The Acne and Diet Connection: Or is it rosacea? A Nutritionist’s Story.

Nutrition writer Michelle Dudash writes about how to eat clean

Things hit rock bottom when I needed to apologize to the makeup artist for the horrible state of my skin on the morning of a satellite media tour. You know, when you appear in about 20 on-camera television interviews in the same morning. Fortunately, she was very skilled at her craft, and the not-too-close camera didn’t reveal to viewers what was happening on my face. But the acne (or so I thought) was incredibly embarrassing, and physically painful too. Would people think that I don’t take care of my skin? That I don’t wash my brushes? A dietitian is supposed to look healthy, after all.

Over the past year I have gulped down pills, slathered on expensive creams, endured facial peels, and seen three different dermatologists. I desperately tried different diets, from gluten-free (despite a lack of supporting evidence) to very low glycemic (with some evidence) in the hopes of clearing my skin. Nothing seemed to make a lasting, significant difference. My husband convinced me to try one more dermatologist.

The doctor looked at my skin and wrote a couple of prescriptions. I asked her if she believes that diet affects acne. Like most dermatologists she explained, “There’s no strong evidence to warrant me prescribing a certain diet for you.” But then she took a closer look at my face and dropped a bomb: “It looks like you might have rosacea.”

Rosacea!? The word conjures for me images of middle-aged men with Rudolph red noses and old ladies with flushed cheeks. She explained that it is commonly agreed, even in conventional medicine, that certain foods can trigger rosacea flare-ups. And in a semi-progressed stage, rosacea looks like acne. Because of my pregnancy, though, she was hesitant to prescribe a diet for fear that I’d get too restrictive. “Trust me,” I assured her, “I’m a dietitian.” She rambled off a few foods that can cause issues and when I begged her for additional reliable information resources, she directed me to the National Rosacea Society.

I hurried to my car and immediately looked up rosacea do’s and don’ts. I became a NRS member to gain access to all of the information they had to offer. My new routine completely changed the state of my skin within a week. First, I stopped using the Clarisonic brush, “scrub pads” and salicylic acid, since anything but gentle fingertips and the mildest face wash can wreak havoc on rosacea-prone skin. Almost overnight my skin looked less “angry”. By the end of the week, my skin even started to clear a bit. Within a few days, I began avoiding the common dietary and environmental triggers of rosacea, and a week later began using the prescriptions.

Over the past four months of food journaling and trial and error (because it can vary among individuals), I’ve concluded that my rosacea triggers are pickled and fermented foods (an olive or two is fine, but not five baby pickles!), anything piping hot (I let my coffee cool slightly first, or go with iced coffee), red wine (so I stick mostly to white wine, or have just a small amount of red) and spicy foods. Other culprits may exist. Following this diet at home is easy. Eating at good restaurants can get tricky, though, with their fondness for butter and cream (additional triggers, I think). While one good dinner out doesn’t cause too much trouble, throwing caution to the wind for a few consecutive days does.

The creams my dermatologist prescribed, Finacea and Clindamycin, seem to be working well. I wash my face and apply these religiously, followed by a light moisturizer and sunscreen. As usual and always. Four months later my skin is clear and I even will venture out in public sans makeup or huge sunglasses that cover my face.

If you have a skin problem, don’t delay. See a board-certified dermatologist who is patient in dealing with acne (or rosacea) patients. You’ll be glad you did.

Have you ever experienced facial skin issues? Do you now? Are they food related? I want to hear about it.

Bonus tips: Since I wrote this post, readers have been asking me which products I use on my skin. I use Cera Ve cleanser in the morning and Neutrogena Fresh Foaming Cleanser in the evening (since it also removes makeup and sunscreen well). In the morning I pat on Clindamycin, as well as Finacea before bed. If I have any dry spots I dab on Theraplex Hydro Lotion and Aquaphor for really dry or flaky areas. Often I pat on the Theraplex on the days I don’t have time to wait 30 minutes after washing my face before applying the prescriptions. For sunscreen (which I always wear before stepping outside) I usually use NARS Pure Radiant Tinted Moisture SPF 30. When I apply a full face of makeup I use Bobby Brown Skin Foundation Stick. There you have it!

