Rosacea and small intestinal bacterial overgrowth

Though you are probably aware that small intestine bacterial overgrowth (SIBO) is often a causal factor in irritable bowel syndrome (IBS), too few are aware that it can be the cause of acne rosacea. Consider a study published in the journal Clinical Gastroenterology and Hepatology in which the authors aim...

"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."

They enrolled 113 rosacea patients and 60 healthy controls who underwent lactulose and glucose breath tests (BTs) to assess the presence of SIBO. Those whose breath tests were positive for SIBO were randomized to receive rifaximin therapy or placebo. A group of patients with negative BTs also got rifaximin. They were all re-tested after one month and evaluated for rosacea by dermatologists. What did their data show?

"The prevalence of SIBO was higher in patients than controls. 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). 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."

The lack for response by patients whose breath tests were negative for SIBO further confirms that getting rid of the small intestine bowel overgrowth is what caused the rosacea to clear up. Thus the authors conclude:

"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."