Rosacea is a chronic inflammatory skin condition characterized by facial flushing and redness, often concentrated on the central face. Estimated to affect up to 15% of certain populations, particularly fair-skinned individuals of European descent, rosacea can significantly impact one's quality of life. While there is no known cure, a combination of medication, lifestyle adjustments and dietary changes can help manage the symptoms and decrease flare-ups. This article explores the role of diet in managing rosacea, identifying trigger foods, and highlighting foods that may help reduce flare-ups.
Understanding Rosacea
Rosacea is divided into four main subtypes based on clinical characteristics: erythematotelangiectatic, papulopustular, phymatous, and ocular. Patients may present with symptoms from multiple subtypes concurrently, or with isolated findings that do not fit a specific subtype. The exact pathogenesis of rosacea is unknown, but several factors are believed to contribute, including genetics, immune system changes, gut bacteria imbalance, and environmental triggers.
The Role of Inflammation
Inflammation occurs as a result of an immune response in the body. It can also result from oxidative stress, a state where the body experiences a high level of oxidants, called free radicals, which can cause cell damage. Due to the inflammatory nature of rosacea, reducing inflammation in the body could help alleviate symptoms.
The Gut-Skin Connection
Emerging evidence suggests that rosacea is also underpinned by the health of the gut microbiome, which refers to the collection of bacteria that live in your gut. People with rosacea are often found to have more bad bacteria and less good bacteria in their gut. The gut microbiome plays an important role in training both the innate and adaptive immune systems. Dysbiosis of intestinal bacteria may result in activation of plasma kallikrein-kinin pathways, leading to downstream neurogenic inflammation. Epidemiologic studies suggest that patients with rosacea have a higher prevalence of gastrointestinal disease, and some studies have reported improvement in rosacea following successful treatment of small intestinal bacterial overgrowth (SIBO).
Identifying Rosacea Trigger Foods
Certain foods and beverages may act as "triggers" for rosacea exacerbations. These triggers can vary widely from person to person, making it essential to identify individual sensitivities. A simple way to determine which foods trigger your rosacea is to keep a record of what you’ve eaten before a flare-up. Common trigger categories include heat-related, alcohol-related, capsaicin-related, and cinnamaldehyde-related foods.
Read also: Rosacea, Food Triggers, and Gut Health
Common Food and Beverage Triggers
- Alcohol: Alcohol can flare up facial flushing related to rosacea through vasodilation (expanding) of the blood vessels in the skin. The risk of aggravating your rosacea from alcohol is dose-dependent, meaning the more alcohol you drink, the greater the risk. Red wine, in particular, contains a lot of histamine, which can trigger inflammatory responses. A 2017 study showed that increased consumption of alcohol was found to be directly related to an increased risk of rosacea in women. The study found that white wine and liquor were especially associated with a higher risk of rosacea in the study participants.
- Hot Foods and Beverages: The heat from hot food and drink can directly cause facial flushing from vasodilation, which can then trigger further rosacea symptoms. Hot beverages such as hot coffee and hot tea are common triggers.
- Spicy Foods: Capsaicin, found in certain spices and peppers, causes the widening of blood vessels (vasodilation) and flushing, which can indirectly exacerbate rosacea.
- Cinnamaldehyde-Containing Foods: Cinnamaldehyde is found in several seemingly unrelated foods, including tomatoes, citrus, cinnamon, and chocolate. This compound is involved in the activation of a signaling pathway associated with rosacea and can affect sensory nerves in the skin, causing blood vessels to dilate.
- High Histamine Foods: Histamine is involved in multiple mechanisms related to rosacea, including inflammation, immune regulation, and facial flushing. High histamine foods include aged cheese, wine, processed meat, tomatoes, citrus fruits, legumes, and chocolate.
- Dairy: According to a 2019 study, diets with a high dairy content may worsen rosacea.
- Niacin-Rich Foods: Niacin, or vitamin B3, causes blood vessels to dilate, promoting redness, flushing, and stinging. Niacin-rich foods include liver, chicken breast, salmon, peanuts, and tuna.
The Role of Specific Compounds
Certain compounds found in foods can trigger or aggravate rosacea symptoms. These include cinnamaldehyde, histamine, formaldehyde, and niacin.
- Cinnamaldehyde: Cinnamon contains cinnamaldehyde in large concentrations and is a commonly reported trigger food among people with rosacea. Chocolate also contains cinnamaldehyde and histamine. This compound is involved in the activation of a signaling pathway associated with rosacea.
- Histamine: This compound is involved in multiple mechanisms related to rosacea, including inflammation, immune regulation, and facial flushing. The role histamine plays in these mechanisms is well understood but less is known about the effects of dietary histamine specifically, on rosacea.
- Formaldehyde: Beef, pork, and poultry contain formaldehyde. This compound plays a role in inflammation and in the burning/stinging sensation experienced by some patients with rosacea.
