9 Common Rosacea Triggers (and How to Beat Them)by Barbara O'Dair Health Writer
If you’re like the other 16 million Americans living with rosacea, you want to know how to prevent your next flare. This chronic skin condition can bring on persistent redness or darkening—your skin tone determines which one—plus red or purple bumps, pustules, and visible blood vessels trailing across your face. Common triggers are often just part of everyday living—like eating certain foods or spending time outside. So, how do you stay in the clear? We’ll tell you all we know.
The Dark Side of Sunshine
The sun’s ultraviolet rays and rosacea are not friends—sunlight was cited as the most common rosacea trigger by 81% of patients in a National Rosacea Society survey. So, wear a hat, avoid the midday sun, and protect your skin with a mineral-based sunscreen with titanium dioxide or zinc. “Chemical sunscreens convert UV rays to heat, which is a known trigger for rosacea,” warns Elika Hoss, M.D., a dermatologist and assistant professor for Mayo Clinic Alix School of Medicine in Scottsdale, AZ. Also, look for one that protects from UVB and UVA rays, since both can worsen rosacea symptoms.
How Heat Fires Up Rosacea
It’s not just a sunny day that can trigger your rosacea. It’s steam rooms, hot lattés, heavy sweaters, and toiling over a hot stove. Why? “Heat causes blood vessels to dilate,” says Anne Chang, M.D., a dermatologist at Stanford Health Care in Palo Alto, CA. And when this occurs, blood vessels become more visible under your skin, causing redness and broken vessels to surface. If heat brings on your symptoms, work to keep your body temp down: Lower your thermostat, stop drinking hot beverages, and avoid humidity. You may also want to skip the heavy sweater: Better to dress in layers you can lose.
The Stress Connection
Along with acne and dry skin, rosacea can sometimes be triggered by stress, according to research—but we don’t know why. “Stress is tricky,” says Dr. Hoss. “It activates the sympathetic nervous system, which can cause flushing.” Adds Dr. Chang: “Stress may lead to skin changes, such as the composition of lipids or microbiome on the skin. We don't know for sure. More research is needed.” To beat stress and the rosacea that may soon ensue, try deep breathing, meditation, and other stress management techniques.
The Link Between Rosacea and Alcohol
“Rosacea people have hyperactive blood vessels,” says Dr. Hoss—so even moderate drinking can cause problems. Research suggests that alcohol weakens the immune system and dilates blood vessels, contributing to rosacea’s hallmark redness and flushing. If you know that drinking brings on your rosacea, the simplest thing to do is to abstain. If you choose to drink, get yours on the rocks, which cools the heat of alcohol. Then alternate with a glass of water, which dilutes the booze.
Certain Spices Can Trigger a Flare
Spicy food might give you a kick, but is adding that hot sauce really worth it? Capsaicin, found in hot peppers, cayenne, and curry, is a common rosacea trigger. “Spices can activate receptors on nerves in the skin, which releases proteins that dilate blood vessels,” explains Dr. Hoss. When tiny vessels beneath the skin widen, blood flow increases to potentially contribute to chronic inflammation. Choose milder fare, like the Mediterranean diet, or foods with garlic, onions, or leeks. Also, pass on vessel-dilating cinnamon, citrus, and chocolate, as well as foods high in histamine, like processed meat and anything fermented.
Your Skincare Products Matter
“Anything that can cause irritation can potentially trigger rosacea,” says Dr. Chang. “If there are ingredients in makeup that are pro-inflammatory, a flare could occur.” According to Dr. Hoss, even more problematic is what you use to take off your makeup—wipes or toner, or even the physical rubbing—which can more commonly trigger a flareup. Also, avoid lotions and creams with retinols or alpha hydroxy, or hairsprays containing alcohol, witch hazel, or fragrances that may cause inflammation. To keep flares at bay, use gentle skin products for moisturizing, and wash your face with your fingertips.
Medications to Watch
We know—you have little choice when it comes to taking prescribed vasodilator medications, beta blockers, topical steroids, opiate painkillers, antibiotics, or even ibuprofen for heart conditions or other health issues. Yet all can dilate the blood vessels and trigger rosacea, according to John Wolf, M.D., chairman of dermatology at Baylor College of Medicine in Houston, TX. While you can’t just ditch your meds, do your best to control your other triggers while you’re on them—and if your rosacea worsens, ask your doctor if there are alternative treatments you might consider, suggests Dr. Wolf.
Intense Workouts Don’t Work Out for Rosacea
The National Rosacea Society (NRS) reports: “Any physical exercise that greatly increases your core body temperature may result in flushing and a flare-up of rosacea symptoms.” A natural reaction, says Dr. Chang, because intense workouts can, yep, dilate those blood vessels. In an NRS study, aerobics came in first as the most triggering type of exercise. Fend off flares by breaking up your exercise routine into shorter sessions; use a fan; apply a cool, wet cloth to your face, and much on ice chips to cool off. “We never want to tell people not to exercise,” says Dr. Hoss.
Rosacea and the Skin-Gut Connection
Can improving your gut health help prevent flare-ups? Epidemiologists are sleuthing out answers now, as there may be a link between rosacea and an individual’s gut microbiome, where the largest part of the immune system is located. Multiple studies suggest those with rosacea have more gastrointestinal disease, with one study reporting improvement in rosacea symptoms after the successful treatment of bacterial overgrowth in the small intestine. Researchers at Johns Hopkins University found that rosacea patients “were depleted in several different species of bacteria, some of which are known to promote healthy skin.” Watch this space.
Treatments Are Available to Tame Rosacea Symptoms
Treatments for rosacea include “topical creams [that] cause blood vessels to constrict and reduce redness,” says Dr. Chang. Anti-inflammatory oral medications can treat papules and pustules—but are not recommended for long-term use, since antibiotics can destroy “good” bacteria, leading to cramping, diarrhea, and other complications. Laser and light therapies are used to remove dilated vessels, and to treat redness and visible blood vessels. Plus, a variety of green-based cosmetics are available to mask rosacea flare-ups. All will help you feel more comfortable in your own skin.