Rosacea: The Important Role of Lifestyle Management as a Treatment

Author: Aisha Savannah, MD
Supervisor: dr. Fransiskus Xaverius Clinton, Sp.D.V.E

Rosacea derives from the Greek word meaning “rose-like,” which describes the main symptomatology of repeated flushing alone or in combination with transient or persistent erythema.¹ Roscacea is a chronic inflammatory skin condition that presents with flushing, persistent erythema, pimples or pustules, visible blood vessels, and thickening of the skin on the nose, chin, cheeks, and forehead. People with rosacea may also experience secondary symptoms such as itching, burning, or stinging.²

This condition is more common in women than in men, at a ratio of 3:1, and generally begins about ten years earlier in women. Typically, it starts between the ages of 35 to 45 for women and 45 to 55 for men. However, recent research indicates that flushing, an early sign of rosacea which is often not recognized.¹ In daily clinical practice, patients often have morphological characteristics of more than one rosacea subtype and may complain of increased sensitivity of the facial skin with symptoms of burning, stinging, and itch.³ There are four clinical subtypes of rosacea based on the predominant signs and symptoms such as erythematotelangiectatic, papulopustular, phymatous, and ocular.⁴

Several factors contribute to the development of rosacea, including genetic predisposition, immune system reactions, microorganisms, environmental influences, and neurovascular dysregulation. Ultraviolet (UV) exposure is known to trigger rosacea and may also play a role in its underlying causes. A family history of rosacea increases the likelihood of developing the condition, and certain human leukocyte antigen (HLA) markers have been linked to rosacea in some patients.⁴

The facial distribution of the disease is generally recognized to have a significant negative psychological impact on patients, although the statistical evidence for this effect is poor. Patients report significantly impaired self-esteem and may become unemployed, stop socializing, get divorced, or develop depression.

Early diagnosis and treatment are crucial to avoid permanent scarring, persistent erythema, and complications affecting the eyes. In recent years, rosacea treatment guidelines and expert recommendations have introduced a range of treatment options, including topical and oral medications, light-based therapies, skincare routines, and lifestyle modifications.^1,2

Thorough education and instructions for proper general skin care is a critical component of adequate rosacea management because consequent application of adequate nonirritating skin care can significantly prevent or attenuate relapses or tone down dry skin or pain sensations.¹

Essential skin care advice elements are¹:
(1) Avoid the trigger factors.
(2) Usage of foundations and facial coverage without aggravating symptoms of rosacea.
(3) Use of sunscreen SPF (sun protection factor) with minimum 30+
(4) Use of moisturizers frequently
(5) Usage of drying cleansing for an oily nose
(6) Regular use of gentle cleansers for the whole face
(7) use of matte green–toned foundations to mask skin redness
(8) Please avoid to rubbing the face

Moreover, educating patients about behavioral strategies and approaches to reduce the facial skin symptoms will reduce the psychological disease burden and significantly improve patient’s quality of life and patient outcome. Recommended lifestyle changes include

1. Probiotics
   Recommendations to promote a healthy gut microbiome include the consumption of a fiber-rich diet. Prebiotics have been defined as non-digestible food ingredients that selectively stimulate the growth and/or activity of beneficial GI microbes Research indicates that consuming a wide variety of dietary fibers, in sufficient quantity, will encourage the growth of a diverse and a healthy gut microbiome.⁵
2. Vitamin and minerals
   Recent studies suggest to consume a vitamins and minerals as adjunctive therapies on rosacea. Studies have focused on topical and oral forms of key vitamins and minerals like vitamin A, vitamin D, zinc, and omega-3 fatty acids.⁵
3. Avoid spicy foods and alcohol
   Capsaicin-, heat-, or alcohol-related nutritional triggers may be intertwined with the multifactorial pathophysiology of rosacea, including dysbiosis of the skin microbiome, vascular malformation, and immune dysregulation, yet their impact varies greatly between individuals.

Take home message:

1. Find a dermatologist. If you have a persistent skin condition characterized by flushing, persistent redness, pimples, visible blood vessels, and skin thickening, mainly on the face. And followed by itching, burning, and stinging sensations.
2. Rosacea can significantly impact mental health, leading to low self-esteem, social withdrawal, and even depression.
3. Early diagnosis and comprehensive treatment—including topical/oral medications, light therapy, and lifestyle changes—are crucial to prevent permanent skin damage.
4. Managing in lifestyle will helps to reduce recurrent condition
   Effective management involves avoiding known triggers (like spicy foods and alcohol), using non-irritating skin care products, wearing sunscreen, and maintaining a healthy lifestyle, including a balanced diet with probiotics and essential vitamins.

Bibliography:

1. Steinhoff M, Buddenkotte J. Roscacea. In: Kang S, Amagai M, Bruckner A, Enk AH, Margolis DJ, McMichael AJ, Orringer JS, editors.Fitzpatrick’s Dermatology. 9th ed. McGraw-Hill Education; 2019. p.1419–43.
2. Zhang H, Tang K, Wang Y, Fang R, Sun Q. Rosacea Treatment: Review and Update. Dermatol Ther (Heidelb). 2021;11(1):13 –24
3. Rainer BM, Kang S, Chien AL. Rosacea: Epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017;9(1):1–10.
4. Farshchian M, Daveluy S. Rosacea. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557574/)
5. Algarin YA, Pulumati A, Jaalouk D, Tan J, Nouri K. The role of vitamins and nutrients in rosacea. Arch Dermatol Res. 2024;316(5):142.