# Rosacea

Category: Conditions

Rosacea is fundamentally a condition of mitochondrial inefficiency and tissue hypoxia, driven by systemic energy failure rather than a primary skin disease. Peat argued that the visible vascular dilation, fibrosis, and hyperplasia characteristic of rosacea result from a…

9 passages · 2 authors · 1987–2026 · Most-cited: [Ray Peat](https://bioenergeticoracle.com/md/voices/ray-peat/index.md)

Canonical page: https://bioenergeticoracle.com/concepts/rosacea

## Synthesis

**Rosacea** is fundamentally a condition of *mitochondrial inefficiency* and tissue hypoxia, driven by systemic energy failure rather than a primary skin disease. [Source 1, 2] Peat argued that the visible vascular dilation, fibrosis, and hyperplasia characteristic of rosacea result from a mismatch between energy supply and energy demand in the affected tissues, causing cells to secrete signals like adenosine and lactic acid that trigger vasodilation and angioneogenesis. [Source 2] The proliferation of blood vessels is a compensatory attempt to deliver more oxygen to energy-depleted cells, but this becomes a vicious cycle as the thickened, fibrotic tissue further impedes oxygen delivery. [Source 7, 9]

The central nutritional deficiency Peat identified was **riboflavin (vitamin B2)**, an essential component of mitochondrial respiratory enzymes that is extremely sensitive to destruction by blue and ultraviolet light. [Source 2] He documented a striking case of a man whose bright red nose, cheeks, and halting speech resolved within hours of intravenous B-vitamin injections, only to return fully over a weekend without them; a decade later, he had developed **rhinophyma** and required heart valve replacement. [Source 3, 6] Peat emphasized that once mitochondrial damage occurs from riboflavin deficiency, the tissues may require *more than the normal amount of the vitamin* to function properly, and that the enlarged, invasive blood vessels will not necessarily regress even with prolonged supplementation. [Source 3, 7] He also noted that vitamin K and coenzyme Q10 interact closely with riboflavin in regulating mitochondrial metabolism, and that other B vitamins are affected when riboflavin's actions are disturbed. [Source 2]

Beyond riboflavin, Peat implicated several systemic factors. **Bacterial endotoxin** (lipopolysaccharides) absorbed from the intestine acts as a ubiquitous source of inappropriate excitation and energy depletion, and intestinal stimulation to speed transit has been observed to immediately relieve rosacea symptoms. [Source 2, 4] He rejected the notion that cathelicidin or other defensive proteins are the cause, likening that reasoning to saying *pus is the cause of boils*; rather, nutritional deficiencies lead to excessive exposure to endotoxin and nitric oxide, which drive the vascular leakiness, angiogenesis, and fibroblast stimulation. [Source 4] Estrogen excess was also identified as a likely hormonal contributor, particularly given the higher incidence in women aged 30 to 50, a period when estrogen levels are often pathologically elevated rather than declining as commonly believed. [Source 1, 2]

Peat distinguished between therapeutic agents that address the underlying energy defect and those that merely suppress symptoms. **Niacinamide** (not nicotinic acid, which releases histamine and serotonin) was among the anti-inflammatory nutrients he recommended, alongside riboflavin and glycine. [Source 4, 5] Caffeine, by increasing cellular energy efficiency and opposing adenosine, can inhibit the vasodilation, angioneogenesis, and fibrosis central to rosacea progression. [Source 2] He noted that antibiotics like tetracycline, while historically used for presumed infection, actually help through their *anti-inflammatory actions* rather than germicidal effects. [Source 1] Danny Roddy has observed that many individuals have found antibiotics useful for learning more about their condition, mentioning tetracyclines, macrolides, and penicillins as options discussed with Peat. [Source 8] Peat also reported that delicate red blood vessels and varicose veins could disappear completely after using **thyroid** and oral **DHEA**, indicating that restoring systemic energy metabolism can reverse vascular tone loss. [Source 7]

## People also ask

### How does riboflavin deficiency contribute to rosacea?

Peat argued that riboflavin is essential for mitochondrial respiratory enzymes and is easily destroyed by light; its deficiency causes mitochondrial inefficiency and tissue hypoxia, which trigger the vasodilation and blood vessel proliferation seen in rosacea.

### Why might antibiotics help rosacea if it is not an infection?

The corpus describes that antibiotics like tetracycline assist through their anti-inflammatory actions rather than germicidal effects, helping to reduce the vascular leakiness and fibrosis driven by endotoxin and nitric oxide.

