If you live with rosacea, you know the drill. The flushed cheeks, burning sensation, and sudden flare-ups that seem to come out of nowhere. You reach for your cream, you avoid your triggers, maybe even take a prescribed medication, but the cycle continues. What if the issue isn’t just surface-level? Rosacea is a result of chronic inflammation, so why does modern medicine keep trying to patch it up rather than eliminate it? It’s time we talk about the root cause, not just the redness.
What is Inflammation Really?
Inflammation is your immune system’s response to perceived threats, whether that’s an injury, infection, irritant, or anything your body considers potentially harmful.
Under normal circumstances, inflammation is actually your friend. Cut your finger? Inflammation brings immune cells to fight off bacteria and repair tissue. Get a splinter? Inflammation works to push it out and heal the wound. This type of acute (meaning occurring suddenly and rapidly, often appearing worse initially) inflammation is protective, necessary, and temporary.
But rosacea involves chronic inflammation, which is an entirely different beast. Instead of showing up to help and then leaving when the job is done, chronic inflammation appears to set up permanent residence in your face!
This persistent inflammatory state creates a bunch of problems. Your blood vessels become more reactive and prone to dilation, leading to rosacea’s characteristic redness and flushing. Your skin’s barrier function becomes compromised, making it more sensitive to triggers that wouldn’t bother most people. For some rosacea sufferers, their nerve endings become hypersensitive, causing burning and stinging sensations. And in some cases, inflammatory cells accumulate to form the bumps and pustules leading to papulopustular rosacea (type 2).
Once chronic inflammation takes hold, it becomes self-perpetuating. Inflamed tissue releases chemicals that attract more inflammatory cells, which release more inflammatory chemicals, creating a vicious cycle that can continue indefinitely without proper intervention.
The Inflammation-Rosacea Connection
Rosacea is a result of inflammation as explained by science.
Increased Levels of Inflammatory Markers
Research has consistently shown that people with rosacea have low grade systemic inflammation in their skin, even in areas that appear normal to the naked eye. This suggests that inflammation isn’t just present during flares; it’s a constant, underlying process that makes flares possible.
The Innate Immune System is Overactive
One of the key players in rosacea-related inflammation is something called the innate immune system. This is your body’s first line of defense, designed to respond quickly to threats. In people with rosacea, this system appears to be hyperactive, responding to normal stimuli as if they were dangerous invaders.
For example, that glass of wine that triggers your rosacea isn’t actually toxic to your skin. But your overactive inflammatory response treats it like a threat, launching a full-scale immune reaction that results in flushing, burning, and redness. The same thing happens with sun exposure, spicy foods, stress, or any of the other common rosacea triggers.
Inflammatory Peptides Like Cathelicidins
Antimicrobial peptides, which normally help fight off infections, are produced in excessive amounts and may actually contribute to inflammation rather than helping resolve it.
There’s also compelling evidence that the microbiome, the community of bacteria living on your skin, plays a role in rosacea inflammation. People with rosacea often have imbalanced skin microbiomes, with certain inflammatory bacteria being overrepresented while beneficial bacteria are diminished. This imbalance can perpetuate the inflammatory cycle and make skin more reactive to triggers.
Mast Cells
Mast cells (those same guys involved in allergic reactions) are also more active in rosacea skin.
Why Modern Medicine Doesn’t Address Chronic Inflammation
Here’s where things get frustrating for anyone dealing with rosacea: despite overwhelming evidence that chronic inflammation is the root cause, most conventional treatments focus on managing symptoms rather than addressing the underlying inflammatory processes.
Take topical antibiotics like metronidazole, one of the most commonly prescribed rosacea treatments. While these can help reduce inflammatory bumps and pustules, they don’t address why your skin is inflamed in the first place. They’re essentially putting a band-aid on a symptom while the root cause continues unchecked.
Oral antibiotics like doxycycline are prescribed for their anti-inflammatory properties. This is actually closer to addressing the real problem, but even here, the approach is temporary and surface-level. Doxycycline can help reduce inflammation while you’re taking it, but it doesn’t reset your immune system or fix the underlying dysfunction that’s causing chronic inflammation. Once the drug is out of your system, the inflammation returns.
Laser treatments and IPL therapy can be highly effective for reducing redness and visible blood vessels, but they’re essentially cosmetic fixes. They improve how your skin looks without changing the inflammatory processes that caused those blood vessels to become dilated and visible in the first place. That’s why many people need repeated laser treatments, the underlying inflammation continues to cause new vascular changes.
Even newer treatments like brimonidine gel, which temporarily constricts blood vessels to reduce redness, can make your skin look better for a few hours. But they do nothing to address the chronic inflammation that’s causing the blood vessels to be reactive in the first place.
So Where Does Inflammation Begin?
So where is all this inflammation coming from? Here are some common contributors:
1. Gut Health
Many people with rosacea also suffer from digestive issues like IBS, acid reflux, or small intestinal bacterial overgrowth (SIBO). The gut-skin axis is real, and when your gut is inflamed or leaking (aka leaky gut), inflammatory substances can enter the bloodstream and make their way to your skin.
2. Diet
Processed foods, sugar, alcohol, and spicy foods can all stoke inflammation. On the flip side, anti-inflammatory diets rich in omega-3s, leafy greens, and antioxidant-rich foods can help cool things down.
3. Chronic Stress
Stress isn’t just a trigger; it’s a root cause. Chronic stress raises cortisol levels, which in turn increases inflammation. It also disrupts gut health and weakens your immune system. It’s a triple whammy for rosacea.
4. Hormonal Imbalance
Hormones, particularly estrogen and progesterone, play a role in immune function and inflammation. This may explain why many people see their rosacea worsen with menstrual cycles, menopause, or hormone therapy.
5. Environmental Exposures
UV rays, pollution, harsh winds, and even the microbiome of your skin all interact with your immune system. A weakened skin barrier is more prone to inflammation, and chronic exposure only worsens the issue.
What Actually Helps Calm Inflammation Long-Term?
I’m kidding when I say inflammation is the devil. Really, it’s your body trying to protect you. The goal isn’t to wipe it out completely, but to restore balance. Here’s what can help:
1. Healing the Gut
Probiotics, low-FODMAP or anti-inflammatory diets, addressing SIBO with professional help can reduce systemic inflammation.
2. Stress Management
Mindfulness, breathwork, therapy, walking in nature, and improved sleep quality are vital to improving your health.
3. Anti-Inflammatory Nutrition
Focus on foods that reduce inflammation: wild-caught salmon, turmeric, ginger, blueberries, bone broth, flaxseed, and cruciferous vegetables. Seriously consider dropping gluten and dairy from your diet for at least 12 weeks.
4. Functional Medicine Testing
Sometimes it’s worth digging deeper. Bloodwork for inflammation markers, hormone panels, and gut health testing can provide valuable insight.
5. Gentle Skincare
Support your skin’s barrier instead of attacking it. That means minimal products, no harsh cleansers. Stop running to Sephora and trying multiple new products at once. If your skin is badly inflamed, it won’t feel like anything is working anyways.