An essential part of rosacea management includes understanding what causes rosacea and what triggers rosacea flare ups. As we continue our Rosacea Awareness Month series, we’re arming you with the knowledge you need to understand how the environment, medical conditions, stress, and genetics can trip the rosacea switch. (And no, we aren’t ignoring diet, we are dedicating an entire blog to the prominent role diet plays in rosacea.) Hold on – This is going to be a bumpy (but informative) ride!

What Causes Rosacea
What is rosacea caused by? Unfortunately, the exact cause of rosacea is unknown. There is an ongoing debate over whether rosacea triggers actually cause rosacea. While some sources indicate it can even occur without triggers, research has proven that many factors are involved in the development of rosacea. Some rosacea sufferers report that elimination or avoidance of triggers alleviates their symptoms, while others cite that doing so did not benefit them or prevent their rosacea from progressing. Here are the possible suspects for what causes rosacea flare ups theorized by scientists to help you manage your complexion:

Mites: Rosacea sufferers have higher than normal levels of a microscopic skin mite that erodes the skin surface and penetrates into the dermis, causing inflammation. Bacteria (bacillus oleronious) in the mite’s feces produce antigenic proteins that are likely responsible for what causes rosacea bumps, pimples (papules, pustules), and eye involvement  (ocular rosacea).The debate over whether the presence of the mite leads to the rosacea condition or if having rosacea creates an environment in which the mite thrives continues.

Sun & Environment: Cumulative sun overexposure and repeated sunburns play a major role in rosacea development and aggravation. The National Rosacea Society found that sun exposure was the biggest culprit for what triggers rosacea on the face. Here’s the how and why behind this trigger:

1.) Heat from the sun causes capillaries to dilate.

2.) UV rays damage the dermis (skin layer beneath the epidermis), which causes disorganization, Elastin and Collagen breakdown, and increased sugars (glycosaminoglycans) in the skin. As a result, capillary walls lose the ability to “bounce back,” contributing to permanent dilation - a key rosacea symptom. In addition, lymphatic drainage suffers, leading to swelling, inflammation, possibly papules, and the development of more blood vessels (angiogenesis).

3.) UV radiation easily penetrates to deeper layers in light-skinned individuals, inducing VEGF (vascular endothelial growth factor) production, which is linked with dilated blood vessels or capillaries and may increase interleukin 8, which plays a role in inflammation, a key rosacea trigger. This ties into the genetic link of rosacea that those of Northern European or Celtic descent are more prone to rosacea.

Heat: Heat from weather, hot beverages (and soup!), or washing with hot water are prominent factors for what causes rosacea flushing and capillary dilation, which are common rosacea symptoms.

Harsh Weather: Abrupt temperature changes such as extremes of heat or cold cause blood vessels (capillaries) to dilate and contract, which can lead to permanently dilated blood vessels, a central element of what causes rosacea on cheeks. According to the National Rosacea Society, hot weather is the third biggest factor in triggering rosacea. People living in geographic climates with sweltering summers and frigid winters who move from hot to cold frequently exhibit the telltale visible blood vessels of rosacea. Wind is another rosacea trigger.  Keeping an adequate barrier between the skin and the environment is crucial for minimizing this response and helping prevent chapped, reddish cheeks.

Stress: Stress and stress-related conditions like anxiety can trigger reactions in the body, which bring about rosacea symptoms and flare-ups. According to the National Rosacea Society, stress is the second biggest factor in triggering rosacea. Incidentally, rosacea flare-ups in and of themselves may impact mental wellness, with embarrassment or self-esteem issues over having a “ruddy” appearance causing even more stress and triggering more rosacea symptoms. How stress triggers rosacea:

1.) It activates the fight or flight system and the accompanying surge in stress hormones like adrenaline, cortisol, and testosterone.

2.) Stress hormones are acidic and can cause facial flushing or blushing rosacea symptoms.  They also increase oil production, which creates an environment that the demodex folliculorum mite loves (oil is food for the mite).

3.) Long-term, repeated stress affects the circulatory, nervous, and immune systems plus it elevates inflammation. Overproduction of cortisol, an adrenal steroid hormone that normally buffers stress, can break down proteins and dampen the immune system, contributing to an inflammatory response.

4.) People tend to hold their breath when stressed, which increases blood acidity, believed to be a big rosacea trigger (or cause). One more reason to breathe deeply!  For example, when you hold your breath, your face turns red due to carbon dioxide build-up and oxygen shortage.

5.) Stress can also lead to behaviors like drinking, poor eating habits, and inadequate rest, which beget rosacea. Limiting stressors and engaging in de-stressing activities or techniques will help slow oil production and balance the blood pH, improving the rosacea and well-being. Relaxation techniques like deep breathing, meditation, walking, going to a spa, journaling, or counseling can foster skin-calming peace, harmony, or tranquility. Unfortunately, hot baths, hot tubs, or a glass of wine are not ideal solutions for rosacea sufferers due to the flushing that heat and alcohol induce.

Vascular Disorders & Dysfunctions: Rosacea is a microcirculation disorder, including minor vascular anatomical disorders such as problems with the blood vessel valves and the cooling system. This causes a backflow of blood, accumulation of fluid, and stagnation. Scientists believe that blood vessels in rosacea sufferers become damaged and permanently dilated when repeatedly dilated by certain stimuli as follows:

1.) A faulty, overactive heat exchange system of the brain in rosacea sufferers contributes to increased blood flow to the head. It acts like a chronic fever, preventing cool venous blood from circulating to the brain and promoting flushing.