### What role do thyroid and DHEA play in reversing rosacea symptoms?

Peat reported that using thyroid and oral DHEA could make delicate red blood vessels and varicose veins disappear completely, indicating that restoring systemic energy metabolism can reverse the loss of vascular tone.

## Related concepts

- [Acne](https://bioenergeticoracle.com/md/concepts/acne/index.md)
- [Caffeine](https://bioenergeticoracle.com/md/concepts/caffeine/index.md)
- [Diabetes](https://bioenergeticoracle.com/md/concepts/diabetes/index.md)
- [Fish Oil](https://bioenergeticoracle.com/md/concepts/fish-oil/index.md)
- [Fructose](https://bioenergeticoracle.com/md/concepts/fructose/index.md)
- [Glucose](https://bioenergeticoracle.com/md/concepts/glucose/index.md)

## Cited passages

Passage numbers match the `[Source N]` markers in the synthesis above.

### Source 1 — Rosacea, inflammation, and aging: The inefficiency of stress

Ray Peat · Article · 2013 · https://raypeat.com/articles/articles/rosacea-inflammation-aging.shtml

> # Rosacea, inflammation, and aging: The inefficiency of stress
>
> Rosacea, or acne rosacea, has been defined as "vascular and follicular dilation involving the nose and contiguous portions of the cheeks . . ." that may involve persistent erythema with hyperplasia of sebaceous glands.
>
> Stedman's Medical Dictionary 23rd edition.
>
> Light-skinned people, especially women between the ages of 30 and 50, sometimes develop a persistent redness of their cheeks and nose. It may begin as a tendency to flush excessively, but the blood vessels can become chronically dilated. Similar processes occur in dark-skinned people less frequently.
>
> The eyes are sometimes involved, with redness of the exposed areas (conjuctival hyperemia). New blood vessels develop in the area, and the flow of blood through the affected tissue is greatly increased. The tissues become thickened and fibrotic, with the multiplication of fibroblasts and the increased deposition of collagen.
>
> The cornea normally receives its oxygen from the air, and its nutrients from the aqueous humor. As rosacea of the eye develops, the blood vessels surrounding the cornea become increasingly visible, and, especially on the inner (nasal) side of the eye, the vessels tend to enlarge and become tortuous. Rhinophyma, or potato nose, has been described as a late development of rosacea.
>
> Too often, the medical reaction is to give the condition a name, and to distinguish its variants as if they were different problems, and then to use the most direct means to eliminate the problem they have defined.
>
> A typical attitude is that "Rosacea is an enigmatic disease with multiple exacerbations and remissions, and, unfortunately, treatment is directed toward symptomatic control rather than cure" (Randleman).
>
> Lasers or other radiation, caustic chemical abrasion, surgical planing and dermal shaves, and other forms of surgery may be used to destroy the superficial blood vessels, and to reduce the enlarged nose or other irregularities. A few decades ago, when rosacea was believed to be the result of a local infection, antibiotics were used to treat it, and some of them, including tetracycline, helped. It was discovered that some antibiotics have anti-inflammatory actions, apart from their germicidal effects, and now it is very common to prescribe the chronic use of tetracycline to suppress symptoms.

### Source 2 — Rosacea, inflammation, and aging: The inefficiency of stress

Ray Peat · Article · 2013 · https://raypeat.com/articles/articles/rosacea-inflammation-aging.shtml

> The excess excitation that produces nitric oxide and lactic acid lowers the energy production of vascular cells, possibly enough to lower their contractile ability (Geng, et al., 1992), causing vasodilation. When flushing is caused by a mismatch between energy supply and energy demand, caffeine can decrease the vasodilation (Eikvar & Kirkebøen, 1998), but when vasodilation is caused more physiologically by carbon dioxide, caffeine doesn't have that effect (Meno, et al., 2005). In a study in which drinking hot water or coffee was compared with drinking room-temperature coffee or caffeine, it was found that the hot liquids caused flushing, but cool coffee and caffeine didn't.
>
> Caffeine increases cells' energy efficiency, and by opposing the effects of adenosine (secreted by cells that are stressed and energy-depleted), it can inhibit vasodilation, angioneogenesis (Merighi, et al., 2007; Ryzhov, et al., 2007), and fibrosis (Chan, et al., 2006).
>
> One nearly ubiquitous source of inappropriate excitation and energy depletion is the endotoxin, bacterial lipopolysaccharides absorbed from the intestine (Wang and White, 1999). That this ubiquitous toxin has a role in rosacea is suggested by the observation that intestinal stimulation, to speed transit through the bowel, immediately relieved symptoms (Kendall, 2002). Increased cortisol (Simon, et al., 1998) and sepsis (Levy, 2007) interfere with mitochondrial energy production.
>
> Simple nervous blushing or flushing is usually considered harmless, and when a person is overheated, the reddening of the skin has the function of facilitating heat loss, to restore a normal temperature. But even nerve-regulated flushing can involve a distinct interference with mitochondrial respiration, and can stimulate the overgrowth of blood vessels.
>
> Cancer's respiratory defect that Warburg identified, fermentation with lactic acid production even in the presence of adequate oxygen, was the result of some kind of injury to the mitochondria. He showed that one of the injuries that could produce aerobic glycolysis was a deficiency of riboflavin. He observed that tumors generally were anoxic, and that cancers typically appeared in the midst of tissue that was atrophying, and suggested that the cancer cells' survival was favored by their ability to live without oxygen.

