 13 of 16 patients with negative BTs for SIBO remained unchanged, and this result differed from SIBO-positive cases (P < .001).
CONCLUSIONS:

This study demonstrated that rosacea patients have a significantly higher SIBO prevalence than controls. Moreover, eradication of SIBO induced an almost complete regression of their cutaneous lesions and maintained this excellent result for at least 9 months.

Thank you again and welcome to the RF.

[JBDMD]

Thank You

Thank you JBDMD for sharing this info. You couldn't post the link because you are a new member.
Is this the abstract?

Yes, it is. Thanks for posting the abstract.

Melissa, I'm an orthopedic surgeon so I'm pretty hard to impress, but, I'm stunned with what's happened with the Flagyl. At literally 72 hours into the course (2 gram day one, then 250mg tid times seven days) my face had cleared!!! I had the flushing for years and couldn't understand it. Then a little over a year ago, my face started breaking out in a way that was classical rosacea. By the time I took the Flagyl my face looked like hamburger and it was heading to my nose. I obviously was searching for an answer and couldn't find one.

As I said, my IBS had gone off the charts and I honestly thought I might have something really bad going on, like the C word. Long story short, I travel to Costa Rica frequently and thought, OK, "parasite." Then, to be thorough, I searched Google Scholar for, "IBS, rosacea, carbohydrate sensitivity" and voila, SIBO popped up. I thought since Flagyl was listed as a treatment for this constellation of symptoms, as well as a parasite, I'd try it.

Again, I'm stunned. I wish I'd taken a before picture, but if I showed it and me now, someone would say it was photoshopped.

Anyway, thank you for this group. It is truly a blessing.

Re: the article, in orthopedics, we call a study like that a "benchmark study." 80% resolution in the treated group, then 80% improvement in the control group when treated. Are you kidding me? That doesn't happen in double blind controlled studies. I'm also convinced I have the SIBO, so have switched my diet accordingly to no sugar /no grain / no starch which is where I was heading anyway. I suspect the relapses after antibiotic treatment are from failure to successfully modify diet.

My last question is, how is this SIBO / rosacea connection viewed in the world of dermatologists? I saw a few typical snotty remarks on the Mayo site and other academic websites. This info needs to be disseminated. The risk profile is so low, and the price is so low, there's no reason for folks not to try it.

JBD




Thank you again and welcome to the RF.

[MasK]

I have been far from this forum during some months, but recently my IBS started to make me probs again, and at the same time the flushing did increase very much.
So I googled IBS rosacea and found your recent posts about metronidazole.
As my doc spoke about this drug some months ago (I have SIBO, pathogens overgrowth), today I was so desperate because of the pain in the belly and the flushing (I have been beet red all the day) that I asked him (showing your abstract and other related studies) if he would agree to prescribe me a metronidazole course. And he did.
I hate taking drugs, and especially antibiotics, but it is too embarrassing now. I have to say no to jobs proposals because of this. I'm a pro musician and I work each week for different employers, orchestras, etc. When you say no to some jobs, the word spread and the risk is very high that you won't be hired again in the future... It's working only by reputation.

I know FOR SURE that my digestive symptoms and my rosacea are linked, both are going up and down in the same time.

So I will give this crap a try, and I will post my results. I should start my metro course tomorrow.
Pray for my soul.
I'm so scared about making things worse...

[Melissa W]

My last question is, how is this SIBO / rosacea connection viewed in the world of dermatologists? I saw a few typical snotty remarks on the Mayo site and other academic websites. This info needs to be disseminated. The risk profile is so low, and the price is so low, there's no reason for folks not to try it.

JBD

Hi JBD,
It's difficult to generalize regarding all dermatologists but going by the people at the RF I would say that there are many of them that have difficulty convincing their dermatologists to try certain treatments. I respect my doctor immensely and would not still be going to him if I did not and he is relatively open to certain things. However, I remember bringing this issue to him at least 3 years ago (SIBO/rosacea link) with the articles to provide more info and while he didn't actually dismiss it per se but he didn't think it was worth trying (for me at least). Well, your post has made me rethink this issue again and I am actually seeing him tomorrow and will ask him to prescribe Flagyl for me. It seems low risk so I am hopeful he will reconsider.

Ofc, it seems it depends what type of bacteria is causing the issues (hydrogen vs methane producing) but it cannot hurt to try the Flagyl. I also understand that recurrence is not uncommon but one step at a time. I would guess that many rosaceans (at least the ones that post here) have a relatively healthy diet so perhaps that would help once the SIBO is eradicated.

