Does one need to follow a specific diet if one suffers from rosacea?

The rosacea is a chronic inflammatory dermatosis primarily affecting the central region of the face. It presents as diffuse erythema resulting from persistent dilatation of the blood vessels, often associated with cutaneous hypersensitivity and sensations of burning or tingling. The evolution of rosacea is generally cyclical, with phases of exacerbation and periods of remission. Over time, the erythema may become permanent and be accompanied by additional inflammatory signs.

We distinguish several clinical forms of rosacea : vascular rosacea (or couperose), characterised by redness and vasomotor flushing, the papulopustular rosacea, characterised by inflammatory papules that can resemble acne, the hypertrophic form, rarer, associated with skin thickening, such as the rhinophyma, and the ocular rosacea, which affects the eyelids and ocular surface, causing redness and dryness of the eyes.

Given the variety of clinical presentations and the potential for rosacea to worsen, we recommend consulting a dermatologist at the first sign of suggestive symptoms. Medical advice allows for an accurate diagnosis and tailored management before any dietary changes are undertaken.

Rosacea is a chronic inflammatory skin disease that manifests as diffuse redness associated with persistent dilation of blood vessels. The evolution of rosacea is generally cyclical, with phases of exacerbation and periods of calm.

If diet is not a direct cause of rosacea, it can influence the severity and frequency of flare-ups in some individuals. Several patients report that specific foods trigger or exacerbate redness, while others are better tolerated. To date, there is no universally recommended diet for rosacea. However, some foods involve mechanisms linked to inflammation and vascularisation, which suggests they could help to space out rosacea flare-ups.

Coffee or tea.

Coffee is often cited among foods that trigger a rosacea flare-up, primarily due to its caffeine content. Yet scientific data temper this notion. In practice, it is not so much the caffeine itself as the high temperature of the beverages that appears to promote flushing. Very hot drinks induce a reflex vasodilation of the cutaneous vessels, which can exacerbate the vasomotor flushing characteristic of rosacea. In some individuals, very hot coffee or tea can thus transiently provoke redness.

By contrast, a large prospective study (82,737 women followed from 1991 to 2005) showed an inverse association between caffeine consumption and the risk of developing rosacea.

Female participants with a high caffeine intake indeed exhibited a reduced risk of rosacea. More specifically, consuming four cups of coffee a day or more was associated with a significant reduction in the risk of rosacea flare-ups, whereas decaffeinated coffee did not show any significant association.

These results suggest that caffeine could exert a vasoconstrictive effect which could theoretically limit rosacea. However, this association was not observed for caffeine from other sources such as tea, soft drinks or chocolate. Given the current state of knowledge, coffee may therefore be of interest, provided it is consumed lukewarm rather than very hot. Nonetheless, further research is still required to confirm this.

Foods containing vitamin B2 (riboflavin).

The hypothesis of a link between vitamin B2 (riboflavin) and rosacea dates back to the 1940s, when a riboflavin deficiency was suggested to exacerbate certain inflammatory skin manifestations. Riboflavin plays a key role in the cellular energy metabolism and the functioning of antioxidant systems, notably via its coenzymatic derivatives (FAD and FMN). Some clinical observations have reported that topical application of vitamin B2 can improve skin appearance in individuals with rosacea, particularly by reducing erythema and inflammation.

The exact mechanism remains debated, however. It has been proposed that riboflavin may modulate the inflammatory response by limiting immune cell adhesion to the endothelium and reducing the oxidative stress locally. As inflammation and vascular dysfunction are directly involved in the pathophysiology of rosacea, this effect could theoretically help to alleviate symptoms. Nevertheless, the data mainly concern topical use; no study has demonstrated that oral supplementation alters the clinical course of the disease. Thus, it is difficult to regard vitamin B2 as a dietary component to be prioritised in cases of rosacea. A balanced diet that adequately covers riboflavin requirements undoubtedly contributes to maintaining healthy skin, but it does not constitute a treatment for rosacea as such.

As a guideline, the recommended dietary intake of vitamin B2 for adults is approximately 1.6 to 2 mg per day.

Zinc-rich foods.

The zinc is a trace element involved in the regulation of immunity, wound healing and the inflammatory response, which explains its relevance in inflammatory dermatoses. However, clinical data on oral zinc supplementation in rosacea patients remain conflicting. A double-blind study evaluated the effect of zinc sulfate (220 mg twice daily for 90 days) in 44 patients with rosacea. After three months, an improvement in severity scores was observed in both zinc and placebo groups, but this did not translate into any clinical benefit. The authors concluded that oral zinc did not demonstrate significant efficacy compared with placebo in this population.

