Introduction
Rosacea is a chronic skin disease with an undulating course when a person is in remission or exacerbation. At the moment, the pathogenesis of the disease is not fully understood, however, there is a correlation between genetic and environmental factors as possible causes of its occurrence. It manifests itself in the form of redness of the skin, which is called erythema.
In addition, the disease is characterized by dilation of small vessels of the skin and papules and pustules, which are similar in appearance to such a problem as acne. Rosacea is localized on the face, affecting especially the cheeks and chin. In addition, the auricles, scalp and décolleté area suffer from rashes. At the same time, nutrition and diet play an important role in the treatment and care of affected skin areas.
The symptoms of rosacea and its manifestation depend on the stage of the disease. Some people may not be aware that they have this problem, as it resembles acne. At the erythematous stage, areas of hyperemia appear on the face and décolleté (França & Lotti, 2019). At the same time, with a papular form, patients have grouped small papules in large numbers (Cary & Maibach, 2020).
Other stages are determined by swelling of the skin and an increase in the elements of the rash. To contain these forms and their deterioration, it is necessary to identify useful and negative products that affect the condition of the skin. In addition, it is important to note that with any manifestation of the disease, patients must follow an established balanced diet.
There is no complete conviction among current research that a number of certain foods can alleviate symptoms. However, researchers are convinced that certain foods help with certain forms of rosacea (Alia & Feng, 2022). Certain nutrients can have anti-inflammatory effects and reduce swelling. At the same time, other dishes worsen the stage of the course of the disease, forcing a person to experience physical and aesthetic discomfort. Thus, the addition of certain elements in the diet can improve the quality of life of people with rosacea.
The pathogenesis of rosacea is influenced by various nutrients and diet improves or worsens it depending on the foods a person eats. Some dishes contribute to a longer remission and maintaining a normal skin condition. While other food is a trigger for new rashes and periods of aggravation (Searle et al., 2021). Thus, the paper will highlight aspects related to nutrients that improve skin condition.
In addition, those products will be described that reduce the time of remission and contribute to more serious exacerbations (Schmitz, 2021). The study will consider and expand the explanation of the pathogenesis of the disease and the possible causes of its occurrence. The main subheadings of the paper will be the following: pathogenesis, diet, triggers, the role of proper nutrition and conclusion.
Thus, the work will be based on the impact of diet on rosacea. Diet is not enough to completely cure this chronic disease, but it greatly improves the situation. Poor nutrition contributes to the appearance of more serious problems and rashes. At the same time, proper nutrition considers the necessary elements to maintain skin condition. In addition, the pathogenesis of rosacea affects the course of remission and complications. Despite the fact that it is not fully understood, there are certain factors that affect the manifestation of the disease. Thus, the paper focuses on those aspects that can contain or exacerbate rosacea.
Annotated Bibliography
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. Web.
The paper is a collaboration between Dr. Erisa Alia and Hao Feng. Erisa Alia is a certified dermatologist with many years of experience in cryosurgery and the treatment of skin diseases in various ways, including phototherapy and laser therapy. At the same time, Hao Feng is a MD and director of the Department of Laser Surgery and Cosmetic Dermatology, with a constant contribution of scientific work to the development of the field. Their work is focused on educating other doctors in the field of dermatology and people who have encountered rosacea. As in the work of Tamara Searle, the authors identify triggers that contribute to the worsening of the disease. These elements include malnutrition products containing a large amount of histamine and capsaicin. At the same time, an improvement in the condition of the skin is considered when eating prebiotics and fiber. This work highlights the topic of the bibliography through a study on the benefits and disadvantages of various foods and microorganisms that affect the skin condition in patients with rosacea.
Cary, J. H., & Maibach, H. I. (Eds.). (2020). Rosacea. Springer International Publishing.
The authors of the book are PhDs in dermatology who have edited and compiled many articles into a guide to rosacea. Both are active dermatologists and have transferred their experience of treating patients to the book. The manual provides the reader with the latest data in the field of rosacea research. It is focused on a narrow audience and involves the study of dermatological areas by students. Unlike Schmitz’s book, where the author focuses on treating the problem, Cary & Maibach propose to consider the disease as a whole and its impact on the psychology of the patient. In addition, the authors look at rosacea and other diseases, including cancer and gastrointestinal problems. The book is an essential source for an annotated bibliography, as it considers in depth with the causes of dermatological issue and its correlation with other illnesses. Moreover, the authors consider the external manifestations of rosacea and the role of pathogenesis in its occurrence.
