The Rosacea Elimination Diet: Foods to Avoid
Updated: Aug 16, 2020
I was talking to one of my friends about her rosacea. She describes it as a very frustrating skin condition, because for years she's had to deal with flushing. Her cheeks and nose get very red , especially when she's feeling overheated or stressed or embarrassed.
In the last few years, it's gotten worse. The redness no longer comes and goes – her nose is pretty much always red. Sometimes she also experiences flares of what we call inflammatory papules--red bumps on the cheeks that look like acne. These bumps may look like acne, but they're not. They're one of the signs of rosacea.
She's started to notice that certain foods seem to make her flushing worse. These foods will sometimes even trigger a flare of the red papules. That's a common experience for most persons with rosacea, since there are multiple foods and beverages that have been reported to act as "triggers" for rosacea.
While there are effective prescription topical and oral medications for rosacea, they don't work for everybody, and patients often have to stay on them for months at a time, or even years. That's why it's worth trying the rosacea diet for the next month to see if these changes might help.
With the rosacea diet, you'll avoid the foods and beverages that are known to trigger flares of rosacea. You probably won't have to avoid all of these forever, but I recommend complete avoidance for the first one month. After that time, you'll reintroduce each food, one at a time, every few days, to see if you can pinpoint any foods that seem to make your rosacea worse. It helps to keep a food diary during this process.
Why do I recommend avoidance of these particular foods? It's based on what we know of the biological mechanisms that cause rosacea.
What causes rosacea?
We don't know the exact reason that some people develop rosacea. It's believed to be a complex combination of changes in the nerves in the skin, blood vessels in the skin, immune system, and even possibly the microbes that live on our skin. These changes ultimately lead to over-sensitive blood vessels in the skin, which dilate (open up) in response to different triggers. Once these blood vessels dilate, you start to see redness of the skin. Over time, the blood vessels can become permanently dilated. In some people, these changes also lead to very sensitive skin and sometimes inflamed skin, in the form of red bumps or pustules.
Based on the research that's been done into the causes of rosacea, we have some suggestions on foods that might act as triggers. (The research has also suggested some foods that may help.)
Foods to avoid
There's a surprising lack of in-depth research into food triggers for rosacea, but we do have some helpful information from surveys of rosacea patients. In one survey of over 400 patients conducted by the National Rosacea Society, over 75% of the respondents had tried to change their diet due to their rosacea. Of this group, 95% reported that they had experienced fewer flares after changing their diet.
In looking at the results, we can break the triggers down into four general groups.
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%), beer (30%) and hard liquor (42%).
Capsaicin is a particular substance that is 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 particular 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 that is found in a number of different foods. These foods don't appear to be related when you first look at them, but chemical analysis has shown that one common component is the chemical cinnamaldehyde. 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%).
Why do we believe that these particular foods act as triggers?
Hot temperatures are a trigger for vasodilatation. This means that they cause our blood vessels to open up (dilate), in order to help our body release heat. The flushing that we see in rosacea is thought to play a role in ultimately triggering skin inflammation.
There is also research that suggests a role for certain channels that are present in our nerve cells and skin cells. These are called transient receptor potential channels. Research has found that these channels may be activated by cold or hot temperatures, as well as certain foods. When these channels are activated, they trigger dilation of the blood vessels, which results in flushing.
What foods activate these channels? Specific food substances include capsaicin and cinnamaldehyde.
In surveys, there are other foods that patients have described as rosacea triggers, so there's clearly more research that's needed in this area.
If you're trying to avoid possible rosacea triggers, I do recommend keeping a food diary. While there are many potential food triggers, they don't cause problems for everyone. That's why keeping a diary and taking notes on what foods may be your personal triggers can be so helpful.
In an upcoming post, I'll go over some of the evidence that suggests that certain foods may be helpful for rosacea patients.
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Dr. Rajani Katta is the author of Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. To receive future updates on preventive dermatology and the role of diet, sign up here.