Rosacea - Naturopathic MedicineNaturopathic Medicine Summary

Naturopathic Medicine

Naturopathic Summary

Rosacea is a chronic skin condition that mainly affects the face.[1] Many adults in the United States and around the world suffer from the symptoms of rosacea that affect their quality of life.[1] Naturopathic doctors will work with their patient to understand the disease process in rosacea, identify and remove risk factors, and make lifestyle modifications by reducing stress, dietary modifications, and supporting the microbiome through a fiber-rich diet.

Treatment Philosophy

In naturopathic medicine, it is thought that the skin is a window showing the health of the gut and microbiome, and that treating the underlying cause will improve the skin condition. Rosacea has been associated with small intestine bacterial overgrowth,[2] and further examination and treatment of that condition may be warranted, depending on the person. Lifestyle modifications through stress management and dietary changes may also be necessary to address the rosacea.


Rosacea is an inflammatory disorder that primarily affects the face and less commonly the eyes and nose causing redress, swelling, stinging, dryness flushing, and dilated blood vessels.[1] Four different subtypes of rosacea have been identified:

  • Type 1 (Erythematotelangiectatic): diffuse redness and dilated vessels on the central forehead, cheeks, and chin
  • Type 2 (Papulopustular): pimples and pustules with diffuse redness on the central forehead, cheeks, and chin
  • Type 3 (Phymatous): thickened oil glands that can occur on the nose (rhinophyma), forehead (metaphyma), chin (gnathophyma), or ears (otophyma).
  • Type 4 (Ocular): redness and irritation of the eyes associated with a gritty feeling. 

It is possible for several of these subtypes to overlap in the same person.[1]


Rosacea is more common in people with lighter skin color, and the frequent facial redness can cause people to become self-conscious and impact self-esteem.[3] Although the exact cause of rosacea is not known, there are several possible associations that have been suggested including the following:[4,5]

  • Heat
  • Ultraviolet light exposure
  • Spicy foods
  • Microbial overgrowth on the face and in the gut, including the presence of Demodex mites on the face.

Risk Factors

Your body

  • Nutritional Status: One small study found that patients with rosacea have higher vitamin D levels than control groups.[6] However, the difference in the vitamin D levels was close and so it is not clear if vitamin D plays a role in rosacea.
  • Small intestinal bacterial overgrowth (SIBO): Patients with rosacea, mostly type 2, were shown to have an abnormal population of bacteria in their gut, known as SIBO, when compared to people without rosacea.[2] This study found that 46% of the people with rosacea had SIBO whereas only 5% of those without rosacea had SIBO[2] Treatment of the SIBO with an antibiotic lead to improvement of their rosacea.[2]


  • Smoking: The role of smoking cigarettes in the development and control of rosacea is unclear. Smoking has been associated with rosacea in some studies,[7-9] but other studies found that smoking did not have an association,[10] or was even associated with a decreased risk for rosacea.[11]
  • Stress: Emotional stress can play a role in worsening rosacea.[12] Stress was the most frequently mentioned trigger of the rosacea in one study.[13]
  • Diet: A diet high in spicy foods or excessively hot foods has been associated with worsening of rosacea symptoms.[14,15] Certain foods can cause rosacea to flare, such as spicy foods and the chemical capsaicin, which is found in peppers. Patients with rosacea have higher levels of the TRPV receptor in their skin.[16] When this receptor is activated, it can cause blood vessels to become dilated.
  • Alcohol Consumption: Alcohol use has been traditionally associated with the presence of rosacea, but the research studies do not support this. Three studies have evaluated this association[8,17,18] and a weak association was found in one study[8] and the other two studies found no association with alcohol use.[17,18]  
  • Skin products: Skin products can easily irritate the skin in those with rosacea. A survey by the National Rosacea Society showed that patients reported many ingredients in skin products irritated their skin including alcohol (66%), fragrance (30%), and astringent products such as witch hazel (30%).[19] Cleansers should be used carefully, as the skin of people with rosacea can be sensitive.[20] 


  • Steroids: The use of steroids on the face can lead to the development of steroid-induced rosacea.[21]


  • Climate: Hot weather can cause rosacea to flare.[22] Sun exposure is correlated with erythematotelangiectatic and papulopustular types of rosacea.[23]
  • Temperature: Heat stress can speed up the sweating and vasodilation onset in rosacea.[24] Exposure to the prolonged heat of an oven can worsen rosacea.[25]


