Facial redness (erythema) & flushing are the most common symptom of rosacea with the cause of the inflamed dilated blood vessels reaction to rosacea triggers.
The symptoms of rosacea include facial redness and flushing, inflammatory papules and pustules which can occur and persist for weeks. It can include facial swelling. The eye may become involved in an occurrence known as ocular rosacea, in which the eyes become inflamed, red, irritated, dry and may be crusty.
What are the Rosacea symptoms?
Rosacea symptoms affect primarily those of Caucasian or other ethnic groups with lighter toned skin. However, rosacea patients are affected with symptoms throughout the world irregardless of national origin with approximately 100 million of the 7 billion people on earth having rosacea symptoms. Most rosacea researchers and medical groups think that the the numbers are much smaller in the range of 40 to 60 million people, however, they do not gather the information through as many channels and organizations and individuals as our International Rosacea Foundation staff does.
Some rosacea patients have knowledge of symptoms of facial rosacea and ocular rosacea. Whoever, most rosacea patients do not have the knowledge of 'why their dermatologist chose the rosacea treatment' or 'what the expected results will be. The rosacea patient mostly lives in 'hope' and a real desire of the best rosacea treatments for facial rosacea and ocular rosacea. Often the patient continues for years with various dermatologist. And most dermatologist continue to try various treatments for various patients with very different symptoms. The frequent migration of patients and the dermatologist failure to learn of the patient's past history prevents poor performance. Or again the 5'Ps of life and of medicine: Prior planning Prevents Poor Performance.
Facial Redness or Flushing
An effective rosacea treatment begins with an understanding of the symptoms of rosacea which leads to the proper diagnosis and treatment of rosacea based on your specific rosacea symptoms. Controlling your rosacea may depend on your ability to adapt and adjust to the factors which influence your rosacea.
To understand rosacea and distinguish rosacea from other facial skin related conditions, the patient needs to understand and be able to identify the symptoms of rosacea. The classic symptoms of rosacea can vary from person to person, however there are many commonalities. Rosacea can vary in intensity based on many contributing factors and symptoms as you will see below:
Facial skin redness or erythema is the most common symptom of rosacea. Facial skin redness is caused by hundreds of tiny dilated blood vessels near the surface of the facial skin that become inflamed or dilated due to many rosacea triggers. The inflammation of rosacea is not acne, but some dermatologist label the two skin disorders when found together as acne rosacea. Sometimes blackheads and whiteheads are also present. It is a fairly common disorder -- about one in every twenty Americans is afflicted with it (Drs. Faria and Edward.) Likewise the amount of rosacea suffers would be about the same in other countries where light skinned people exist and have been previously known to have rosacea. However, we have now learned that many others in non-Caucasian countries have rosacea. It is harder to see flushing and facial redness when the skin is darker, but the burning and pain still exist. Even African, and those from Middle Eastern countries such as Iraq, Iran, Syria, Israel, Jordan, Kuwait, Saudi Arabia, etc. and those from the Far East of Japan, China, Singapore and other countries. Too many focus on rosacea in the United States, Canada, UK, Germany and the Nordic countries of Denmark, Finland, Iceland, Norway, and Sweden.
The symptoms of rosacea begin with facial skin redness and develop to more frequent flushing of the face, particularly the nose and cheeks. This facial flushing is caused by the swelling of the blood vessels under the skin. This 'red mask' can serve as a flag for attention.
Each of the following items is part of a complex interaction of several systems which can aggravate or increase the symptoms of facial skin redness.
Clock Rosacea or Systemic Flushing
Flushing or facial skin redness is more likely to occur when the body temperature is elevated. The body does operate on a clock! Hospital physicians have known for years that the lowest body temperature of the 24 hour day is usually around 3:00 to 4:00 A.M. while the highest temperature of the day is generally 7:00 to 8:00 P.M. The average rosacea sufferer does not have hospital waking and sleeping hours, therefore their temperature lows and highs may vary 3 to 5 hours each way. A high temperature for some may be as early as 3:00 P.M.
