If you are one of the nearly 15 million people in the U.S. living with rosacea, you know that it can feel like you’re fighting an uphill battle to determine the causes of your flareups and avoid rosacea triggers. However, sometimes, it may seem like you have nearly constant flareups no matter what you do. It can be frustrating, but here, we’ll walk you through some of the most common triggers. Our goal is to help you become more knowledgeable about the potential causes of your flareups, so you can start making positive changes. It takes time and determination, but almost every patient can take control and significantly decrease their rosacea flare ups.
What is Rosacea?
If you’re newly diagnosed with rosacea, you may not know exactly what it is. It’s a chronic but treatable skin condition that typically affects the center of the face (nose, cheeks, chin, forehead). In the early stages of a flareup, you will notice flushing or red coloring, but without proper intervention from your dermatologist, more serious flareups can occur, causing inflammation, bumps, and/or pustules to develop. This is particularly true of men with rosacea who frequently notice swelling and bumpiness on their noses. In about half of the cases, there is also eye irritation and watering. Most people develop and struggle with rosacea between the ages of 30 and 50, and though anyone can develop rosacea, it’s much more common for people with fair skin. While the majority of those with rosacea are women, cases in men are usually much more serious.
What are the Common Rosacea Causes?
As of yet, not one cause of rosacea has been established. Instead, researchers have noted a number of common biological factors shared by those who struggle with this condition, including:
- Neurovascular dysregulation – certain nerves around blood vessels are chronically irritated causing the face to redden as it would from an insect bite or allergen
- Innate immune system defects – part of the immune system, meant to protect and heal the body, functions improperly leading instead to damage
- Microscopic mites – these mites called Demodex Folliculorum are a common contributor to rosacea symptoms and the mites are found in much larger numbers in those struggling with rosacea
- Genetics – two variants of the human genome may be specifically associated with this disorder
The most common symptoms of rosacea are chronic or sporadic red coloring and skin thickening on the face. Almost all cases of rosacea are centered on the face, but in rare cases, these symptoms may also occur on the neck, chest, scalp, and ears. During diagnostic examinations for this condition, you will likely present with at least two of the following symptoms:
- Redness – of the nose, cheeks, chin, and forehead that looks like a sunburn that doesn’t go away or diminish.
- Rhinophyma –enlargement of the nose due to skin thickening, which may block the airway.
- Skin thickening – in addition to the most common skin thickening on the nose, other areas of skin on the face may also become thicker or scaly in appearance.
- Bumps or pimples – they may be flat, red bumps or pus-filled pimples that look like acne, but they typically burn or sting.
- Telangiectasia – the noticeable appearance of the small blood vessels usually on the cheeks and nasal bridge.
- Eye irritation – may include eyes that are red in appearance, watering eyes, or crusty buildup around the eyes.
- Burning, stinging, and itching – may make facial skin feel tight or hot.
- Edema – generalized swelling of the face may happen, but more often raised red, scaly patches form.
- Dryness – not your typical winter weather dryness, skin may be rough, scaly, or cracked.
Common Rosacea Triggers
According to a National Rosacea Society survey of more than 1,000 rosacea sufferers, the following are the 20 most common triggers for rosacea:
- Sun Exposure – 81% triggered
- Emotional Stress – 79% triggered
- Hot Weather – 75% triggered
- Wind – 57% triggered
- Heavy Exercise – 56% triggered
- Alcohol Consumption – 52% triggered
- Hot Baths – 51% triggered
- Cold weather – 46% triggered
- Spicy Foods – 45% triggered
- Humidity – 44% triggered
- Indoor Heat – 41% triggered
- Skin-Care Products – 41% triggered
- Heated Beverages – 36% triggered
- Certain Cosmetics – 27% triggered
- Medications – 15% triggered
- Medical Conditions – 15% triggered
- Certain Fruits – 15% triggered
- Marinated Meats – 10% triggered
- Certain Vegetables – 9% triggered
- Dairy Products – 8% triggered
Beverages & Foods that Trigger Rosacea
You may have noticed that many of the above common triggers are foods or beverages, and the first step for most people to avoid flareups is developing a rosacea diet. Every person’s triggers are different, but some of the foods that most often lead to triggers include:
- Sour cream
- Cheese (except cottage cheese)
- Soy sauce
- Yeast extract (bread is OK)
- Broad-leaf beans and pods including lima, navy or pea
- Citrus fruits, tomatoes, bananas
- red plums, raisins or figs
- Spicy and thermally hot foods
- Foods high in histamine
- Alcohol, especially red wine
- beer, bourbon, gin, vodka or champagne
- Hot drinks, including hot cider, hot chocolate, coffee or tea
Avoiding these and any other foods and beverages that seem to correspond to your flareups, may be the easiest place to get started making changes to improve your condition.
