Rosacea case study
Sam was struggling with rosacea that had appeared suddenly in her mid 40s. She had been diagnosed with Crohn’s in her early twenties, but had not experienced flares for many years and had felt relatively well. She was dismayed to realise that she had developed rosacea when she felt she was already looking after herself and doing all the right things. She felt she didn’t know what else she could do in addition to try to help the rosacea.
We ran the Organic Acids Test and the Stool Chemistries test, which together provide a really broad screening tool that covers all the key areas in autoimmune health. I analysed the results alongside her answers to the extensive health and nutrition questionnaire that I use with all my clients.
Four areas in particular stood out:
Perimenopause and hormonal dysregulation
Sam had not realised that she had entered perimenopause as her menstrual cycle was still completely regular. A key feature of perimenopause is exaggerated peaks and troughs of oestrogen, which is particularly difficult to handle emotionally and physically.
This is why testing for oestrogen on one day only during perimenopause can be extremely misleading. It is also why adding additional oestrogen doesn’t necessarily help. In some cases it can further unbalance the oestrogen - progesterone ratio, especially if progesterone is already low, which it often is in both perimenopause and autoimmunity.
We tested Sam’s reproductive hormones across 28 days to confirm her oestrogen profile, which showed extreme peaks and troughs of oestrogen, as well as lowish progesterone levels.
When oestrogen drops from high to low, not only does this cause symptoms such as mood swings and hot flushes, but can also overwhelm the liver’s ability to detoxify effectively, as these high amounts of oestrogen need to pass through pathways that are also needed to process other toxins. This can lead to increased inflammation, which is a key trigger for autoimmune conditions.
It can also have a knock on effect on sleep, which negatively affects sleep and metabolic function, again contributing to inflammation.
2. Nervous system dysregulation / stress
By talking through the timeline of events leading up to the rosacea appearing, Sam realised that her stress levels had been high for a while. We talked about how perimenopause can lower our tolerance to stress.
Sam explained that she had been exploring a potential diagnosis of autism and ADHD with a counsellor, following diagnoses of other family members. While the diagnoses had not yet been confirmed, she was keen to understand how these conditions can affect the nervous system and why they are linked with autoimmune conditions.
Many of us can find that we know the health of our nervous system affects our overall health directly, and we can work out ways to help regulate our nervous systems to some extent, but the underlying patterns of stress remain stubborn and difficult to shift.
Sam and I talked about this, and we decided to try a different approach, based on developing an understanding of potential triggers for stress that can affect everyone, but particularly those who are neurodivergent.
3. Issues with digestive secretions (stomach acid, digestive enzymes and bile)
We noticed from the test results that certain digestive secretions were low. This can be due to a variety of reasons, ranging from stress and nutrient deficiencies to genetics. Difficulty in producing certain digestive enzymes is also associated with neurodivergency.
When digestive secretions are low at any point within the digestive chain, this can cause a cascade of knock on effects, altering pH levels, leading to incomplete digestion, intolerances, immune reactions, gut microbiome dysregulation, and inflammation. All of these issues are associated with rosacea.
4. Her skin care routine was not supporting her skin health
Once rosacea has been present for a while, it is hard to get it to improve without giving the skin a helping hand through specific skin care products. Hyperkeratinisation, sensitivity to UV rays, broken skin barrier through inflammation and dryness, and a disrupted skin microbiome can all be part of the picture.
What steps did we take?
We thought hard about how we could take the fewest steps that would have the greatest impact. These steps also needed to feel comfortable and right for Sam.
Improvements tend to come when we tackle a few areas simultanesouly, reducing the load on the body enough so that its innate ability to heal can re-emerge.
Nervous system
We started by looking at ways that Sam could regulate her nervous system, as stress is one of the biggest contributors to rosacea. We talked through the situations that triggered her nervous system (more information here). Rather than trying to resist her natural reactions to these situations, such as panic and anxiety, overwhelm, overwork and burnout, she gradually started to recognise when these situations were arising, anticipating them and managing them better.