Disclosure: This post contains Amazon Affiliate links.


You might also enjoy:

Diet and Acne: How a Low-Glycemic Load Diet May Lesson Breakouts

Tomato & Avocado Quinoa Salad with Cumin & Cilantro (and the skin saga continues)

The New Coke Ad: Is aspartame safe? A nutritionist’s point of view.


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  1. Lisa H
    Posted September 3, 2013 at 7:34 am | Permalink

    For years I suffered with acne flare-ups. What you describe is close to what I went through: going to dermatologists and doctors who prescribed different medications. It wasn’t working. It wasn’t until my 40’s that it became extremely painful and I knew it was being caused by something I was eating, as the rash was mainly around my mouth, but also extended to the tops of my shoulders. I finally found someone to help me, and after a year of trial and error, discovered I was allergic to eggs (egg whites are even worse than the yolks). Thanks for sharing your experience, I am sure you are helping others!

    • Posted September 3, 2013 at 8:46 am | Permalink

      Hi Lisa,

      Thanks for sharing. Wow – a reaction to eggs like that! I would never have guessed. Curious – what kind of professional helped you figure it out? A derm? Dietitian? Holistic practitioner? I’m so glad you figured it out. It is amazing how healthy skin can have such an impact on self-confidence and just general well-being, no?


      • Lisa H
        Posted September 5, 2013 at 1:02 pm | Permalink

        I ended up with a naturopathic doctor. We tried the elimination diet and the N.E.A.T. program. Finally it was the blood test for allergies (the skin test came up negative, as my allergies are digestive, which is totally different from skin allergies). I used the blood test as a last resort, because the outcome can be effected by what has, or has not, been eaten prior to the test. Eggs came up as a huge allergen, so I eliminated them from my diet for three months. All my symptoms disappeared, so then I slowly tried to reintroduce eggs into my diet (like a cookie, or a slice of cake). The rashes returned, taking about 10 days to totally clear from my system. Now, I just stay away from anything with egg, which is in almost everything: egg washes on bread, any sweet bakery item, salad dressings, pastas, and surprisingly, some wines, as egg whites may be used to remove the tannins from wine.
        Absolutely clearing my skin has been a wonderful boost to my self-esteem! I feel better, both inside and out!

  2. Sandy
    Posted March 18, 2014 at 6:37 am | Permalink

    It has been about a year ago, I went to a dermatologist on another issue but also asked her why I was having more acne now than when I was a teenager. (I am 60). She informed me that it was rosacea. She prescribed topical clindamycin. I used it for awhile, but it did not make any changes in my skin. I asked her if there is a connection between your gut and skin. She said no. I am not so sure of that. I experience IBS and have started eating less fructose and gluten and that has really helped my digestion, but I am also wondering if a food allergy is a reason for the rosacea. I am interested to pursue that more. Michelle, how did you go about doing a food diary to indicate what food was the cause? Did you eliminate things and add them back?
    Lisa, I googled N.E.A.T program but did not come up with anything related. Any information on that would be great.
    Thanks so much for any input.

    • Posted March 18, 2014 at 11:04 am | Permalink

      Hi Sandy,

      Thanks for sharing your story. I was pregnant at the time so didn’t go on too strict of a diet. I cut out the triggers that are the most common and started journaling. After a month when my skin was looking great, I allowed the trigger foods here and there (while still journaling) and could see the trends of which were triggers and causing flareups. Make sense?

      As far as the journal itself, just grab a little notebook and write down all the foods you eat – 1 page for each day. At the top I wrote what my skin looked like in the morning and evening. After a few weeks, look back at the pages and I bet you’ll see a trend. Also note any things out of the norm – extreme weather, sweaty workout, etc.

      Good luck!

  3. Sandy
    Posted March 20, 2014 at 7:07 am | Permalink

    Yes, that does make sense. I am going to start the diary today. I hope I can determine the cause of my rosacea from this and have the results you did. Thank you for sharing your story.

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