Ep 372 – The Rogue Pharmacist: Rosacea is Not One Condition

0:00:00.2 Maggie Staszcuk: At Skin Script Professional Skin Care, we've always been and always will be committed to the success of licensed skincare professionals. Passionate about beautiful skin? So are we. Our professional grade masks, enzymes, peels and retail products are crafted for real results, formulated to suit every skin type and Fitzpatrick classification. And now Skin Script is entering an exciting new chapter with refreshed branding and new products. It's not a rebrand, it's a refresh that reflects our growth while keeping our core values and commitment to you, the professional, exactly the same. Discover the trusted brand that grows with you. Visit skinscriptrx.com and elevate your treatment room today. Hello and welcome to ASCP and the Rogue Pharmacist with Benjamin Knight Fuchs. In each episode, we'll explore how internal and external factors can impact the skin. I'm Maggie Staszcuk, ASCP's program director, and joining me is Ben Fuchs, skincare formulator and pharmacist. Hi, Ben.

0:01:11.5 Ben Fuchs: Hello, Maggie. Good to see you. Happy New Year.

0:01:13.6 Maggie Staszcuk: Happy New Year. Ben, we hear the word rosacea used as if it's one single condition, but clinically that's not really accurate. Can you break down why rosacea should be thought of as multiple conditions rather than one diagnosis?

0:01:29.3 Ben Fuchs: Yes. It all goes back to the idea that a principle of natural healing, as opposed to pharmaceutical healing and medical healing, natural healing, which estheticians practice for the most part, is where you see the problem is not where the problem begins. That's just a principle. So, for example, if you have heart disease, it doesn't start at the heart. If you have schizophrenia or mental health problem, it doesn't start in the brain. If you have arthritis, it doesn't start in the joints. You got to go upstream to address a health problem at the causal level. I always think of the analogy of fruit and root. You have an apple that's rotten on the tree, you can't do anything about the rotten apple. You got to go to the fruit, you got to go to the root and you got to go to the soil. And it's the same thing with health and it's the same thing with the skin. In fact, it's especially true about the skin because it's very rare, very, very, very, very rare, almost never does a skin problem occur because something's going wrong with the skin. It does happen occasionally, but for the most part, you're going upstream and nothing exemplifies that more than rosacea, which, by the way, means red. Rosy, like rose, red.

0:02:01.0 Maggie Staszcuk: Makes sense.

0:02:32.8 Ben Fuchs: Whenever you see red, rashiness, redness in the body, you can pretty much assume you've got some kind of immune activity. And redness is part of the four, is one of the four cardinal signs of inflammation; dolor, calor, rubor and tumor. If you go to medical school, they say there's four cardinal signs of inflammation: dolor, pain; calor, heat; tumor, growth or swelling; and rubor, redness. So it's the redness component of inflammation. Inflammation is the calling card of the immune system. It's how we visibly see immune activity. So when you have redness, you can pretty much assume that you're dealing with some kind of immune activity, inflammation and immune activity. Where does the immune system live mostly? Immune system mostly lives in the digestive tract, in the intestine specifically. And so it's somewhat obvious because everybody who has this condition knows that certain foods will trigger a response. And it always amazes me how we know that, right? Even non-clinicians know that certain foods will trigger a redness response, but for some reason, when we see rosacea, we automatically assume a skin problem. For example, you probably heard of this thing about the mites, right?

0:03:47.2 Ben Fuchs: That's the big thing now is the Demodex mites. Well, they don't tell you is everybody has Demodex mites. They're part of the microbiome, the normal skin microbiome. So everybody should have rosacea if it was really Demodex mites. Well, it's not Demodex mites because obviously people who have rosacea know certain foods will trigger a redness response. And we know that there's comorbidities associated with rosacea, things like people who have rosacea are more prone towards psychiatric issues, they're more prone towards digestive issues, they're even more prone towards cardiovascular health issues. So every pointer tells us that rosacea is not a skin problem, it's an internal problem caused by multiple factors, most importantly the digestive factors.

0:04:23.2 Ben Fuchs: And so if you really want to address rosacea, you've got to address, and this is true, by the way, about all skin conditions. Actually, let me backtrack. It's true about all health conditions, you always want to go back to the digestive system. And sometimes I feel like I'm beating a dead horse here because how have we ever talked about anything with the skin and not talked about the digestive system? They go hand in hand. And I've been saying this for decades since I learned about it in pharmacy school in the 1980s. It's just now starting to get understood that there's a connection between the digestive system/immune system, because the immune system lives in the intestine as I said, and skin problems like rosacea.

