Rosacea: what you need to know

Rosacea is a common skin condition, affecting over three million Canadians each year. While there’s no cure, many find that dietary changes play a role in reducing the severity and frequency of their symptoms. And emerging research on the connections between gut health and skin health is giving rise to support for this idea. Here’s what the science says about the role your diet may play in your rosacea, and which foods are best and worst for the skin condition.

What is rosacea?

Rosacea is a chronic inflammatory skin condition that is heightened by an impaired skin barrier. It causes flushing, skin sensitivity, and redness, typically to the middle of your face. While the chin, cheeks, nose, and forehead are most often affected, rosacea can also manifest on your chest, neck, scalp, ears, and even your eyes.

For many, rosacea starts as a tendency to flush or blush easily in their younger years. It may happen unexpectedly, or for little to no reason at all. As you age, the condition progresses to more ongoing redness, though it may disappear and reappear at different times. Typically, your skin will begin to feel more inflamed, dry, or sensitive as the condition progresses.

While rosacea can affect anyone, it most commonly occurs in fair-skinned women over the age of 30.

What are some common rosacea signs and symptoms?

The most recognizable sign is facial redness, typically in the central area of your face. You may also experience dry skin that feels irritated, sensitive, and warm to the touch.

As the condition progresses, you may develop pustules or papules that resemble acne. Blood vessels on your cheeks and nose can swell, causing them to become more visible. These are also called telangiectasia, or spider veins.

In some cases, untreated rosacea can progress to rhinophyma, a condition where the nose enlarges and becomes bumpy and red. This is more common in men.

In a certain percentage of cases, rosacea can also cause eye issues. Irritated, dry, swollen, or red eyelids are known specifically as ocular rosacea. Some report that the condition causes their eyes to feel gritty and itchy. For some, ocular rosacea precedes any skin symptoms, and can even occur entirely without them.

Risk factors for rosacea

Your chances of developing rosacea increase if you:

• Are over the age of 30
• Are a woman
• Smoke or have smoked in the past
• Are fair-skinned
• Have sun damage (skin damage from sun exposure)
• Have a family history

What causes rosacea?

Rosacea is an inflammatory skin disease, but its exact cause isn’t yet clear. Genetic factors likely play a role in the disorder as it tends to run in families. Scientists think, however, that a few different variables might be in play when it comes to the condition.

One part of the equation involves the improper dilation of blood vessels. This leads some researchers to think that rosacea could be due in part to dysfunction of the vascular system.

Alternatively, another theory involves a hyperactive immune response, in which the immune system overreacts to otherwise harmless triggers. Demodex mites — tiny mites that live on everyone’s faces — are found in higher proportions on the faces of some with rosacea, leading some researchers to believe the skin condition may in part be an immune response.

Many rosacea patients have high levels of cathelicidin — an inflammatory mediator involved in your body’s immune response. Cathelicidin is a natural antimicrobial that promotes cellular inflammation, leading some to suspect it has a role to play in the condition. Especially since treatments affecting inflammatory responses, like certain antibiotics, can effectively address symptoms of rosacea.

Most people with rosacea cite sun exposure as a trigger for flare-ups. But while the underlying mechanisms aren’t fully understood, researchers think UV sun exposure may be one of the underlying causes of the condition as well.

It’s clear that both genetics and environmental factors play a role in causing rosacea. Much new research is now also focusing on the link between the skin disorder and gut health.

Non-dietary triggers

While you may experience dietary landmines, lifestyle and environmental factors can also trigger flare-ups. Some of these include:

• Sun or wind exposure
• Experiencing strong emotions — especially embarrassment and anger
• Extreme temperatures, either hot or cold
• Vigorous exercise
• Taking prescription drugs that cause blood vessels to dilate or topical medications that irritate or dry out your skin
• Certain cosmetic products
• Allergies

What is the connection between gut health and rosacea?

While science can’t fully explain why, it’s becoming increasingly clear that what happens in your gut can affect the appearance of your skin. Changes in your balance of gut flora have a knock-on effect and can disrupt the mucosal lining of your intestines, resulting in a more permeable gut.

Essentially, this means that microscopic particles that would otherwise be flushed out of your system, instead pass through your intestinal walls and into your circulatory system. Your body identifies these tiny particles as pathogenic, triggering your immune system to activate, causing inflammation.

While acute inflammation is an appropriate immune response, misdirected and chronic inflammation can lead to all sorts of issues. Autoimmune diseases, gut dysbiosis — upset tummy — and reduced immune functioning are some of them, but they may also spark skin concerns such as rosacea.

A large study out of Denmark shows that those with rosacea have higher incidences of other gastrointestinal issues than normal. If you have the skin condition, you’re more likely to also have small intestine bacterial overgrowth (SIBO), celiac disease (CeD), H. pylori infection, Crohn’s disease (CD), or another form of gastrointestinal dysfunction.

