The Impact of Diet on Rosacea

Mechanisms, Triggers, and Management Strategies

Rosacea is a chronic inflammatory skin condition characterised by redness, flushing, and sensitivity, often triggered by dietary and environmental factors. While genetics, vascular, immune and neurological factors play a role, certain foods can exacerbate symptoms by causing vasodilation (widening of blood vessels), increasing inflammation, or overstimulating nerve channels in the skin. Understanding which foods contribute to flares can help manage and reduce flare-ups.

The Complexity of Rosacea, Food Triggers & Beneficial Dietary Patterns

Understanding why certain foods trigger a rosacea flare is complex and diverse, with some individuals reacting to common triggers, and others not reacting at all. However, there are several categories of foods that can be individually evaluated and avoided if found to trigger flares. I do want to emphasise the triggers are varied across patients and it is not helpful to avoid all potential triggers due to the risk unnecessary food restriction and food demonisation. Identifying personal triggers through careful and systematic observation is helpful if it allows an individual to work out what is impacting them.

Looking at the recent research in this space, a 2023 study (Chen., et al) looking at the association between specific foods or food groups and participants with either acne or rosacea showed that triggers were significant across both groups, but rosacea patients were less likely to report positive benefit from food / dietary patterns compared to acne participants. This is consistent with previous research that shows foods often being a trigger for rosacea flares but relatively few beneficial outcomes from dietary interventions compared to acne. With acne there are much clearer associations between both trigger foods / food groups and beneficial dietary patterns supportive of acne outcomes.

Despite the paucity of research, two recent studies have shown that the Mediterranean Diet may help prevent rosacea development and allow for better control of symptoms when adhered to. I do want to emphasise that the 2024 paper (Ruis., et al) reporting better control of symptoms, correlated it to a high adherence to Mediterranean dietary patterns, which emphasises plant foods, olive oil, nuts & seeds, legumes, whole grains and fish / seafood with moderate dairy and lower intake of animal products.

Mediterranean Eating

A high adherence to Mediterranean dietary pattern, which emphasises plant foods, olive oil, nuts & seeds, legumes, whole grains and fish / seafood with moderate dairy and lower intake of animal products, may help reduce rosacea severity.

One rationale for the benefits seen with a higher adherence to the Mediterranean Diet is the high plant food intake, which is associated with more dietary antioxidants. The role of oxidative stress in rosacea is one potential factor in the severity and progression of the condition. Overproduction of reactive oxygen species in oxidative stress can contribute to cellular damage and be a factor in several skin diseases. Antioxidants have the potential to dampen down the effects of oxidative stress and as such cellular damage in rosacea.

The Mediterranean diet is also considered anti-inflammatory. Given the role of inflammation in the progression and severity of rosacea, a diet that reduces inflammation overall is likely to have some beneficial impact. A diet higher in plant polyphenols and fibre is also likely to support the gut microbiome, disruption of which is strongly implicated in rosacea…but that is a bigger topic for a follow up article.

Another factor with the Mediterranean dietary pattern that may provide benefit is the higher intake of linoleic acid from nuts and seeds. Rosacea patients show a pattern of abnormal lipid metabolism, which can drive damaging changes in skin keratinocytes (Wang., et al, 2025). Linoleic acid consumption may block this effect. Dietary sources of linoleic acid include flax, chia, walnuts, avocado, edamame, navy beans and chickpeas. Canola oil also has a high content of linoleic acid, but its consumption is rife with potential health risks, so it is best avoided generally, as are other seed oils (sunflower, safflower, corn, soybean). Looking at a supplemental option for linoleic acid, Evening Primrose Oil is a beneficial source of gamma linoleic acid, and its use has been associated with decreased trans epidermal water loss and redness in rosacea patients previously.

Foods and Beverages That May Worsen Rosacea

1. Hot Food and Beverages

Temperature matters when it comes to rosacea. Hot food and drinks can cause direct vasodilation, leading to increased flushing and skin sensitivity. This occurs due to the stimulation of transient receptor potential vanilloid-1 (TRPV1) channels, which are implicated in rosacea flare-ups. Cooling down food and beverages before consumption can help minimise reactions. Think iced tea or coffee instead of drinking it hot.

