By Randi Mann, WHNP-BC, NCMP, APNP
Rosacea is a chronic skin inflammation that can make you run for cover at a time when spending time outside with friends is all you want to do. Even indoors, it’s hard to ignore your red, bumpy face when you’re staring at your own reflection on every video call!
Are you tired of rosacea running your life? Let’s discuss what causes rosacea, who is most at risk, and how you can avoid the main triggers.
What Does Rosacea Look Like?
There are four main rosacea subtypes, and each affects a different part of the face with different tell-tale symptoms. You might find your symptoms switch from one subtype to another, or experience more than one at a time.
To further complicate matters, some subtypes look a lot like acne, although the best way to treat this skin condition is almost the opposite of conventional acne treatments.
The 4 Types of Rosacea:
Erythematotelangiectatic rosacea (ETR)
This type of rosacea shows up as redness in the center of your face. You may see broken blood vessels, experience a stinging sensation, and your skin may be swollen and sensitive.
With a look similar to a typical acne breakout, Papulopustular rosacea gives you pus-filled bumps and a bonus of red, oily skin with visible broken blood vessels. Women in their late 40’s and 50’s are the most often affected by this type.
Often wrongly associated with excessive alcohol consumption, Rhinophyma rosacea primarily affects the nose. It causes the skin on your nose to become thickened and bumpy, with visible pores and broken blood vessels. This subtype usually occurs alongside at least one other subtype and affects more men than women.
Ocular rosacea affects the eyes of up to 60% of rosacea sufferers, often going undiagnosed as it mimics seasonal allergy symptoms (although the symptoms are experienced year-round). It irritates the eyes, making them bloodshot and watery, often accompanied by burning or stinging. If you suspect you may be suffering from ocular rosacea, it is important to visit your health practitioner to check it out, as this type can cause corneal damage if left to run rampant.
What Causes Rosacea?
Although there is no single cause of rosacea, genetics and environmental factors play a strong role among other factors.
The Role of Genetics in Rosacea
Women are more likely to get rosacea in general, while men might be less likely to have it, but the risk of rosacea symptoms being severe is higher.
Studies show that you may be four times more likely to have rosacea if it runs in your family, with genetics being a factor most often in middle-aged women of Celtic or Scandinavian ancestry, in particular, if they have a personal history with acne.
Recent genetic research has identified a number of genes that affect the immune system, inflammation, protein metabolism, and how stress affects the cells. However, it is important to remember that your genes only indicate what you are predisposed to, and do not indicate how that predisposition will play out. Environmental factors such as pollution, stress, and lifestyle all play a role in gene expression.
Research has identified that those with rosacea are more likely to have an overactive immune system. The body’s immune system is designed to protect you from threats, but if it becomes overactive, your body will respond to its own tissues as if it were a foreign invader.
Inflammation is the body’s way of ‘smoking out’ the invaders with heat. But when inflammation gets out of hand internally, it may show up externally on your face.
The Microbiome & Rosacea
Good & Bad Bacteria
The number of microbes in our bodies outnumbers our own cells 10 to 1. Most of the time the various “good” and “bad“ strains play well together, the good bacteria balancing out the bad, and forming symbiotic microbial ecosystems. But when things get out of balance, the bad bacteria can take over.
You may have heard about the microbiome in reference to the communities of bacteria in our intestinal tract, but we have a whole other microbial community on our skin as well. It is the largest organ after all, and there’s room for a thriving skin microbiome.
Studies also show that the parasitic bacteria H pylori, known to cause stomach ulcers, is seen much more frequently in those with rosacea.
Demodex Skin Mites
A microscopic skin mite called demodex has also been implicated in rosacea. We all host these mites, which like to hang out on our facial skin and in our eyelashes and eyebrows. If you’ve ever wondered why your eye makeup naturally fades, these mites are the reason!
Studies show that those with rosacea have large numbers of these mites on their skin, but they are not actually to blame. The real culprits are the bacteria they carry (bacillus oleronius).
Top 5 Rosacea Triggers and How To Avoid Them
You may find that you remain free of rosacea symptoms for long periods of time, only to have them flare up suddenly. Something is triggering the reaction – but what?
Each person’s rosacea triggers are different, but let’s take a closer look at the most common ones.