It is interesting to me (and somewhat distressing) that this info has been around for quite some time now but seemingly little progress has been made. I know how slowly things move but it can be frustrating.

Thank you again for sharing your experience. It is very helpful to have firsthand accounts of what has helped and what has not. Ofc we are all different but from each individual's experience valuable knowledge may be shared and through that perhaps one day an effective treatment.

I have been far from this forum during some months, but recently my IBS started to make me probs again, and at the same time the flushing did increase very much.
So I googled IBS rosacea and found your recent posts about metronidazole.
As my doc spoke about this drug some months ago (I have SIBO, pathogens overgrowth), today I was so desperate because of the pain in the belly and the flushing (I have been beet red all the day) that I asked him (showing your abstract and other related studies) if he would agree to prescribe me a metronidazole course. And he did.
I hate taking drugs, and especially antibiotics, but it is too embarrassing now. I have to say no to jobs proposals because of this. I'm a pro musician and I work each week for different employers, orchestras, etc. When you say no to some jobs, the word spread and the risk is very high that you won't be hired again in the future... It's working only by reputation.

I know FOR SURE that my digestive symptoms and my rosacea are linked, both are going up and down in the same time.

So I will give this crap a try, and I will post my results. I should start my metro course tomorrow.
Pray for my soul.
I'm so scared about making things worse...

Dear MasK, I am keeping you in my thoughts and hoping that this treatment provides you much needed relief. Hang in there- we are all rooting for you!

Best,
Melissa

[rashley]

Good luck mask!! Hopefully you'll have spectacular results!

[Melissa W]

Just made this thread a sticky so hopefully it can be helpful to more people.

[Mojo7]

Question at Mask

Hey Mask,

Sorry to hear that your IBS is getting worser.

Can you participate the scientific research of the VIB from Belgium --> gutflora research ?

The last thing I know is that you wanted to send a mail to them if you could participate (because the research is for people living in Flanders). What did they say ? I hope so much you can participate ! :-)

good luck with the antibiotics !

[JBDMD]

Just made this thread a sticky so hopefully it can be helpful to more people.

Thanks. If the Flagyl doesn't work, I'd still try the rifaximin. What convinces me most about the SIBO driver is that rifaximin is not absorbed in the gut, so its action can't be systemic. This SIBO mechanism may well be why doxycycline works for some people.

I'm going to try to find what bacteria are involved in SIBO, and then classify them. Most antibiotics are classified by whether they work on gram positive or gram negative bacteria, then secondarily, how they work on subclasses, like TB which is an acid-fast bacteria. Metranidiole, Flagyl, is an anti-parasitic, but also kills anaerobic bacteria, esp those involved in abdominal infections. It was attractive to me because of minimal cost, low side-effect profile and because of the outside chance I had a parasite, Giardia, which I'd gotten before in Costa Rica.

I've run across a topical metronidizole gel for rosacea, which, based on the SIBO postulate, would make it worthless. You'd do just as well rubbing neosporin on your face.

Two important things finally, though. First, I think it's critical to understand, that if someone has SIBO, they have a genetic tendency to send partially digested sugars and starches into the ilium, the last section of the small intestine, to allow the bad bugs to grow. This being the case, they have to alter their diet, or it's going to recur. And second, the rosacea is an outward sign of the inflammatory ravages as a result of the SIBO going on throughout the body which are invisible. Stopping this inflammation is critical to health. What a wonderful positive reinforcement it is that the rosacea documents the reversal of the inflammation.

[MasK]

Thanks. If the Flagyl doesn't work, I'd still try the rifaximin. What convinces me most about the SIBO driver is that rifaximin is not absorbed in the gut, so its action can't be systemic. This SIBO mechanism may well be why doxycycline works for some people.

I'm going to try to find what bacteria are involved in SIBO, and then classify them. Most antibiotics are classified by whether they work on gram positive or gram negative bacteria, then secondarily, how they work on subclasses, like TB which is an acid-fast bacteria. Metranidiole, Flagyl, is an anti-parasitic, but also kills anaerobic bacteria, esp those involved in abdominal infections. It was attractive to me because of minimal cost, low side-effect profile and because of the outside chance I had a parasite, Giardia, which I'd gotten before in Costa Rica.

I've run across a topical metronidizole gel for rosacea, which, based on the SIBO postulate, would make it worthless. You'd do just as well rubbing neosporin on your face.

