Rosacea is a chronic inflammatory skin condition that primarily affects the central face, characterized by recurrent episodes of redness, flushing, telangiectasia, papules, and pustules. Although its manifestations are predominantly cutaneous, recent scientific evidence shows that rosacea involves systemic mechanisms related to innate immunity, oxidative stress, the microbiome, and low-grade chronic inflammation.

This understanding has broadened how the condition is approached in clinical practice. Currently, rosacea management goes beyond controlling skin signs, taking into account metabolic, dietary, and environmental factors that can influence disease activity and patient quality of life.

For healthcare professionals, understanding these mechanisms is essential for developing individualized, evidence-based strategies.

What is rosacea?

Rosacea is a chronic inflammatory dermatosis that mainly affects adults between 30 and 60 years of age. It is more frequent in fair-skinned women, although it can occur across different skin phototypes.

The disease has a variable course and typically alternates between periods of improvement and exacerbation. Common signs and symptoms include:

persistent facial erythema;

flushing episodes;

telangiectasia;

inflammatory papules and pustules;

stinging or burning sensations;

increased skin sensitivity.

Some patients may also experience ocular manifestations, such as dryness, irritation, and eyelid inflammation.

Beyond the skin: understanding the pathophysiology

Although its exact cause is not yet fully understood, rosacea results from the interaction between genetic, immunological, vascular, and environmental factors.

Key mechanisms involved include:

Innate immune dysfunction

Patients with rosacea exhibit increased activity of antimicrobial peptides, especially cathelicidin (LL-37), which can stimulate inflammatory processes and vascular changes.

Neuroinflammation

Hyperactivity of cutaneous nerve endings promotes flushing episodes and sensations of heat, often triggered by stimuli such as heat, emotional stress, and specific foods.

Oxidative stress

Increased production of reactive oxygen species contributes to cellular damage and sustains the inflammatory response, which may intensify the clinical signs of the disease.

Microbiota alterations

Research suggests that imbalances in the skin and gut microbiota can influence the immune response. Furthermore, some studies are investigating the role of microorganisms such as Demodex folliculorum and certain gut bacteria in the pathophysiology of rosacea.

What factors can trigger flare-ups?

Although they vary from person to person, some triggers are frequently reported:

sun exposure;

high temperatures;

alcoholic beverages;

spicy foods;

hot drinks;

emotional stress;

intense physical exercise;

irritating cosmetics.

Identifying these factors is part of the therapeutic strategy and can help reduce the frequency of flare-ups.

Clinical assessment: a broader perspective

Rosacea management should consider not only skin manifestations but also factors related to lifestyle and overall health.

In clinical practice, it is important to evaluate:

frequency and intensity of flare-ups;

dietary history;

sleep quality;

stress levels;

gut health;

presence of metabolic and inflammatory diseases;

use of medications and cosmetics;

psychosocial impact of the disease.

This approach supports a more individualized, patient-centered treatment plan.

Nutrition and rosacea: is there a link?

Although no specific dietary pattern is considered a treatment for rosacea, evidence suggests that diet can influence inflammatory activity and vascular response in some patients.

Strategies frequently discussed in the literature include:

Identifying dietary triggers

A food diary can help identify foods associated with flare-ups, allowing for individualized adjustments without unnecessary restrictions.

Modulating inflammation

A diet rich in fruits, vegetables, legumes, whole grains, and sources of unsaturated fats can contribute to metabolic balance and the modulation of the inflammatory response.

Supporting antioxidant balance

Antioxidant nutrients participate in cellular defense mechanisms against oxidative stress, one of the processes involved in the pathophysiology of rosacea.

Gut health

The integrity of the gut microbiota has been identified as a potential factor related to systemic inflammation and the gut-skin axis. Although this relationship is still being investigated, maintaining a fiber-rich diet and healthy habits can promote gut balance.

Nutritional supplementation in clinical practice

When based on an individualized assessment, supplementation can be part of the treatment plan for patients with rosacea.

Antioxidant nutrients, bioactive compounds, and strategies aimed at supporting gut health are being investigated for their potential to contribute to the balance of oxidative stress and the inflammatory response.

Furthermore, nutritional formulations developed to provide antioxidants and other nutrients can be part of personalized protocols, always respecting the patient's clinical individuality, laboratory tests, and therapeutic goals.

It is important to highlight that supplementation does not replace dermatological treatment, but it can act as a complementary strategy within a multidisciplinary approach.

An integrative approach for better results

Managing rosacea involves a combination of different therapeutic strategies, including medical treatment, skincare, a balanced diet, and patient education regarding triggers.

Beyond controlling skin lesions, this approach seeks to reduce the frequency of flare-ups, preserve skin barrier function, and improve quality of life.

Multiprofessional monitoring can be especially important for patients with persistent manifestations or associated comorbidities.

Conclusion

Rosacea is a chronic inflammatory condition that goes beyond visible skin changes. Scientific advances demonstrate that mechanisms related to immunity, oxidative stress, vascular function, and the microbiota play a role in its pathophysiology, reinforcing the importance of an integrated view of the patient.

In clinical practice, the combination of dermatological treatment, lifestyle changes, nutritional therapy, and evidence-based complementary strategies can contribute to a more comprehensive management of the disease.

For healthcare professionals, understanding these interactions expands care possibilities and fosters a personalized approach, aimed not only at symptom control but also at promoting health and quality of life.

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