Rosacea is a chronic inflammatory skin disease characterized by diverse symptoms, including persistent erythema, papules, pustules, telangiectasia, and ocular symptoms. The pathophysiology of rosacea involves an unbalanced immune system predisposed to excessive inflammation, vascular and neuronal alterations, and triggers from cutaneous microorganisms. The gut-skin axis, which describes the bidirectional interaction between skin and gut microbiota, is a key concept in understanding the pathogenesis of inflammatory skin diseases like rosacea. Recent advancements in next-generation sequencing have provided valuable insights into the microbiome, but the characterization of gut and skin microbiota in rosacea patients remains underexplored compared to other inflammatory skin diseases. The clinical course of rosacea is often unpredictable, with frequent flare-ups and sustained symptomatology. Probiotic supplementation has shown potential in improving the clinical evolution of these patients, similar to its effects in other pathologies. This review aims to explore the mechanisms by which the microbiome influences the pathogenesis of rosacea and the potential benefits of modulating the skin and gut microbiota. The gut-skin axis is crucial in understanding the multifactorial origin of rosacea, which includes genetic, lifestyle, and immune system factors. The gut microbiota, influenced by environmental and lifestyle factors, can impact the immune system and skin health. Dysbiosis in the gut can lead to a compromised intestinal mucosal layer, impaired epithelial tight junctions, and increased translocation of bacteria or harmful compounds into the bloodstream. This can result in a hyperresponsiveness of B-cells and impaired T-cell differentiation, potentially contributing to the inflammatory response in the skin. Recent studies have characterized the skin microbiota in rosacea patients using next-generation sequencing techniques. These studies have found that the skin microbiota in rosacea patients may be associated with disease severity, but the exact mechanisms are not fully understood. The presence of certain bacteria, such as *Demodex* mites and *Bacillus oleronius*, has been linked to rosacea, but their role in the disease's pathogenesis is complex and not yet fully elucidated. In conclusion, the gut-skin axis plays a significant role in the pathophysiology of rosacea, and modulating the gut and skin microbiota could be a promising therapeutic approach. Further research is needed to fully understand the mechanisms involved and to develop effective treatments.Rosacea is a chronic inflammatory skin disease characterized by diverse symptoms, including persistent erythema, papules, pustules, telangiectasia, and ocular symptoms. The pathophysiology of rosacea involves an unbalanced immune system predisposed to excessive inflammation, vascular and neuronal alterations, and triggers from cutaneous microorganisms. The gut-skin axis, which describes the bidirectional interaction between skin and gut microbiota, is a key concept in understanding the pathogenesis of inflammatory skin diseases like rosacea. Recent advancements in next-generation sequencing have provided valuable insights into the microbiome, but the characterization of gut and skin microbiota in rosacea patients remains underexplored compared to other inflammatory skin diseases. The clinical course of rosacea is often unpredictable, with frequent flare-ups and sustained symptomatology. Probiotic supplementation has shown potential in improving the clinical evolution of these patients, similar to its effects in other pathologies. This review aims to explore the mechanisms by which the microbiome influences the pathogenesis of rosacea and the potential benefits of modulating the skin and gut microbiota. The gut-skin axis is crucial in understanding the multifactorial origin of rosacea, which includes genetic, lifestyle, and immune system factors. The gut microbiota, influenced by environmental and lifestyle factors, can impact the immune system and skin health. Dysbiosis in the gut can lead to a compromised intestinal mucosal layer, impaired epithelial tight junctions, and increased translocation of bacteria or harmful compounds into the bloodstream. This can result in a hyperresponsiveness of B-cells and impaired T-cell differentiation, potentially contributing to the inflammatory response in the skin. Recent studies have characterized the skin microbiota in rosacea patients using next-generation sequencing techniques. These studies have found that the skin microbiota in rosacea patients may be associated with disease severity, but the exact mechanisms are not fully understood. The presence of certain bacteria, such as *Demodex* mites and *Bacillus oleronius*, has been linked to rosacea, but their role in the disease's pathogenesis is complex and not yet fully elucidated. In conclusion, the gut-skin axis plays a significant role in the pathophysiology of rosacea, and modulating the gut and skin microbiota could be a promising therapeutic approach. Further research is needed to fully understand the mechanisms involved and to develop effective treatments.