pdf of this article

For more information about skin conditions and treatment, contact:


Elizabeth H. Hamilton, MD, PhD
Amy Stein, MD
Julie Dodge, PA-C

Lindsey Dudley, PA-C
4321 Medical Park Dr., #102
Durham, NC 27704
Telephone: (919) 220-7546 (SKIN)

What You Consume Affects Your Skin

Diet can be critically important in caring for the overall health and beauty of your skin, according to Dr. Amy Stein of Regional Dermatology of Durham. “Certainly, diet is not the only factor,” she acknowledges. “Genetics, sun exposure, medicines, stress, and smoking all play a part. But diet can play an important role.”

Amy Stein, MD

Allergies and Triggers

“There are some instances,” explains Dr. Stein, “when food allergies directly affect skin conditions. Dermatitis herpetiformis is one such example. It presents with intensely itchy bumps or blisters—often on the knees, elbows, and buttocks. In the case of this diagnosis, it’s necessary to screen for gluten sensitivity, because dermatitis herpetiformis is associated with celiac disease, which requires a gluten-free diet.”

But more common than a specific food allergy, she notes, “are the food triggers that affect your skin. If you blush or flush when you eat certain foods, or perhaps when you have a glass or two of red wine, you may have a relatively benign skin condition called rosacea—a common, chronic inflammatory skin disorder.

“Rosacea may be driven by hormones and stress certainly worsens it. It can present with facial redness, swollen red bumps, and sometimes visible blood vessels,” she says. “And rosacea often has a clear association with food triggers, including alcohol, spicy foods, hot foods and drinks, and caffeine generally.

“But, we’re all different, and those common triggers aren’t universal. A glass of red wine might cause a severe reaction for some people, and another rosacea patient can drink alcohol without flushing.”

Thus, Dr. Stein advises her patients to know their trigger foods, so they can decide if and when they want to indulge in a trigger event. “Often a person will learn how to control or at least minimize his or her flare,” she says, “such as avoiding drinking alcohol when at a public function to avoid flushing.”

While sometimes mistaken for it, rosacea is distinct from adult acne, notes Dr. Stein. “And, with acne, the food connection can be less clear cut. Dairy and sugar are often cited as potential culprits, but even these triggers seem to be a very individual experience. There are definitely people who notice that whenever they eat a certain food, they break out. But we don’t know exactly why. So, the simple answer to these problems is to try to avoid or minimize the foods that affect you.

“The bottom line is that what we consume not only can affect both rosacea and acne, it also can affect any kind of inflammatory process. And inflammation—whether triggered by food, stress, trauma, or illness—plays a critical role in most skin conditions.”

Stress and Your Skin

“While certain foods can be a blush-flush trigger for some people, it’s also true that stress plays a huge role in a variety of skin conditions,” Dr. Stein notes. “Almost every skin problem we treat has an emotional component to it, either as a causative factor or a complicator factor.

“When there is more stress—in other words, more inflammation— dermatologic conditions can worsen significantly,” she says. “Many chronic and acute conditions, including eczema and psoriasis in addition to acne and rosacea, flare when stressors increase.” Because of this stress-skin connection, Dr. Stein advises patients about effective stress reduction techniques, especially diet and exercise.

“We have only to look at this past year to appreciate the interconnections of stress, diet, and health,” she says. “The significantly increased stresses—physical, emotional, and financial—our patients have experienced in 2020 are reflected not just in their skin problems but also in poorer eating choices and weight gain. And excess weight creates its own series of health problems.”

Obesity and Your Skin

“Obesity is definitely a risk factor and co-morbid condition for so many health issues—including skin problems,” notes Dr. Stein. “Hidradenitis suppurativa, for one, presents with inflamed cysts, abscesses and painful lesions typically under the arms, in the groin area, or under the breast—most often in overweight people.

“Excess weight reflects underlying inflammation—affecting all aspects of our health,” she explains. “And that can exacerbate many skin conditions such as psoriasis or rosacea. It’s all connected. So, losing weight not only decreases the risk for cardiac events, it is also likely to prevent or improve many skin conditions.”

Managing Rosacea and Acne

While one’s own food choices can play a role in reducing rosacea and acne problems, Dr. Stein points out that there are many options available to help manage these skin conditions. “Just as food triggers vary from person to person,” she says, “the most effective treatment must also be individualized.

“People have different presentations of rosacea. With redness of the face, you can decrease that to some degree with topicals,” she says. “For those who have both redness and acne type bumps, we will give prescription medications in addition to general skin recommendations. But with blood vessel involvement, you’re going to benefit from laser treatment. Rosacea responds beautifully to laser treatment, which can be an excellent option for some patients.”

Dr. Stein sometimes uses antibiotics for an anti-inflammatory effect. And she always recommends sunscreen, since the sun itself can be a trigger. But she also recommends to all her patients that they eat a well-balanced diet containing ample plant foods and protein, and that they drink an appropriate amount of water each day. While not claiming to be more than a passionate nutrition and exercise enthusiast, she says, “I do counsel in terms of what I think are healthy choices in lifestyle and food. and more importantly, the unhealthy food choices, the ones that negatively affect inflammatory skin conditions—including too much alcohol, processed foods, or sugar.”

But moderation is key. “When you’re talking about something like acne and rosacea, if somebody told me you can never have a glass of wine again, or some chocolate, I wouldn’t listen to them. So, I wouldn’t tell anybody that either, right?”

And Dr. Stein models her own advice. “I really do think diet plays a role for me. I know my genetics are not the best, and so I do everything I can control to try to be healthy. I am not perfect with what I eat, but I focus on healthy, whole foods and basically try to eat a well-rounded diet and exercise almost every day.”