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Rosacea triggers: understanding what causes flare-ups
Identifying your own rosacea triggers can help you manage flare-ups without avoiding everything.
Rosacea triggers vary from person to person. Focus on the triggers that clearly worsen your own symptoms; you do not need to avoid every item on a list.
What causes rosacea?
The causes of rosacea are complex and incompletely understood. A combination of factors, including genetics, changes to the immune system and alterations in skin and gut organisms, contributes 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. Flare-ups of flushing often follow exposure to certain circumstances, activities or foods.
What are rosacea triggers?
Rosacea triggers are factors 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, while less common triggers may affect fewer than 10%.
Triggers interact with receptors in the walls of blood vessels, which appear to be more sensitive in people with rosacea. When activated, they increase blood flow through the vessels of the face, causing redness and flushing.
Researchers are investigating links between rosacea, diet and gut organisms. These links do not establish that a particular diet or gut-health product will control rosacea.
Common rosacea triggers
Rosacea can be triggered by a wide range of environmental, emotional and dietary factors. Medical conditions, medications and substances that irritate the skin can also contribute to rosacea flare-ups.
According to research conducted by the National Rosacea Society, the most common rosacea triggers include 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, may also predispose to flare-ups.
Sun exposure
Sun exposure is the most common trigger for rosacea. People with rosacea should protect the face by using sunscreen daily, wearing a wide-brimmed hat and staying indoors or in the shade when the UV index is high.
Food and drink triggers
Certain foods and drinks have been shown to cause rosacea flare-ups. These include:
- Spicy foods: foods and sauces containing capsaicin (such as chillies or red capsicum) or cinnamaldehyde (found in tomatoes, chocolate, cinnamon and citrus).
- Alcohol: particularly red wine, beer and spirits.
- Dairy products: yoghurt, cream and cheese may trigger symptoms in some people.
- Hot beverages: tea, coffee and hot chocolate consumed at high temperatures.
Additional rosacea triggers
Other triggers include medical conditions, medications, environmental factors and substances that irritate the skin.
Medication and medical conditions
Rosacea is more common during menopause and in people with a chronic cough. Certain medications may also trigger rosacea flare-ups, including steroid creams and vasodilator medications used to treat migraines, blood pressure or heart conditions.
Vitamin B3 in the form of niacin can cause facial flushing even in people without rosacea. (Note that niacin is different from nicotinamide, which is sometimes used to help prevent skin cancers and solar keratoses.)
Skin care products
In rosacea, many skin care products can cause irritation and stinging. Ingredients that may worsen rosacea include:
- Alcohol
- Fragrances
- Sodium lauryl sulphate (commonly found in shampoos)
Astringents, toners, heavy foundations and waterproof make-up can also trigger rosacea flare-ups.
Skin irritants
Physical irritants that can worsen rosacea include shaving, hot water and frequent touching, rubbing or scratching of the skin.
Environmental triggers
Exercise, hot weather, wind and cold weather can all trigger rosacea symptoms. Hot environments such as baths, showers, saunas or cooking in front of a hot stove may also worsen flushing.
| Trigger | Suggested management |
|---|---|
Sun exposure |
Stay in the shade or indoors when the UV index is 3 or above. Use a broad-spectrum, low-irritant, fragrance-free sunscreen. (We often recommend a children’s sunscreen.) Wear a broad-brimmed hat and sunglasses to protect the face. |
Stress |
Maintain a healthy diet and regular exercise routine. Find activities that help reduce stress, such as mindfulness or meditation. Good communication and practical steps to reduce ongoing stress may also help reduce flare-ups. |
Food and drinks |
Monitor how different foods and drinks affect your rosacea. Red wine is the most common alcohol trigger. Consider reducing:
Some people also find symptoms worsen with foods such as tomatoes, citrus fruits, chocolate, soy sauce, vinegar or highly processed foods. Eating a balanced diet high in fibre and including fermented foods such as yoghurt, kefir, kimchi or sauerkraut may support gut health. Reducing high glycaemic index foods (such as sugar, white bread, cakes and confectionery) may also help some people. |
Exercise |
Try to keep cool during exercise:
|
Bathing, showering and cleansing |
Use lukewarm rather than hot water for showers or baths. Avoid spas and saunas. Do not rub or scrub the face. Avoid rough towels, sponges or excessive touching of the skin. When shaving, use an electric shaver or a single gentle pass with a sharp razor. |
Skin care products |
Moisturise the skin daily. Avoid products containing:
Use fragrance-free products formulated for sensitive skin. A simple moisturiser with ingredients such as niacinamide or colloidal oatmeal may be helpful if tolerated. Botanical ingredients can also irritate sensitive skin; introduce one product at a time. |
Identifying your triggers
Most people with rosacea are not affected by all triggers. There is no need to avoid a trigger unless it clearly worsens your symptoms. Identifying the triggers that affect you personally is an important part of managing rosacea.
Keeping a “rosacea diary” for two to three weeks can help identify patterns. Each day, record factors such as:
- Weather conditions such as sun, heat, wind, cold or humidity.
- Food and drinks including alcohol, spicy foods, hot drinks and certain fruits or vegetables.
- Activities such as exercise, hot baths or exposure to hot environments.
- Your emotional state and stress levels.
- Skin care products used on the face.
- Medications, including rosacea treatments.
Keeping note of rosacea symptoms, the number of flare-ups and their severity can help link symptoms to possible triggers. Taking daily photographs of the face may also help track improvement with treatment or trigger avoidance.
Managing your triggers to prevent a flare-up
Some measures are recommended for everyone with rosacea:
- Reduce sun exposure and protect the face from ultraviolet radiation.
- Establish a regular skin care routine for rosacea using products that moisturise the skin and reduce inflammation.
Other measures only need to be taken if a particular trigger is known to worsen symptoms.
When trigger management is not enough
Reducing personal triggers can help, but persistent symptoms may also need medical treatment. A skin condition assessment can confirm the diagnosis and guide treatment.
MBBS, MA (Virtual Comm), Grad Cert Hlth Info, Grad Dip Comp Inf Sci
Rosacea assessment and treatment
If trigger management isn't controlling your symptoms, a doctor assessment can confirm the diagnosis and determine whether prescription medications or laser treatment may help.
Find out about our skin condition assessment