1 – Foods and Beverages
Fried and spicy foods, drinks that contain alcohol or caffeine, hot soups and drinks, and foods that contain cinnamaldehyde (like cinnamon, citrus fruit, chocolate, and tomatoes) are all high on the list of foods to avoid if you have rosacea.
Pass on the hot sauce, and instead sprinkle some fresh herbs or lemon juice on your meal to punch up the flavor. Try iced decaf versions of your favorite teas and coffees – lavender and mint make calming and delicious iced teas for example!
2 – Sun and Weather Conditions
Do you get rosacea flare-ups in the summer? Basking in the sun may be relaxing, but the sun is a known rosacea trigger.
Avoid direct sunlight on your face during the hottest parts of the afternoon, and when you do venture out into the sunshine, wear a broad-brimmed hat for extra protection.
Sunscreen with a 30 SPF or higher is a great way to protect your face from strong summer rays. But did you know that the wrong sunscreen can make your rosacea worse? Opt for water-based, fragrance-free sunscreens that won’t irritate your sensitive skin.
The Environmental Working Group’s 2020 Guide to Sunscreens is a great resource to find a safe, effective sunscreen, and other facial products that contain SPF.
Heat & Extreme Weather
Heat is an important trigger, but it’s really about avoiding all extreme weather conditions. Very cold or windy weather can also aggravate rosacea. Reduce the impact by wearing light-colored, breathable clothing in hot summer months. Don’t forget a cardigan for those sudden temperature drops when you enter arctic a/c conditions!
3 – Exercise
If you’ve ever had a rosacea flare-up after an intense cardio workout, you’re not alone. If you’re a runner, it’s important to keep your runs to the early mornings or evenings when the weather is cooler. Or change up your routine and try slower, more gentle exercise such as walking or yoga. Skip the Hot Yoga if you have rosacea as heat is an aggravating factor.
4 – Stress
How was your day going the last time you had a flare-up? How about the last five times? Stress is the most common rosacea trigger and you may find that flare-ups are closely linked to those tough days.
Taking supplements such as Vitamin B Complex and Magnesium can soothe your nervous system and help your body to handle stress a little better.
If you know a stressful period is coming up (like a looming project deadline), take extra self-care measures to side-step them and avoid flare-ups. Practice good sleep hygiene by going to bed at the same time every night, and avoiding screens an hour before bed. Stay hydrated and make time daily for activities that bring you joy.
5 – Environmental Toxins & Chemicals
Rosacea is all about inflammation, both inside and out. Exposure to toxins and environmental chemicals increases inflammatory markers in the body, potentially leading to chronic inflammation concerns, such as rosacea.
Major sources of environmental toxins include pesticides in produce, preservatives, and other chemicals in personal care products (like makeup, nail polish, and perfume) as well as those in household cleaning products.
Read the Ingredients
Look at the ingredient lists – how many of your products contain chemical names so long that even a spelling bee champ would be stumped? Check out the Environmental Working Group’s extensive list of Consumer Guides to find chemical-free home and body care products that are good for you and the environment.
Keeping Track of Your Rosacea Triggers Can Help Manage Symptoms
Confirm your personal rosacea triggers by tracking what’s going on when you experience flare-ups. Do flare-ups occur when you eat certain foods? Experience certain stressors? A combination? A Rosacea Diary can reveal your trigger patterns, and help you take action to avoid them.
Rosacea and Self-Esteem
As unpleasant as a red face may be, the psychological impact of rosacea is harder still. It’s a condition that you literally carry on your face. Many rosacea sufferers fear that people may suspect an alcohol problem or poor hygiene, even though these are not the cause.
The results of a National Rosacea Society survey demonstrates how profoundly rosacea impacts quality of life. 90 percent of rosacea patients reported low self-esteem, while 52 percent avoided face-to-face contact out of embarrassment. Another survey showed that an astonishing 51 percent of patients with severe rosacea symptoms had missed days at work because of their condition.
What Can You Do To Reduce Rosacea Symptoms?
2 Supplements Can Help Reduce Rosacea Symptoms
What nutrients can you take to reduce your rosacea flare-ups?
1 – Zinc
Research shows that taking a zinc supplement regularly can reduce rosacea symptoms by up to 75%, likely by providing immune system support.
