The Role of the Gut Microbiome in Rosacea
The microbes living within our gut don’t just help us to digest food, they also influence the way our immune system functions, our metabolism, and even the health of our skin. When the gut microbiome is balanced, this helps to keep inflammation under control. But when it becomes disrupted, this can set off a cascade of immune and inflammatory responses that affect all areas of the body, including the skin. Disruptions in the gut microbiome may play a role in triggering rosacea. Notably, studies have found higher rates of gut disorders such as small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome, and even Helicobacter pylori infections in people with rosacea.,, These associations suggest that an imbalanced gut may set the stage for skin inflammation, either by increasing systemic inflammation or by altering how the immune system responds to environmental triggers.
Gut Dysbiosis: How Imbalance May Drive Flare-Ups

Personalized Treatment Strategies for Rosacea
As there will always be considerable variability in gut microbiome composition and specific disease triggers between patients, a one-size-fits-all approach to rosacea treatment is often insufficient. With personalized treatment approaches, the aim is to figure out what imbalances are driving symptoms in each patient, so that interventions such as diet changes, lifestyle tweaks like reducing stress or alcohol intake, or probiotics, can be tailored for the best results. Evidence is growing that modulating the gut microbiome can make a real difference. For example, in a clinical trial, patients with papular-pustular rosacea who took E. coli Nissle alongside a vegetarian diet and standard topical therapy saw significant improvement in their symptoms, compared to those who received diet and topicals alone. Improvements included better skin, normalized stools, and a shift towards protective gut bacteria. Supporting this approach, a recent mouse study tested two probiotic strains, Ligilactobacillus salivarius 23-006 and Lacticaseibacillus paracasei 23-008, for their effects on rosacea-like skin inflammation. The combination of these strains reduced skin lesions and inflammation, improved gut microbiota balance, and strengthened the intestinal barrier. These findings highlight how targeting the gut microbiome could be a practical strategy to manage rosacea.How Enbiosis Supports Microbiome Balance

References:
• National Rosacea Society. (2024, May 23). New study estimates rosacea’s worldwide prevalence. Rosacea.org. Retrieved September 2, 2025, from https://www.rosacea.org/blog/2024/may/new-study-estimates-rosaceas-worldwide-prevalence
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• Drago, F., et al. (2016). The role of small intestinal bacterial overgrowth in rosacea: A 3-year follow-up. Journal of the American Academy of Dermatology, 75(3), e113–e115.
• Wang, F. Y., & Chi, C. C. (2021). Rosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut-Skin Axis of Rosacea. Advances in Therapy, 38(3), 1415–1424.
• Guertler, A., Hering, P., Pacífico, C., Gasche, N., Sladek, B., Irimi, M., French, L. E., M., B., & Reinholz, M. (2024). Characteristics of Gut Microbiota in Rosacea Patients—A Cross-Sectional, Controlled Pilot Study. Life, 14(5), 585.
• Li, J., Yang, F., Liu, Y., & Jiang, X. (2024). Causal relationship between gut microbiota and rosacea: A two-sample Mendelian randomization study. Frontiers in Medicine, 11, Article 1322685.
• Qi, X., Xiao, Y., Zhang, X., Zhu, Z., Zhang, H., Wei, J., Zhao, Z., Li, J., & Chen, T. (2024). Probiotics suppress LL37 generated rosacea-like skin inflammation by modulating the TLR2/MyD88/NF-κB signaling pathway. Food & Function, 15(17), 8916–8934.