Understanding Rosacea: the root causes and what to do about it

Let’s talk about rosacea. If you’ve been battling with flushed cheeks, persistent redness, or breakouts that feel a bit like acne but don’t quite behave the same way, chances are you’ve either been told you have rosacea or you’re wondering if that’s what’s going on. 

Rosacea affects millions of people, and it’s so often misunderstood or oversimplified. It’s rarely just about sensitive skin. It’s a message from the body that something deeper is going on. As a nutritional therapist, I see rosacea not as a random skin condition but as a signal that the body is out of balance. And the good news is, when we pay attention to that signal and start supporting the body from the inside out, things really can shift.

What Is Rosacea, really?

Rosacea is a chronic inflammatory skin condition. It often shows up as persistent redness on the cheeks, nose, forehead or chin, along with bumps, visible blood vessels, or even dry, irritated eyes. For some, it flares up in response to specific triggers. For others, it feels like it never really settles.

But rosacea isn’t just skin deep. It’s often a reflection of something happening beneath the surface. The skin is one of the body’s key elimination organs, and when internal systems are overwhelmed or imbalanced, the skin often steps in to help. That’s why a skin issue like rosacea deserves a whole-body approach.

The myths that keep people stuck

One of the most common misconceptions is that rosacea is purely genetic and there’s nothing you can do about it. While there may be a genetic component for some people, that doesn’t mean your skin is destined to be reactive forever. 

Another common myth is that rosacea is just about avoiding certain triggers like alcohol, spicy food or the sun. While it’s true that some things can make symptoms worse, removing triggers doesn’t address the underlying issue. It’s symptom management, not root-cause healing.

And let’s not forget the idea that there’s no real solution beyond medicated creams. Topical treatments might help in the short term, but they rarely address what’s actually causing the inflammation in the first place.

What could be driving it?

There’s no one-size-fits-all answer, but there are some really common themes I see again and again in clinic. One of the biggest is digestive health. The connection between the gut and the skin is incredibly strong. If someone is struggling with issues like bloating, irregular digestion or reflux alongside rosacea, that’s a clear sign we need to investigate the gut.

SIBO, or small intestinal bacterial overgrowth, is particularly common in people with rosacea. It’s where bacteria that should be in the large intestine start overpopulating the small intestine, leading to inflammation and disruption in digestion. That inflammation doesn’t stay confined to the gut. It travels through the body and often shows up in the skin.

Histamine sensitivity is another piece of the puzzle. If you’ve ever noticed that your skin flares after red wine, aged cheese, or fermented foods, histamine sensitivity may be at play. Histamine is a natural part of the immune system, but when it builds up faster than the body can break it down, it can lead to a whole host of symptoms—including rosacea.

Hormonal imbalances and stress are also important to explore. For many women, rosacea worsens during perimenopause or times of high emotional or physical stress. And then there’s the role of detoxification. If the liver is under pressure and not processing toxins efficiently, the skin may take on some of that burden, leading to visible signs like redness or inflammation.

There’s even a connection between rosacea and tiny skin mites called demodex. These mites naturally live on the skin, but in some people with rosacea, they seem to be overpopulated or trigger an inflammatory response.

What can help you get to the root?

The first step is testing. Functional testing allows us to stop guessing and start getting clarity. Stool testing can reveal imbalances in the microbiome, signs of inflammation, or hidden infections. Breath testing can show whether SIBO is present. In some cases, we might explore histamine or hormone levels, depending on what your symptoms are telling us.

Understanding what’s going on in your body allows us to build a plan that’s specific to you. That’s where real change happens.

You don’t have to work this out alone

Rosacea can feel confusing and overwhelming, especially when the advice out there is so focused on the surface. But you don’t have to navigate this by yourself. My role as a nutritional therapist is to help you connect the dots between your symptoms and what’s really going on internally.

There is no quick fix. But there is a path forward. And when you approach rosacea with curiosity rather than frustration, when you start to see it as your body asking for support rather than misbehaving, everything changes.

If you’re ready to stop managing symptoms and start addressing the root, I’m here to guide you through it.