What’s triggering my rosacea?

Common culprits

Symptom triggers may not be the same for everyone with rosacea, but commonly include:

• Activities — exercise, cigarette smoking
• Beverages — alcohol, hot drinks
• Dietary — spicy food, dairy, certain fruits (eg, citrus, tomatoes) or vegetables, processed meats
• Environmental — sunlight, changes in temperature (hot or cold), air pollution
• Stress
• Drugs - potent topical steroids, calcium channel antagonists (blood pressure medication), and high-dose niacinamide and other drugs that can induce flushing.

In a survey of over 1000 patients with rosacea by the National Rosacea Society, the following were identified as the top five triggers:

• Sun exposure (81% of patients)
• Emotional stress (79%)
• Hot weather (75%)
• Wind (57%)
• Heavy exercise (56%).

Why do rosacea triggers cause symptoms?

While the exact reason some people get rosacea in the first place isn’t fully understood, the condition is known to involve:

• Increased blood flow to the skin (through a process called vasodilation)
• Inflammation.

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!

Vasodilation

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.

Inflammation

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.

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.

Trigger avoidance

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:

• Rosacea (overview)
• Rosacea image spotlight