Conversely, another study conducted in Baghdad between 2002 and 2004, involving 25 patients, reported more favourable outcomes. Participants received 100 mg of zinc sulphate three times daily under a double-blind protocol with a crossover after three months. In patients treated with zinc from the outset, the mean severity score (initially 8 ± 2.0) decreased significantly as early as the first month. After switching to placebo, a slight rebound in the score was observed, without a return to baseline. In the initial placebo group, improvement only appeared after zinc was introduced.

These methodological discrepancies (small sample sizes, different doses, variable durations) make interpretation challenging. Mechanistically, zinc could modulate inflammation by inhibiting activation of the transcription factor NF-κB, which is involved in the production of pro-inflammatory cytokines such as TNF-α and IL-1β. However, the data remain insufficient to routinely recommend that patients take a zinc-based dietary supplement for rosacea. It is preferable to naturally incorporate zinc-rich foods into one’s diet to fulfil the body’s requirements, without placing undue hope on an effect during rosacea flare-ups.

For reference, the recommended dietary intake of zinc for adults is approximately 8 to 11 mg per day.

Foods containing omega-3 fatty acids.

Omega-3 fatty acids (notably EPA and DHA) are recognised for their anti-inflammatory and immunomodulatory properties. They are involved in the synthesis of lipid mediators capable of modulating the inflammatory response and limiting the production of pro-inflammatory cytokines. However, rosacea is partly driven by immune and neurovascular dysregulation, with excessive activation of inflammatory pathways. From this perspective, omega-3s are among the foods to favour in cases of rosacea, even though human clinical data remain limited.

A recent experimental study explored their role in a murine model of rosacea induced by the peptide LL37. Dietary omega-3 supplementation reduced cutaneous erythema and decreased the infiltration of dermal inflammatory cells, such as mast cells, neutrophils and CD4+ lymphocytes. The authors also showed inhibition of the TLR2/MyD88/NF-κB pathway, involved in inflammatory activation, as well as a reduction in pro-inflammatory cytokines. Bioinformatics analyses revealed a significant overlap between the pathways modulated by omega-3 and those involved in the pathophysiology of rosacea, particularly the erythematotelangiectatic form. Although these results are promising, they come from an animal model: they suggest a potential nutritional benefit, but do not yet allow conclusions on the usefulness of omega-3 in alleviating rosacea flare-ups in humans.

The recommended intake of omega-3s varies according to different sources, but regular consumption of oily fish (1 to 2 times per week) is generally advised as part of a balanced diet.

Is the Mediterranean diet the most suitable for rosacea?

The Mediterranean diet is often cited among dietary models beneficial in inflammatory contexts. Rich in fruits, vegetables, legumes, whole grains, fish, olive oil, and nuts, and low in red meats and ultra-processed products, it is characterised by a high intake of antioxidants, fibre, and mono- and polyunsaturated fatty acids. This nutritional profile could theoretically modulate the inflammatory pathways involved in rosacea, while supporting the gut microbiome, whose role is increasingly studied in this skin condition.

A prospective study conducted between 2018 and 2021 involving 3,496 adults explored the link between adherence to a Mediterranean-type diet and the risk of rosacea. The researchers employed an adherence score (Mediterranean Diet Score) based on seven food groups. After adjustment, each one-point increase in the score was associated with a significant decrease in the risk of rosacea. Interestingly, this protective association was observed in participants with a BMI below 24.5 kg/m², but not in those who were overweight or obese, suggesting an interaction between metabolic status and inflammatory response.

These results support the idea that the Mediterranean diet might be preferable, particularly for individuals with rosacea.

Tip : Individuals with rosacea do not always react in the same way to foods. The best method to ascertain what is beneficial or detrimental for you is to maintain a diary detailing your diet and to record the frequency and intensity of your rosacea flare-ups.

While diet may have an effect on rosacea flare-ups, it can in no way substitute for medical treatment and dermatological monitoring.

While some foods appear compatible with skin prone to redness, others are regularly reported as triggers of flare-ups. However, there is no universal list of good and bad foods for rosacea universally applicable: sensitivity varies from one individual to another. That said, the following foods are frequently advised against for people with rosacea.

