Drug for intestinal ailments a new rosacea treatment
Word has spread that a doctor has had success treating the skin disorder, rosacea, with a drug typically used to treat gastrointestinal issues caused by small intestinal bacterial overgrowth commonly known as SIBO. However, some doctors have expressed reservations about the treatment.
St. Louis Post-Dispatch
ST. LOUIS — Occasionally, patients with enlarged blood vessels on their faces and unusually bulbous noses will schedule appointments to see Dr. Leonard Weinstock.
But Weinstock is not a dermatologist. He's a founding partner of Specialists in Gastroenterology in Creve Coeur, Mo.
Nevertheless, word has spread that he's had success treating the skin disorder, rosacea, with a drug typically used to treat gastrointestinal issues caused by small intestinal bacterial overgrowth commonly known as SIBO.
"What's gaining ground is this theory that irritable bowel syndrome is related to rosacea," Weinstock said.
Rosacea symptoms can range from minor aesthetic flare-ups to major disfigurations on the face; from frequent blushing and enlarged blood vessels to unsightly lesions and thickening of the skin and nose. (Think W.C. Fields' schnoz.) Sometimes, it also causes watery, irritated eyes.
The National Rosacea Society estimates that the skin condition affects more than 16 million Americans. The group also maintained that the cause of it is unknown and that there is no cure.
The group has surveyed people who suffer from rosacea and found that its acne-like effects can cause significant psychological, social and occupational problems if left untreated.
Weinstock was studying the link between restless leg syndrome and small intestinal bacterial overgrowth, a couple of years ago, when he read a published study in a medical journal, linking rosacea to small intestinal bacterial overgrowth.
About six months ago, he decided to conduct his own in-office study.
When he noticed signs of the condition on patients that he was treating for gastrointestinal issues, he'd ask them to take a lactulose breathing test which assesses bacterial overload in the small intestines.
Eight of 13 patients tested positive for SIBO. After treating them with Xifaxan for 10 days, five were markedly better, one was slightly improved and two were unchanged.
"There are many many different triggers for rosacea," he said. "But some do appear to be coming from that bacteria in the small intestines."
His findings mirrored those of the study at the Department of Internal Medicine, Gastroenterology Unit at the University of Genoa, Italy, that he'd read about in the Journal of Clinical Gastroenterology and Hepatology.
The Italian researchers also began by administering the lactulose breath tests to 113 rosacea patients. Fifty-two of the rosacea patients (46 percent) tested positive for the bacterial overgrowth. The 52 patients were randomly divided into two groups that received either the Xifaxan or a placebo. Twenty-six of the 28 patients who received Xifaxan saw marked improvement in their rosacea symptoms. The rosacea afflicting all 20 of the patients treated with the placebo either remained the same or worsened. They were later given the Xifaxan as well and 15 of them saw complete eradication of the symptoms.
Weinstock points out that the Italian researchers also gave breath tests to 60 control subjects who did not have rosacea, and found that the prevalence of bacterial overload was markedly lower in them than in rosacea patients. Only three out of the 60 controls (who showed no signs of rosacea) tested positive for bacterial overload.
Dr. Dee Anna Glaser, professor and vice chairman of dermatology at St. Louis University, is excited by the studies at the University of Genoa and in Weinstock's office. Perhaps, she said, this means they're getting closer to new therapies for rosacea.
"But I do have significant reservations," she said. "We use all kinds of antibiotics and anti-inflammatory medications, both oral and topical to treat rosacea. So I think it deserves a larger trial. (But the current studies are) just not big enough and not in diverse enough populations. You need a multicenter trial. It needs to be investigated more thoroughly."
In other words, there could be something there, she said, but she won't be sending patients to Weinstock anytime soon.
Weinstock stresses that Xifaxan won't work on all rosacea cases, because not all cases are triggered by small intestinal bacterial overload.
"I've talked to several dermatologists about this but they don't want to change from what they're doing," he said. "Many people get comfortable with what they're doing. Many want to see a lot of double-blind studies before they'll change what they do."
Weinstock, an associate professor of clinical medicine and surgery at Washington University, did disclose that he is a member of the speaker's bureau at Salix Pharmaceuticals, which makes Xifaxan.
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