An imbalance in your gut microbiome doesn’t have to be permanent, however. In one study, subjects with rosacea given the immune modulator polyoxidonium and the probiotic bifidobacterium — a probiotic full of “good” gut bacteria — experienced more symptom remission than those in the control group. This suggests that your gut flora might have a role to play in the disease.

Is rosacea caused by diet?

Many people with rosacea report that their diet influences symptoms. In one National Rosacea Society survey, more than three-quarters reported changing their diets to better control their symptoms. Amazingly, 95% of them reported that this produced positive results.

In the same survey, most respondents identified alcohol as a trigger for flare-ups, and red wine seemed to be especially problematic. If you have rosacea, there’s a good chance that limiting or getting rid of alcohol altogether can help to reduce the frequency, severity, or both.

A word of caution, however. There’s a societal notion that rosacea is attributable to excessive alcohol consumption, which can leave those with the condition feeling stigmatized. It’s important to note that while evidence does show that diet can play a role in symptoms, it’s not the primary cause.

What to avoid to reduce rosacea flares

While much of the dietary evidence is largely anecdotal, certain things appear repeatedly on the do-not-consume list for those with rosacea. Each person is different, however many claim their top dietary offenders include:

• Tomatoes
• Alcohol
• Spicy food
• Marinated meats
• Chocolate
• Citrus
• Hot food and drinks
• Histamine-rich foods like aged cheeses, processed meats, and alcohol
• Foods containing capsaicin (especially hot peppers and red peppers)

If you think your diet might be a factor in your rosacea, your best bet is to keep a food diary. Keep track of everything you eat and see if you can correlate it with any flare-ups. Once you think you’ve found the culprit, see if removing that element from your diet makes a difference to your skin. What is clear, is that triggers are individual-specific.

What to eat to reduce rosacea flare-ups

Research isn’t conclusive, but some initial evidence shows that certain substances may help to reduce symptoms. It appears that supporting proper gut health by feeding your internal microbiome may play a role.

• Probiotics — as mentioned, bifidobacterium, may be helpful in reducing symptoms. Other probiotics have been found to be effective when it comes to H. pylori — a bacteria that can infect your digestive system and lead to the development of rosacea.
• Prebiotics — a form of dietary fibre found in garlic, onions, oats, and apples, among others — may help to promote a healthy gut flora by nourishing beneficial gut bacteria.
• Fermented foods — foods and beverages preserved using controlled microbial growth and fermentation — may help to nourish good bacteria and rebalance your gut microbiome. Take this with a grain of salt, however, as fermented foods contain histamines which may exacerbate symptoms for some.

Coffee and rosacea

Coffee gets its own category here as its effects on the condition can be confusing. If you have rosacea, coffee might be on your do-not-drink list, as many find it triggers their face to flush.

The thing is, studies don’t back this up. One even found that the higher your caffeine intake, the lower your likelihood of having a rosacea flareup. This suggests that caffeine may actually play a role in reducing your symptoms.

That doesn’t mean, however, that drinking hot coffee isn’t triggering your flare-ups. One study asked people with rosacea to drink a cup of coffee and a cup of water, both at 22 degrees Celsius, and flare-ups weren’t reported in either case. When they increased the temperature of the coffee and water to 60 degrees, however, they experienced flushing with both drinks.

It seems that the temperature of your coffee is likely to blame for any rosacea-related flushing, not the coffee itself. If you want to keep your morning caffeine fix, try lowering the temperature before drinking.

How is rosacea treated?

While there’s no cure for rosacea, there are effective treatments that can help to minimize symptoms.

In addition to avoiding triggers, dermatologists usually recommend a skincare regimen that includes cleansing twice daily with a gentle cleanser. Since people with rosacea tend to have more sensitive skin, using gentle skincare products can help prevent both chemical and allergic reactions and flare-ups. Dermatologists may also suggest prescription medications. These can be oral antibiotics, topical medications designed to reduce redness, or acne medications. Which ones you’re prescribed depends on your specific symptoms and their severity.

While you may think of rosacea as “just a skin condition,” its psychological impacts can be profound. People with rosacea report higher rates of depression and anxiety, and many report avoiding social interactions because of their symptoms. If you put off doing certain things because of your condition, or if you’re experiencing pain, burning, or stinging in the affected area, it might be time to speak to a dermatologist.

A dermatologist can suggest lifestyle modifications and prescribe treatments to help you manage your specific symptoms. Book an appointment with a dermatologist today to take the first steps towards treating your rosacea symptoms.

Alternatively, if you have rosacea and experience digestive issues, your gut microbiome may be to blame. A naturopathic doctor can help rebalance your inner microbiome and work towards reducing your rosacea symptoms. Book an appointment to speak to a naturopathic doctor today and see how an inner approach to health can transform your outside.