Background

Rosacea is a common chronic condition that may affect up to 10% of people with fair skin.  It is generally more common in women over the age of 30.  There are four clinical subtypes: (1) erythematotelangiectatic rosacea is characterized by flushing and redness of the central face; (2) papulopustular rosacea is characterized by acne-like papules and pustules of the central face; (3) ocular rosacea is characterized by redness, itching, and irritation of the eyes; (4) phymatous rosacea is characterized by thickening of the facial skin—especially of the nose, chin, and cheeks—and is the least common.  A person may have only one subtype or may present with a combination of subtypes.  Erythematotelangiectatic and papulopustular are the most common forms seen in the general population.  Many people with rosacea also have sensitive skin and may experience stinging and burning with many personal care products.

The causes of rosacea are not well understood but appear to include the following:

1. Immune system regulation of responses to microorganisms and trauma—including ultraviolet (UV) radiation.
2. Higher levels of immune system proteins known to promote inflammation and blood vessel proliferation.¹
3. Heightened inflammatory reaction to Demodex folliculorum (a mite found in most people, but present in higher numbers on the skin of people who have rosacea) and a bacterium that is found in the GI tract of this mite.²
4. Dysfunction of cutaneous blood vessels—likely related to immune and inflammatory reactivity.³
5. Possibly small bowel overgrowth. One group of researchers found higher rates of small bowel overgrowth in patients with rosacea, and treatment with antibiotics resulted in significant improvement or clearance of the rosacea symptoms.⁴

There are many potential triggers for rosacea flares including sun exposure, extreme temperature exposure, rapid changes in temperature, exercise, spicy foods, hot beverages or foods, alcohol, irritation from topical skin care products, emotional states—especially anger, rage, or embarrassment—and some medications (beta-blockers and niacin).

Treatment

Identify and Avoid Triggers

It is important to minimize flares of rosacea because repeated flares result in more vigorous inflammatory responses with each subsequent flare.⁵  Although there is a long list of potential triggers that are common, an individual may react from one to several known triggers or have triggers not on the list.  Keeping a symptom journal of when and where rosacea flares occur can help identify which substances or activities result in flares for an individual.  Once a flare has been triggered, using a cool mist or compress to the skin will help limit the extent of the flushing episode.  This will limit overall inflammation as well as serve to increase comfort during the flare.