Rosacea Symptoms, Causes + Treatments

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Rosacea (pronounced rose-ay-sha) is a chronic skin disorder which first appears as a mild redness of the skin that looks like sunburn but the redness doesn’t disappear. It can then worsen, the skin can feel tight and dry, and flushing can occur which feels hot, burning and uncomfortable.

Rosacea sufferers may also develop pimples or acne-like bumps, and have dry, burning and gritty sensations in the eyes. A thickening of the skin, caused by enlarged sebaceous glands, can also lead to the nose becoming larger and disfigured (known as 'bulbous'). (References below)

Is rosacea contagious?

Rosacea isn’t contagious or infectious, the rosiness or blushing effect is caused by enlarged blood vessels under the skin and these blood vessels fail to function like normal ones.

  • There are approximately 45 million rosacea sufferers worldwide.
  • Fair skinned adults are more likely to get rosacea than darker skinned folks.
  • Rosacea can occur at any age, however it’s more common in middle-aged women.

Where does rosacea appear?

Rosacea usually appears on the face (cheeks, nose, chin and forehead).


What is couperose?

Couperose is broken capillaries which cause the skin on your face to appear red or pinkish and it can feel tight and irritated, like rosacea. However, it is mild compared to rosacea and it does not involve acne-like bumps.



 Rosacea can be aggravated by:


allergies (triggering histamine release)


anxiety and worry

dairy products


exposure to sunlight

extreme temperatures

foods containing histamine

hot drinks


laughing, crying

physical activity*

poor diet and lifestyle

saunas or hot baths

sudden temperature changes


some medications (such as topical steroids)

spicy and hot foods

skin-care products

stress, inability to cope

vitamin and mineral deficiencies

windy weather


* Although physical activity aggravates rosacea, exercise should not be avoided as it’s an important part of recovery.


What causes rosacea?

Rosacea is primarily a disorder of the facial blood vessels. Facial skin contains hundreds of blood vessels of different shapes and sizes and with rosacea, where the facial skin becomes easily flushed, the underlying facial blood vessels don’t behave as they should.

To understand rosacea better, it’s important to look at the functional and structural changes that occur in the blood vessels of rosacea sufferers.

Normal blood vessels perform these important functions to keep the skin healthy:

  • Facial blood vessels deliver essential nutrients and oxygen to the skin. Just like the postman delivers letters to your home each day, your blood vessels transport and deposit vitamins, minerals, fats and oxygen to your outer layer throughout the day (and night) so your skin can function properly.
  • Facial blood vessels remove waste products that have been produced by facial skin cells. Just as you put out your household garbage each week for collection by the local garbage men, your facial skin cells also put out their garbage daily and the bloodstream takes these waste products away for removal from the body.
  • Facial blood vessels help to regulate internal body temperature. If your body’s internal temperature gets too high it triggers the blood vessels to dilate. This expansion of the vessels allows an increase in blood flow, which releases large amounts of heat from the skin’s surface. This helps the internal body temperature to normalise and afterwards, healthy blood vessels return to their regular size.

The abnormal functioning of facial blood vessels in rosacea sufferers:

  • Rosacea blood vessels expand (dilate) when exposed to ordinary substances that normal blood vessels do not respond to.
  • Rosacea blood vessels can expand wider than normal blood vessels.
  • Rosacea blood vessels can continue to dilate for abnormally long periods of time.

All three of these changes cause an abnormal increase in blood flow to facial skin and this results in facial flushing.

In rosacea, the functional changes occur first and if these functional changes are left untreated then more serious structural changes may eventually occur.

The normal structure of facial blood vessels:

Blood vessels are hollow tubes which transport blood that is rich in nutrients and oxygen from the heart to the body’s outermost organ — the skin.

  • Facial blood vessels contain vascular smooth muscle cells and endothelial cells which work to control blood flow and change the blood vessel diameter.


Imagine that vascular smooth muscle cells and endothelial cells are like nightclub bouncers. A bouncer acts as a regulator, usually increasing the flow of people through the door when the club is empty but restricting the amount of patrons who flow into the club when the space reaches their legal capacity. Likewise, normal blood vessels in the skin should dilate (increase blood flow to your skin) and constrict (which reduces blood flow to the skin) on cue, to meet the body’s demands and maintain good health.


