It’s best to think of Rosacea as a 'reactive' skin condition. The skin reacts to a trigger to result in dilation of the blood vessels and result in an increased sensitivity of the skin overall.
Anything that makes the skin sensitive will reflexively lead to blood vessels dilating which results in flushing or blushing followed by breakouts. High histamine foods such as alcohol, smoked meats, shellfish, canned foods, and legumes can also cause vasodilation or a relaxation of the blood vessels. This can only exacerbate or make rosacea flare. Since rosacea is a chronic condition, although we have many treatments meant to control the symptoms, ultimately it is best managed by avoiding triggers. Since high histamine foods can trigger rosacea it is best to try to find other options!
There are so many dietary fads and trends focused on inflammatory foods and anti inflammatory diets! A day does not go by where I am not asked what role inflammatory foods play in various skin conditions. When it comes to rosacea, the key is avoidance of foods that result in flushing as a result of dilating our blood vessels. There are some studies that have linked a higher prevalence of GI disorders and bacterial overgrowth in our gut to flaring rosacea. Along these lines, a diet high in fiber may actually help reduce flares and reduce inflammation. This is referred to as a “prebiotic” diet. A prebiotic diet is rich in fiber that is not processed until it gets to the colon. Probiotics are the “good” bacteria for your colon. Prebiotic foods feed or support probiotics! Prebiotic fibers include onions, raw garlic, bananas, endives, asparagus, and whole grains.
Identifying triggers for rosacea can be difficult. Sometimes the initial flushing is missed as people are more often bothered by breakouts that can follow a few days later. There can be a delay in seeing the breakouts that makes it tougher to tie back to specific foods. When trying to identify triggers, it helps to get out a traditional month-at-a-glance calendar and track the worst days for rosacea flares. Focusing on routine aspects of your diet are far more helpful than the random menu item you happen to choose while on vacation! Many of my patients note early in the week flares. Sometimes this is triggered more by the red wine with a weekend dinner. If your rosacea is flaring early in the week but settles down through the week, focus on your weekend habits. If you start the week out great but feel like your skin spirals out of control during the week, take a good look at your routine habits during the week- such as, excess coffee or caffeine, lunch at work. Sometimes the issue is less diet and more stress related to incidents. This is worth keeping in mind if your flares are isolated to just a few days a month on your calendar but show no other signs of consistency.
Ocular rosacea is a form of rosacea that affects the eyes. It can affect about 50-70% of patients with rosacea. It may or may not be associated with rosacea of the skin. There is no specific diagnostic test for ocular rosacea. It is characterized by bloodshot eyes, excess dryness, gritty or foreign body sensation, itching, photophobia or fear of lights. Untreated ocular rosacea can result in eyelid and eye surface inflammation that can involve the cornea and even affect vision over time. The treatment of choice is oral doxycycline. Rosacea can vary in its progression and appearance but for many its a chronic progressive disease. It can start with flushing or blushing that comes and goes, then this starts to stick around. As it fluctuates people struggle with their skin feeling oily but also flaky or dry. Classically they will say they put on moisturizer and an hour later their skin is flaky again. They can’t figure out if they should moisturize or dry out their skin! This turns into breakouts that look like acne but do not behave like acne (you go to pop a “pimple” but they don’t really come to a head- they just get angrier at you). This is followed by the skin starting to swell or thicken and taking on a p’eau d’orange or orange-peel skin appearance with widened patulous pores. If it continues then the skin can become even thicker and result in “phymatous” changes. This is the class “WC Fields” nose but can also occur on the chin, cheeks or forehead.
Early diagnosis and treatment is key to control the progression of this chronic disease! Ultimately the potential for scarring or at the very least permanent changes to the overall appearance of the skin can occur.