Two important things finally, though. First, I think it's critical to understand, that if someone has SIBO, they have a genetic tendency to send partially digested sugars and starches into the ilium, the last section of the small intestine, to allow the bad bugs to grow. This being the case, they have to alter their diet, or it's going to recur. And second, the rosacea is an outward sign of the inflammatory ravages as a result of the SIBO going on throughout the body which are invisible. Stopping this inflammation is critical to health. What a wonderful positive reinforcement it is that the rosacea documents the reversal of the inflammation.

You meant metronidazole.
I made stool tests showing I have a Pseudomonas Aeruginosa infection, along with E. Coli (don't know which subtype though).
The metronidazole won't work on pseudomonas since it is an aerobic bacteria. Anyway, I'll post my results, I will just wait a bit to be sure that, if there is an effect, it is lasting.

[MasK]

Hey Mask,

Sorry to hear that your IBS is getting worser.

Can you participate the scientific research of the VIB from Belgium --> gutflora research ?

The last thing I know is that you wanted to send a mail to them if you could participate (because the research is for people living in Flanders). What did they say ? I hope so much you can participate ! :-)

good luck with the antibiotics !

I sent a message via the website, but didn't get any answer sadly.

[JBDMD]

You meant metronidazole.
I made stool tests showing I have a Pseudomonas Aeruginosa infection, along with E. Coli (don't know which subtype though).
The metronidazole won't work on pseudomonas since it is an aerobic bacteria. Anyway, I'll post my results, I will just wait a bit to be sure that, if there is an effect, it is lasting.

For sure. Go with it. For $10 there's little downside.

I'm not sure stool tests will be of benefit, since this is small bowel (ileum) not colon. There are some breath tests, but it seems to me the diagnosis is based on (1) symptoms, and (2) response to treatment. But, again no real downside to the tests.

There's a lot of SIBO stuff out there on the internet, just not so much linking it to rosacea. But my results were overwhelming.
It's likely the bacterial spectrum will vary from person to person in SIBO, so treatment is a little trial and error. When faced with something like that, I generally advise my patients to go with the cheapest / lowest risk option first, and work our way toward more expensive, more side effects. If it works, it works.

[Melissa W]

Thanks. If the Flagyl doesn't work, I'd still try the rifaximin. What convinces me most about the SIBO driver is that rifaximin is not absorbed in the gut, so its action can't be systemic. This SIBO mechanism may well be why doxycycline works for some people.

I'm going to try to find what bacteria are involved in SIBO, and then classify them. Most antibiotics are classified by whether they work on gram positive or gram negative bacteria, then secondarily, how they work on subclasses, like TB which is an acid-fast bacteria. Metranidiole, Flagyl, is an anti-parasitic, but also kills anaerobic bacteria, esp those involved in abdominal infections. It was attractive to me because of minimal cost, low side-effect profile and because of the outside chance I had a parasite, Giardia, which I'd gotten before in Costa Rica.

I've run across a topical metronidizole gel for rosacea, which, based on the SIBO postulate, would make it worthless. You'd do just as well rubbing neosporin on your face.

Two important things finally, though. First, I think it's critical to understand, that if someone has SIBO, they have a genetic tendency to send partially digested sugars and starches into the ilium, the last section of the small intestine, to allow the bad bugs to grow. This being the case, they have to alter their diet, or it's going to recur. And second, the rosacea is an outward sign of the inflammatory ravages as a result of the SIBO going on throughout the body which are invisible. Stopping this inflammation is critical to health. What a wonderful positive reinforcement it is that the rosacea documents the reversal of the inflammation.

Thanks JBD. I saw my dermatologist this AM and he prescribed the Flagyl for me. He wasn't thrilled with doing it though because he is concerned about possible side effects- I think his words were that it could kick my a** LOL but he doesn't think it will work because he told me he hasn't seen it work for any of his patients. He is still willing to have me try it with the caveat that I stop if it disagrees with me and he wanted to run liver tests but then he forgot and I am not seeing him for at least a month or more.

He didn't want me to start with 1g bid for the first day as you did because he said I don't weigh enough for that high of a dose so we compromised and I am going to take 750mg bid q2d and then 250 mg tid q5d. I hope that will be sufficient to help if there is any chance it will. I understand that if it does work it will recur unless I fix the underlying problem but if it does work that will be one more clue.

Thanks again JBD for bringing this topic up once more. My dermatologist does agree that rosacea is not just one disease but probably a disease process with many different causes. If only we could figure it out...

edited to add dosage schedule.