- Niacin: Beef, pork, chicken, turkey, salmon, tuna, and anchovies all contain niacin.
Foods That May Reduce Rosacea Flare-Ups
Due to the inflammatory nature of rosacea, reducing inflammation in the body could help alleviate symptoms. Certain foods can help support the gut microbiome, which may also reduce rosacea symptoms.
Anti-Inflammatory Foods
- Omega-3 Fatty Acids: Omega-3 fatty acids block inflammatory pathways within the body, reducing inflammation.
- Fiber-Rich Foods: Foods rich in dietary fiber promote gut health and the growth of beneficial bacteria.
- Prebiotics: Prebiotics are considered “food” for the bacteria living in the gut. They help promote bacterial growth and activity, which both contribute to a healthy gut microbiome. They are important to keep the good bacteria that are already in your gut healthy and can help reduce inflammation in the body. Many dietary plant fibers act as prebiotics.
- Probiotics: Probiotics are foods that contain live “good” bacteria which can contribute to a healthy gut microbiome. Certain types of good bacteria found in a healthy gut-microbiome have been found to reduce inflammation in the skin of patients with rosacea. Probiotic foods include fermented foods in which live active microbial communities are a key component. This includes such foods as yogurt, kefir, miso, kimchi, and sauerkraut.
- Antioxidant-Rich Foods: Foods high in antioxidants, such as blueberries, strawberries, spinach, and carrots, are rich in vitamins C, E, and carotenoids. Antioxidants neutralize free radicals, which can worsen skin stress and inflammation.
Mediterranean Diet
A Mediterranean diet can help manage inflammatory conditions such as rosacea. This includes the following foods:
- Healthy fats high in omega-3s (wild salmon, tuna, sardines, mackerel, walnuts, chia seeds, flaxseeds)
- Plant-based foods
- A variety of fresh fruits and vegetables
- Whole grains
Dietary Strategies for Managing Rosacea
Elimination Diet
Since triggers can vary between individuals, an elimination diet may be helpful. Start keeping a symptom diary, tracking your meals, especially common triggers like spicy foods, alcohol, and hot beverages. Also, keep track of any symptoms you have around the same time as your meals, or at least within the same day. After a few weeks, look back at your diary to identify any patterns around certain foods. If so, those could be your triggers. Try to stay away from those particular foods and see if your symptoms improve.
Gradual Dietary Adjustments
Dietary adjustments should be a gradual process. Try to reduce your intake of trigger foods and observe your skin's response. For example, limit spicy foods and alcohol intake for a week and then monitor your skin condition. If there’s no significant reaction, enjoying them in moderation is fine. The key is to identify your skin's sensitivities and maintain a balanced diet.
Read also: Gentle Skincare for Rosacea
Tips for Managing Rosacea Through Diet
- Adopt General Eating Habits:
- Eat Slowly: Taking your time can help you notice early signs of a flare-up, allowing you to pinpoint problem foods.
- Stay Hydrated: Drinking enough water helps maintain overall health and can reduce inflammation.
- Moderation Is Key: You don’t necessarily need to cut out every suspect food forever-try portion control first.
- Keep a Food Diary: Jot down what you eat and how your skin responds to uncover patterns that might otherwise slip under the radar.
- Practical Advice for Food Preparation:
- Cook at Home: Controlling ingredients and cooking methods can go a long way in lowering the risk of hidden triggers like excessive salt, spicy additives, or rich sauces.
- Use Mild Herbs: Instead of chili powder or hot sauce, experiment with gentle seasonings like basil, oregano, or thyme.
- Experiment with Substitutes: Try dairy-free versions of ice cream made from almond or coconut milk to see if your skin fares better.
Additional Treatments and Considerations
Traditional Rosacea Treatments
First-line traditional rosacea treatments include preventive measures, such as sun protection, gentle skin care, and identification and avoidance of known triggers, including diet and stress. Second-line traditional rosacea treatments include medications and treatments, such as topical brimonidine, azelaic acid, oral doxycycline (or another oral tetracycline), topical metronidazole, topical oxymetazoline ivermectin, sulfacetamide-sulfur, oral isotretinoin (for severe cases that did not respond to other treatments), and laser and intense pulsed light therapies.
The Role of Probiotics and Prebiotics
One way to maintain a healthy gut microbiome may be to consume probiotics or prebiotics. Probiotics contain live organisms that can help improve the gut microbiome. Yogurt and sauerkraut are examples of probiotic foods. Prebiotics act as “food” for these organisms. They include high-fiber foods such as whole grains and vegetables.
Nutritional Supplements
Nutritional supplements that contain healthy fats and other nutrients may help improve your rosacea or soothe dry and gritty eyes in adults with rosacea. These supplements may include omega-3 fatty acids and zinc sulfate.
Read also: Gentle Skincare Routine