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Last Reviewed: May, 2024
By Dr Libby Whittaker, DermNet Medical Writer (2024)
Reviewing dermatologist: Dr Ian Coulson (2024)
Edited by the DermNet content department
Symptom triggers may not be the same for everyone with rosacea, but commonly include:
In a survey of over 1000 patients with rosacea by the National Rosacea Society, the following were identified as the top five triggers:
While the exact reason some people get rosacea in the first place isn’t fully understood, the condition is known to involve:
These are two key mechanisms by which the triggers listed above worsen rosacea symptoms such as facial flushing. The exact ways these mechanisms work is complex and we still don’t understand all the ins and outs of it!
Walls of blood vessels are made up of muscles that can tighten and narrow (vasoconstriction) or loosen and widen (vasodilation). When blood vessels close to the skin widen (vasodilate), it causes redness (flushing), which is particularly evident in people with pale skin. Vasodilation is a way to help you cool down and can be a normal response, for example when it is hot or when you are exercising.
However, in people with rosacea, vasodilation in the face occurs more easily and frequently in response to triggers such as sunlight, warm weather, exercise, and alcohol. Because of this, noticeable facial flushing may occur after even a very short period of exposure to (or small amount of) these triggers.
The other main mechanism linked to rosacea symptoms is inflammation.
Certain microscopic receptors (sensors) on cells in the skin are thought to become more active in response to some rosacea triggers. Dietary triggers are used as an example in the table below.
Trigger |
Receptor activated |
---|---|
Spicy food containing capsaicin (a pepper extract) |
TRPV-1 (full name: transient receptor potential vanilloid-1) |
Cinnamaldehyde (a naturally-occurring substance found in a number of foods including citrus fruits, tomatoes, cinnamon, and chocolate) |
TRPA-1 (full name: transient receptor potential ankyrin-1) |
Increased activation of these receptors leads to a cascade of inflammation-producing (‘pro-inflammatory’) molecules, ultimately resulting in symptoms such as facial pain and skin redness. This is, in part, because inflammation can actually cause vasodilation as well.
One study found that people with rosacea had more TRPV-1 receptors in their skin than people without rosacea. This could explain why your skin may react more strongly to spicy food if you have rosacea.
TRPV-1 is also one of several receptors thought to be triggered by emotional stress in rosacea.
Identifying and avoiding the triggers that worsen your rosacea symptoms can reduce the triggering of these inflammatory pathways, and is a key part of managing this condition.
Keeping a symptom diary to work out what your triggers are may be a helpful step.
A free downloadable symptom diary from the National Rosacea Society is available here.
For more information about rosacea and its treatment, see:
Buddenkotte J, Steinhoff M. Recent advances in understanding and managing rosacea. F1000Res. 2018;7:F1000 Faculty Rev-1885. doi: 10.12688/f1000research.16537.1 Journal
National Rosacea Society. Rosacea Triggers Survey. Available here
Sulk M, Seeliger S, Aubert J, et al. Distribution and Expression of Non-Neuronal Transient Receptor Potential (TRPV) Ion Channels in Rosacea. Journal of Investigative Dermatology. 2012;132(4):1253–1262. doi: 10.1038/jid.2011.424 Journal
Weiss E, Katta R. Diet and rosacea: the role of dietary change in the management of rosacea. Dermatol Pract Concept. 2017;7(4):31–37. doi: 10.5826/dpc.0704a08 Journal
Yang P, Feng J, Luo J, et al. A Critical Role for TRP Channels in the Skin. In: Emir TLR, editor. Neurobiology of TRP Channels. Boca Raton (FL): CRC Press/Taylor & Francis; 2017. Chapter 6. doi: 10.4324/9781315152837-6 Available here
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