Liz Fuller, a freelance makeup artist in the Boston area, has experienced rosacea since her late twenties. “I’ve been extremely embarrassed by my rosacea on occasions when I don’t wear makeup,” Liz says. “Luckily, I am able to cover it up, but when I am running errands, meeting a friend for a walk or coffee, [and going] makeup-free, it’s embarrassing.”
Even worse are the people who ask Liz if she has a sunburn and who sometimes take it upon themselves to lecture her about the dangers of sun exposure. “I have an acquaintance who points it out every time I see her, so I now try to avoid her,” Liz says.
Liz is certainly not alone. According to the American Academy of Dermatology (AAD), an estimated 14 million Americans live with rosacea, most between the ages of 30 and 50.
What Is Rosacea?
It’s still not entirely known what causes rosacea and there’s currently no test that can determine whether you have the skin disorder. But there are several factors that might be at play in the appearance of this skin condition. These include:
A protein in the body: According to the AAD, it’s thought that certain types of rosacea may be caused by the way in which the body naturally processes a protein called cathelicidin. This protein helps protect the body from infection, but it can also cause redness and swelling when your body doesn’t properly process it.
Genetics: There can also be a hereditary component to rosacea. While it’s more common in people of Celtic or Scandinavian backgrounds, anyone including those with darker skin tones can have a genetic predisposition to it.
A common skin mite: “There is another type that is caused by a sensitivity to a mite that lives on all our skin called demodex. In this case, you can develop discrete acne breakouts and bumps along the background redness,” dermatologist Dr. Hysem Eldik says.
While a definitive cause of rosacea has yet to be determined, what is known is that there are several different versions of the condition that are defined by the symptoms you experience.
“The most common type is the background redness patients develop with little tiny blood vessels scattered throughout,” says Dr. Eldik. Rosacea can also present with an acne-like appearance, thicker skin around the nose, or flare-ups that are centered in the skin around your eyes.
Just as there is no one cause of rosacea, any one person can also face more than one of these types in a single flare-up. (Yes, nothing is easy when it comes to this skin condition.)
When It Comes to Rosacea Triggers, We Know a Little More
While we may not totally understand the origin of rosacea, what is better understood is what can trigger a flare-up. Genetics or biological factors may cause the disorder, but when it comes to setting off a new episode, the culprit is often a lifestyle factor.
Alcohol, hot drinks, and spicy foods are all common triggers, including for Liz who says she has a problem with all of these, including specifically red wine. Heat can also be a trigger, which can be set off by things like sun exposure, a soak in the hot tub, or a long, hot shower. In this same theme, Dr. Eldik says exercise and sweating can also cause rosacea to flare.
Finally, stress can set the condition off. Mariela Meakes has experienced the condition for two years now and says she’s “noticed that if I get embarrassed or in a situation when you feel your face get hot, the rosacea will worsen.”
The Rosacea-Hormone Connection
Like many skin conditions, there is also a connection between hormones and rosacea. Though, like many things having to do with this specific skin issue, that connection isn’t fully understood yet.
“We observe rosacea flares during periods of hormonal imbalances like menstrual cycles, pregnancy, and menopause, so we know there is a relationship,” Dr. Eldik says. But he adds that it’s also common to see flares outside of these conditions, so hormonal changes aren’t the only factor at play here.
“There are other skin conditions that are more indicative of underlying hormonal imbalances like acne, hair loss, unwanted hair growth in the chin/chest area, and deepening of the voice,” Dr. Eldik says. With rosacea, the evidence is more observational “that it can be flared by a state of hormonal imbalance as opposed to being a direct cause of elevated hormone levels.”
While There’s No Cure Yet, There Are Things You Can Do
There is no known cure for rosacea but there are several steps you can take that may help to keep new flare-ups at bay or soothe the ones already present.
When it comes to your skincare routine:
Use fragrance-free products whenever possible.
Choose gentler ingredient options, like ascorbyl glucoside, which dermatologist Alicia Zalka describes as a “kinder, gentler vitamin C” and niacinamide which “in lower doses (less than 10%) is extremely well-tolerated by many skin type.”
It’s extremely important to wear SPF daily and to stay out of the sun as much as possible.
And for any particularly stubborn cases, talk to your dermatologist for a stronger, topical prescription rosacea treatment.
In addition to paying attention to the products you use on your skin, it’s also important to keep an eye on lifestyle factors that can trigger a flare-up. Remember, though, that not every potential trigger will be one that affects you, so a little trial and error is in order. Some things that may help are cutting back on dairy, gluten, alcohol, or spice. And as much as possible, try to maintain a lifestyle that promotes hormonal balance. In some cases, when hormones level out, rosacea becomes less noticeable.
Rosacea can be wildly frustrating and sometimes even physically painful. While there’s currently no cure that is 100% effective, there are ways you can experiment with your skincare and lifestyle routine to find some solutions that make a difference for you and your skin.
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