Why does rosacea flare up?

What happens during a flare?

Blood vessels near the skin widen, a process called vasodilation, bringing more blood to the surface and causing flushing. Normally, this helps the body cool down. With rosacea, facial blood vessels widen more easily and frequently, so even brief exposure to heat, sunlight, exercise or alcohol can cause noticeable flushing. Inflammation is the other main mechanism. Sensors on skin cells are thought to react more strongly to certain triggers, starting an inflammatory response that contributes to redness and facial pain. The exact cause of rosacea itself is still not fully understood.1

What can trigger a flare?

• Weather and temperature triggers include sunlight, hot weather, cold weather, wind and hot baths.
• Food and drink triggers include alcohol, especially red wine, spicy foods and hot drinks.
• Activity and emotional triggers include exercise and stress.
• Product triggers include some skincare, makeup and hair products, including hairspray that reaches the face.
• Medicine triggers include potent steroid creams and some blood pressure medicines.

You do not have to avoid every possible trigger, because the list is not a set of terms and conditions. Focus on the factors that actually coincide with your symptoms rather than cutting out foods or activities simply because they appear on a list.5

How do you find your own triggers?

1. 1Keep a daily diary for at least two weeks. Record food, drinks, skincare and hair products, weather, temperature, emotions and activities.
2. 2Record symptoms alongside those details. Note when symptoms begin, how strong they are and how long they last. Include flushing, warmth, burning, redness or bumps rather than recording redness alone.
3. 3Look for exposures that repeatedly coincide with flares. A few weeks of records can help, but tracking for months is sometimes needed to identify a pattern.
4. 4Make changes around the triggers you identify. Keep the focus on your own patterns rather than someone else's avoidance list.

Record ordinary activities such as household chores and work as well as meals and weather, because a useful diary does not need the literary ambitions of a memoir. Redness can be harder to see on brown or black skin. Warm cheeks or a feeling of warmth can help you notice flushing even when a colour change is less obvious.245

What helps reduce flares?

Wear sunscreen with at least SPF 30 every day, use gentle skincare products for sensitive skin and cover your face in cold weather. Avoid heat, strong sunlight and humid conditions where possible. If heat or exercise is a trigger, avoid strenuous activity in hot weather. If stress is a trigger, try relaxation techniques such as deep breathing. Limit the foods and drinks that worsen your symptoms. Suitable skincare and precautions around personal triggers can reduce flares, but rosacea has no cure.346

Why does rosacea still flare during treatment?

Triggers can still cause flares while you are treating rosacea. Identifying them can improve treatment results and help prevent worsening. Repeated flushing can eventually leave persistent redness or visible blood vessels in some people. Rosacea is not caused by poor hygiene, and acne treatments bought without a prescription will not treat it.234

When should you see a doctor?

See a doctor if you have symptoms of rosacea, especially if you have not had a diagnosis, because other skin conditions can look similar. Treatment can help control symptoms. Seek urgent medical care if you have rosacea with eye pain, blurred vision, sensitivity to light, a red eye or a gritty feeling. These can signal keratitis, inflammation of the clear front surface of the eye, which needs urgent treatment.4