One of the most distressing symptoms of rosacea is facial flushing and redness. This often occurs as a “flare-up”, which can be brought on by external influences known as triggers. An important and effective part of rosacea management is to identify and reduce exposure to triggers.
What causes rosacea?
The causes of rosacea are complex and incompletely understood. A combination of factors, including genetics, changes to the immune system and skin and gut organisms leads to redness of the face, skin tenderness and visible facial blood vessels.
A common symptom of rosacea is facial flushing. Blood rushes to the face causing uncomfortable heat and redness of the skin. Sometimes these flare-ups of flushing follow exposure to certain circumstances, activities or foods.
What are rosacea triggers?
Rosacea triggers are things that can bring on an episode of facial flushing and redness. They vary from person to person. Some of the more common triggers affect 75-80% of people with rosacea, but less common triggers may affect less than 10 per-cent.
Why triggers make rosacea worse
Triggers interact with receptors in the walls of blood vessels, which seem to be more sensitive in people with rosacea. When activated, they stimulate increased blow through the blood vessels of the face, causing redness and flushing.
Some triggers such as stress and diet can influence the types of organisms present in the digestive system. This can lead to circulation of inflammatory substances known to make rosacea worse.
Common rosacea triggers
Rosacea can be triggered by a wide range of triggers including environmental, emotional, dietary, and exercise-related. Medical conditions, medications and substances that irritate the skin can also trigger rosacea flare-ups.
According to research conducted by the National Rosacea Society (USA). The most common rosacea triggers are sun exposure, emotional stress and hot weather.
Stress can trigger rosacea
Emotional stress is one of the most common rosacea triggers. Sudden changes in emotion such as laughing, feeling angry, embarrassed or anxious can result in an episode of facial flushing or redness. Long-term emotional stress such as financial, relationship or occupational problems can predispose to flare-ups.
Sunlight
Sun exposure is the most common trigger for rosacea. People with rosacea should be careful to avoid sun exposure on the face by using sunscreen daily, wearing a wide-brimmed hat and staying indoors or in the shade when the UV index is high.
Rosacea food triggers
Multiple foods and drinks have been shown to cause rosacea flare-ups. These can include
Spicy foods
Foods and sauces containing capsaicin (found in chillies, red capsicums) or cinnamaldehyde (found in tomatoes, chocolate, cinnamon and citrus)
Alcohol
Most commonly red wine, beer, gin, vodka, sparkling wines
Dairy
Yoghurt, cream and cheese are relatively uncommon rosacea triggers.
Hot beverages
Drinks and food consumed at a hot temperature, including tea, coffee and hot chocolate
Additional rosacea triggers: medical, environmental, irritant and exercise
Medication and medical conditions
Rosacea is more common during menopause, and in people with a chronic cough.
Medications which can cause rosacea flare-ups include steroid creams and vasodilator medications, which increase blood flow. These medications include drugs used to manage migraines, blood pressure, heart conditions and anxiety.
Vitamin B3 in the form of niacin causes facial flushing even in people without rosacea. (Note that niacin is not the same as nicotinamide,which we sometimes recommend for prevention of skin cancers and solar keratoses.)
Skin care products
In rosacea, many skin products cause irritation and stinging of the skin. Ingredients commonly found in skin care products that can lead to worsening of rosacea include:
- alcohol
- fragrances
- sodium lauryl sulphate (in many shampoos)
Astringents, toners, heavy foundations and waterproof make-up can all lead to rosacea flare-ups.
Skin irritants
Physical irritants to the skin including:
- shaving
- hot water
- touching, rubbing and scratching the skin
Exercise
Exercise raises body temperature and can trigger rosacea.
Weather conditions
Hot weather, wind and cold weather are all known to worsen rosacea.
Heat
Hot environments such as hot baths and showers, saunas, cooking in front of a hot stove, sitting near a heater or open fire.
Recent research has shown that wearing face masks can aggravate rosacea.
Identifying your triggers
Most people with rosacea aren’t affected by all triggers. There's no need to avoid a trigger unless it causes worsening of rosacea symptoms, so it's useeful to work out exactly what triggers affect you.
It can be helpful to keep a “rosacea diary” to record information. Each day for 2-3 weeks, record factors such as:
- Weather conditions: sunny, hot, windy, cold, dry, humid
- Food and drinks: hot/spicy foods, hot drinks, alcohol, fruits and vegetables
- Activities: exercise, hot baths and showers, hot environments
- Emotional state and stress
- Products used on the face
- Medications (oral and topical, including rosacea treatments)
Keep note of rosacea symptoms, number and severity of flare-ups. Relating the rosacea symptoms to the potential triggers can help you identify the main triggers in your case.
Taking daily photos of your face can also provide useful information about how well treatments and avoiding triggers has worked.
Managing your triggers to prevent a flare up
Some measures are recommended for everyone with rosacea:
- Reduce sun exposure
- Establish a skin care routine using products that reduce inflammation and moisturise the skin
Other measures need only be taken if a particular trigger is known to cause or worsen rosacea.
Rosacea is manageable, once you know your triggers
Reducing or eliminating triggers substantially reduces the number of flare-ups.
Research by the National Rosacea Society has shown that:
- Altering the diet is successful in reducing rosacea symptoms in 95 per cent of food-triggered cases
- Stress management techniques reduce flare-ups in 67 per cent of cases
Prescription medications and laser treatments are effective in reducing rosacea symptoms, but managing triggers is the heart of rosacea management which helps control symptoms for most people.
References and recommended resources
- National Rosacea Society (rosacea.org)
- American Academy of Dermatology (https://www.aad.org/public/diseases/rosacea)