Rosacea
Root-Cause Care for Rosacea
Rosacea is an inflammatory condition, and the redness on your face is often connected to what is happening in your gut and your skin's microbiome.
The Basics
What rosacea actually is
Rosacea is a chronic inflammatory condition that mostly affects the center of the face. It can look like persistent redness and visible blood vessels, acne-like bumps and pustules, or, less commonly, thickened skin on the nose. Many people also feel burning, stinging, swelling, or dryness.
Rosacea can affect the eyes too, causing red, irritated eyelids and eyes, and those symptoms should always be checked by an eye doctor. It is most often diagnosed in women over 30 with fair skin, but it is probably missed in people with darker skin. Rosacea can also look like, or appear alongside, acne, seborrheic dermatitis, or the facial rash of lupus, which is why a careful evaluation matters.
The inflammation behind rosacea doesn't stay in the skin. People with rosacea have higher rates of high cholesterol, high blood pressure, and coronary artery disease (Hua, 2015), which is one more reason to look at the whole body.
Why rosacea keeps coming back
If you have rosacea, you have probably been told to avoid your triggers and wear sunscreen, and you may have tried prescription creams, gels that shrink blood vessels, oral antibiotics, or laser treatments. These can calm flares and reduce redness, and they are sometimes the right tool. What they don't treat is why your skin's immune response and blood vessels are so reactive in the first place, which is why the redness and breakouts tend to return.
What I Look For
What is often driving it
Rosacea rarely has a single cause. These are the patterns I look for most often, some on the skin and some deeper inside the body.
On the Skin
An overactive skin defense system
Your skin makes its own antimicrobial compounds to fight off bacteria, viruses, and fungi. In rosacea, the skin makes too much of one of these, called cathelicidin, and in a form that drives inflammation, redness, and new blood vessel growth instead of simply protecting the skin. The skin also tends to have more mast cells, the immune cells that release chemicals causing flushing and swelling (Muto, 2014).
Demodex mites
These microscopic mites live in the hair follicles of almost everyone's face. People with rosacea tend to have far more of them, and bacteria that live on the mites can set off an inflammatory response (Jarmuda, 2012).
Triggers that flush the skin
Heat and cold, sun, hot drinks, spicy food, alcohol, exercise, strong emotions, some medications, and irritating skin products can all widen the blood vessels in the face. In rosacea, the nerves and blood vessels react to these triggers more strongly than they should.
From the Inside
Gut imbalance and leaky gut
People with rosacea often show signs of a more permeable gut lining (Yüksel, 2022), which lets inflammatory signals reach the rest of the body and keeps the immune system on alert.
SIBO and H. pylori
Small intestinal bacterial overgrowth, or SIBO, is more common in people with rosacea, and some people stay clear for years after it is successfully treated (Parodi, 2008). H. pylori, a stomach bacterium, can also play a role, and treating it can reduce rosacea symptoms (Saleh, 2017).
Food triggers
Many rosacea food triggers work by dilating blood vessels. Alcohol, hot drinks, and spicy foods are the most common, and foods containing a compound called cinnamaldehyde, such as cinnamon, tomatoes, chocolate, and citrus, can do the same (Weiss, 2017).
Sources:
Hua TC, Chung PI, Chen YJ, et al. Cardiovascular comorbidities in patients with rosacea: A nationwide case-control study from Taiwan. J Am Acad Dermatol. 2015;73(2):249-54. PubMed 26004520
Muto Y, Wang Z, Vanderberghe M, et al. Mast cells are key mediators of cathelicidin-initiated skin inflammation in rosacea. J Invest Dermatol. 2014;134(11):2728-2736. PubMed 24844861
Jarmuda S, O'Reilly N, Żaba R, et al. Potential role of Demodex mites and bacteria in the induction of rosacea. J Med Microbiol. 2012;61(Pt 11):1504-1510. PubMed 22933353
Yüksel M, Ülfer G. Measurement of the serum zonulin levels in patients with acne rosacea. J Dermatolog Treat. 2022;33(1):389-392. PubMed 32293942
Parodi A, Paolino S, Greco A, et al. Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clin Gastroenterol Hepatol. 2008;6(7):759-64. PubMed 18456568
Saleh P, Naghavi-Behzad M, Herizchi H, et al. Effects of Helicobacter pylori treatment on rosacea: A single-arm clinical trial study. J Dermatol. 2017;44(9):1033-1037. PubMed 28452093
Weiss E, Katta R. Diet and rosacea: the role of dietary change in the management of rosacea. Dermatol Pract Concept. 2017;7(4):31-37. PubMed 29214107
C: Cut inflammatory foods. Identifying and reducing your personal food triggers, especially the ones that cause flushing, and adding more vegetables, fiber, and fish.
L: Lower toxic burden. A very gentle, fragrance-free skincare routine, since essential oils and strong antimicrobial products can cause major flares, and sun protection chosen carefully because some sunscreens irritate rosacea-prone skin.
E: Eliminate gut pathogens. Testing for and treating SIBO, H. pylori, and other gut overgrowths, and addressing Demodex mites, which sometimes requires a prescription because natural products don't reliably clear them.
A: Absorb key nutrients. Targeted nutrients that support the skin barrier and help calm oil production and inflammation, along with omega-3 fats.
R: Rebuild and Restore. Repairing the gut lining, and calming the nervous system, since stress and strong emotions are some of the most common flushing triggers.
What to expect
Rosacea skin is very sensitive, so we start gently and add one new thing at a time. Some treatments make the skin look worse for a short time before it improves, and we will talk through that ahead of time so it doesn't catch you off guard. When a prescription is the right tool, I will tell you, and we can use it alongside the root-cause work.
Ready to find out what is driving your rosacea?
A free consultation is the best way to see whether this approach is the right fit for you.