Rosacea Causes: Symptoms, Types and Triggers

The exact cause of rosacea is not yet known. Several mechanisms may play a part:

• Immunity and inflammation: the immune system activates cells that keep the skin inflamed, and the natural defences of affected skin are more active than those of skin without rosacea.
• Nerves and blood vessels: the role of the nervous and circulatory systems is being studied.
• Family: several people in the same family can have rosacea, with no simple genetic link. Having an affected relative is not enough to predict it or to establish a diagnosis.
• Environment: genetic, immune and environmental factors may all play a part.

When you encounter a trigger, the blood vessels in your facial skin dilate. This causes episodes of redness and warmth, often among the first signs you notice.

Demodex mites are microscopic and invisible without a powerful microscope; they live on the skin of almost everyone. They are often found in greater numbers when a person has rosacea, and they may play a part. They are not enough to explain the condition. Their presence is not a reason to apply a product on your own: during the examination, the doctor determines what is appropriate for your skin.

The first sign is often redness that comes and goes. Over time, it can become persistent and more visible, especially on the cheeks, nose, chin and forehead. Small dilated blood vessels sometimes trace a network of red lines on the surface of the skin, and small red bumps or pus-filled pimples can give the skin a rough, uneven look. The skin of the face is often sensitive, and the affected area can feel very hot or sting.

Severity ranges from mild to severe: your skin may stay calm for weeks, then the redness may return. The traditional names for the types describe the predominant signs, and several types can overlap: on examination, the doctor focuses on the signs actually present rather than on a single label.

Mild Rosacea: What You Notice First

At the start, mild rosacea often looks like redness that keeps coming back, with a feeling of warmth or tingling, without many pimples. Brief redness after exercise or a hot drink does not prove rosacea. Repeated episodes, redness that persists between flare-ups and skin that has become sensitive are, however, things to describe during the examination. To understand what is happening to you, the doctor compares what you feel with what they observe on your skin.

The medical name describes the visible signs: redness (erythema) and small visible blood vessels (telangiectasias). It is also called vascular rosacea. When this redness and these vessels appear on their own, without pimples, people often think of couperose; on examination, the doctor clarifies whether it is in fact rosacea.

On darker skin, early signs, such as flushing, can go unnoticed or be mistaken for another condition. Redness and small blood vessels are harder to see there, but other signs can alert you: dry, swollen skin, darker patches, pimples, a feeling of warmth that is present most of the time. Faint redness is therefore not enough to rule out rosacea, and an in-person examination remains the way to confirm it.

Seborrheic dermatitis causes greasy, yellowish scales on reddened skin in areas with more sebum: the scalp, ears, eyebrows and folds between the nose and mouth. Lupus can cause butterfly-shaped facial redness, rarely with pustules. On examination, the doctor can tell these conditions apart from rosacea. Redness that comes with other symptoms, or that occurs alongside an illness or a treatment already under way, should first be discussed with your regular doctor.

Steroid-Induced Rosacea: When a Cortisone Cream Is Involved

A cortisone cream, a corticosteroid obtained by prescription, applied to the face for a long time can bring on flare-ups and worsen symptoms. It can also cause a rash that looks like rosacea, called steroid-induced rosacea. Note the names of the creams you use or have used and how long you applied them, then bring them to the person who prescribed them: do not change how you use a treatment without consulting your prescriber.

Phyma is thickened, swollen skin covered in bumps. When it affects the nose, it is called rhinophyma, the most common form of phyma. If your nose is thickening or its shape is changing, have it examined: the doctor confirms the cause of this change before discussing treatment. How it progresses varies from one person to the next.

A trigger is anything that makes your rosacea flare. It can bring on a flare-up without being the cause of the condition. Sun, heat, stress, alcohol and spicy food come up most often, along with hairspray. Exercise, extreme temperatures, hot drinks, wind, very dry or very humid air and warmth in heated rooms are also triggers. Triggers differ from one person to the next: your own list is often shorter than this one.

No food, bananas included, has to be avoided by everyone. Some patients cite bananas among possible triggers, along with citrus fruits, tomatoes, red plums, raisins and figs, with no established frequency or cause-and-effect link. You do not have to avoid them unless one of them triggers a flare-up in you. If a food seems to come before your redness, also look at the context: a very hot drink, a spicy dish, a warm room or a glass of alcohol can add up.

The Gut and Probiotics

The idea that a bacterium on the skin or in the gut causes rosacea has not been demonstrated. Even for a stomach infection, findings conflict and research is ongoing. The evidence on probiotics concerns their use alongside a treatment, not a universal solution to start on your own. It does not support recommending just any probiotic to reduce redness. Do not take probiotics or an antibiotic on your own to reduce your redness. Persistent digestive symptoms warrant a separate assessment by your doctor.

To find your triggers, a diary is better than a list of things to avoid. For at least two weeks, note each day what you eat and drink, the products you apply to your skin, your exposure to cold, heat, sun, exercise or stress, then describe your symptoms, their intensity and how long the redness lasts. Then compare these notes with your flare-ups: you are looking for what comes up before your redness, not what happened only once.

• Cleanse: a gentle cleanser, without rubbing the skin.
• Moisturize: keep the skin well moisturized, especially in the cold season, when the air is dry.
• Protect: a sunscreen with an SPF of 30 or higher, every day.
• Avoid: anything that irritates the skin can make rosacea flare.

These steps support your skin; they do not come with a promise of a cure. The rosacea treatment depends on what bothers you: pimples, redness or visible small blood vessels. Treatments prescribed during a consultation often target only one of these signs; there is no promise that they will make the condition go away.

Redness and flare-ups can cause emotional discomfort, lower self-esteem and confidence, anxiety, and sometimes depression. If the redness is weighing on you, mention it during the consultation, as you would mention burning or tingling. This emotional discomfort varies from person to person and matters as much as the signs visible on your skin.

Bring your diary and the list of products you use on your face, along with your current treatments, including any cortisone cream and how long you have used it. Say what bothers you most: the redness, the pimples, the blood vessels or the warmth. To show how things have changed, you can also take photos, keeping the same light, angle and distance as much as possible. They help you prepare for the consultation but do not establish the diagnosis.