Can diet help with rosacea? The short answer is “maybe” according to Dr. Catherine Zip, a Calgary dermatologist and spokesperson for the Acne and Rosacea Society of Canada. Dr. Zip helps us understand how diet affects rosacea, what foods can cause rosacea flare ups and how a diet promoting a healthy gut may help with rosacea.
“When counselling patients about ways to improve their rosacea, doctors may recommend avoidance of trigger foods and beverages, including spicy foods, hot drinks, and alcohol.
In a survey of over 400 rosacea patients done by the National Rosacea Society, 78% had altered their diet because of their rosacea, and of this group, 95% felt that this had resulted in reduced flares. However, few studies have examined the relationship between diet and rosacea.
What foods can make rosacea flare?
The foods reported to trigger rosacea in the survey done by the National Rosacea Society fell into 4 groups:
- Heat-related, including hot tea and hot coffee
- Alcohol-related, including both wine and hard liquor
- Capsaicin-related. Capsaicin is found in hot sauce, jalapeno peppers, cayenne peppers, and other chili peppers
- Cinnamaldehyde-related. Cinnamaldehyde is found in many seemingly unrelated foods, including tomatoes, citrus fruits, cinnamon, and chocolate
How can food aggravate rosacea?
Although we don’t know for sure how certain foods aggravate rosacea, there is likely more than one mechanism by which this can happen. Certain foods may activate receptors in the skin that trigger dilatation of blood vessels, leading to flushing and inflammation.
Diet can also impact the microbial composition of the gut, which may also impact rosacea. Alterations in the composition of microorganisms in the gut, known as the microbiota, and the collective genetic pool of these organisms, known as the microbiome, may trigger inflammation in the skin.
What do we know about the link between rosacea and gastrointestinal disease?
In a large Danish study of patients with rosacea, several gastrointestinal conditions were found to be more common in individuals with rosacea than in controls. These conditions included celiac disease, Crohn’s disease, ulcerative colitis, Helicobacter pylori (H pylori) infection, small intestinal bacterial overgrowth (SIBO), and irritable bowel syndrome.
More research is needed as to whether or not treatment of any associated gastrointestinal problems would help improve rosacea. However, it may be prudent to follow a diet that can reduce the risk of gastrointestinal diseases associated with rosacea.
How can those with rosacea support a healthy gut?
The gut microbiome may play a role in rosacea. So how can we promote a healthy gut microbiome? Eating a diet that is high in fibre is important. Many plant fibres in the diet act as prebiotics, which promote the growth and activity of beneficial gut microbes. Dietary fibre also reduces gut transit time, which is also associated with a healthy gut.
Prebiotic foods include vegetables (artichokes, asparagus, onions, garlic , leeks, radishes, carrots), fruits (tomatoes, berries, bananas), seeds, legumes and grains (oats, barley).
Probiotics are live microorganisms which are consumed to improve or restore a healthy gut flora. Although clinical trials are lacking, they may also be helpful in the treatment of rosacea by improving the gut microbiome. Probiotic foods that contain active microorganisms include fermented products such as yoghurt, kefir, miso, kimchi and sauerkraut.
Do any specific nutrients help rosacea?
There is no convincing evidence to date that taking specific nutrients is helpful in improving rosacea.
How about caffeine?
Most studies have not shown an association between intake of caffeine and worsening of rosacea. One study of patients with rosacea showed no effect of consuming room temperature caffeinated coffee on flushing, whereas hot coffee or hot water did trigger flushing. In fact, one recent study showed that caffeine intake from coffee (but not other substances including tea and soda) was associated with a decreased risk of developing rosacea.
What can we take away about the role of diet in rosacea?
- Keeping a food diary can help you determine if specific types of foods and beverages, including hot drinks, alcohol, and capsaicin and cinnamaldehyde containing foods, trigger flares of your rosacea.
- Eating a healthy diet, by promoting and maintaining a healthy gut microbiome, may help in the management of rosacea. Aim to eat a wide variety of high fibre, plant-based foods.”
- Weiss E, Katta R. Dermatol Pract Concept. 2017;7(4):31-37.
- Wilkin J. J Invest Dermatol. 1981;76(1):15-18.
- Li S, Chen M, Drucker A et al. JAMA Dermatol. 2018;154(12): 1394-1400.
Dr. Catherine Zip is a Calgary dermatologist and spokesperson for the Acne and Rosacea Society of Canada. She is a Clinical Associate Professor at the University of Calgary. Dr. Zip is in private practice at the Dermatology Centre in Calgary.