Zinc Sulfate for Rosacea

Oral zinc sulfate in the treatment of rosacea: a double-blind, placebo-controlled study. Sharquie KE, Najim RA, Al-Salman HN. Int J Dermatol. 2006 Jul;45(7):857-61.

BACKGROUND: Rosacea is a skin problem not uncommonly encountered world-wide. There is a need for an effective and well-tolerated treatment for this disease. OBJECTIVE: To evaluate the efficacy and side-effects of zinc sulfate in rosacea in a randomized, controlled, double-blind trial. PATIENTS AND METHODS: Patients with rosacea who attended the outpatient Clinic of Dermatology and Venereology in Baghdad Teaching Hospital were recruited into this study between October 2002 and August 2004. A disease severity score was calculated for each patient. The patients were randomly allocated to receive either zinc sulfate 100 mg or identical placebo capsules three times per day. Zinc sulfate and placebo capsules were given in a double-blind manner. Following 3 months of starting the treatment, the patients crossed over, i.e. patients on placebo crossed over to zinc sulfate and those on zinc sulfate crossed over to placebo. RESULTS: Twenty-five patients with rosacea were included in this study: 16 (64%) females and nine (36%) males. Nineteen patients completed the study: 11 (58%) females and eight (42%) males. Patient age ranged from 21 to 64 years with a mean +/- SD of 48.2 +/- 9.3 years. Duration of the disease ranged from 1 to 14 years with a mean +/- SD of 4.4 +/- 3.2 years. In the group started on zinc sulfate, the score before therapy ranged from 5 to 11 with a mean +/- SD of 8 +/- 2.0. The mean started to decrease directly after the first month of therapy with zinc sulfate to a significantly lower level. After shifting to placebo treatment, the mean started to rise gradually in the fifth month but remained significantly lower than the levels before therapy. In the group started on placebo, the score before therapy ranged from 5 to 9 with a mean +/- SD of 7 +/- 1.3. The mean remained high in the first 3 months of therapy while the patients were on placebo. After shifting to zinc sulfate, the mean started to decrease after the fourth month to significantly low levels. No important side-effects were reported apart from mild gastric upset in three (12%) patients on zinc sulfate. CONCLUSION: Zinc sulfate was found to be a good option in the treatment of rosacea, as it was safe, effective and lacking important side-effects.
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Robert Jay Rowen, MD Editorial on Zinc Sulfate and Rosacea

Zinc dramatically reduces signs of acne rosacea

Original Internist, March, 2007 by Steve Austin  

Design: Randomized double blind crossover clinical trial

Participants: Of 25 rosacea patients, (aged 21-64 years), 19 completed the trial.

Study Medication and Dosage: 100 mg of zinc sulfate (ZnS[O.sup.4]) containing 40 mg Zn was administered three times per day for three months.

Main Outcome Measure: Rosacea severity scores

Key Findings: In the arm that initially received ZnS[O.sup.4] therapy, the mean baseline severity score was 8. (Scores of 5-10 reflect moderate severity, with scores below 5 reflecting mild signs and those above 10 reflecting severe signs.) This number fell to 5.7 at one month, to 3.4 at two months, and to 1.6 at the end of the three-month intervention (p<0.01 compared with baseline).

In the arm that received ZnS[O.sup.4] during the second half of the trial, the mean baseline severity score was 7, which fell to 5.9 at one month, 3.9 at two months, and 1.9 at the end of the three-month ZnS[O.sup.4] intervention (p<0.01 compared with the end of the placebo period).

In both groups, erythema began improving after two months, though papules and pustules showed improvement after only one month. Telangiectasia scores did not improve in either group.

During placebo administration, scores began moving back toward baseline in the group that had initially been assigned to ZnS[O.sup.4], though the mean score had only risen to 2.6 by the end of the third month. In the arm initially assigned to placebo, severity scores increased mildly during the placebo administration.

Practice Implications: In the 1970s and '80s, several trials reported that Zn supplementation aided patients with acne vulgaris. The new report extends those findings to patients with acne rosacea.

The effect was dramatic--an average of approximately a 77% decrease in severity in three months. The mechanism behind the effect remains unclear, though the researchers speculate the Zn might have an effect against demodex mites or other potential pathogens. Alternatively, they suggest that a free radical-scavenging effect of Zn might be responsible.

This trial was conducted in Iraq. Much of the Middle East contains a diet low in Zn, complicated further by the use of phytate-rich unleavened bread, which reduces bioavailability of Zn. Serum Zn levels were not measured in the new report, so it remains possible that the effects observed here were simply the function of overcoming a deficiency that may not exist in western populations. However, there is much overlap between acne vulgaris and acne rosacea, and the earlier reports of positive effects of Zn supplementation in vulgaris patients came mostly from western trials. Thus, a therapeutic trial of Zn supplementation in rosacea patients is now worth consideration. Long-term (three months or longer) Zn administration should be accompanied by supplementation with 1-3 mg per day of copper to prevent a Zn-induced copper deficiency.

Sharquie KE, Najim RA, Al-Salman HN. "Oral zinc sulfate in the treatment of rosacea: a double-blind, placebo-controlled study." Int J Dermatol 2006; 45:857-61.

By Steve Austin, N.D.
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