0:04:58.8 Ben Fuchs: Also, rosacea, where does it occur? It occurs right in the middle of the face, right? Sometimes there's ocular rosacea and sometimes people have rosacea will have some other skin issues in the T-zone, but for the most part, you're dealing with right this middle band in the face where the nose is and the cheeks. What do you have there? You have a concentration of lymph. The lymphatic system is concentrated in that cheek area and it's like a belt, a lymphatic belt you can think of it as. And what does the lymph tell us when you have a lymphatic issue? It tells us that there's lymphocytes, there's white blood cells, there's immunity. That's what the lymph does. Lymph does other things too, but one of its major roles is to transport immune factors and toxicity. So all pointers tell us that when you're dealing with rosacea, you're dealing with an internal condition, which means an immune condition, an inflammatory condition, and that can involve many factors. We mentioned the intestine, but also the stomach. There's a bacteria called H. Pylori. Have you heard of this?

0:05:54.1 Maggie Staszcuk: Yeah.

0:05:56.7 Ben Fuchs: So H. Pylori is also associated with. Elevated levels of H. Pylori in the stomach are also associated with rosacea. And it turns out that H. Pylori in the stomach is associated with something called achlorhydria, or low stomach acid. And low stomach acid is another cause of inflammation and immunity because downstream from low stomach acid, you have intestinal problems because you need stomach acid in order to have effective processing of food at the level of the intestine. So everything tells us that when you're dealing with rosacea, you're dealing with an internal condition, an immune condition, an inflammatory condition. And whenever that happens, you always want, first things first, you always want to focus on digestive health. From a topical perspective, there are certain things that you can do. If you go to a doctor, what do they give you for rosacea? They give you antibiotics, right? And antibiotics are a little misleading because while antibiotics obviously kill bacteria, there's a secondary mechanism of action that antibiotics have, and that is anti-inflammation. And so some of the effects that you're getting from metronidazole, which is the standard antibiotic that they give for rosacea, are due to their anti-inflammatory effects.

0:07:08.0 Ben Fuchs: First of all, every chronic health issue, every one of them are inflammatory. There's no such thing as a chronic health condition, dermatological or otherwise, that's not inflammatory. That's first of all. So given that we want to address this, maybe we should think of what is inflammation. Well, inflammation is a defensive response. It's like an airbag going off, it's a protection. So if you have a protective response that you want to get rid of, you can do a couple things. There's two mechanisms. You can go outside in or top down and just suppress inflammation. And this is the standard strategy that skincare companies use or that dermatologists use or the medical community uses. But doesn't it make more sense to figure out what the offending agent is? It seems like, right?

0:07:29.1 Maggie Staszcuk: Yeah.

0:07:50.3 Ben Fuchs: So you can go top down and just kind of press down on the inflammatory response, and maybe you may even do it effectively, but you still have the enemy, if you will. The bad guy is still there. The way I look at it, let's figure out the bad guy. Let's take care of the initial cause of the protective response, the offending agent.

0:08:09.8 Ben Fuchs: And that's why food is so important, and that's why digestive health strategies are so important, and that's why nutritional supplements that support digestive health are so important. You and I have talked about SIBO. SIBO is a serious health problem systemically, but it's also a serious problem for the skin, and it's involved in rosacea, small intestinal bacterial overgrowth. So doing the FODMAPs diet, that is eliminating the foods that trigger the growth of bacteria. Are you familiar with FODMAPs?

0:08:23.2 Maggie Staszcuk: I am, yeah.

0:08:36.6 Ben Fuchs: Yeah, these are the sugars that feed bacteria. So eliminating FODMAPs kind of foods, some of which are so-called good foods, could be FODMAP foods like certain fruits and vegetables. Eliminating histamine-producing foods, that's also important. This is not just for rosacea, this is for all inflammatory conditions, but including rosacea. Eliminating histamine-inducing foods or foods that contain histamine. Protecting against leaky gut using collagen peptides, vitamin A. Eliminating fried fats. I don't know if you know this, I think we've talked about this, but fried fats are very inflammatory for the intestine. And who doesn't like fried fats, right? French fries, pizza, hush puppies, fried okra. There's zillions of these foods. Very inflammatory for the intestine. And it's very possible that our collective addiction, our national addiction or obsession with fried foods, is behind almost epidemic levels of leaky gut. And that's another issue, leaky gut. So patching up a leaky gut, eliminating fried fats, estrogen can be involved in leaky gut. Leaky gut affects women a lot more than men, there's an estrogen component. So working with the hormone system is important. Using things like collagen peptides, hyaluronic acid, fucoidan, aloe vera, vitamin A, all of these can have a beneficial effect for the intestine.