Spicy foods.

Spicy foods are among the most frequently reported triggers of a rosacea flare-up. Capsaicin, found in chilli peppers and certain spices, activates the TRPV1 receptor (Transient Receptor Potential Vanilloid 1), expressed notably by cutaneous nerve fibres. This receptor plays a key role in nociceptive and neurovascular mechanisms. Its activation leads to the release of neuropeptides such as CGRP (calcitonin gene-related peptide) and PACAP, which induce a vasodilatation of blood vessels. In individuals with rosacea, who already exhibit vascular hyperreactivity, this stimulation can exacerbate erythema and the sensation of heat. Furthermore, repeated activation of these neuroinflammatory pathways may sustain local inflammation. Thus, very spicy dishes are generally among the foods to avoid for anyone suffering from rosacea.

Alcoholic beverages.

Alcohol is frequently cited among the foods to avoid if one suffers from rosacea, due to its vasodilatory effect. Physiologically, alcohol promotes the release of mediators such as bradykinin and certain catecholamines, which leads to a dilation of cutaneous vessels and a local rise in temperature. Furthermore, alcohol stimulates the production of pro-inflammatory cytokines, which can promote rosacea flare-ups. From an epidemiological perspective, a large prospective study of 82 737 women followed over 14 years identified 4 945 new cases of rosacea. The analyses demonstrated a progressively increased risk associated with higher alcohol consumption. Certain beverages, notably white wine and spirits, appeared more strongly linked to the risk than other types of alcohol.

It would, however, be unjust to systematically associate rosacea with the consumption of alcohol : although it may exacerbate symptoms, the vast majority of rosacea cases occur independently of any alcohol.

Hot beverages.

Whether it is tea, coffee or hot chocolate, it is inadvisable to drink these beverages when they are extremely hot if you suffer from rosacea. It should be noted that it is not the drinks themselves that are to blame, but their temperature. When consumed at high temperatures, they promote a dilation of blood vessels, leading to redness and hot flushes.

Dairy products.

The role of dairy products in rosacea is a matter of debate.

Certain observations suggest that dairy products may act as triggers for rosacea, while other epidemiological research has failed to confirm this association, or has even observed a neutral or protective effect depending on the type of product consumed. Several hypotheses have been proposed. Dairy products contain bioactive proteins and growth factors that could influence inflammatory signalling. They may also modulate the gut microbiota, which is increasingly under investigation in rosacea because of links between dysbiosis and low-grade systemic inflammation. Given the current state of knowledge, it is therefore difficult to make a general recommendation.

Note : Fermented products, such as yoghurt, provide probiotics that can support intestinal equilibrium, which could theoretically mitigate the skin inflammation observed in rosacea.

Foods rich in saturated fats.

Foods high in saturated fats, such as cured meats, fried foods and certain ultra-processed products, are often cited among those to avoid for sufferers of rosacea, although direct evidence remains limited. That said, it is true that a diet rich in saturated fatty acids promotes a low-grade systemic inflammatory state, which could theoretically exacerbate the symptoms of rosacea.

Although there is no formal evidence regarding rosacea, moderate consumption of fats fits within a coherent approach to overall health.

Foods containing cinnamaldehyde, such as cinnamon.

Cinnamaldehyde is a compound capable of activating the TRPA1 receptor (Transient Receptor Potential Ankyrin 1). This receptor, expressed by cutaneous sensory nerve fibres, is involved in neurovascular and inflammatory mechanisms. Its activation can lead to the release of vasoactive neuropeptides, promoting vasodilation of dermal capillaries and the appearance of redness or sensations of warmth. However, the threshold dose capable of inducing a reaction has not been clearly established, and sensitivity varies widely between individuals.

Good to know : In addition to cinnamon, cinnamaldehyde is present in tomatoes, carrots, chocolate, apples and oranges – but this doesn’t necessarily mean you need to avoid these foods if you have rosacea. You can continue to eat them and, by noting when you experience flare-ups, you will see whether your skin is sensitive to any of these items.

Whether or not you have rosacea, any major dietary changes should ideally be discussed with a healthcare professional in advance. The latter can help you distinguish the real triggering factors from simple coincidences and can give you advice depending on the subtype of rosacea, especially in case of papulopustulose or ocular rosacea. The objective is to act globally, without multiplying unnecessary restrictions.

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