2 – Probiotics
Probiotic supplementation also shows great promise, by rebalancing our microbiome so that potentially damaging bacterial strains are kept in check by the good microbes.
Facial Skincare For Rosacea
Proper facial care is vital. Studies indicate that washing your face morning and evening with an alcohol-free cleanser and using an oil-free moisturizer will improve your facial appearance. However, you need to monitor your skin’s needs and respond accordingly. If your skin is dry and irritated, washing it less often can help. If your skin is oily, less moisturizing may be useful.
Are you ready to get to the root of your rosacea? We can help identify your triggers with Food Sensitivity Testing, check the status of your immune system, test your toxin levels, and see what’s going on with your microbiome.
Get in touch and let’s get to work on creating a personalized treatment plan with key nutrients that will have you putting your best face forward.
Resources & References
Akdogan N, Alli N, Incel Uysal P, Candar T. Role of serum 25-hydroxyvitamin D levels and vitamin D receptor gene polymorphisms in patients with rosacea: a case-control study. Clin Exp Dermatol. 2019;44(4):397-403. doi:10.1111/ced.13769
Hoffmann J, Gendrisch F, Schempp CM, Wölfle U. New Herbal Biomedicines for the Topical Treatment of Dermatological Disorders. Biomedicines. 2020;8(2):27. Published 2020 Feb 8. doi:10.3390/biomedicines8020027
Kallis PJ, Price A, Dosal JR, Nichols AJ, Keri J. A Biologically Based Approach to Acne and Rosacea. J Drugs Dermatol. 2018;17(6):611-617.
Park BW, Ha JM, Cho EB, et al. A Study on Vitamin D and Cathelicidin Status in Patients with Rosacea: Serum Level and Tissue Expression. Ann Dermatol. 2018;30(2):136-142. doi:10.5021/ad.2018.30.2.136
Rainer BM, Thompson KG. Characterization and analysis of the skin microbiota in rosacea: a case-control study. Am J Clin Dermatol 2020;21(1):139–147. doi:10.1007/s40257-019-00471-5
Szántó M, Dózsa A, Antal D, Szabó K, Kemény L, Bai P. Targeting the gut-skin axis-Probiotics as new tools for skin disorder management?. Exp Dermatol. 2019;28(11):1210-1218. doi:10.1111/exd.14016
Two AM, Wu W, et al. “Rosacea: part II. Topical and systemic therapies in the treatment of rosacea.” J Am Acad Dermatol. 2015;72(5):761-70.
Vaughn AR, Pourang A, Clark AK, Burney W, Sivamani RK. Dietary supplementation with turmeric polyherbal formulation decreases facial redness: a randomized double-blind controlled pilot study. J Integr Med. 2019;17(1):20-23. doi:10.1016/j.joim.2018.11.004
Yuan X, Huang X, Wang B, et al. Relationship between rosacea and dietary factors: A multicenter retrospective case-control survey. J Dermatol 2019;46(3):219–225. doi:10.1111/1346-8138.14771
Zip C. “The role of skin care in optimizing treatment of acne and rosacea.” Skin Therapy Lett. 2017;22(3):5-7.
National Rosacea Society: https://www.rosacea.org/
American Academy of Dermatology Association: https://www.aad.org/
Randi Mann, WHNP-BC, NCMP, APNP, is a woman’s hormone expert and the owner of Wise Woman Wellness LLC, an innovative wellness and hormone care center at 1480 Swan Road, De Pere. Mann is the author of the eBook: A Guide to Gluten and Going Gluten Free. She is a board certified Women’s Health Nurse Practitioner and NAMS Certified Menopause Practitioner, one of a handful in Wisconsin and less than 1600 worldwide to achieve this distinction. She combines the best of conventional, functional and integrative medicine to help women with female, thyroid and adrenal hormone issues to live healthier, more abundant, joy-filled lives using a blend of compassion, cutting edge science, practical guidance and humor. Contact her at 920-339-5252 or via the Internet at www.wisewomanwellness.com. Join the introductory virtual seminar, “End Hormone Havoc – Crazy Hormones Cause Fatigue, Weight Gain and Brain Fog and How to Fix Them!”, offered monthly, to learn about specialized thyroid, adrenal and female hormone testing and customized, bioidentical hormone treatments to achieve lifelong optimal hormone balance, increased vitality and longevity.