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Rosacea | A complete guide to understanding your diagnosis

Updated: Nov 13, 2022

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What is Rosacea?

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. Because of this, rosacea causes can vary.

RELATED | Dr. Erum Ilyas discusses Rosacea with Everyday Health


What are triggers for Rosacea?

Rosacea triggers include anything that makes the skin sensitive to reflexively lead to blood vessels dilating which results in flushing or blushing followed potentially by breakouts. Since rosacea is a chronic condition, although we have many treatments meant to control the symptoms, ultimately it is best managed by avoiding triggers.

High histamine foods can also cause vasodilation or a relaxation of the blood vessels. These include:

  • Alcohol

  • Smoked meats

  • Shellfish

  • Canned foods

  • Legumes

This can only exacerbate or make rosacea flare. Since high histamine foods can trigger rosacea it is best to try to find to consider dietary changes if you find a connection.

Does inflammation play a role in rosacea?

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.

RELATED | Dr. Erum Ilyas discusses Rosacea with Everyday Health


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

  • Whole grains

How can I tell if I have a dietary trigger for my rosacea?

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 make 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 is 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 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. Consider how excess coffee or caffeine or lunch at work may play a role.
Sometimes the issue is less dietary and more stress-related. 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.

RELATED | Dr. Erum Ilyas discusses Rosacea with Everyday Health


Can anyone get Rosacea?

Although traditionally many people think of rosacea as primarily affecting people of Northern European ancestry, I would argue that it is underdiagnosed and flat-out missed in almost every other ethnicity. I routinely have patients of color that have seen numerous other doctors and had their diagnoses missed simply because their skin type did not show the classic “rosy cheeks” because it's not as apparent. As a dermatologist of color, I always worry that our resident physicians are not taught to look for other signs and symptoms of rosacea outside of rosy cheeks to accurately make a diagnosis.

Most of my patients of color are only diagnosed with rosacea once it has become severe with potential scarring. The key to diagnosis is to ask good questions and not just go by the visual appearance of the skin.

  • Does your skin sting, burn, or feel warm to the touch when you drink alcohol, eat spicy foods, or are you in stressful situations?

  • Do you have breakouts that kind of look like acne but do not behave like acne- i.e., when you try to pop a pimple nothing comes out of it- just clear fluid AND it looks worse after?!

  • Does the skin on your cheeks have an “orange peel” look with the pores looking widened and skin somewhat thickened?

What is ocular rosacea?

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.

Ocular rosacea is characterized by: