Acne and rosacea: a complete guide by Alison Bowser

In this exclusive extract from her new book, Alison Bowser examines rosacea triggers, both nutritional and environmental

Acne book

Unlike acne, rosacea seems to be sensitive to triggers that can make it worse. This may be a vital key to controlling rosacea. Understanding what may trigger an ‘attack’ or worsening of rosacea as soon as possible may help avoid many of its negative effects, including depression and feeling out of control.

Triggers for rosacea include diet, lifestyle and medication, and may be a combination of all or some of these factors. There are also other triggers such as the strong influence of weather/temperature and changing seasons. Some of these are obviously beyond our control, but there is still a lot that can be done to help reduce exposure to any trigger factors identified.

The importance of finding out what makes your rosacea worse cannot be emphasised enough and should be one of the priorities in a treatment plan. Few doctors will discuss or consider a treatment plan for rosacea, but this is a multi-pronged approach that looks at every aspect of life that may affect rosacea, not just treatment alone.

There are undoubtedly many potential triggers for rosacea and the following list will be far from complete. However, the best advice is to use it as a guide, applying the principle that being aware of the impact of the various aspects of daily life will allow you to keep an open mind to a selection of possibilities. It is likely that there will not be one single trigger, but many small triggers that combine to make the problem.

A survey carried out in 2005 identified the following most common triggers:

Emotional stress
Nearly 75 per cent reported that stress alone was responsible for their flare-ups. Many added that their rosacea made them feel more stressed, which created a vicious circle. Episodes of stress have been known to trigger rosacea instantly, and the flare-ups can last until the stress is under control. Understanding this connection could be helpful to identify the time to start treating the skin in advance of a flare-up.

Hot or cold weather
Nearly 70 per cent cited extremes of temperature as their trigger. Cold weather leaves the skin feeling extremely tingly for some. A sudden change in temperature, coming from outside cold into a centrally heated building, is particularly challenging. Hot weather will encourage a flushing response, and in those predisposed to flushing this can obviously make rosacea far worse. Prolonged exposure to sun could also damage the skin and make rosacea worse.

Wind
In the survey, 52 per cent of respondents reported that windy weather made rosacea worse. Some added that having to avoid the wind meant dropping outdoor pursuits or having to give up a job that involved working outdoors.

Spicy foods
Under half (42 per cent) of respondents reported that spicy foods triggered their rosacea. This figure seems rather low as this is commonly believed to be the culprit in rosacea. Spicy foods can trigger a flush response that contributes to rosacea symptoms.

Alcohol
Drinking alcohol made rosacea worse for 63 per cent of respondents. Some additional comments in the survey reflected society’s belief that rosacea happens to alcoholics, and this leaves people with rosacea often feeling too embarrassed to drink openly in public. Many people with rosacea will avoid alcohol altogether for this reason.

Hot baths
In the survey, 39 per cent felt hot baths (or saunas) made their rosacea worse. Any excess steam should be avoided wherever possible as this triggers a flush response.

Skincare products
Make-up or skincare products were blamed by 56 per cent for their flare-ups, although many were unable to say which particular brand or type was the culprit. Some people added that they tried to avoid any products that contained alcohol or might be astringent.

Hot drinks
The heat from a hot drink (or soup) in a cup held close the skin can worsen rosacea. This has the same effect as being in a steam bath or sauna. In the survey, 28 per cent reported this as a trigger factor. It is worth noting that caffeine has been shown to make no difference – it is the heat that is important.

Certain foods
Although 44 per cent blamed particular foods, the range of food and food groups was hugely varied, including:

* tomatoes
* cheese (except cottage cheese)
* spinach
* yoghurt
* plums
* raisins
* vinegar
* yeast-containing foods
* chocolate
* marinated foods

Medicines
Some medicines may act as vascular dilators, meaning they change the flow of blood around the body. These may make the symptoms of rosacea worse. They might include alpha- or beta-blockers for treating high blood pressure or heart problems, or medicines that contain steroids, especially those used on the skin.

Unknown triggers
Interestingly, nearly a quarter (23 per cent) couldn’t pinpoint what triggered their rosacea. It could also mean that some people don’t believe they have any triggers.

Multiple triggers
It is possible that someone could have one, two or many of the common triggers described above, which could make it hard to manage everyday life. It is not known how many people have multiple triggers, but anecdotally it is likely to be around half of all people with rosacea. Some people are careful to avoid anything that makes their skin worse, following strict diets or making lifestyle adjustments.

Appreciating the variety of causes and triggers for rosacea can put you back in the driving seat. It gives you the power to seek suitable treatments and avoid anything you believe makes it worse. While there is no ‘cure-all’ when it comes to rosacea, there are many avenues to explore. Try to stay positive and remember that however bad your flare-ups may be, there will be options to help keep the skin under control and irritation and discomfort to a minimum.

Acne and rosacea: the complete guide by Alison Bowser published by Vermilion at £10.99 from Amazon.

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