### Source 3 — Rosacea, inflammation, and aging: The inefficiency of stress

Ray Peat · Article · 2013 · https://raypeat.com/articles/articles/rosacea-inflammation-aging.shtml

> A 37 year old slightly alcoholic man with a bright red nose and cheeks was an amateur fiction writer, but he was having trouble with his memory for words, and for everyday events. Even conversationally, he had to struggle for relatively familiar words. On the suggestion that riboflavin might help his memory, by allowing his brain cells to use oxygen more efficiently, he had his doctor give him an intravenous injection of B vitamins. When I saw him the next day, his conversation was perfectly fluent, and he obviously had easy access to a good vocabulary. Just as noticeable was the normal color of his nose and cheeks. For a week, he had a daily injection of the B vitamins, and his nose color and vocabulary stayed normal. But on the weekend, after not having the shots for two days, his nose and cheeks were again maraschino cherry red, and his speech was halting, as he struggled for words. He forgot the whole episode, and neglected to return to the doctor for more of the vitamin injections. Ten years later, he had developed a medium-sized potato nose, and had his heart valves replaced.
>
> His vitamin requirements were apparently abnormally high. At first, the problems resulting from damaged mitochondria seem mostly functional (flushing, mood, memory problems, etc.) and variable, but chronically disturbed functions lead to structural, anatomical changes, as prolonged stimulation alters tissue maintenance and growth.
>
> Abram Hoffer, who had been treating schizophrenia and senile dementia with niacin, accidentally discovered that it cured his bleeding gums. That led to its use to treat heart disease.
>
> The "orthomolecular" ideas of Hoffer and Linus Pauling were developed in a context of biochemistry governed by genetics, molecular biology, in which the goal was to provide a chemical that was lacking because of a genetic defect in metabolism. Their idea of using nutrients as drugs has led to many unphysiological practices, in which an isolated nutrient is supposed to have a drug-like action, and if in isolation it doesn't act like a drug, then it should be used only according to the normal genetically determined nutritional requirement.
>
> But in reality, nutritional requirements are strongly influenced by history and present circumstances. For example, when corneal mitochondria have been damaged by riboflavin deficiency, they have been found to subsequently require more than the normal amount of the vitamin to function properly.

### Source 4 — Dr Ray Peat On Causes Of Rosacea

Ray Peat · Email · Aug 8, 2007 · https://lowtoxinforum.com/threads/dr-ray-peat-on-causes-of-rosacea.25518/

> **Ray Peat:** Things that cause inflammation, such as bacterial endotoxin, stimulate the defensive formation of proteases and cathelicidin, so it doesn't seem productive to say that "too much" of those defensive proteins is the cause of rosacea. Isn't it a little like saying that pus is the cause of boils? Nutritional deficiencies lead to excessive exposure to endotoxin and nitric oxide, and the associated factors that cause vascular leakiness, vasodilation, angiogenesis, stimulation of fibroblast growth and collagen production. Medical people who are willing to talk about the antiinflammatory action of antibiotics seem to be unaware of the antiinflammatory effects of many simple essential nutrients, such as niacinamide, riboflavin, and glycine, or of the natural antiinflammatory hormones that are consistently deficient in the inflammatory-"autoimmune" diseases. [references]

### Source 5 — One Radio Network: Health & Diet

Ray Peat · Interview · Dec 4, 2013 · http://l-i-g-h-t.com/files/one-radio-network-patrick-timpone-dr-peat-answers-questions-regarding-health-diet-and-nutrition-part-1.mp4