The symptoms of flushing usually occur when the body becomes fatigued and/or stressed which stimulates the sympathetic nervous system. Any activation of these nerves causes vasoconstriction of 'blood vessels' -- except in the 'facial blush/flush areas' where it induces potent vasodilatation of the facial skin or flushing with the resulting 'rosacea redness'.
Stress stimulates the sympathetic nervous system.
Lack of sleep stimulates the sympathetic nervous system with a minimum of 8 to 9 hours being needed nightly.
Anxiety (fight or flight) stimulates the sympathetic nervous system.
Increase in internal body temperature stimulates the sympathetic nervous system, whereas obviously a decrease in body temperature decreases the sympathetic system due to the parasympathetic system calming the system.
The sympathetic nervous system is especially important in defining the symptoms of rosacea patients who tend to have one or more of the following:
- Genetically weak blood vessels
- Damaged blood vessels from years of sun
- Damaged support system for blood vessels (collagen-elastic of skin)
- Increase in number of blood vessels
Heavy Meal and Sugar/Carbohydrate Flushing
This facial skin flushing or vascular dilation is caused by more stress on the digestive system resulting in a higher blood flow to the digestive system with the residual blood being heavier to the face. Three small meals with breakfast being the most important and grazing or snacks in between is better for limiting the symptoms of this kind of flushing. This will maintain the proper blood sugar content for energy to prevent fatigue or exhaustion. The type of food that you eat is also very important as various foods stimulate blood flow differently.
Simple carbohydrates such as donuts, sugars, alcohol, etc. enter the blood stream quickly causing hyperglycemia (high glucose spikes.) This rapid influx of sugar into the blood stream is a potent vasodilator.
Carbohydrates are needed for energy and as a part of every meal; however, try to enjoy baked potatoes, beans, corn, apples, etc. instead of simple carbohydrates.
Fiber intake decreases the amount of food that the stomach has at one time and prolongs digestion; therefore, it prevents the sudden influx into the blood stream with the resultant facial skin flushing.
When a rosacea patient is erroneously treated for a prolonged time with topical steroids the disorder may at first respond, but inevitably the signs of steroid atrophy emerge with thinning of the skin and marked increase in telangiectasis. The complexion becomes dark red with a copper-like hue. Soon the surface becomes studded with round, follicular, deep papulopustules, firm nodules, and even secondary comedones. The appearance of the facial skin redness is shocking with a flaming red, scaling, papule-covered face. Steroid rosacea is an 'avoidable condition' which in addition to disfigurement is accompanied by severe discomfort and pain. Withdrawal of the steroid is inevitably accompanied by exacerbation of the disease, a trying experience for a patient and physician. ((Drs. Gerd Plewig and Albert Kligman.) Always avoid steroids or cortisones for any purpose. If you are on them now, get off as quickly as possible as the body and skin continue to be further addicted to steroids or cortisones for any medical purpose. Most dermatologists know not to prescribe a steroid for rosacea.
This kind of vascular dilation is caused by an adrenaline rush. Adrenaline facial skin flushing is the same as systemic flushing, but it is hormone released. Stress is the body's reaction to a perceived threat. Adrenaline and hormones are released, and the nervous system is activated, sharpening our senses, but simultaneously our pulse rises, our muscles tense and our immune system begins to shut down.
Adrenaline activity can also cause acne in both men and women as a reaction to mental or physical stress. In women, half of their testosterone is produced by the ovaries with the other half being produced by the adrenal glands. Estrogen smoothes out the testosterone produced by the ovaries, but when the estrogen level drops several days before the menstrual periods, sometimes resulting acne occurs especially when the adrenal glands over produce due to stress or fatigue. The adrenal glands can be stressed continually in both men and women resulting in too much testosterone with the resulting over stimulation of the sebaceous glands. Similarly, in the male an over abundance of testicular testosterone especially with overly stimulated adrenal glands causes the overly stimulated sebaceous glands. Quite often more stress is placed on the adult after puberty resulting in the symptoms of over active sebaceous glands. While we can not produce more estrogen to level out the testosterone, we can drink much more water which will help relieve the symptoms of stress and assist both acne and rosacea. Getting enough sleep and finding ways to relax will help relieve stress and reduce the adrenaline reaction that follows.