However, the abnormal structural changes in the facial blood vessels of rosacea sufferers are as follows:

  • Rosacea facial blood vessels may become permanently dilated from dysfunctional endothelial cells — like a balloon that has been blown up and let out so many times that it eventually fails to deflate back to its original size.
  • Damage may occur to vascular smooth muscle.
  • New blood vessels may branch out from existing blood vessels (angiogenesis) and more blood vessels near the surface of your skin will make your skin appear red.

You don’t have to fully understand the structural and functional changes in rosacea to be able to treat your condition; you just need to remember things that make your condition worse so you can limit your exposure to them. This is important because you can help to prevent your blood vessel functional changes from becoming permanent structural changes (FYI: structural changes are bad news so you want to treat this condition as early as possible).


Rosacea Treatment Plan

Step one: Limit histamines

Because the redness of rosacea is created by enlarged blood vessels under the skin, we’ll look very closely at histamine foods and their ability to enlarge blood vessels.

Histamine can trigger facial flushing in rosacea sufferers. There are two ways you can be exposed to histamine:

  • First, histamine is released within the body when exposed to stress or an allergen (an allergen causes an allergic histamine reaction such as redness or swelling).
  • Second, histamine is naturally found in many delicious foods and drinks such as wine, cheese and chocolate. Let’s look at these two points in more detail.

Histamine release and rosacea

When you have an allergic response, the substance you’ve come into contact with stimulates the release of antibodies, which then attach to your mast cells and cause histamine to be released. For example, you might be allergic to the yellow food colouring tartrazine, found in the packaged dessert you just ate, so your body goes into panic mode and releases the antibodies that attach to mast cells. Then histamine is freed into your bloodstream, which causes your skin to itch and flush with redness. Do you have any of the following?


Histamine/allergic symptoms:

  • itchy nose, sneezing and increased mucus production;
  • watery or burning sensation in eyes;
  • skin rashes or hives;
  • congested sinuses;
  • headache or migraine;
  • wheeze in lungs or spasms;
  • stomach cramps,
  • diarrhoea;
  • skin itchiness;
  • skin flushing/redness, or rosacea.


Histamines are able to cause such havoc in your body because they are present in almost all body tissues, waiting for a trigger to release them into the bloodstream. Histamine is stored in the skin, lungs, intestinal lining, mast cells and basophils.

  • The release of histamine can be triggered by anything your body deems an allergen, such as drugs, chemicals, inhaled particles such as pollen, insect venom and some foods.
  • Histamine release can also be triggered by stress.


Histamines in foods and drinks

Aside from allergy foods triggering histamine release, histamine is also naturally found in many foods and drinks, in varying amounts. Large amounts can be found in chocolate, cheese, wine, spicy food and beer which is why they’re more likely to cause a reaction than other histamine-containing foods.

  • Histamine has the ability to signal to your body to enlarge the blood vessels and allow maximum blood flow, which leads to a facial flush.
  • Headaches can be caused by histamine-containing chocolate because histamine causes the blood vessels in the brain to dilate and this increases pressure in the head.



    Amine/Histamine-rich foods and drinks

    Histamine-releasing foods, which cause a histamine reaction in the body

    anchovies, sardines, tuna


    beer, brandy, liqueur, port, rum, sherry

    canned foods


    chocolate, cocoa powder/drinks

    ciders, cider vinegar, vinegar

    cola soft drinks


    fermented drinks

    fermented foods/yoghurt/soy sauce

    coloured fish (not white-fleshed fish)

    jams and preserves

    cooked meats: day-old leftovers

    frozen fish

    processed meats (deli meats, sausages etc.)

    Probiotic supplements

    sour cream


    mushrooms, champignons

    tomatoes, tomato juice and sauce

    wines, especially red wine

    yeast extract

    oranges, orange juice


    roasted cashews and roasted nuts




    certain nuts




    milk/dairy products





















    Amine- and Histamine-free foods

     Amine-free foods (enjoy these)


    most vegetables

    lentils, beans




    custard apples^














    freshly cooked beef*

    skinless chicken*

    lamb, veal*


    fresh white fish*

    soy milk, tofu



    decaffeinated coffee

    coffee, tea^

    peppermint tea^










    rice, rice flour, rice malt syrup

    rolled oats





    maple syrup

    sunflower oil

    raw cashews (not roasted)

     *Amines increase in meats and fish the day after they are cooked, so if you have rosacea you should avoid day-old meats, leftovers containing meat or broth, and frozen fish and frozen cooked meats.