> **Caller:** Talk about using the far infra-red sauna and niacin for Rosacea?
>
> **Ray Peat:** Niacin sometimes refers to Nicotinic acid, and this happens to increase your histamine, serotonin and prostaglandins, so I don’t think it’s good for anyone to take Nicotinic Acid. And Niacinimide is a form of that same vitamin which is active in cells and doesn’t re;ease those inflammatory processes.
>
> **Caller:** natural ways to reverse high Prolactin levels Sometimes Progesterone does, but Thyroid is the basic thing, Tryptophan and Serotonin happen to turn on a trigger that increases Prolactin and TSH, they tend to go together. If your Thyroid doesn’t respond adequately to the Rising TSH, it isn’t able to lower the Prolactin, a supplement of Thyroid is sometimes needed, without that sometimes increasing the salt in your diet or using B6 supplement can sometimes correct the Prolactin, B6 is involved in correcting the Serotonin/Tryptophan metabolism, so it doesn’t cause the inflammation, so it doesn’t cuse the high Prolactin

### Source 6 — Rosacea, Rhynophyma, Pterygium & Riboflavin — & Varicose Veins

Ray Peat · Newsletter · Jul 1987

> # Rosacea, Rhynophyma, Pterygium & Riboflavin—& Varicose Veins
>
> newsletter
>
> Townsend Letter for Doctors
>
> July, 1987
>
> Several times lately I have heard that the cause of rosacea is unknown; for example, in Dr Donohue's newspaper column, he wrote that we don't know the precise cause, but then said that hot beverages and spicy foods can contribute to such enlargement; so does alcohol. For many years I have assumed that the cause was known to anyone who cared to know, so I think it might be useful to describe some case histories, and some processes that relate to the cause.
>
> In 1964 a somewhat alcoholic neighbor of mine was interested in improving his memory, since he had trouble finding the words he wanted when speaking or writing. His nose was remarkably red, but at the age of 41 or 42 it was not noticeably enlarged. I suggested many times that riboflavin might help, since I inferred from his very vascularized nose that his tissues were experiencing relative hypoxia, and that his brain tissue might be suffering even more than his nose, since such extensive new growth of blood vessels would seem less likely throughout the brain. For several weeks, he kept coming back asking me to remind him what it was that I had suggested; I started giving him notes, but he mislaid them. Finally he retained one of the notes long enough to ask his doctor to give him some vitamins, and the doctor prescribed daily injections of the vitamin B complex. I saw him in the afternoon a few hours after his first injection, and was surprised to see that his nose was no longer red; he spoke fluently and quickly, and did not have to search for words. Each day that week he returned for more injections, and both his nose and his memory stayed healthy. However, over the weekend, when the doctor's office was closed, both problems returned in full: his nose was as red (and shiny) as ever, and he struggled for some word in almost every sentence. By Monday it seemed that he had forgotten the whole episode, and didn't return for more injections.
>
> I moved away around that time, and didn't see him again until 1976. At that time, his nose didn't seem particularly red, but it had enlarged and become very lumpy—a potato nose, or rhynophyma.

### Source 7 — Rosacea, Rhynophyma, Pterygium & Riboflavin — & Varicose Veins

Ray Peat · Newsletter · Jul 1987

> In her case, it seemed that the contact lenses, shutting off direct contact with the air, had led to an invasive growth of blood vessels to the edge of the cornea, probably partly because of a riboflavin deficiency.
>
> I think this would be called a pterygium, but I think the same kind of process would be called rosacea if it occurred on the nose or cheeks. Oxygen deficiency causes connective tissue cells to produce extra collagen. This would intensify the problem of delivering oxygen to the cells, tending to set up a vicious circle. Even normal levels of riboflavin and other nutrients and oxygen in the blood wouldn't be enough to allow the necessary amount to reach the cells, once the lumpy fibrous overgrowth had begun to develop.
>
> I gave the woman and her son each 10 of riboflavin one morning, and suggested using that amount for a few weeks. The boy's nose didn't bleed that day or in the night, and as far as I know, it never bled again. He stopped having his fits of rage. Several years later his mother became chronically insane; I believe her heavy smoking, a poor diet, and an increasing hormone imbalance, were probably causing an increasingly severe energy deficiency in her brain. In that organ, as in the heart and lungs, androgenic steroids and other anti-glucocorticoids such as progesterone, are probably responsible for a normal resistance to atrophy during starvation. However, girls suffering from anorexia nervosa do sometimes have demonstrable shrinkage of the brain (which can be reversed by good nutrition) showing that the brain is not absolutely protected from catabolism, especially when the steroid hormones are out of balance.
>
> The brain seems to be extremely resistant to the overproduction of fibrous tissue, unlike the exposed tissues of the eye and nose. There are some degenerative brain diseases, though, in which the supportive glial cells are overproduced. This may represent a basic stress-reaction, not so different from that which occurs in potato-nose and pterygium.
>
> Although I have seen nearly instantaneous effects of a small dose of riboflavin, I want to emphasize that the enlarged and invasive blood vessels caused by a deficiency of that vitamin will not necessarily go away even with prolonged supplementation with riboflavin.