Exercise flushing is caused by the cardiovascular system pumping harder and faster due to exercise with the result being vascular dilation. The key is to minimize vascular dilation while exercising to reduce the symptoms of facial skin redness.
Exercise should be done moderately in a cool area keeping the body well hydrated with water to minimize the facial skin redness. It's best to adapt slowly over time to the exercise so that the body is aerobic (with oxygen) instead of anaerobic (without oxygen causing redness.) Therefore, you can handle more vigorous exercise as your exercise training increases. Better cardiovascular shape and exercise means more oxygen in the blood which constricts blood vessels.
Smoking, a vascular dilator which robs the skin of oxygen, is a potent initiator of telangiectasis and the symptoms of facial skin redness. The smoker may have a variety of medical problems such as high blood pressure and mineral deficiencies which can cause the appearance of telangiectasis.
Hot Shower/Bath Flushing
Obviously the skin is redder by the stimulation of hot showers/baths which is vascular dilation. Overall, it is better to shower in tepid water in the range of 85 to 95 degrees to cool the body and prevent vascular dilation. You may choose to shower with warmer water to open the pores up to clear them or for relaxing; however, remember to begin to lower the temperature to a much lower degree for cooling off to prevent the skin from turning red or to reduce the redness from the prior higher temperature. The cooler water temperature produces vascular constriction, cooling the skin and reducing the effects of facial skin redness.
The best way to avoid this type of flushing is to not drink any alcohol! All alcohol is fermented, but because beer and wines (red wine being the worst) are not further distilled, they can cause the symptoms of allergy facial skin redness for many rosacea sufferers. Alcohol is a diuretic which pushes water out of the body cells. In this state of dehydration, the body is prone to skin redness and flushing. Alcohol is a concentrated source of calories and is metabolized very quickly. This causes the blood vessels to dilate causing facial redness symptoms.
If you feel you need to drink alcohol at social functions or to relax, here are some recommendations to minimize the flushing effect:
- Avoid beer as it is higher in carbohydrates. However, if you like beer, drink domestic beer from your own country as it is usually sold within six weeks of production. Foreign beers imported into your country usually have preservatives which make for more redness. Domestic 'light beer' usually does not have as many carbohydrates and less alcohol content making it the beer of choice.
- Wine is heavy in carbohydrates and even higher in preservatives/sulfides and alcohol causing more flushing with the red wines usually being the worst for most of us. If you prefer wine, a white wine would be best.
- It is better to drink small amounts of gin, vodka, or whiskey, diluted with water instead of sugared soft drinks or mixes which also can stimulate the cardiovascular system. A good choice would be a Long Island Ice Tea substituting the mix with water and diluting it. Small amounts of gin are frequently less stimulating than vodka or whiskey. You should "chase" any alcoholic drink with water.
Although these recommendations can help to minimize facial skin redness/flushing, the best advice is to not drink any type of alcohol.
Cold Weather Flushing
These flushing flare ups result from coming in from the cold into a warm room. While the rosacea sufferer is outside in the cold weather the cardiovascular system is pumping hard, however, the extremities such as the feet, hands, ears, and nose get less blood supply than the rest of the body. It's partially due to direct contact, but it is more a result of conservation of heat by internal thermostat -- causing constriction of vessels by decreasing sympathetic activity to vessels (similar to taking a 'cool' shower.) When the rosacea sufferer enters the warm office or home, the warmer temperatures quickly warm the facial skin areas and extremities while the cardiovascular system is still in a moderately high exercise mode. The rosacea sufferer should try to minimize the extreme cold exposure by warming up the car prior to use or wearing a facial mask/hat/scarf depending on length of exposure and severity of cold temperatures. After being exposed to the cold for a long period, try to enter the building slowly so the cardiovascular system will not be as stimulated, and then proceed slowly into the warmer office/home to minimize facial redness/flushing.
Food Allergy Flushing
In our experience, many patients with rosacea have other symptoms that suggest the diagnosis of food allergy. A red nose, cheeks, and red ears act like warning lights that turn on when a food reaction starts. Rosacea patients should identify the reactive foods when this flushing or vascular dilation occurs. Often, it is the symptoms of food allergy that motivate people to start diet revision and an improvement in their rosacea condition is noted along with improvement in other symptoms such as gastrointentestinal disturbances, migraine headache, sinusitis, and fatigue.
