Rosacea is a chronic redness involving the central part of the face which often starts between the age of 30 and 60 years of age. Rosacea is a fairly common skin condition which causes a range of facial skin symptoms ranging from facial flushing to raised papules and thickening of the facial tissues. Rosacea can also occur in the eyes, known as ocular rosacea.
There are four main types of rosacea:
- Erythematotelangiectatic: Also known as ETR, this is the mildest form of rosacea. Symptoms include sensitive, easily irritated skin, redness, dryness and sensitivity to many skin care products.
- Papulopustular: Burning or itching skin with red papules and pustules.
- Phymatous: Chronic rosacea can worsen over time resulting in the skin on the chin, cheeks, nose or ears becoming thickened, irregular in texture and deformed.
- Ocular: Eye redness, dryness, and burning can occur with or without skin symptoms.
Possible causes and associated risk factors:
People with fair skin appear to be more prone to rosacea and it tends to appear between the age of 30 – 60 in both men and women. The exact cause of rosacea is unknown and whilst it is not curable it can be effectively managed to help keep flare ups under control.
The skin's innate immune response appears to play an important role in rosacea as high concentrations of antimicrobial peptides such as cathelicidins have been observed in rosacea. Cathelicidins promote infiltration of neutrophils in the dermis and dilation of blood vessels.
The neutrophils release nitric acid which also promotes vasodilation. Fluid leaks out of these dilated blood vessels causing swelling (oedema); and proinflammatory cytokines leak into the dermis, increasing the inflammation.
Matrix metalloproteinases (MMPs) such as collagenase and elastase also appear important in rosacea and appear in higher concentrations. MMP enzymes remodel normal tissue and help in wound healing and production of blood vessels (angiogenesis). This may contribute to the thickening and deformity of the skin often seen in chronic rosacea. MMPs may also activate cathelicidins contributing to inflammation.
Researchers found that PACAP, a neuropeptide (pituitary adenylate cyclase activating polypeptide) a potent blood vessel dilator in humans, is 20 to 30 times upregulated in rosacea, possibly explaining that characteristic redness and why anything triggering vasodilation may worsen rosacea symptoms.
Hair follicle mites (Demodex folliculorum) are sometimes observed within rosacea papules but their role is unclear.
There does appear to be a link with gut health and rosacea. An increased incidence of rosacea has been reported in those who carry the stomach bacterium Helicobacter pylori, but most dermatologists do not believe it to be the cause of rosacea.
SIBO or small intestinal bacterial overgrowth is 10 x more prevalent in Rosacea. Altered gut microbiota promote the release of Substance P in both the gut and the skin which induces vasodilation, oedema, mast cell degranulation and TNFa release.
Different foods and drinks may provoke rosacea flare ups. It tends to be different for everyone and so to find out what your triggers are it is advisable to keep a food diary.
- Hot beverages
- Green tea, black tea, chai tea, coffee
- Spicy food – chilli, capsicum, paprika, black pepper
- Cinnamaldehyde containing food – cinnamon, spices, tomatoes, citrus fruits, chocolate
- Some histamine foods including fermented foods, aged foods, cheese, sauerkraut, wine, soy sauce, tofu, eggplant, and canned fish. Add link to histamine blog
- Food additives – benzoates, sulphites, nitrites, glutamate, artificial food dyes
- Certain probiotics, in particular – lactobacillus casei, L reuteri, L helveticus, L delbrueckii, L bulgaricus
- Be wary of high dose vitamin supplements – particularly vitamin C and B vitamins
- Co enzyme Q10
- Seek guidance from a qualified skin expert to determine the best products and skin treatments for your skin.
- Avoid heavy or occlusive oil-based facial creams.
- Avoid ingredients that cause burning, stinging, or increase facial redness. Common troublemakers include alcohol, witch hazel, menthol, peppermint, eucalyptus oil, clove oil, and fragrances.
- Avoid the use of a topical steroid to the rosacea as although short-term improvement may be observed (vasoconstriction and anti-inflammatory effect), it makes the rosacea more severe over the next weeks (possibly by increased production of nitric oxide).
- Protect from UV rays. Use a light facial sunscreen.
- Keep the face cool to reduce flushing
- Minimise hot, spicy foods, alcohol, hot showers and baths and warm rooms.
- Keep a food diary to monitor symptoms and food triggers.