    ^ Contains salicylates which some rosacea or eczema sufferers can be sensitive to.

    Read more about salicylates here >


    If you want to drink alcohol for a special occasion your best choices would be gin, vodka or whisky, as they don’t contain amines or salicylates (although, being alcohol, they can still cause a histamine reaction). You can drink them with soda or mineral water (but not lemon squash, tonic water or any other mixer). However, avoiding alcohol can be helpful during your anti-rosacea program.


    Why is my body reacting to histamines?

    In a rosacea-free person who does not react to histamine-containing foods, their body processes histamines in a more efficient way. You see, your liver has the task of safely removing histamines by a process called sulfation, and people with rosacea are thought to have poor sulfation ability.

    When sulfation and other liver detoxification reactions are overburdened, histamine is not removed from the body fast enough and problems such as vasodilation can result.

    Amines and sulfation

    Sulfation in the liver sounds a bit confusing but whenever I explain liver detoxification I liken it to a horse race around a race track. Histamine is the race horse that is travelling along the blood vessels and it needs to be sternly guided to the finish line for safe removal from the body. Now histamine ‘race horses’ can’t find the finish line all by themselves — horses just aren’t that disciplined on their own — they need ‘jockeys’ to steer them in the right direction. In your body, sulphur is the jockey that can ride histamine horses safely to the finish line. When sulphur is available in the body, histamine is quickly removed from the blood stream, so only the appropriate amount of blood vessel dilation can occur.

    You can improve sulfation (histamine removal from the bloodstream) by including sulphur-rich foods such as garlic, onion and cabbage in your diet.

    Sulphur-containing amino acids (methionine, cysteine and taurine) are found in protein-rich foods such as chicken. All of the other detoxification pathways need support to take the burden off the sulfation pathway in the liver, so also take the other liver ‘jockeys’— omega-3, glycine, magnesium, B vitamins, selenium and vitamin C.

    • Poor sulfation (not enough jockeys) in the liver detoxification (race track) can make you more susceptible to environmental illness, rheumatoid arthritis and nervous system problems such as Parkinson’s disease and motor neuron disease.



    Q: ‘I get awful facial flushing, especially in summer. What can I do to quickly relieve the flush?’

    People with severe rosacea produce a lot of body heat so they feel hot and uncomfortable much of the time. If you are having a facial flush or experiencing excessive heat, try the following:

    • Suck on an ice cube.
    • Wet your skin with cold water or fill a plastic bag with ice cubes and hold next to the skin.
    • During a flush if you have no ice cubes or access to cold water, you can visualise bathing in a swimming pool filled with ice cubes. Studies show that the brain can’t tell the difference between what is real and what is vividly imagined. Picture bathing with ice cubes floating around you, even pretend to shiver and you will soon cool down.


    Q: ‘I have rosacea and my skin gets itchy all the time. Is there anything I can do to get some relief?’

    If you’re feeling itchy try the following:

    • Drink a cold glass of water.
    • Fill a plastic bag with ice cubes and hold next to the skin.
    • Drink an alkalising vegetable juice with ice cubes. Try celery, carrot, cucumber and mint (if you are sensitive to salicylates use celery, peeled pear and mung bean sprouts as they are salicylate-free).


    Step two: Exercise

    Exercise is essential for eliminating rosacea. I found this out the hard way ...

    My own personal experience is with mild rosacea. It wasn’t so bad because luckily I found a way to get rid of it before it had a chance to get worse. The first signs of rosacea began to appear twelve years ago; my chin was always red and I had to camouflage it with make-up, but my skin colour suddenly improved after I took dairy products out of my diet.

    I had a skin prick test and blood test for allergies and intolerances and modified my diet slightly so I enjoyed having a clear complexion for a while. However a few years later, even without having dairy in my diet, I started getting facial flushing.