França, K., & Lotti, T. (Eds.). (2019). Advances in integrative dermatology. John Wiley & Sons.
Dr. França is a Clinical Assistant Professor in Skin Surgery and Dermatology. In addition, the competence of the author includes psychiatry and behavioral sciences. Torello M. Lotti is Professor of Dermatology and Head of Department at the University. Many years of experience of the authors allowed them to edit articles on the treatment of skin diseases and combine them into a book. The target audience is focused on professionals and is written in academic language. The book considers the pathogenesis of the disease and the possible influences of genetics and environment. At the same time, in this regard, the book can be compared with the book Rosacea by John Havens Cary and Howard I. Maibach, who consider the clinical understanding of the illness and its causes. For an annotated bibliography, the work is important because it describes the origin of the disease and how to treat it.
Searle, T., Ali, F. R., Carolides, S., & Al-Niaimi, F. (2021). Rosacea and Diet: What is New in 2021?. The Journal of clinical and aesthetic dermatology, 14(12), 49-58.
The authors of the article are doctors of science in the field of dermatology, which allows to speak about their competence. In addition, they have current experience in the diagnosis and treatment of skin diseases. The authors have written other articles that focus on the treatment of dermatitis and possible ways to improve the condition of rosacea. The article is written in a fairly simple language, which allows to conclude that it is aimed at the average reader who wants to expand their knowledge. The authors point to the detrimental effects of alcohol and caffeine on skin suffering from rosacea. Dr. Alia and Dr. Feng note the same serious effect of these elements in the presence of disease. Since it is necessary to have a deep knowledge in the application of diet and ways of maintaining a satisfactory condition in illness, the book provides the necessary information for this. The article is of practical interest for this work and is used as a source. This is because the authors reveal the essence of the diet for rosacea, including those micronutrients that should be eaten and dishes that worsen the possible consequences of worsening the condition.
Schmitz, S. (2021). Treating Acne and Rosacea with Chinese Herbal Medicine. Singing Dragon.
Schmitz is a well-known practitioner of Chinese medicine in the treatment of acne and rosacea. The author has a long history of applying his knowledge in the West and Asia, where they have combined the most effective treatments for dermatological problems. The book is primarily aimed at a professional audience and reveals different approaches to understanding and treating rosacea. Nevertheless, the manual is written in an understandable language and can be read by non-dermatological readers.
The book shares similarities with other bibliographies in the field of treating rosacea as a disease requiring treatment. However, in addition to the diet, Schmitz suggests Chinese practices to maintain the remission of the disease. The book is used as a source and is necessary for an annotated bibliography, as it describes possible foods in the event of a disease. In addition, the author shows the methods of treatment on clinical examples, which are given in one of the chapters of the manual.
At the moment, rosacea is a fairly common inflammatory disease. At the same time, incidence rates can be different and vary widely. This is due to the lack of strict diagnostic criteria. However, after diagnosing a skin problem, treatment is aimed at reducing the possible inflammatory process. In addition, the pathogenesis of the disease is not completely clear, however, there are certain theories and opinions regarding the causes of rosacea.
Pathogenesis
In the case of rosacea, the pathogenesis remains a wide field for studying the problem. However, in the absence of explicit criteria and indicators, scientists suggest a certain genetic etiology in individuals of northern European origin (Schmitz, 2021). At the same time, the specific gene that contributes to the appearance of rosacea has not been established.
At the present stage, scientists have come to the conclusion that rosacea is a combination of a number of disorders in the human organism. This applies to malfunctions in the regulation of the immune system, “abnormal neurological and vascular signaling, and dysbiosis of microorganisms ultimately leading to skin sensitivity and inflammation” (Weiss & Katta, 2017). Thus, in patients with rosacea, the innate immune system is impaired.
Due to atypical functioning, the malfunctioning of the system leads to the release of inflammatory cytokines. At the same time, the difference between healthy skin and an organism affected by rosacea is observed in a significantly lower expression of the antimicrobial peptide cathelicidin (Weiss & Katta, 2017). It is an important molecule that protects against bacteria and prevents the skin from developing dermatological diseases (Searle et al., 2021). However, it differs in patients with rosacea, suggesting a possible effect of cathelicidin on pathogenesis.