As mentioned earlier, rosacea redness is partially caused by high calorie carbohydrates (pastas, breads) and sugar spiking from all sweet foods. Quite different are the foods that are blood vessel dilators such as vinegars, hot spices, and various other spicy seasonings, hot sauces, peppers (including black pepper) and meat marinades. Tomatoes, citrus fruits, and related juices, bananas, and red plums, raisins, figs, pasta, cheese, and chocolates are some of the worst offenders to many. Other very common known flushing foods are liver, yogurt, sour cream, vanilla, soy sauce, yeast extract, eggplant, avocados, spinach, broad-leaf beans and pods, including lima, navy or peas. Allergies to malt and yeast beverages, and fermented alcohols would fall into the allergy induced redness category. Stimulants such as coffees, teas, soft drinks with caffeine, alcohol beverages, and chocolates stimulate the system resulting in more facial redness or dilation.
Thermally hot foods and drinks even cause vascular dilation or flushing in non-rosaceans. Avoid all hot foods and drinks until they have cooled to body temperature or better yet cooled well below body temperature. The best way to drink a small amount of coffee, tea, or soft drink is refrigerator cold as this will not cause as much vascular dilation.
Food allergies are common in causing nasal membrane mucous resulting in vascular dilation causing reddening or facial flushing for many. This condition gets the same response (but for very different reasons) as the common cold or influenza which often causes facial flushing due to a bacterial and virus infection.
Aspartame and NutraSweet in soft drinks, jellos, and other foods causes noticeable flushing in 30% of rosaceans. Try a 60 day non-aspartame period to watch your facial skin redness improve.
After all the foods that cause more vascular dilation or blushing, a bonus is that cherries, blackberries, and blueberries which are vascular constrictors actually assist in reducing the symptoms of facial skin redness.
Pollen and Contact Flushing
Spring in most countries is the time for pollen and mold spores with the result that it affects many rosacea sufferers. However, some areas have enough warmth and proper vegetation for pollen and mold spores year around. You may even see mold spores growing in your bathtub or shower.
Many rosacea patients have ocular rosacea with symptoms of redness or flushing of the eye (bloodshot appearance) that results in a distressed eye or 'stressed person'. This ocular rosacea flushing can be rectified or most often a noticeable improvement can be made with Rosacea-Ltd IV which you can learn more of at the Ocular Rosacea page. The Rosacea-Ltd application is painless and most effective for this systemic therapy for for inflammatory or 'red eye' can be appropriate especially for recalcitrant or long term cases of ocular rosacea Flushing.
In an asthma attack, the breathing pathways constrict, making it difficult to exhale carbon dioxide. When you can't exhale an adequate amount of carbon dioxide, you can't inhale oxygen. The lack of oxygen causes the face to turn red. Again not a true rosacea flush, but it's not uncommon for rosacea suffers to also have asthma. Asthma flushing/redness can result from a food allergy, airborne pollutants or toxins. Using an allergen air filter and changing it every one to two weeks can help reduce indoor pollens, toxins, fungi, and/or molds in the home. Air purifiers can also be helpful. Controlling your environment as much as possible can help to relieve some of the symptoms of asthma.
These are some of the primary types of flushing that result in the symptoms of facial skin redness. The goal is to decrease vascular dilation through vascular constriction which will minimize flushing of any type. The blood vessels continue to grow with age and are stimulated and damaged by stress, food/drinks, dehydration, weather, sun exposure, abrasive soaps/exfoliating medications, hot bath, exercise, etc. The more blood vessels one has near the surface of the skin, the more one is likely to flush and stay flushed.
You will find on the following page 2 of rosacea symptom (by clicking at the right) as well as the various classifications and definitions to be most helpful. Likewise the Rosacea-Ltd IV product for facial rosacea is most effective in combating rosacea symptoms. As most often state, "You can't lose anything but your rosacea" is a most honest and fair statement.