    If the gas heater was on in winter I would flush. I was also overly sensitive to the summer heat and I couldn’t splash my face with warm water in the morning without my face being pink for the rest of the day. I also got patchy, red flushing during and after exercise. This was embarrassing so I used to apply make-up before going to the gym, just so I wouldn’t look like a blushing beetroot. Not that I ever exercised much! As I’ve mentioned before, I just never liked exercise; it always fatigued me and sometimes brought on cold and flu symptoms so I’d feel rotten for a whole week. However whenever I did stick to an exercise routine my rosacea would magically disappear. Then I would find another excuse to ditch the regime and my rosacea would soon return. So I did some extra research to see if this was a common reaction.

    The Rosacea Support Group website states that ‘Many rosaceans have noted that moderate (not strenuous) exercise seems to help alleviate their rosacea symptoms’.

    Other specialists have also said that many sufferers find the same success with exercise, which could be due to increased sympathetic constrictor tone to the facial blood vessels.

    Other scientific reasons why exercise can improve rosacea:

    • Moderate exercise burns up the body’s lipid stores, which potentially leaves less fat available for the inflammatory response. However, excessive exercise, such as running a marathon, does the opposite and promotes inflammation in the body.
    • Moderate exercise decreases blood levels of arachidonic acid (AA).17 AA from meat and dairy can be used to make inflammation in the body so it’s important to reduce AA levels by exercising and avoiding dairy if you suffer from rosacea.
    • Exercise enhances the amount of anti-inflammatory endorphins in the bloodstream.
    • Excess glucose in the blood can damage blood vessels and exercise reduces blood glucose levels.

    Regular exercise also improves blood circulation and good circulation is vital for healthy skin. An efficiently pumping circulatory system is necessary to carry nutrients and oxygen to your skin. If you have poor circulation, your skin literally becomes starved of nutrients because you are giving it an inadequate supply of essential fatty acids, antioxidants and oxygen.

    How does skin that is starved of nutrients survive?

    Think about it ... skin that lacks oxygen and nutrients will rot and die (as is the case with gangrene). So when your blood supply is sluggish or hampered in some way, the skin needs extra blood vessels to supply more nutrient-rich blood and it needs wider blood vessels to allow more flow with less effort.

    Poor circulation also means there is an inefficient removal of bodily wastes such as industrial toxins, pollution, dead cells and chemicals. Increased waste and skin cell turnover can cause the facial oil glands to become blocked and enlarged. This can eventually lead to nose and skin disfigurement seen in chronic rosacea.


    Exercise tips for rosacea

    • Initially when you exercise, you will get flushing and feel uncomfortable but bear with it as this reaction will eventually disappear.
    • If possible, exercise in air-conditioning or go swimming to avoid negative symptoms.
    • Exercise and sweat for at least fifteen minutes a day. However, keep your routines moderate and under one hour until your rosacea has cleared up.


    Step three: Promote good intestinal health

    Rosacea may also be exacerbated by poor gastrointestinal tract health and intestinal permeability. Ideally, your intestines should only allow tiny particles (that have been extracted from properly digested foods) to enter the bloodstream. These microscopic amino acids, glucose, vitamins, minerals and fatty acids are small enough to pass through a healthy gut wall while the larger particles stay in the intestines then pass through to the colon for removal in the faeces.

    But when the intestinal wall is unhealthy, it can develop larger than normal holes that allow the wrong-sized particles into your blood vessels. To get a clear idea of what I mean, picture that you’re in a kitchen, you’ve cooked some rice and you’re now using a strainer to drain the water from the rice. The rice ends up in the strainer and the liquid passes through. Imagine what would happen if the colander holes were too large: when you strained the rice, some of the grains would pass through—this is not ideal.

    When your gut lining is permeable, foreign particles pass though, enter your bloodstream and cause an immune system response. This basically means your body panics at the invasion and a cascade of histamines is released from your cells. And as you know, histamines cause blood vessel dilation.

    According to French researchers "Many dietary and hormonal factors are known to affect the severity of rosacea symptoms, several of which also modulate the activity of the enzyme intestinal alkaline phosphatase (IAP). The role of IAP in inhibiting an inflammatory response to intestinal bacteria suggests a mechanism by which intestinal pathologies may be linked to the skin inflammation characteristic of rosacea." (Journal abstract from ScienceDirect.)

    All rosacea sufferers should make sure they have good digestion and intestinal health. A probiotic supplement and chewing your food properly may help.


