ASCP Esty Talk Ep 372 – The Rogue Pharmacist: Rosacea is Not One Condition

Date: January 30, 2026
Host: Maggie Stasik (ASCP Program Director)
Guest: Benjamin Knight Fuchs (Skincare Formulator, Pharmacist)

Episode Overview

This episode challenges the common perception of rosacea as a singular skin disorder. Host Maggie Stasik and pharmacist Ben Fuchs dive into why rosacea is better understood as a collection of systemic, mostly internal, conditions manifesting on the skin. Ben connects the dots between gut health, the immune system, inflammatory triggers, and topical symptoms, advocating for a root-cause rather than a suppressive, symptom-based approach for treating rosacea.

Key Discussion Points & Insights

1. Rosacea Is Not a Localized Skin Condition

• [01:13] Ben debunks the myth that rosacea is a straightforward skin issue.
  • “Where you see the problem, is not where the problem begins.” – Ben Fuchs [01:29]
  • Like many health issues, skin manifestations are typically the "fruit", with roots elsewhere in the body, especially upstream in the digestive tract.

2. Understanding the Visible Symptoms

• [02:32] Ben details the meaning of "rosacea" (rosy, redness) and connects visible redness to inflammation.
  • The four cardinal signs of inflammation (pain, heat, swelling, redness) are explained.
  • “When you have redness, you can pretty much assume that you’re dealing with some kind of immune activity.” – Ben Fuchs [02:41]

3. The Immune and Digestive Connection

• [03:10] “The immune system mostly lives in the digestive tract, in the intestine, specifically.” – Ben Fuchs
  • Many with rosacea notice dietary triggers for flare-ups.
  • Comorbidities such as psychiatric, digestive, and cardiovascular issues often present in those with rosacea, suggesting a broader systemic dysfunction.

4. Demodex Mites Debate

• [04:10] Ben addresses misconceptions about Demodex mites:
  • Demodex mites are part of everyone’s skin microbiome.
  • “If anybody tells you that it’s Demodex mites that are causing rosacea, that’s just pure silliness.” – Ben Fuchs [11:35]

5. Lymphatic and Immune Activity in the Face

• [05:15] Rosacea typically appears in the middle of the face, corresponding to concentrated lymphatic tissue.
  • The lymphatic system transports immune cells and helps clear toxicity, supporting the immune/inflammatory pattern of rosacea.

6. Key Internal Triggers & Gut Health

• [06:15] Common factors implicated in rosacea:
  • Digestive issues (esp. intestinal inflammation)
  • H. pylori infection in the stomach
  • Low stomach acid (achlorhydria)
    • “Low stomach acid is another cause of inflammation and immunity... you need stomach acid for effective processing of food.” – Ben Fuchs [07:12]
  • Leaky gut syndrome
  • Small Intestinal Bacterial Overgrowth (SIBO)

7. Topical vs. Internal Treatments

• [07:50] Ben critiques standard medical approaches (antibiotics, anti-inflammatories).
  • Antibiotics like metronidazole work in part due to anti-inflammatory action, not only by killing bacteria.
  • Suppressing inflammation externally (top-down) is less effective than addressing internal triggers.
  • “Let’s figure out the bad guy. Let’s take care of the initial cause of the protective response, the offending agent.” – Ben Fuchs [08:04]

8. Dietary Interventions and Supplements

• [08:36] Effective dietary and supplement strategies:
  • Eliminate FODMAPs (bacteria-feeding sugars, even in “healthy” foods)
  • Avoid histamine-rich and histamine-inducing foods
  • Avoid fried fats (strongly inflammatory to the gut)
    • “It’s very possible that our collective national addiction to fried foods is behind almost epidemic levels of leaky gut.” – Ben Fuchs [09:30]
  • Support gut barrier with:
    • Collagen peptides
    • Hyaluronic acid
    • Vitamin A
    • Fucoidan
    • Aloe vera
  • Support digestion and stomach acid:
    • Apple cider vinegar
    • Betaine HCl
    • Chewing food thoroughly
  • Focus on repairing leaky gut and hormone balance, especially estrogen in women.

9. The Gut-Skin Axis

• [11:38] “Bottom line is inflammation in the gut is causing inflammation on the skin. That's a secondary response.” – Maggie Stasik
  Ben breaks it down further:
  • Primary: Triggers (usually food) cause gut inflammation.
  • Secondary: Gut inflammation leads to skin inflammation.
  • Tertiary: Visible rosacea symptoms.

10. Topical Strategies for Symptom Management

• [12:22] While root cause must be addressed internally, topical ingredients may help with excess oiliness or breakouts:
  • Salicylic acid or AHAs for sebaceous secretions
  • Topical redness suppressants are less useful; the redness is the body’s coping mechanism
  • Benzoyl peroxide and retinoic acid generally ineffective for lymphatic zone breakouts

Notable Quotes & Memorable Moments

• “Where you see the problem, is not where the problem begins.” – Ben Fuchs [01:29]
• “When you have redness, you can pretty much assume that you’re dealing with some kind of immune activity.” – Ben Fuchs [02:41]
• “The immune system mostly lives in the digestive tract, in the intestine, specifically.” – Ben Fuchs [03:10]
• “If anybody tells you that it’s Demodex mites that are causing rosacea, that’s just pure silliness. Focus on the triggers.” – Ben Fuchs [11:35]
• “Let’s go to the root. Don’t worry about the fruit. Take care of the root, and the fruit will get taken care of.” – Ben Fuchs [10:53]

Key Timestamps

• 01:13 – Rosacea not one condition, but a set of systemic issues
• 02:31 – Inflammation and immune response explained
• 03:10 – Gut-immune-skin connection
• 04:10 – Demodex mites myth
• 05:15 – Lymph and cheek redness
• 06:15 – Digestive/stomach problems and skin outcomes
• 08:36 – Dietary strategies: FODMAPs, fried fats, supplements
• 11:38 – Gut inflammation leads to skin inflammation (summary)
• 12:22 – Topical approaches for oiliness and breakouts

Summary & Takeaways

• Rosacea manifests on the skin but is rooted in internal, primarily digestive and immune system, imbalances.
• Diet, gut integrity, and inflammation are central to rosacea management.
• Treatments that focus only on skin symptoms (topical or antibiotics) fail to address the underlying causes and may just suppress important bodily signals.
• The most effective strategies focus on identifying and removing dietary and bacterial triggers, healing the gut, supporting digestion, and using supplements that protect and repair the digestive lining.
• Topical products offer only modest benefits for excess oil and breakout management, not for the redness or root issues.

For professional skincare practitioners:
This episode encourages a holistic, root-cause approach to rosacea—alerting you to look "upstream" for causes, no matter how topical the complaint may appear, and empowering you with practical dietary and supplement recommendations to relay to clients.