As for other factors that compose part of the pathogenesis, they include neurological signaling. Moreover, in patients with rosacea, there is a difference in the microbial composition of the skin (Weiss & Katta, 2017). Stimulation of the transient receptor potential channels occurs due to heat and dietary aspects, which leads to an inflammatory process. Thus, the consumption of various micro and macro elements is reflected in the skin and the degree of development of rosacea.
Diet
During the period of exacerbation and remission of various dermatological diseases, in addition to drugs, a therapeutic diet plays a vital role. It helps the body maintain strength and restore deteriorating skin (Woźniacka et al., 2022). A therapeutic diet allows one to accumulate the necessary nutrients and vitamins if the patient does not have enough of them. In addition, it prevents the spread of the disease and its transition to a more serious form (Cary & Maibach, 2020). For some diseases, diet is the most effective method of containment. In these cases, the processing technology of the product, the temperature regime of food and the frequency of intake are considered.
As mentioned above, rosacea is not completely curable, however, with the help of a diet, it is possible to increase the remission period. In the treatment of rosacea, the emphasis is on the causes of its occurrence (Dursun et al., 2019). At the same time, intestinal dysfunction plays a rather high role in the deterioration or improvement of the condition (Woźniacka et al., 2022). Thus, nutritional issues are a very important element and should be identified at the initial stages.
Since scientists and doctors still don’t agree on what causes disease, it can be difficult to explain the effect of diet. However, one of the main factors is that people with rosacea are more sensitive to heat (Dursun et al., 2019). Thus, when a person’s blood rushes to the face and it turns red and warm, people with a dermatological problem experience more severe thermal changes, which leads to an inflammatory process (França & Lotti, 2019). That being said, while everyone’s reactions to foods are different when it comes to triggers, the main goal of a diet is to eliminate ingredients that tend to aggravate people’s skin conditions on average.
First of all, the dermatologist needs to identify those products that provoke the progression of the disease. Consumption of foods that do not cause an aggressive skin reaction contributes to a faster and more successful remission (Chen et al., 2021). In the course of the studies, experts came to the conclusion that the skin with rosacea is favorably affected by: fermented milk products, vegetables and fruits, and fish and meat that are steamed (Searle et al., 2021). In addition, it is important to pay attention to those products that contain substances that favorably affect the regeneration of the skin.
At the same time, a change in diet can provoke a worsening of the condition. Thus, more than 70% of adults reported exacerbation of rosacea when changing foods and deviating from the prescribed diet (Weiss & Katta, 2017). When changed to established products that can help with healing, about 80% of people reported a positive effect on the skin (Weiss & Katta, 2017).
This may explain the relationship between the onset and course of rosacea and the functioning of the intestinal tract. After the studies, scientists concluded that many bolt-on rosacea experienced gastrointestinal disorders to varying degrees. Therefore, a possible correlation is drawn between the degree of disease and gastric problems in the recipients.
In this regard, it is worth to understand that diet is one of the ways to curb rosacea. Restriction of certain foods, designated as triggers, allows one to smooth out the course of the disease. Despite the fact that there is no complete cure for the disease and no solid evidence of the effectiveness of the diet, scientists talk about the connection between rosacea and gastrointestinal disorders. Thus, the diet may reduce the risk of skin deterioration and disease progression. In this regard, it is essential to highlight possible triggers that reduce the period of remission and useful products that approves one to maintain the condition.
Triggers
Among the products, there are a sufficiently large number of triggers that lead to aggravation of the symptoms of rosacea. Doctors point out that these things include: heat, spicy foods, frequent drinking, and foods containing cinnamaldehyde. In addition, food triggers are mentioned by rosacea patients themselves. For example, a National Rosacea Society survey shows that 78% of 400 people surveyed changed their diet after being diagnosed (Searle et al., 2021). Moreover, 95% of this number report improvements and reductions in flare-ups after starting regular dietary intake (Searle et al., 2021). Thus, it is possible to talk about the benefits of diet in terms of curbing the disease.
In addition, participants in the survey noted a number of other triggers that they experienced before starting the diet. Recipients cited hot drinks as problematic, in particular coffee and tea (Searle et al., 2021). This is indicative of the effect of temperature on rosacea (Chen et al., 2021). People have complained about the harmful effects of capsaicin, which is found in some spices and hot peppers (Weiss & Katta, 2017).
In addition, cinnamaldehyde is present in foods such as tomatoes, chocolate, citrus fruits, and cinnamon. They figured in the responses of respondents about what they consider triggers (Weiss & Katta, 2017). Thus, the survey allows one to highlight those products that adversely affect the condition of the skin.
