Case reports: severe exacerbation of rosacea induced by cinnamon supplements

Journal of Drugs in Dermatology, June, 2008 by Tracy M. Campbell, Rachel Neems, Julie Moore

Abstract

The authors report a case of a 68-year-old Caucasian female with type 2 diabetes mellitus who experienced an acute exacerbation of her rosacea 2 weeks after self-initiating cinnamon oil pills to lower her blood sugar levels. Historically, cinnamon oil has been used for a variety of medicinal purposes, but recently the use of cinnamon oil in lowering blood glucose and cholesterol levels in patients with type 2 diabetes is being investigated and gaining popularity amongst the general population. The use of cinnamon has commonly produced cutaneous side effects of irritant or allergic contact dermatitis and been reported to have vasodilatory effects. Yet, there are no reports of cinnamon use triggering a rosacea exacerbation in the literature.

Case Report

A 68-year-old Caucasian female with history of very mild papulopustular rosacea localized to her nose presented to the dermatology clinic with a 4 day history of a sudden eruption of multiple erythematous papules and pustules involving the nose, nasolabial folds extending to the right inferior eyelid, and chin (Figure 1). Past medical history was significant for hypertension, controlled with valsartan, and type 2 diabetes mellitus, controlled with diet and exercise. The patient presented with mild papulopustular rosacea well controlled on metronidazole lotion twice daily. With this exacerbation, the patient reported no new medicines, lotions, sun exposure, or treatments except a recent self-initiation of oral cinnamon pills 500 mg daily. The patient had been taking the supplement for 2 weeks to help control her blood sugar levels, and initiated treatment with 1 pill every other day for 1 week and then daily for 1 week. The patient denied any other side effects from the cinnamon supplements.

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After the initial visit, the patient was instructed to discontinue the cinnamon pills and start doxycycline 100 mg twice daily along with alclometasone topical cream daily. At 3 week, the rosacea had significantly improved. The alclometasone topical lotion was discontinued and the patient was given metronidazole lotion twice daily and routine use of sun block was recommended. After 2 months of treatment the patient's rosacea was almost resolved (Figure 2). Doxycycline was tapered over 2 months and then discontinued. The patient continues to notice exacerbations of rosacea during rechallenges with cinnamon infused foods. Before taking cinnamon pills, the patient noted no cinnamon sensitivity. However, currently the patient flares when ingesting food with a minute amount of cinnamon as an ingredient in food, such as cinnamon rolls, apple butter, and pumpkin pie. She notices a flushing, blushing sensation with new onset cen-trofacial papules and pustules approximately 12 hours after ingesting any amount of cinnamon or cinnamon flavoring. The patient is currently well controlled with cinnamon avoidance and metronidazole topical therapy.

Discussion

Cinnamon comes from medium-sized evergreen trees native to southeast Asia. The various components of cinnamon are used in seasonings, fragrances, and medicines. Cinnamo-mum verum, also known as Cinnamomum zeylanicum, is packaged in pill form, powder form, or oil in pill form and sold over the counter. The essential oils are recovered from the tree's leaves, bark, and twigs by steam distillation. The major component of this cinnamon bark oil (60%-75%) is the volatile oil, cinnamaldyhyde. (1) From ancient times until now, this oil has been used in various cultures for its' reported antifungal, antiviral, bactericidal functions, as well as to aid in gastrointestinal motility dysfunction as it slightly increases gastric secretions. (12) Its indications approved by the German Commission E Monographs, a therapeutic guide to herbal medicine, includes loss of appetite and dyspeptic complaints. (1)

Recently, the use of cinnamon to lower blood glucose and cholesterol levels in patients with type 2 diabetes has been gaining popularity. (4) For many years, researchers have been investigating the insulin-sensitizing properties of cinnamon. One study revealed a chemical component of cinnamon, a hydroxychalcone, which acts as a mimetic of insulin by stimulating the autophosphorylation of the insulin receptor and up regulating glucose uptake and glycogen synthesis.'' Further, a study in Pakistan was the first to investigate the application of these effects on patients with type 2 diabetes. The study concluded that cinnamon taken at 1, 3, or 6 g daily significantly decreased the triglycerides, LDL cholesterol, and total cholesterol levels after 40 days. (4) However, a recent study performed in the US could not confirm these observations. The authors comment that differences in diet, BMI, baseline glucose levels, and the use of concurrent medications between the 2 populations may he significant confounding variables.'' While the research still remains indeterminate of this herbal therapy's success in treating diabetes mellitus, a growing number of diabetic patients are starting to self-medicate with this over-the-counter remedy.