Rosacea Elimination Diet
Managing Rosacea Through Diet
Whether you call them elimination diets, avoidance diets, or detox diets, sometimes staying away from certain foods can help in the treatment of certain skin conditions. Unfortunately, there is a lot of misinformation out there when it comes to avoidance diets – they certainly don't help in every case, and they are definitely not one size fits all.
These diets must be carefully matched to your particular skin condition, medical history, allergy history, and sometimes, test results.
The goal of this article is to explore the management of rosacea through diet and to help you start a conversation with your dermatologist if you have rosacea. Certain foods, when avoided, may lead to improvement in rosacea.
For any elimination diet, a few important questions must be asked:
- Who are the people who benefit from this diet?
- Why do we think that this diet works? In other words, is there a plausible scientific explanation?
- Do we have a way of predicting who might benefit from this diet?
- What are the specifics of the diet? What foods should you avoid, and how long before you might expect to see results?
Diets for Rosacea: Foods to Avoid
When one of my friends began to experience the symptoms of rosacea, she responded well to medicated creams initially. Several years later, though, she started to experience worsening flares, with many red bumps and pustules (inflamed white pimple-like bumps) that were visible on her nose and cheeks.
That's when we discussed starting oral antibiotics. First, though, I wanted to make sure she had successfully made the lifestyle changes that may help with rosacea.
Rosacea is one of the skin conditions where lifestyle changes can make a big difference. This includes protecting against sun exposure and being careful about situations that can cause overheating, such as long hot showers.
Diet is another important lifestyle factor. She decided to focus on lifestyle changes for the next month. In her case, these changes worked remarkably well, although the response to lifestyle changes can vary. I was amazed when I saw her several months later with clear skin.
What did she do? In addition to continuing her topical treatment regimen, she avoided certain foods that seemed to act as triggers for her rosacea. She called these her "sour and spicy" triggers. Specifically, she stopped eating lemons, certain spices, and tomatoes.
Foods and Beverages That Act as Rosacea Triggers
Although there's a surprising lack of in-depth research into foods that act as triggers for rosacea patients, the National Rosacea Society has published surveys of its members. These results provide some helpful guidelines. In a survey of over 400 patients, over 75% of the respondents had tried to change their diet due to their rosacea.1 Of this group, 95% reported they had experienced fewer flares after changing their diet.
What were some of the top triggers reported in this survey? The top beverages included hot beverages (e.g., tea and coffee) and alcoholic beverages (e.g., wine and beer). Top trigger foods included spicy foods, hot peppers, tomatoes, citrus, and chocolate.1
This list includes a wide variety of foods and beverages, and at first glance it may be hard to see the connections. Research in this area, however, has revealed some important connections among the items on this list and has also suggested a hypothesis to explain why eliminating these foods and beverages may help. Examining the causes of rosacea can help us understand why diet changes may help.
Causes of Rosacea: The Importance of Blood Vessels in the Skin
We don't know the exact reason why people develop rosacea, but its etiology is due to a complex combination of a genetic predisposition combined with changes in the nerves, blood vessels, and immune system of the skin.2
Certain triggers, such as ultraviolet (UV) radiation, skin microbes, and diet, can worsen the redness and inflammation of rosacea perhaps due to over-sensitive blood vessels in the skin of patients with rosacea.
In rosacea, blood vessels in facial skin open up (dilate) in response to different triggers. Once these blood vessels dilate, the skin starts to appear red. Over time, these blood vessels can become permanently dilated. In some people, these changes lead to very sensitive skin and sometimes inflamed skin, in the form of red bumps and pustules.
We know that the food and beverage triggers listed above act to open up blood vessels (known as vasodilation), which is likely why these foods can worsen rosacea. For example, hot beverages cause blood vessels to dilate in order to help our body release heat. Alcoholic beverages can cause flushing, which leads to redness and a warm feeling, also due to vasodilation.