Skin Care Products that Trigger Rosacea
Almost any skin or hair care products, perfumes, and makeups can cause flareups. For many people with rosacea, this is due to some key ingredients in those products. The ingredients you should look for and avoid in your skin care products include:
- Hydro-alcoholic compounds
- Witch hazel
- Peppermint oil
- Glycolic acid
- Lactic acid
- Sodium laurel sulfate (check shampoos and toothpastes)
In most cases, creams are easier on the skin than lotions and gels, and you should avoid using astringents or toners. Check for the following ingredients that calm the skin to help reduce your risk for flareups:
- Green tea extract
- Argan oil
- Linoleic oils
Weather & Temperature-Related Rosacea Triggers
Your dermatologist will likely recommend you avoid any situation where you would become overheated, including going to the sauna, sitting in hot tubs, taking hot baths, and spending time in any other excessively warm environments. Cold, strong winds, and high humidity levels are also commonly associated with rosacea flareups. Sun exposure is the most common trigger for rosacea flareups, so it’s important that you protect yourself from the sun by wearing coverups and hats, staying in the shade, and choosing a good sunscreen. Before you purchase sunscreen, look for these beneficial ingredients that should be included:
- Zinc and/or titanium dioxide
- Silicone that is often listed as dimethicone, orcyclomethicone, or cyclomethicone
- Broad-spectrum protection of SPF 30 or higher
- Unscented – A label that says no fragrance or fragrance free, so avoid these
Medications & Medical Conditions that Trigger Rosacea
Certain medications and medical conditions can also increase your chances for a flareup. Some medications that are often associated with rosacea flareups include vasodilators and topical steroids. Chronic cough, caffeine withdrawal syndrome, and menopause can all lead to a greater risk for rosacea flareups.
Other Conditions that Trigger Rosacea
Exertion during exercise, lift and load jobs, and other physical activity can trigger rosacea flareups. Extreme emotions, especially stress and anxiety, are also closely linked to an increase in rosacea flareups.
A walk is not likely to lead to a rosacea flareup, but a long run or repeated heavy lifting may. Regular exercise is an important aspect of maintaining good whole-body health, so you should work closely with your dermatologist to create an exercise plan that minimizes rosacea flareups.
Start a Flareup Diary
Many people are frustrated by the lengthy process of identifying their triggers, but it’s worth the effort. One of the easiest ways to determine your triggers is to keep a flareup diary. To identify triggers, you should start by tracking the following factors for one week:
- Weather condition – sunny, windy, cloudy, humid, hot, cold, mild, or dry. Take some basic notes to help you remember the temperature and other weather conditions that may trigger flareups.
- Foods – list what you ate for each meal. Make a special note if you consume any of the foods that are common triggers for rosacea (listed above).
- Activity level – make note of your activities, especially those that are out of the ordinary. Make a special note of common triggering activities (exercise, hot shower/bath, indoor heat on, time outdoors in sunshine, etc.).
- Emotional health – make note of any stress, anxiety or other extreme emotional responses.
- Skin care – list any products used on your face or in your hair.
- Medications – list any medications, both those specifically for rosacea and those for other conditions.
- Rosacea – note the condition of your rosacea. Typically, something as simple as stating no flareup, mild flareup, or severe flareup will suffice.
If you begin to see a correlation in flareups and specific variables, you should cut out the habit, product, food, etc. that you believe may be linked to your flareups. It’s recommended to choose just one possible trigger at a time to cut out for one week. Then, track your rosacea condition for the week to determine whether or not there are positive changes. The whole process can take months or even years to complete, but it’s really the key to managing flareups and accurately identifying your triggers.
When to Visit Your Dermatologist
A dermatologist will partner with you to create a plan to manage your rosacea. They can help you to understand potential triggers, choose the right skin care products, create your rosacea diet, and provide prescription medications when necessary. If you’re not already working with a dermatologist, you should take a few moments to complete our appointment request form to schedule a visit with the U.S. Dermatology Partners location near you.