Rosacea. You've probably heard of this super common skin condition - or maybe you've experienced it yourself. From chronic facial redness to swollen red pumps and pimples, rosacea symptoms are more common than you may think. In fact, rosacea is one of the most common skin conditions with over 3 million cases diagnosed every year in the U.S. alone. A quick Google search and you can learn about the symptoms and statistics around this common skin disorder...but the causes and triggers of rosacea are not quite as clear. Today we're looking at the lesser known facts around the mystery condition that is rosacea. These are 7 things you need to know about rosacea and how to manage rosacea symptoms.
1. There Are Different Types Of Rosacea
Did you know that there are four different types of rosacea? There are! While all rosacea is characterized by a flushed face appearance, each 'sub-type' of rosacea is characterized by it's own symptoms. In fact, you can even have rosacea...in your eyes! (What?!)
These are the four sub-types of rosacea & their symptoms:
1. Erythematotelangiectatic rosacea: general redness & flushing, especially in the center of the face (ie. cheeks and nose), visible blood vessels
2. Papulopustular rosacea: general redness & flushing, plus facial swelling and acne breakouts
3. Phymatous rosacea: redness & flushing, plus a thickening of facial skin (aka. skin feels thick in affected areas) and bumpy skin texture
4. Ocular rosacea: swollen eyelids, watery or bloodshot eyes, the feeling of having something in your eye, increased light sensitivity, redness, burning or itchy eyes, history of styes and dryness
"Ocular rosacea may be present in varying degrees in up to 50 percent of rosacea sufferers. In an NRS survey of 1,780 rosacea patients reporting ocular symptoms, only 27 percent said they had been diagnosed with the condition, possibly indicating under-diagnosis."
2. Genetics & Environmental Factors Equally Contribute To Rosacea
While the exact cause(s) of rosacea are yet to be determined, there have been studies done on identical and fraternal twins to determine whether genetics play a role. What they've found is that while genetics do play a role, environmental factors (ie. your lifestyle) play an equal role!
Interestingly, they found a positive correlation between UV (sun) exposure and rosacea, as well as body mass index (BMI), smoking, alcohol consumption, and more. In other words, the greater your UV exposure (or insert any of the aforementioned), the greater your chances of having rosacea.
These lifestyle and environmental correlations can help you identify which aspects of your lifestyle may be causing or contributing to rosacea symptoms.
"The researchers found that the disorder occurred significantly more often in both identical twins than in both members of a pair of fraternal (nonidentical) twins."
"The researchers evaluated factors such as gender, age, smoking/alcohol consumption history, heart health and lifetime sun exposure to determine the influence of certain environmental variables on the disease, and...found correlations with lifetime ultraviolet radiation exposure, body mass index (BMI), smoking, alcohol consumption, cardiovascular issues..."
3. Rosacea May Be Correlated With Trauma
If you know Wabi-Sabi Botanicals, you know we're alllll about The Skin-Spirit Connection. We could write a book on how early trauma is connected to all sorts of emotional, mental & physical symptoms. More specifically, modern researchers and theorists have zero'd in on the links between early trauma and autoimmune disease.
While rosacea is not considered an autoimmune disease itself, it is an inflammatory disorder that has been linked to autoimmune disease. In fact, women with rosacea are significantly more likely to develop co-occurring autoimmune conditions (ie. psoriasis, celiac disease, rheumatoid arthritis, etc.) Individuals with rosacea also have the same mast cells (that release histamine when they believe the body to be under attack, thereby causing inflammation) that individuals with autoimmune disease have.
"Mast cells...release many mediators involved in rosacea, including histamine, associated with flushing...Virtually all the mast cells in the rosacea patients were positive for interleukin 17 — which plays a key role in the development of rheumatoid arthritis and psoriasis."
Interestingly, in one study, researchers also discovered that rosacea patients have a more active and sensitive sympathetic nervous system - that same system that kicks into gear when we're under stress or in danger. Studies have indicated that rosacea patients often have a heightened fight-or-flight response - a response that becomes very easily or chronically activated by early traumatic experiences.
"The bumps (papules) and pimples (pustules) of rosacea...may be the result of an allergy-like reaction to environmental and emotional triggers."
"When the normal immune system is faced with any of a broad range of potential dangers...receptors recognize potential danger and protect the body by prompting the production of protective substances that isolate and neutralize any harmful effects. With rosacea, however, these protective substances, like overzealous guards, turn the body on itself, leading to inflammation."
"The rosacea patients...experienced heightened sympathetic nerve activity compared to those without rosacea during both the mental and physical portions of the test. "
For individuals with rosacea, you may want to take a look at early traumatic experiences that may have created a heightened 'panic' (ie. fight-flight-or-freeze) response that continues to manifest, even on a purely biological/physical level, today. To learn more on this topic, both Waking the Tiger by Peter Levine and The Body Keeps the Score by Bessel Van Der Kolk are recommended reading.
