How do rosacea and acne respond to diet?

In a recent study published in Nutrients, researchers examined the connections between diet, rosacea, and acne.


Rosacea and acne vulgaris are common skin conditions that necessitate appropriate dietary considerations to complement treatment protocols. Assessing the impact of diet on facial dermatological conditions poses challenges due to subjective self-reported data, the absence of contemporary dietary patterns, and the lack of disease-specific dietary guidelines.

Comprehensive observational controlled trials are needed to elucidate the relationships between specific dietary components and disease risks, facilitating the development of preventive strategies and treatments.

There is limited information on dietary modifications for rosacea compared to acne, and dietary recommendations for rosacea are scarce.

About the Study

In this cross-sectional controlled study conducted between September 2020 and June 2021, researchers investigated the dietary patterns of individuals with rosacea and acne.

The exploratory study encompassed two patient groups: the rosacea patient group (RG) and the acne patient group (AG), along with their corresponding control groups, RCG and ACG, respectively.

The study included individuals aged 12 years and older, regardless of disease severity and treatment. The control groups comprised healthy individuals with no prior history of facial dermatological conditions and were matched for age, body mass index (BMI), and gender.

Pregnant and lactating women were excluded from the analysis. Dietary habits of the participants over the past four weeks were subjectively assessed through self-documentation of foods considered beneficial or triggering, followed by standard food frequency surveys (FFS) to evaluate dietary practices.

The research team introduced the rosacea nutrition score (RNS) and the acne nutrition score (ANS) based on eating habits to predict the risk of rosacea and acne. The predictive accuracy of the scores was assessed using the area under the ROC curve (AUC) findings, with only those achieving AUC values above 0.6 contributing to the scores.

Furthermore, the researchers employed the Youden Index to determine cut-off values, the Dermatology Life Quality Index (DLQI) to assess the influence of diet on quality of life, and the EuroQol EQ-5D-EL scores to evaluate health status.

The study examined the predilection sites for acne (chest, back, and face) and rosacea (eyes, chest, and face), with disease severity graded by a dermatologist based on inflammatory lesions (pustules, papules) and non-inflammatory lesions (comedones) for acne.

Additionally, the three primary types of acne (acne comedogenic, conglobate, and papulopustulosa) were identified. The global ROSacea COnsensus (ROSCO) criteria were applied to evaluate rosacea patients. Participants self-reported disease severity as mild, moderate, or severe.

Facial sebum expression, skinfold thickness, and fat measurements at various regions were assessed. Serum samples were collected to measure glucose, insulin-like growth factor (IGF)-1, insulin, glycated hemoglobin (HbA1c), cholesterol, fructosamine, triglycerides (TG), Homeostatic Model Assessment for Insulin Resistance (HOMA) index, C-reactive protein (CRP), total white blood cell count, zinc, and vitamin D levels.


The study included a total of 296 individuals, with 120, 32, 105, and 36 belonging to the AG, ACG, RG, and RCG groups, respectively. Acne and rosacea patients exhibited significantly higher levels of facial sebum production compared to their respective control groups.

The FFS results indicated that 81% of acne patients and 71% of rosacea patients reported that their diet influenced disease severity.

Dietary triggers for acne included fried foods, chocolate, milk, refined sugar, dairy products, and alcohol. Rosacea patients identified alcohol, particularly wine, as the primary trigger, followed by fried foods, spices, coffee, chocolate, milk, and refined sugar.

Both acne and rosacea patients perceived nuts, vegetables, fish, tea, and whole grains as beneficial for skin health. Fruits, particularly citrus fruits, were found to benefit acne patients but exacerbate rosacea.

Individuals with acne consumed significantly fewer vegetables, fruits, pasta, soy products, and boiled potatoes than their control counterparts. They also reported lower consumption of coffee, water, milk, and wine.

In contrast, RG patients consumed more ham, honey, meat, fried potatoes, and burgers than their control group. Rosacea patients consumed significantly fewer legumes and soy and drank less coffee than their control group.

It’s worth noting that rosacea patients consumed significantly more oral supplements than acne patients. The clinical scores for dietary influences were more precise for acne than rosacea, with odds ratios (ORs) of 14.5 and 5.5, respectively. Cut-off values of 7.0 and 4.0 were established for the 13-item ANS and seven-item RNS, respectively.

The AG group exhibited higher IGF-1 levels and lower TG levels compared to their controls.

Individuals with increased IGF-1 expression had a higher likelihood of chest acne (62%) compared to face acne (34%) and reported consuming more dairy products than those with unaltered IGF-1 expression.

Acne conglobata was associated with higher HbA1c and CRP levels compared to acne comedonica and papulopustulosa. Individuals with rosacea had higher HOMA scores and lower zinc and TG levels compared to their control group.

In comparison to rosacea patients, those with acne had significantly higher levels of IGF-1, cholesterol, low-density lipoprotein (LDL), and TG. Acne had a more pronounced impact on quality of life compared to rosacea, with mean DLQI scores of 7.0 and 5.4, respectively.

In conclusion, the study results underscore the significance of dietary control in managing rosacea and acne. Favoring legumes, vegetables, nuts, olive oil, and fatty fish while moderating the intake of cheese, alcohol, and meat may offer potential benefits to individuals dealing with rosacea and acne.

These insights hold promise for developing personalized interventions to enhance treatment outcomes. Healthcare practitioners can also leverage the clinical scores to assess risk based on dietary habits.

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