Other foods and beverages can cause vasodilation by acting on certain skin and nerve cells. They do this via certain channels that are present on these cells. These channels, called transient receptor potential (TRP) channels, are activated by different triggers. When they're activated on nerve cells, the nerve cells cause vasodilation of our skin blood vessels. When this happens, you'll see flushing.
TRP Channel Activation
What causes activation of TRP channels?
Research has found that these channels may be activated by cold or hot temperatures. They can also be activated by certain foods.3
What foods activate these channels? Many of the foods that rosacea patients describe as triggers contain either capsaicin (spicy foods, peppers) or cinnamaldehyde (tomatoes, citrus, chocolate).
There are other foods that patients have described as rosacea triggers, so there's clearly more research that's needed in this area. It's common to find very different trigger foods from one individual to another.
In looking at the results of the National Rosacea Society survey, most of the reported triggers fell into four general categories.
Figure 1. Foods to Avoid
(Reprinted with permission from www.skinanddiet.com)
In this group, hot beverages were a frequent trigger. Hot coffee (33%) and hot tea (30%) were common triggers.
Alcohol was a common trigger, including wine (52%), hard liquor (42%), and beer (30%).
Capsaicin is a particular substance found in certain spices and peppers. This was one of the most common triggers, with many rosacea patients describing it as a problem. In this study, patients reported spices as a trigger (75%), as well as hot sauce (54%), cayenne pepper (47%), and red pepper (37%).
Cinnamaldehyde is a substance found in numerous different foods. On the surface, these foods don't appear to be related, but chemical analysis reveals they share a common component, the chemical cinnamaldehyde.4 Foods that contain cinnamaldehyde include tomatoes, citrus, cinnamon, and chocolate. In this survey, these foods were frequent triggers of rosacea, including tomatoes (30%), chocolate (23%), and citrus (22%).
Discovering Your Own Trigger Foods: The Importance of a Food Diary
At this time, there aren’t any blood or skin tests to predict which foods should be avoided. It is also important to note that for some people with rosacea, food is not a trigger at all.
That's one of the reasons why a food diary is so important. While there are many potential food triggers, individual sensitivities vary. That's why keeping a diary and taking notes on what foods may be your personal triggers can be incredibly helpful.
With a food diary (either handwritten or recorded in an app), all food and beverages consumed during the day are recorded. Whenever a flare of rosacea occurs, you can record this and look back over the prior few days. Compare your possible triggers to the list of known trigger foods. This may help you pinpoint your personal triggers.
Another approach you may wish to discuss with your dermatologist is "full avoidance then reintroduction." With this approach, you avoid all four categories of known trigger foods and beverages for one full month. If you find that this helps, you can then reintroduce the individual foods one at a time, waiting a few days in between. This may help you pinpoint certain trigger foods. Of course, these decisions should be made together with your doctor to ensure you are not avoiding foods that are vital for your health.
The Bottom Line
If you're experiencing frequent flushing or skin inflammation due to rosacea, you may consider an elimination diet to pinpoint your particular food and beverage triggers. Also be sure to discuss your plan with your dermatologist to get professional input and guidance.
- Hot Sauce, Wine and Tomatoes Cause Flare-ups, Survey Finds | Rosacea.org. Accessed July 12, 2021. https://www.rosacea.org/rosacea-review/2005/fall/hot-sauce-wine-and-tomatoes-cause-flare-ups-survey-finds
- Two AM, Wu W, Gallo RL, Hata TR. Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol. 2015;72(5):749-758; quiz 759-760. doi:10.1016/j.jaad.2014.08.028
- Aubdool AA, Brain SD. Neurovascular Aspects of Skin Neurogenic Inflammation. J Investig Dermatol Symp Proc. 2011;15(1):33-39. doi:10.1038/jidsymp.2011.8
- Scheman A, Rakowski E-M, Chou V, Chhatriwala A, Ross J, Jacob SE. Balsam of Peru: past and future. Dermat Contact Atopic Occup Drug. 2013;24(4):153-160. doi:10.1097/DER.0b013e31828afab2