    Step four: Take supplements

    Take supplements that promote healthy blood flow

    These include natural antihistamine supplements (buffered vitamin C – magnesium ascorbate), omega-3 fish oil and chlorophyll.

    Vitamin C

    Vitamin C also has an antihistamine effect and is a well-known antioxidant. Dosage: Take 100mg of buffered vitamin C (magnesium ascorbate) twice a day


    Chlorophyll is the green pigment in plants and chlorophyll supplements are useful for improving red blood cell health (such as Grants Liquid Chlorophyll or Swisse Double Strength Chlorophyll+ tablets – take 3-4 tablets daily). Read Chapter 3, ‘Guideline No. 1’, for more information as chlorophyll is an essential treatment specific for rosacea.


    Step five: Eat a healthy diet

    According to researchers from Florida, USA, "the belief that food aggravates rosacea has been accepted. Patients are counseled to avoid rosacea triggers and, thus, refrain from such items as spicy foods; alcoholic beverages; and hot, caffeinated drinks. The list of triggers can be more extensive and include fruits, marinated meats, and cheeses." (The Role of Diet in Acne and Rosacea article can be found here.)

    Remember to eat a healthy diet and limit your intake of amine-rich foods. If you are after a specific program with recipes, The Eczema Diet is a low-amine and low salicylate program with 80 recipes. Drink 1 ½ to 2 litres of filtered water daily.

    Aside from food, also remember to rest if you are feeling unwell. Relaxation and meditation may help as stress and tension can trigger facial flushing if you already have rosacea.


    Rosacea Treatment Plan: Key points to remember

    Limit histamines in your diet

    • Avoid alcohol, chocolate, cheese, oranges, spicy food and allergy foods.
    • Stress and anxiety also trigger histamine release so read Chapter 19, ‘Beauty breathing’ for effective relaxation techniques, or learn how to meditate.


    • Improve your circulation. Exercise for at least fifteen minutes every day, sweat

    and breathe deeply.

    • Exercise is the most essential step to improving your rosacea; without it, all

    other steps will only offer minor benefit.

    Promote good intestinal health

    • Take a probiotic supplement if necessary; chew your food properly; drink water.

    Take supplements that promote healthy blood flow

    • Take magnesium ascorbate (beffered vitamin C) and drink Green Water (chlorophyll)

    Eat a healthy, low histamine diet


    This is an edited extract from The Healthy Skin Diet (Exisle Publishing). Reprinted with permission.


    Fischer, K., 2008, The Healthy Skin Diet, Chapter 18, Exisle Publishing, Sydney.
    Whitehead, J. (2009). Intestinal alkaline phosphatase: the molecular link between rosacea and gastrointestinal disease?. Medical hypotheses, 73(6), 1019-1022.
    Keri, J. E., & Rosenblatt, A. E. (2008). The role of diet in acne and rosacea. J Clin Aesthet Dermatol, 1, 22-26.
    Nase, G. 2005, ‘Beating rosacea, vascular, ocular and acne forms’, retrieved 16 August
    Wilkin, J., et al. 2002, ‘Standard classification of rosacea: report of the National Rosacea
    Society expert committee on the classification and staging of rosacea’, Journal of the American Academy of Dermatology, vol. 46, no. 4, pp 584-7.
    Swain, A.R., Soutter, V.L. and Loblay, R.H. 2002, Friendly Food, Royal Prince Alfred Hospital Allergy Unit, Murdoch Books, Sydney.
    Rosacea Support Group website, 2006, ‘Exercise influence’, retrieved 18 August
    Masumura, S., et. al. 1992, ‘The effects of season and exercise on the levels of plasma poly-unsaturated fatty acids and lipoprotein cholesterol in young rats’, Biochimica et Biophysica Acta, 1125 pp 292-6.

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    • wen bin on

      does the following food cause rosacea to flare,

      1. kale
      2. lentils
      3. asparagus
      4. chia seeds
      5. sauerkraut
      6. apple cider vinegar

      i hope to hear from you soon.
      thank you!

    • Katherine on

      Can you explain? The foods to avoid state probiotics and yet later on it says to take probiotics. I’m confused. I have rosacea and trying to find out exactly what I can eat without pustules and the other rosacea issues. Thanks

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