Sometimes this involved avoiding certain situations, such as sensory overload at loud social events, and sometimes this involved accepting the situations but managing to recover better from them using specific recovery tools such as noise cancelling headphones with a weighted blanket, managing the stability of her blood sugar levels, or engaging in a flow / repetitive activity that soothed her.
Sometimes recognising triggering situations just helped her to stop them spiralling. For example, if her attention was in demand and she finding herself switching constantly between different tasks or people, a common trigger, then she would pull herself away and force herself to commit to just one activity, then have some recovery time.
Regulating our nervous system tells our body that our environment is safe. Each of our body’s systems has a built-in ability to adapt to our environment. When we don’t feel safe, each system acts in a way which is designed to help us escape immediate danger, but if maintained over the long term, promotes inflammation, increasing the risk of autoimmune flares.
For example, when we feel unsafe, our metabolic systems release any sugars from our foods immediately into our blood stream to help us fight or escape, but these peaking and troughing blood sugar levels are highly inflammatory.
Our immune systems become less sophisticated, losing some of their ability to distinguish between what is safe and what isn’t. We start to react to foods and other environmental molecules that we weren’t reacting to before, increasing inflammation.
Cortisol levels also increase, which our livers have to process. If our livers are already overwhelmed, this means that our livers simply don’t have the capacity to manage our toxic load, again leading to increased inflammation.
Digestive health
When we helped Sam’s nervous system to calm down, this allowed her body to produce digestive secretions more effectively. The body has to be relaxed to be able to digest effectively. We also supported this by using digestive enzyme supplements that were specific to her needs.
Over time, her gut microbiome health and ability to tolerate certain foods improved. Improvements in these areas are directly linked to autoimmune skin conditions.
Hormonal health
We helped Sam to balance her hormones as well as she could during perimenopause, and to help her liver to increase its ability to process the high peaking levels of oestrogen. We did this by increasing certain nutrients such as B6 and vitamin C, and reducing her histamine levels to support progesterone production to balance out the high oestrogen. Progesterone is anti-inflammatory and low levels are strongly associated with autoimmunity.
We found that her genetics were impacting her ability to detoxify, which is common in neurodivergency. Her genetic profile meant she needed higher amounts of certain nutrients that influence detoxification capacity. Her genetics also made her susceptible to certain environmental toxins, such as heavy metals and mould, that were reducing her ability to detoxify. We helped her to manage this with supplementation, a few dietary changes, and a protocol for the heavy metals and mould.
Skin care routine
Rosacea needs skin care support in five areas: specialist exfoliation to help with the hyperkeratinisation, deep oil-based cleansing to avoid dirt being trapped in the layers created by the hyperkeratinisation causing bumps in the skin, effective moisturisation which may include specific retinol products, anti inflammatory botanicals, and a good SPF to protect from UV rays.
We helped Sam to put this routine into place twice a day and she noticed a huge improvement not just in the rosacea, but in her skin health overall.
Outcome
By making these changes over a period of around five months, Sam found her rosacea significantly improved to the point where around 90% of the redness had disappeared. She was still getting some bumps under the skin, but these had improved by around 70% and the bumps were disappearing more quickly.
When we are working on the skin-gut axis, it tends to take up to 18 months to see the full benefit of the changes we make, as the body and its microbiomes will take time to adapt. So it is likely that as Sam continues to maintain these changes over the longer term, that further improvements will come.
Sam commented that she found it interesting that although she had thought she was already doing everything she could to help herself, it was only by talking things through with me that she realised that significant issues such as stress and perimenopause had arisen without her noticing. It was helpful for her to have someone else look at her timeline and provide an objective view.
She said that although she obviously didn’t want the rosacea, it had shown her that her body was struggling and needed some changes to be made. She felt emotional about the process we had been through and valued the positive effect that it would have for her going forward.