### Source 8 — Bioenergetic Helpline #11: Honey Diet, Dr. Wilson's T3 Protocol, Coffee, Benefits of Estrogen?

Danny Roddy · Interview · Feb 9, 2026 · https://www.youtube.com/watch?v=fDcloWkYJ5I

> **Caller:** okay thank you i i appreciate it and i didn't think about that i put he did go under the red light too but i didn't realize i have magnesium as well so thank you i appreciate it okay thank you jasper what's up uh it's my first time attending thanks for having me of course i just wanted to know your thoughts on el rura the the lacto simo bacillus strain i think you or pete mentioned it
>
> **Danny Roddy:** I tried it a long time ago, maybe when I was in the paleo carnivore phase and I don't remember anything negative about it. And yeah, a few people have asked me about it, but I haven't looked into it for such a long period of time. I don't have anything that's especially articulate to say about it, but I don't, as far as I know, it's not dangerous.
>
> **Caller:** Yeah. I've been using, I've been making some like a yogurt maker and it seems really helpful.
>
> **Danny Roddy:** Nice.
>
> **Caller:** And I just wanted to add, because some woman was mentioning. vegetable glycerin and i saw i don't know if you know hans amato on twitter but in his recipe he adds vegetable glycerin because it can make rudarin in the in the ferment which is an antibiotic so it seems pretty helpful Oh, interesting. No, I didn't know that. Yeah, it seems to be working for me. But I wanted to ask you about persistent rosacea. I've had it since a young age, and I guess it's from overgrowth, maybe in the colon. So I'd like to experiment with one of the tetracyclines. So do you have any advice on that?

### Source 9 — Rosacea, Rhynophyma, Pterygium & Riboflavin — & Varicose Veins

Ray Peat · Newsletter · Jul 1987

> I moved away around that time, and didn't see him again until 1976. At that time, his nose didn't seem particularly red, but it had enlarged and become very lumpy—a potato nose, or rhynophyma. (Rhynophyma is considered to be an advanced, hyperplastic form of rosacea.) He had undergone surgery for defective heart valves, but seemed to be in good health except for occasional nosebleeds. (He died in 1985.)
>
> Before learning that he had nosebleeds, it had occurred to me that bloodshot eyes and a red nose probably have internal equivalents, which might be revealed as nosebleeds in some individuals, and as strokes in others. I knew a woman whose four year-old son had very frequent nose-bleeds that usually occurred around one or two AM during sleep, or during daytime naps. He also had frequent violent rages, that seemed to happen after he had eaten certain foods, usually cookies or cake. I reasoned that a riboflavin deficiency would waste glucose by blocking mitochondrial respiration, and that blood vessels would dilate to deliver more blood to the tissues. Since blood sugar falls at night, I thought this could account for the regularity of his night-time nosebleeds. His frequent angry behavior seemed to be an exaggeration of the normal irritability of hungry children. His mother had some distinct mental problems, which had included a classical postpartum psychosis. She wore contact lenses, and I noticed that she had chronically visible blood vessels in her eyes, mainly on the side toward her nose. The area was yellowed, and lumpy. Close inspection suggested that the vessels had become increasingly enlarged, numerous and tortuous, until the surface of the eye was distorted by the excess of blood vessels.
>
> The cornea normally has a high concentration of riboflavin, but it is very susceptible to a deficiency of that vitamin. It receives its oxygen largely directly from the air, and partly from the ring of blood vessels at its edge, which are supplied by vessels approaching from the two sides. In her case, it seemed that the contact lenses, shutting off direct contact with the air, had led to an invasive growth of blood vessels to the edge of the cornea, probably partly because of a riboflavin deficiency.

_Generated 2026-07-20 from the Bioenergetic Oracle corpus._