2. Cinnamaldehyde-Containing Foods

The aggravating effects of certain foods on rosacea may be linked to cinnamaldehyde, a compound known to activate transient receptor potential (TRP) ion channels present in sensory nerves and keratinocytes. This activation triggers the release of substance P, which promotes inflammation and leads to the dilation of arterioles in rosacea-prone skin. Common sources include:

• Tomatoes

• Citrus fruits

• Cinnamon

• Chocolate

These foods can stimulate sensory nerves and contribute to increased redness and flushing.

3. Capsaicin-Containing Foods

Capsaicin, found in spicy foods, can cause a burning sensation and trigger rosacea symptoms. Common culprits include:

• Peppers (chili, bell, jalapeño)

• Spicy foods

• Cayenne pepper

Capsaicin activates heat-sensitive receptors, which can lead to increased facial flushing and discomfort.

4. Histamine-Rich Foods

Histamine is a compound that causes blood vessel dilation, potentially worsening rosacea symptoms. Research suggests that histamine receptors (H2 and H3) are upregulated in individuals with rosacea, making them more susceptible to flare-ups. High-histamine foods to watch out for include:

• Aged cheeses

• Fermented foods (kimchi, sauerkraut, soy sauce, kombucha)

• Processed meats

• Alcohol

Assessing for and reducing histamine intake if relevant may help in managing skin sensitivity and facial redness.

5. Caffeine

Caffeine intake in rosacea risk is not clear. Intake can decrease vasodilation via its effects on the sympathetic nervous system. It is also an antioxidant, but increased intake has been associated with rosacea risk, i.e., the more caffeine consumed, the greater the risk. So, it’s not all bad news, some coffee but not too much is likely ok dependant on individual response. For me, coffee was always fine, but alcohol was a problem.

6. Alcohol

Alcohol is a well-known rosacea trigger, particularly wine and liquor, which have also been associated with a higher risk of rosacea in women. Alcoholic drinks can cause immediate facial flushing by inducing vasodilation. The breakdown products of alcohol can also be problematic, contributing to histamine release. While it may not be a trigger for everyone, the risk tends to be dose-dependent and associated the acceleration of rosacea progression. If it is a known trigger, reduction or avoidance may help with rosacea symptoms (Alia & Feng, 2022).

7. Fatty and Fried Foods

A diet high in fatty foods, including:

• Fatty meats (bacon, pork belly)

• Fried foods (fries, deep-fried snacks)

• Lard-based products

These foods have been linked to an increase in rosacea severity. This may be due to the role of fatty diets in promoting chronic inflammation, which can worsen skin conditions. It is generally worthwhile, regardless of skin health, to moderate intake of fatty foods, or at least ensure that there is a good balance between saturated fat and monounsaturated / polyunsaturated fat intake.

Managing Rosacea Through Diet

Since rosacea triggers vary from person to person, a systematic approach to identifying problem foods is important. Eliminating potential triggers / trigger groups and reintroducing them one at a time can help determine personal sensitivities.

While diet is not the sole factor in rosacea management, avoiding known triggers and focusing on an anti-inflammatory diet can help improve skin health. Foods rich in antioxidants, omega-3 fatty acids (for ocular rosacea) and linoleic acid generally may help reduce inflammation and keeping rosacea symptoms under control while further supportive strategies can be put into place.

References:

Alia, E., & Feng, H. (2022). Rosacea pathogenesis, common triggers, and dietary role: The cause, the trigger, and the positive effects of different foods. Clinics in Dermatology, 40(2), 122-127.

Chen, P., Yang, Z., Fan, Z., Wang, B., Tang, Y., Xiao, Y., ... & Shen, M. (2023). Associations of adherence to Mediterranean-like diet pattern with incident rosacea: A prospective cohort study of government employees in China. Frontiers in Nutrition, 10, 1092781.

Rius, I. O., España, A., Sánchez, P. G., Gil, L. A., Vallejo, R. S., Antoñanzas, J., ... & Garijo, N. R. (2024). 51581 Mediterranean diet could improve the response to treatment in rosacea patients: An observational and cross-sectional study in 92 patients. Journal of the American Academy of Dermatology, 91(3), AB255.

Wang, M., Xiao, W., Liu, T., Zhu, Y., Chen, M., Tan, Z., ... & Li, J. (2025). Linoleic acid improves rosacea through repairing mitochondrial damage in keratinocytes. Life Medicine, lnaf005.