One of the main products that worsen the condition can be called alcohol consumption. In particular, patients talked about the effect of wine on their skin and body (Passeron et al., 2020). It is generally accepted that histamine has a serious effect on the dermal vasomotor system of the dermis, and because of this, dysfunction and severe reddening of the skin of the face occur. During alcohol consumption, two of its metabolites, acetaldehyde and acetone, break down, and histamine becomes the product of this interaction.
In addition, alcohol such as champagne can have an effect on the skin condition. It contributes to the immediate activation of the production of pro-inflammatory cytokines, which accelerate the development of rosacea and can worsen the clinical picture of patients (Passeron et al., 2020). At the same time, people note that if they neglect the recommendations, their rash worsens and the skin begins to itch (Plewig et al., 2019). Thus, despite the lack of direct evidence of the harm of alcohol in rosacea, patients report improvements with diet.
Spicy foods and capsaicin are one of the main triggers for rosacea. Despite the fact that some studies do not reveal a clear correlation between illness and spicy food, many patients try to refuse it. The mechanism of these triggers may be due to the fact that one of the receptors is activated when capsoicin enters the body (Passeron et al., 2020). This sets off a process of severe redness and causes vasodilation, a process in which the smooth muscles in the blood vessel walls relax (Plewig et al., 2019).
In addition, cinnamic aldehyde causes an ankyrin receptor reaction, which leads to flushing and puffiness of the face (Weiss & Katta, 2017). Thus, capsaicin is associated with redness and vasodilation of the skin, so reducing it may be beneficial in controlling symptoms.
Another problem with a diet aimed at reducing rosacea is the temperature of the foods consumed. Since the deterioration of the skin and more pronounced redness are a means of vasodilatation, hot food affects the course of the disease. In patients, blood vessels dilate, which can aggravate the clinical picture and lead to severe itching. In addition, histamine affects the condition and degree of rosacea (França & Lotti, 2019). Histamine is found in foods such as tomatoes, ham, cocoa, and fragmented cheeses (Cary & Maibach, 2020). It contributes to the development of vascular hyperpermeability, blood flow increases and pronounced swelling appears in the tissues.
Moreover, histamine is able to accumulate if the enzyme responsible for its breakdown is impaired. This disrupts the skin’s normal response to nutrients, which reduces the skin’s ability to contain flushing, causing itching and burning. However, the impact of histamine intolerance on rosacea has not been fully proven, as this problem occurs in approximately 1% of US residents (Weiss & Katta, 2017). However, scientists are inclined to believe that foods with a high content of this organic compound can be considered as triggers by noting symptoms of illness in recipients after eating (Searle et al., 2021). Thus, whenever possible, patients with rosacea can limit their intake of histamine-containing foods.
When talking about food that is harmful for rosacea, fatty foods should be noted. Some recipients show a positive correlation between deterioration in their condition and consumption of high-fat meals (Dursun et al., 2019). The consumption of such food can lead to a serious imbalance of hyaluronic acid and a lack of fatty acids (Dursun et al., 2019). This violates the epidermal barrier, which causes a clear deterioration in the skin condition.
Thus, different food triggers can affect the condition of the skin. Alcohol contributes to more serious reddening of the skin and the appearance of new papules. At the same time, spicy food, in which capsaicin is observed, causes strong vasodilation. Moreover, it is important for patients to monitor the temperature of food in order to prevent itching and new localization of rosacea. However, in addition to triggers, there are foods that can improve the course of the disease.
Role of Proper Nutrition
Many problems associated with the condition of the skin are closely related to the functioning of the intestines. Therefore, eating foods rich in fiber can significantly improve the course of rosacea. At the same time, most of the dietary plant fibers can play the role of prebiotics (Rupani & Lio, 2021). They are aimed at stimulating and activating beneficial microbes that are localized in the gastrointestinal tract (Chen et al., 2021). In addition, the effect of diet on the microbiome occurs quite quickly and the skin regenerates in a short time. Lack of dietary fiber can affect the intestinal flora and lead to more pronounced manifestation of signs of rosacea.
Dairy products can be other beneficial substances to consume for rosacea. This is due to their anti-inflammatory effect, aimed at regulating the intestinal microflora. However, scientists do not have hard data regarding the exact effectiveness of dairy products (Rupani & Lio, 2021). First of all, this is due to the fact that rosacea often affects representatives of the European race (Searle et al., 2021).