0:09:56.0 Ben Fuchs: And another thing, when you have an intestinal health issue that kind of goes under the radar, not only are you going to be dealing with toxicity in the blood and now you have all this immune and inflammatory activity, but when you have an inflamed intestine, you're not absorbing your nutrients, right? So you're not absorbing your vitamins, you're not absorbing minerals, you're not absorbing electrolytes, you're not absorbing aminos. And what ends up happening is now you get this one-two punch of toxicity and malnutrition. So working on the gut is super, super important. With the achlorhydria element, the low stomach acid, using apple cider vinegar with meals, using aloe vera with meals, a betaine HCl, betaine hydrochloride, things like that. Work on digestive health, intestinal health, and then work at the level of the stomach. And even things like chewing foods can be beneficial. And then food elimination. And those are really the most important strategies for dealing with rosacea. Focus on digestive health. Focus on the enemy that is causing the inflammation. And the good news is, once you do that, you'll never have rosacea again, number one. You won't have to be on antibiotics.

0:10:58.8 Ben Fuchs: And because if you have digestive issues, you're at higher risk for other health challenges, you're going to reduce your risks of accelerated aging, you're going to reduce your risks of joint disease, you're going to reduce your risk of autoimmunity, et cetera. So to me, as a natural pharmacist, I'm saying let's go to the root. Don't worry about the fruit, take care of the root, and the fruit will get taken care of. And if anybody tells you that it's Demodex mites that are causing rosacea, that's just pure silliness. Focus on the triggers, which everybody knows are things that you put in your mouth. And sometimes it's not just food, it could also be alcohol or wine. Sometimes those will trigger an inflammatory response that looks like rosacea as well.

0:11:38.4 Maggie Staszcuk: So to recap, bottom line is inflammation in the gut is causing inflammation on the skin. That's a secondary response.

0:11:49.4 Ben Fuchs: Yes. It's an inflammatory condition in the gut, but the inflammatory condition in the gut itself is caused by triggers. So the inflammation in the gut is already secondary, and then by the time it's on the skin, it's tertiary. The primary cause is the triggers of the inflammation at the level of the gut. And that is obviously it's gonna be food-based. Although once you have leaky gut, it could have to do with the bacteria and the small intestinal bacterial overgrowth condition. So there are strategies that you can use to take care of the bacteria as well.

0:12:18.9 Maggie Staszcuk: Okay. And you also mentioned low acid as well.

0:12:22.5 Ben Fuchs: Low stomach acid, achlorhydria or hypochlorhydria as they say. And interestingly, this is really kind of counterintuitive, but it's true. Low stomach acid can actually trigger acid reflux. And so a lot of people who are dealing with acid reflux are actually using antacids when in reality what they're doing is making the condition worse, and they should be using things like apple cider vinegar and aloe vera, et cetera, betaine HCl to acidify the contents in the stomach. And then if you want a topical strategy for rosacea, you can't really do much about the redness itself, although there are a few anti-redness ingredients. But the redness is actually the body trying to deal with the problem. So you don't really want to suppress the redness. The redness is the body's coping strategy. But there are secondary oils that are produced, and a lot of times rosacea patients will have oily skin and even breakouts. And those can be addressed topically with things like salicylic acid for the sebaceous secretions or alpha hydroxy acids in general. And then you're not gonna really... One of the, and you've probably seen this, where people have breakouts along the lymphatic area in that band that I'm talking about, that belt across the face, and they're trying to use benzoyl peroxide and retinoic acid. That doesn't really work that effectively. But for sebum, you can use things like alpha hydroxy acids and even salicylic acid to get rid of the sebaceous secretions.

0:13:44.9 Maggie Staszcuk: That concludes our show for today, and we thank you for listening. But if you just can't get enough of Ben Fuchs, the ASCP's rogue pharmacist, you can find him at truthtreatments.com. For more information on this episode, or for ways to connect with Ben Fuchs, or to learn more about ASCP, check out the show notes.