2.) Permanent vasodilation, inflammation, and blood stagnation result, causing the redness associated with rosacea.

Medical Conditions: Rosacea can be a symptom of several medical conditions that promote flushing and rosacea flares. What they include:

1.) Gastrointestinal Disorders: This includes dyspepsia, gastritis, and helicobacter pylori infection. The latter is an ulcer-related agent that synthesizes gastrin in the stomach, which has been linked to promoting flushing - a key symptom of rosacea.

2.) A recent study found an overgrowth of small intestinal bacteria in rosacea sufferers, which may indicate this as a key role in causing rosacea. A hydrogen or methane breath test can determine if this is the cause and can be cleared up with a 10-day course of antibiotics. Reducing carbohydrate intake is also beneficial as it reduces the “fuel” required for bacterial fermentation and the intestinal bacteria population.

3.) Inflammatory gastrointestinal tract disorders like ulcerative colitis, Crohn’s disease, diarrhea, and constipation have also been linked with rosacea.

4.) Metabolic acidosis disorder may also have a connection with rosacea.

5.) Hormone imbalances resulting from endocrine disorders or regular hormonal changes (pregnancy, monthly menstrual cycle, and menopause) are largely responsible for what triggers rosacea flares in women since they normally help determine how skin functions.

Estrogens have anti-inflammatory properties, so fluctuations can cause swelling and inflammation, aggravating rosacea. Menopausal hot flashes trigger the flushing, redness, and/or blotchiness rosacea symptoms, while the increased DHEA and Testosterone lead to more oil production believed to trigger rosacea bumps and pimples often mistaken for adult acne. Women with PCOS (Polycystic Ovary Syndrome) may also exhibit rosacea symptoms.

1.) Liver disease, which has several causes, such as alcohol abuse and consumption of certain prescription medications (i.e., long-term antibiotic use), is found to trigger rosacea. Some reports show that improving liver function (and the immune system) reduces inflammation and thus, signs of rosacea.

2.) Additional medical conditions linked with rosacea include chronic cough, caffeine withdrawal syndrome, and possibly lesions on the hypothalamus gland.

Topical irritants, medications & skin treatments:Skin treatments such as microdermabrasion, chemical peels, prescription steroids, or vitamin a (isotretinoin and tretinoin) are believed to aggravate rosacea, triggering flushing and flares. While steroids may help initially, they may trigger a flare over time. Nitroglycerine (and derivatives) and steroids (oral and nasal) may cause flushing.

Strenuous Exercise: Overdoing workouts causes a buildup of lactic acid, which is burned muscle and fat tissue, which is acidic and causes the face to flush, triggering rosacea.  Work that involves heavy lifting will also induce rosacea.

Obesity: Keep moving your body and avoid foods and ingredients linked to obesity, as being overweight has been linked with raised inflammation markers and rosacea symptoms.

Free Radical Damage: Also known as Oxidative stress, this damage is due to a build-up of ROS (Reactive Oxygen Species) believed to damage skin and capillaries, contributing to rosacea symptoms.

Inflammation & Overactive Immune System: The immune system protects us from the environment by releasing anti-inflammatories and anti-microbial peptides. Studies show that rosacea patients have elevated levels of inflammatory proteins, which create an abnormal peptide and the release of vasoactive substances believed to promote inflammation, stagnation, and congestion symptoms of rosacea. Antibiotics can inhibit the enzyme involved in this process. Overall, problems with the immune system and inflammation appear to be a prime source for rosacea, leading many to believe that rosacea could be a whole-body disease.

Aging: What causes rosacea later in life to become more pronounced? The breakdown of structural collagen and elastin proteins that support the deeper skin layers (dermal matrix) weakens the capillary walls, causing permanent dilation and the visible blood vessels associated with rosacea.This leads to less nutritional exchange, which creates a progressive snowball effect.

Ayurvedic Medicine: In Ayurveda, rosacea is believed to be due to excess “pitta,” a fire-like energy that regulates body temperature, hormones, and digestion. Pitta is believed to accumulate in the blood, causing feelings of heat with a red or yellow appearance that tends to spread. Frustration or aggravation can intensify pitta, which may feel worse than it looks. More pitta means more advanced stages of rosacea. Ayurveda believes some people are inherently inclined towards pitta, including those who burn easily and have fair, sensitive skin with freckles, athletic bodies, fine, gray, or thinning hair, and type “A” personalities, but that balancing pitta can determine whether rosacea becomes chronic.

Overexposure to heat, sun, computer screens, microwaves, mobile phones, and chemicals, and heightened emotional states due to anger, anxiety, relationship challenges, excess activity, pressure, frustration, and excessive ambition are also considered factors. Abrasive beauty products and treatments (i.e., microdermabrasion and glycolic peels), hot compresses, and steam or ingesting antibiotics, psychoactive substances, and tobacco also increase pitta. Certain foods and beverages are also found to elevate pitta and deemed greatly responsible for what triggers rosacea. On that note, stay tuned for our next installment, solely focusing on the extremely significant role diet plays in rosacea!

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