  • Vitamin B12: Vitamin B12 (cobalamin) may cause rosacea flares in certain people.[26]
  • Vitamin B3: Vitamin B3 (niacin) can cause flushing if taken in large amounts, so supplementation should be cautioned in patients with rosacea.[27] This is different than using niacinamide, which is a chemical that is very similar to niacin but does not cause the flushing response[28] and may be helpful in rosacea.[29]

Naturopathic Therapies

Patients with rosacea have a higher tendency to suffer from depression and anxiety and tend to avoid social interactions due to their rosacea.[30] Possible stigmatization because of their condition can cause a great deal of mental emotional stress.[30] Mindfulness based stress reduction is a large focus of a naturopathic treatment plan for a per son with rosacea, especially since stress is a known symptom trigger.[13] Mindfulness based stress reduction includes guided imagery, breathing techniques, and repeating mantras to quiet the over-active mind, decrease anxiety and depression, and increase self-esteem.[31]

Botanicals and Herbs

Herbs with antimicrobial and anti-inflammatory properties have been studied in the topical treatment of rosacea and some examples include Quassia amara and Golden Chamomile (Chrysanthellum indicum).[29]

Diet and Lifestyle

Nutrition and diet

  • Diet: Inflammation is a component of rosacea,[32] so a naturopathic diet plan would minimize foods that increase the inflammatory response within the body. Diet may play a role in the disease process of rosacea through the gut-skin connection.[32] Supporting a healthy gut microbiome through the use of probiotics and a fiber-rich diet may be helpful for patients with rosacea.[32]


  • Niacinamide: Niacinamide (also known as nicotinamide) supplementation has been shown to be helpful for rosacea.[33] A small study showed that topical nicotinamide may help improve the barrier function in those with rosacea while another study showed that oral nicotinamide, used in conjunction with zinc, copper, and folic acid, was helpful in rosacea.[33]
  • Probiotics: Probiotics may be beneficial for some people with rosacea.[34,35]


  • Gentle facial cleansers: People with rosacea typically have sensitive skin[36] so gentle facial washes might be needed. Sulfur based facial washes can be helpful as long as the person does not have an allergy to sulfa compounds or medications.[37]
  • Sun protection: Sun protection is important for since exposure can trigger flares.[23]
  1. Mikkelsen CS, Holmgren HR, Kjellman P, et al. Rosacea: a Clinical Review. Dermatol Reports.2016;8(1):6387; PMID: 27942368 Link to research.
  2. Parodi A, Paolino S, Greco A, et al. Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clin Gastroenterol Hepatol.2008;6(7):759-764; PMID: 18456568 Link to research.
  3. Weinkle AP, Doktor V, Emer J. Update on the management of rosacea. Clin Cosmet Investig Dermatol.2015;8:159-177; PMID: 25897253 Link to research.
  4. Steinhoff M, Schauber J, Leyden JJ. New insights into rosacea pathophysiology: a review of recent findings. J Am Acad Dermatol.2013;69(6 Suppl 1):S15-26; PMID: 24229632 Link to research.
  5. Lazaridou E, Giannopoulou C, Fotiadou C, et al. The potential role of microorganisms in the development of rosacea. J Dtsch Dermatol Ges.2011;9(1):21-25; PMID: 21059171 Link to research.
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  8. Aldrich N, Gerstenblith M, Fu P, et al. Genetic vs Environmental Factors That Correlate With Rosacea: A Cohort-Based Survey of Twins. JAMA Dermatol.2015;151(11):1213-1219; PMID: 26307938 Link to research.
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  10. Tan J, Berg M. Rosacea: current state of epidemiology. J Am Acad Dermatol.2013;69(6 Suppl 1):S27-35; PMID: 24229634 Link to research.
  11. Spoendlin J, Voegel JJ, Jick SS, et al. A study on the epidemiology of rosacea in the U.K. Br J Dermatol.2012;167(3):598-605; PMID: 22564022 Link to research.
  12. Two AM, Wu W, Gallo RL, et al. Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol.2015;72(5):749-758; quiz 759-760; PMID: 25890455 Link to research.
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  21. Bhat YJ, Manzoor S, Qayoom S. Steroid-induced rosacea: a clinical study of 200 patients. Indian J Dermatol.2011;56(1):30-32; PMID: 21572787 Link to research.
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