Rosacea, is a chronic inflammatory skin disease that occurs in the middle of the face. It usually presents with recurrent facial flushing, erythema, papules, pustules, and edema. Capillaries may appear as the disease progresses. Expansion and hypertrophy. At present, it is believed that rosacea may be a chronic inflammatory disease dominated by abnormal innate immunity and neurovascular regulation function induced by a variety of factors based on a certain genetic background .
Studies have shown that there are many triggers for the occurrence of rosacea, such as temperature changes, sun exposure, mood changes and spicy food. In addition to sun exposure being a clear trigger for rosacea, diet is also an important trigger for rosacea. According to the National Rosacea Society (NRS), 78% of rosacea patients change their diet to avoid flare-ups, and 95% of them report an improvement in their condition after the change in diet . It can be seen that dietary management plays an important role in the treatment and prevention of rosacea.
Diets that may trigger rosacea
Diets that may trigger rosacea include the following:
1. Alcohol
2. Hot food
3. Spicy food
4. Histamine-containing foods or histamine releasers
5. Niacin-containing foods
6. Foods containing cinnamaldehyde
7. High-fat foods
Alcohol
In an NRS survey of 1,066 people with rosacea, participants reported alcohol (52%), spicy foods (45%), certain fruits (13%), cured meats (10%) and certain vegetables ( 9%) is a trigger for rosacea [3]. Alcohol was a common trigger, including wine (52%) and spirits (42%) [3]. As early as the 14th century, it was even believed that excessive alcohol consumption was the direct cause of rosacea. The mechanism of alcohol-induced rosacea may involve multiple pathways. Alcohol dilates blood vessels, causing flushing and increased skin temperature, which can lead to localized heating. Alcohol also increases pro-inflammatory cytokines and induces cell cycle activating factors that promote epidermal hyperplasia [4]. The reason red wine is more likely to cause rosacea is the resveratrol it contains. Resveratrol has been shown to increase the expression of cathelicidin antimicrobial peptides in cultured keratinocytes [5].
One study found that the consumption of white wine and spirits was significantly associated with the risk of rosacea in women, and that alcohol consumption was associated with a dose-dependent increased risk of rosacea [6]. Beer and champagne have also been reported to exacerbate rosacea [3]. People with rosacea should avoid alcohol and alcoholic beverages to prevent flare-ups and improve symptoms.
Hot food
Hot food is a common trigger of rosacea. Heat can directly cause vasodilation, flushing, and tingling. High temperature also activates the transient receptor potential vanilloid member 1 (TRPV1) cation channel. Activation of TRPV1 releases substance P and calcitonin gene-related peptide, leading to inflammation, vasodilation, flushing, and edema [4]. According to the report, 33% of rosacea respondents cited hot coffee as a trigger, while 30% cited hot tea as a trigger. The study found that neither water nor coffee at 22°C caused facial flushing, while both coffee and water at 60°C caused flushing of similar temporal nature and intensity. The researchers concluded that it was high fever, not caffeine, that caused the flushing [7]. Another study found that increased caffeine intake in coffee was inversely associated with the risk of rosacea [8]. It can be seen that patients with rosacea should avoid hot drinks, not hot coffee, but coffee at room temperature does not induce rosacea.
Spicy food
A common ingredient in spicy foods that can cause rosacea is capsaicin. Capsaicin, which imparts pungency and heat to food, works through TRPV1, which is located on keratinocytes, nerve cells, endothelial cells, and immune cells. TRPV1 is activated by hyperthermia and capsaicin, resulting in vasodilation and inflammation-induced hyperalgesia [9]. Capsaicin is primarily found in chili peppers and condiments, including red peppers, jalapeños, peppers, black peppers, and white peppers. Other spicy foods that do not contain capsaicin may also trigger rosacea, such as mustard, horseradish, cinnamon, cloves, cumin, fenugreek, and ginger
Histamine-containing foods or histamine releasers
Histamine causes cutaneous vasodilation, and histamine receptors H2R and H3R have been found to be upregulated in rosacea skin, leading to facial flushing and edema. In addition to its role in inflammatory processes, histamine also plays a key role in immune regulation, which may be a potential mechanism by which histamine induces rosacea [10]. It is estimated that 1% of the population is intolerant to histamine, which is due to the accumulation of too much or insufficient breakdown of histamine. Common histamine-rich foods include fruits (avocados, bananas, papayas, and pineapples), dried fruits (apricots, dates, raisins, and figs), vegetables (tomatoes, spinach, and eggplants), nuts (cashews, walnuts, and peanuts), Chocolate, milk, fermented foods and smoked fish. Patients reporting histamine intolerance must be careful with histamine-rich foods. Although, histamine release from mast cells is thought to be involved in the pathogenesis of rosacea. However, there are no scientific studies directly linking histamine-containing foods to rosacea. Therefore, extensive restriction of histamine-containing foods is not recommended. However, certain foods high in histamine, such as aged cheese, sauerkraut, wine, and processed meats, should be avoided [11]. Notably, alcohol-related flushing in rosacea may be due to histamine production from the metabolism of acetone and acetaldehyde
Niacin-containing foods
Niacin, also known as vitamin B3, is another cause of flushing in rosacea. Niacin causes cutaneous vasodilation by activating TRPV1 channels in keratinocytes and sensory nerve endings, as well as the niacin receptor G protein-coupled receptor 109A in Langerhans cells, leading to erythema and tingling [4]. Although conclusive evidence is lacking, patients may benefit from avoiding foods rich in niacin, such as liver, chicken breast, tuna, salmon, turkey, anchovies, pork, beef, peanuts, brown rice, mushrooms, and potatoes
Foods containing cinnamaldehyde
Cinnamaldehyde gives cinnamon its characteristic flavor. In addition to cinnamon, it’s also found in tomatoes, citrus fruits, and chocolate. Mustard oil and cinnamaldehyde activate transient receptor potential-anchored protein subfamily (TRPA1) channels, leading to flushing and vasodilation by secreting pro-inflammatory cytokines and neuropeptides [4,10,11]. The mechanism of cinnamaldehyde-containing food-induced rosacea is relatively clear, therefore, cinnamaldehyde-containing food should be avoided.
High-fat foods
A case-control study in China found that regular intake of high-fat foods such as fatty meat, fried foods, and lard was significantly and positively associated with rosacea [12]. Since only one study has linked a high-fat diet to rosacea, a direct link between a high-fat diet and rosacea has not been established.