Accordingly, data collected with other races may not be relevant. In addition, the positive effect of dairy products on the skin may depend on the stage of rosacea (Plewig et al., 2019). In some cases, the substances have a beneficial effect on the skin and bring anti-inflammatory properties. On the other hand, they can worsen the course of the disease and the clinical picture of the patient.
The nutrients contained in fish relieve redness and are not irritating to the gastrointestinal tract. This is especially true for the salmon family; as red fish has anti-inflammatory properties. At the same time, the food should not be extremely hot, so as not to cause vasodilation (Cary & Maibach, 2020). Fish dishes contain those minerals and vitamins that are good for the intestines and necessary for the normalization of metabolism (Rupani & Lio, 2021). Due to this, blood pressure is regulated and cholesterol levels are reduced, which prevent the appearance of redness and itching.
In addition, vitamin-containing nuts and legumes can slow down the course of the disease and improve the clinical picture. In their composition, they contain vitamins PP, which play a role in improving the metabolism of carbohydrates and lipids (Chen et al., 2021). Vitamins are involved in the reparative processes of the skin and improve the functioning of the stomach, which leads to a more favorable form of rosacea (Plewig et al., 2019).
Thus, the skin condition improves and the visible signs of the disease become less noticeable and irritable. Elements that are beneficial for controlling rosacea may include other foods consumed as part of the diet (França, & Lotti, 2019). These include fruits and vegetables rich in fiber and vitamin K. Rice and wheat can allow the body to accumulate vitamin B, useful and necessary for the skin. Therefore, people suffering from rosacea will be able to partially control the course of the disease based on their diet.
Conclusion
In conclusion, it should be mentioned once again that at the moment there are no clear studies on the appropriateness of the diet for rosacea. However, scientists are inclined to believe that some triggers can be identified that aggressively affect the course of rosacea. Alcohol causes a strong vasodilation, which leads to redness. In addition, when its components are broken down, harmful substances enter the body, contributing to the deterioration of the skin and the appearance of papules. A number of adverse effects are caused by spicy food and the hot temperature of dishes.
Nevertheless, it is possible to highlight beneficial elements for controlling rosacea. Most of these products are aimed at the control of the intestinal microflora, the regulation of toxins and the regeneration of the skin. Thus, patients can self-control remission and disease outbreaks through diet.
References
Chen, H., Lai, W., & Zheng, Y. (2021). Rosacea in acne vulgaris patients: Subtype distribution and triggers assessment—A cross‐sectional study. Journal of Cosmetic Dermatology, 20(6), 1889-1896. Web.
Dursun, R., Daye, M., & Durmaz, K. (2019). Acne and rosacea: What’s new for treatment?. Dermatologic therapy, 32(5), 1-4. Web.
Passeron, T., Krutmann, J., Andersen, M. L., Katta, R., & Zouboulis, C. C. (2020). Clinical and biological impact of the exposome on the skin. Journal of the European Academy of Dermatology and Venereology, 34, 4-25. Web.
Plewig, G., Melnik, B., & Chen, W. (2019). Plewig and Kligman’s Acne and Rosacea. Switzerland: Springer International Publishing.
Rupani, R. N., & Lio, P. A. (Eds.). (2021). Integrative Dermatology: Practical Applications in Acne and Rosacea. Springer Nature.
Weiss, E., & Katta, R. (2017). Diet and rosacea: the role of dietary change in the management of rosacea. Dermatology practical & conceptual, 7(4), 31.
Woźniacka, A., Czuwara, J., Krasowska, D., Chlebus, E., Wąsik, G., Wojas-Pelc, A., Rudnicka, L., Narbutt, J., Adamski, Z., Batycka-Baran, A., Czajkowski, R., Czarnecka-Operacz, M., Flisiak, I., Kowalewski, C., Lesiak, A., Maj, J., Majewski, S., Nowicki, R. J., Owczarczyk-Saczonek, A., Owczarek, W., Olszewska, M., Placek, W. J., Reich, A., Sokołowska-Wojdyło, M., Szepietowski, J., Zalewska-Janowska, A. & Zegarska, B. (2022). Rosacea. Diagnostic and therapeutic recommendations of the Polish Dermatological Society. Part 1. Epidemiology, classification and clinical presentation. Dermatology Review/Przegląd Dermatologiczny, 109(2), 101-121. Web.