The ESK blog

TikTok fads for rosacea skin, what does the evidence say?

11 April 2024

Dr Anne Thomson

Rosacea is a chronic skin condition with a cluster of symptoms which include flushing in the face, pimples, inflammation and skin sensitivity. It’s not that uncommon either - studies show it affects anywhere up to 22% of us and is often underdiagnosed.

The cause isn’t fully understood yet and there is no cure. There are a LOT of management options, which is great, but finding the right one(s) can be frustrating, time-consuming and expensive. Little wonder that many rosacea patients are looking for alternatives and doesn’t TikTok love a #lifehack!

But does TikTok have all the answers? Let’s take a closer look…

Nasal Spray…on your face?

Oxymetazoline is a vasoconstrictor commonly found in decongestant nasal sprays used to relieve the stuffy nose of a head cold or hayfever. It’s also available as Rhofade, a 1% cream used to treat the redness of some forms of rosacea. But Rhofade is expensive, requires a doctor’s prescription and is not available in some countries (including Australia). Nasal sprays however, are a dime a dozen…

What TikTok says: Forget the expensive cream, why not just mix some oxymetazoline nasal spray with your moisturiser to get the same effect without the price tag?

What the evidence says: There have been a couple of published case reports and a very small study (for acne) on the use of oxymetazoline nasal spray on the face. But neither of these were big enough to draw any firm conclusions.

On the other hand, we do have evidence that using oxymetazoline 1% cream is safe and can help the redness of rosacea and acne.

The verdict? If you and your doctor think oxymetazoline is worth a try, follow the evidence and stick with the 1% cream. Using nasal sprays on the face hasn’t been adequately studied yet, so we say steer clear for now.

Horse Paste (!!)

Horse paste is an oral medication containing ivermectin, an anti-parasitic agent used to treat worms and other parasites in - surprise! - horses. Ivermectin is used in humans to treat certain worm infections and scabies.

Applied to human skin, 1% ivermectin cream (Soolantin) is an effective treatment for some types of rosacea. It works by reducing the number of Demodex mites, tiny creatures on the skin that are implicated in the inflammation of rosacea. And yes, it too can be expensive.

What TikTok says: Forget the expensive human cream, horse paste is cheap and you don’t need a doctor (or vet) visit!

What the evidence says: Horse paste contains 1.87% ivermectin along with some other anti-parasitics and even flavourings (to get the horse to swallow it). The evidence for applying it to the human face is… zilch. We don’t know if it works, we don’t know if it’s safe.

1% ivermectin cream however, is proven to be effective against the Demodex mite in humans to relieve the redness and pimples of rosacea.

The verdict? Avoid horse paste on your face. Dermatologists have expressed major concerns at the potential side-effects. Lobby your local politician or insurer for better access to (human) medicines instead!

Gut Health

Gut health is definitely having a moment, with increasing evidence of the importance of our gut bacteria (microbiome) in many body systems including the skin. In the Western world, our gut microbiome is Not Happy Jan, with poor diets, stress and antibiotic overuse playing havoc with our tiny friends and being implicated in the rise of many chronic diseases.

But does poor gut health cause rosacea?

What TikTok says: There is some truth in a couple of the TikTok claims we’ve seen. But it’s not the full story as you can imagine. Some say gut health is key and should be addressed before trying anything else; others suggest gut testing (by their own gut testing companies?), looking for imbalances or infections.

What the evidence says: There is indeed a link between rosacea and various gastrointestinal problems like irritable bowel syndrome, coeliac disease and others. Treating infection with h.pylori (the bacteria that cause stomach ulcers), and a condition called SIBO or small intestine bacterial overgrowth, can help rosacea symptoms.

But we don’t know yet what the link is, so we can’t say poor gut health causes rosacea. The gut microbiome is definitely playing a role but so too are genetics, environment and immune system factors. We haven’t quite untangled it all yet.

The verdict? It’s recommended rosacea patients keep their gut microbiome happy, by eating a healthy diet that includes plenty of fibre – think fruit, veg and wholegrains, along with probiotic foods like yoghurt, kimchi or miso.

Identify and avoid food triggers such as spicy foods or hot drinks and manage any gastrointestinal conditions if you have them. There is some evidence for probiotic supplements in rosacea, but more research is needed to see if there is a direct link between diet and rosacea. Watch this space!

So what SHOULD you do?

Finding the right treatment for rosacea usually takes some trial and error and costs can add up; it’s not hard to see why people are looking for cheaper alternatives or a “quick fix”. But it’s important to save your precious dollars for evidence-based treatments that are safe and effective.

This is true of your basic skincare routine too. The evidence here is clear, rosacea skin needs: