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Rosacea
Rosacea is facial redness, flushing, and bumps with deeper roots. We look at the gut, SIBO, Demodex mites, vascular reactivity, histamine, and the nervous system.
What you may be noticing
Cheeks, nose, and forehead that flush easily and stay red longer. Small visible blood vessels. Bumps that look like acne yet do not behave like it. Burning or stinging when you apply products. Some people notice dry, gritty eyes. Triggers include heat, sun, alcohol, spicy foods, hot drinks, exercise, and stress.
Why it is rarely one thing
Rosacea involves overactive innate immunity in the skin, nerve and blood vessel reactivity, and changes in the skin microbiome, including increased Demodex mites. Nerve receptors that sense heat and capsaicin, called TRPV channels, are more active, which explains flushing with heat and spice.
The gut matters too. Research links rosacea with SIBO and with H. pylori, and some studies found skin improvement after SIBO treatment. Inflammatory bowel disease and celiac disease are also more common in people with rosacea. Ocular rosacea affects the eyelids and eye surface, and it deserves care from an eye specialist.
I see rosacea as an immune reaction of the skin, and my stance is that an immune reaction can often be turned down when we find the trigger. The gut-skin axis is usually the first place I look, because when SIBO or H. pylori is present, treating it may calm the skin in a way topical products alone cannot. I also look at the toxic burden bucket. Products that touch your face every day should be free of harsh chemicals and contaminants, because an irritated barrier keeps the innate immune system on alert. That broader toxin link is a working clinical hypothesis, while the gut and nerve-vessel findings come from research.
Each person carries a different mix, which is why a personal trigger map matters more than a generic list.
Patterns we look for
- SIBO and microbiome balance.
- H. pylori status.
- Histamine patterns and mast cell activity.
- Flushing triggers: alcohol, heat, spice, and stress.
- Autonomic balance and sympathetic reactivity.
- Skin barrier integrity and product ingredients.
- Demodex density on the skin.
- Blood sugar regulation.
- Hormone shifts in perimenopause, which can increase flushing.
How I evaluate it
The comprehensive functional neurological exam assesses autonomic responses, including vascular reactivity and temperature regulation, which shape flushing.
Functional labs may include breath testing for SIBO, H. pylori testing, a comprehensive stool analysis, fasting glucose and insulin, vitamin D, inflammatory markers, and celiac antibodies when indicated. I coordinate with your dermatologist and eye care provider. A flushing diary, recording foods, drinks, temperature, stress, and cycle timing, helps reveal your personal pattern over a few weeks.
How we address it
- Coordinate with your dermatologist on topical and prescription options.
- Identify and reduce personal triggers.
- Treat SIBO or H. pylori when present, then restore the gut barrier and microbiome.
- Open drainage pathways and lower toxic burden, beginning with clean, minimal skin products.
- Lower histamine load and calm mast cells where relevant.
- Rebuild the skin barrier with gentle products and daily sun protection.
- Calm autonomic reactivity with breath work, cooling strategies, and vagal tone training.
Your face reflects what happens deeper inside. Calm the deeper system, and the surface often follows.
Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.