4. Acne-Prone Skin & Rosacea Share Many Similarities
Acne and rosacea are not so different. Both obviously characterized by redness and inflammation, they're also both linked to excess sebum production that leads to clogged pores, infection & visible breakouts. Very simply, you can treat your rosacea-prone skin nearly the same way you would treat acne-prone skin. We wrote a whole blog on the DO's & DON'Ts of skincare for acne-prone skin - read it here.
"The rosacea patients had more characteristics common to acne than the control subjects. Facial oil production was 40 percent greater; microcomedones...were twice as numerous and larger in the rosacea patients; and the density of the acne bacterium, Propionibacterium acnes, was nearly twice that of controls."
5. UV Radiation & Heat Trigger Rosacea Symptoms
As we mentioned before, researchers have found a positive correlation between lifetime UV (sun) exposure and rosacea, while other researchers have revealed that rosacea patients tend to have a heightened 'danger' or inflammation response to things it perceives as threatening.
In healthy individuals, the nervous system perceives, you guessed it - heat - as a potential danger or threat. So those of us with ultra-sensitive nervous systems - as in rosacea patients - experience this perceived threat even more intensely. Cue inflammation and rosacea symptoms.
Does this mean stay out of the sun entirely? No, of course not! What it does mean is to limit sun exposure, especially during peak hours (ie. in the afternoon), to use a daily facial SPF, and to avoid or limit other potential sources of excess heat - ie. in the shower, jacuzzis, saunas, etc. - that could trigger symptoms.
"Ultraviolet B (UVB) radiation may increase vascular endothelial growth factor (VEGF), a regulator of blood vessel growth that may cause visible blood vessels (telangiectasia) associated with subtype 1 rosacea...UVB may increase interleukin 8, which plays a role in inflammation."
"A higher rosacea score was positively associated with age and lifetime ultraviolet radiation exposure."
6. Foods High In Vitamin B3 May Trigger Rosacea Symptoms
The primary symptom associated with rosacea is flushing, or a reddening / blushing, of the skin. Vitamin B3, also known as niacin, is well-known for causing flushing and while it's not been identified as a cause of this response in rosacea patients, it has been looked at as a trigger for rosacea symptoms.
"So little is known about the flushing responses in rosacea, and the first step toward their control is to understand the nature of their causes...Since niacin is often a trigger factor for flushing, it was important to investigate this response at the molecular level."
Interestingly, foods naturally high in niacin have often been reported to trigger rosacea symptoms in some individuals - foods like spinach and avocado - indicating there may indeed be a link.
Other common niacin-rich foods include:
- Beef or chicken liver
- Brown rice
- Whole-wheat products (ie. whole wheat bread or pasta)
While it's not necessary to completely eliminate these foods, you can start by noticing how your skin reacts to them and whether they trigger rosacea symptoms. Food-related skin reactions may show up 48-72 hours after consuming the food.
7. Microscopic Skin Mites Might Make Rosacea Worse
Rosacea or no rosacea, most of us have microscopic skin mites that live on our skin called Demodex mites. Crazy, right? These teeny tiny mites are found in oil glands and human hair follicles and are pretty much harmless. In fact, most of the time, they go completely unnoticed.
In rosacea patients, however, researchers have identified a greater number of Demodex mites present as well as a particular bacteria that is associated with the mites. This bacteria is known to cause inflammation and redness (sound familiar?) and may worsen rosacea symptoms.
"The researchers identified Bacillus oleronius as distinct bacteria associated with Demodex mites...these bacteria could be responsible for the inflammation associated with [rosacea]."
As unsettling as this all sounds, there are really easy ways to address Demodex mites. One of the most common home remedies is well-diluted tea tree oil or tea tree-infused products. Other naturally anti-bacterial ingredients like Temulawak (Javanese Turmeric), Lavender & Lemongrass are also great.
Our Top Skincare Picks for Rosacea
1. Blemish Correct Serum
With anti-inflammatory and anti-bacterial Temulawak, the Blemish Correct serum is not just for blemishes. Great for any and all redness and inflammation, this gentle, effective serum also contains White Mustard Seed oil which has naturally-occurring erucic acid that helps to alleviate uncomfortable rosacea symptoms.
3. Valley of Light Illuminative 2-in-1 Mask & Exfoliant
Soothing Temulawak and anti-bacterial Balinese Red Ginger make this mask a great option for individuals with rosacea. Our favorite mask also contains no essential oils or potentially irritating clays, making it the perfect, gentle mask that brightens, purifies and exfoliates skin without irritation.
Great article Elysse, thank you! I’d love to hear more about White Mustard seed oil. Is this the same thing as Abyssinian oil, or different? I had read previously that erucic acid was potentially harmful to skin, especially at high doses.