The most common and distinguishable symptom of rosacea is the flushing. Facial flushing or redness is measured by our ability to process emotions, hydration, chemical influences both topical and internal, stress and our skin’s response to them. The basic classifications are: mild, moderate and severe. These degrees of facial redness are open to interpretation and one person conception of moderate redness may be another person definition of mild redness. We often judge our own degree of redness as more extreme than another observer would.
The standard definition of mild redness is described as a flushed or blushing appearance that comes and goes and is of short duration each time. The skin may appear to have a slight pinkish tint as if one applied too much foundation blusher or have the look of slight sunburn. One may notice that during these episodes the skin may sting, tingle or itch.
In the classic definition of moderate facial redness, one finds that the redness begins to appear more frequently and remain for longer periods of time. The redness tends to be more intense and it is more common at this stage to experience more pronounced stinging, burning or itching of the skin. One may also begin to detect at this stage some broken capillaries resulting in the initial appearance of spidery veins under the skin.
The point at which the facial redness reaches the severe stage, the skin will appear to be bright, flaming red. The skin will feel warm or even hot to the touch. The redness is no longer a symptom that comes and goes with periods of remission but a constant skin tone. The skin will often display signs of swelling, with spider veins present. The skin experiences more intense and continuous burning, pain or itching.
Erythema also known as facial skin redness is the most common rosacea symptom. The facial redness or flushing is the result of the hundreds of tiny dilated blood vessels located near the surface of the facial skin becoming dilated or inflamed. There are many rosacea triggers that cause this inflammation. Rosacea is not acne, but in the past some considered rosacea a type of acne and thus the term acne rosacea came into being. Today this term is used to describe the condition in which both acne and rosacea occur together. It was once thought that rosacea was a condition observed only in people with lighter-skin tones. But with the spread of the western culture and lifestyle, rosacea is now a condition which affects all ethnicities, races and skin tones.
There are many causes or factors that influence the degree of facial redness. Learning to manage or control these situations can help to diminish the impact of facial redness your experience.
Clock Rosacea or Systemic Flushing
Facial skin redness or flushing is more prevalent when the core body temperature is elevated. Our body operates on an internal clock. During the course of a 24-hour cycle, the average body temperature is at its lowest between 3 and 4 a.m. and the highest average body temperature usually occurs around 7 to 8 p.m. When the body becomes stressed or fatigued the sympathetic nervous system is stimulated resulting in flushing or facial redness. This activation of the sympathetic nervous system causes the blood vessels in the facial area to dilate resulting in the strong rosacea flush or facial redness.
The sympathetic nervous system can be stimulated by a lack of sleep, stress, anxiety, a disruption in the body's circadian rhythm. The circadian rhythm is a 24-hour regenerative process in our body. Sleep patterns are a part of this process, when sleep is disrupted due to work schedules, stress, elder care or child care, our body reacts in a variety of ways. When you alter your exposure to light and darkness, you experience a disruption in this rhythm. Some refer to this as the winter blues, a very real problem for people living in areas with limited or reduced sunlight in the winter-time. But this same disruption is seen in those who work night-shift jobs or those who stay inside or sleep during the day.
Our immune system reacts to this process through changes in the types of bacteria living in our bodies. Because of these changes in the flora and fauna bacteria our body is not able to process acidic foods as efficiently leading to an increase in inflammation in the form of higher risk of heart disease, arthritis, coronary problems, rosacea, and even cancer.
Researchers have found that when we experience these disruptions to our natural circadian rhythm, we need to be more attentive to the pH balance within our bodies to counteract the bacterial changes that lead to increased inflammation. Therefore we can conclude that controlling rosacea is multi-step process. Treat and manage the outward systems of the skin but also one must understand that rosacea is more than skin deep, it is a part of a larger and much more complex interaction within our immune system.
The sympathetic nervous system is stimulated by an increase in internal body temperature. Body temperature decreases as a result of the parasympathetic system calming the system. The effects of clock rosacea are more noticeable in rosacea patients with blood vessels damaged by years of sun exposure, those with genetically weak blood vessels, and those with an increased number of blood vessels.
Sugar/Carbohydrate and Heavy Meal Flushing
This form of vascular dilation or facial skin flushing results from stress on the digestive system due to an increase in blood flow to the digestive system with the residual blood being heavier to the face. Consuming three small meals and healthy snacks in between meals will help limit this type of facial redness and flushing. The goal is to maintain the proper blood sugar ratio for energy to reduce fatigue or exhaustion. The kind of foods that you eat is equally important as different foods stimulate the blood flow differently.
Simple carbohydrates such as alcohol, cakes, cookies, donuts, sugars, etc. enter the blood stream quickly resulting in higher glucose spikes or hyperglycemia. The rapid bombardment of sugar into the blood stream serves as a powerful vasodilator. It is better to replace simple carbs with a more complex carbohydrate such as beans, apples, baked potatoes, or corn.
Foods high in fiber makes the stomach feel full and prolongs digestion times thus preventing the sudden inundation of sugar into the blood stream with the resultant facial redness or flushing of the skin.
Steroid-Induced Rosacea Flushing
Steroids are a synthetically manufactured hormone that suppresses the immune system response to reduce redness, swelling, itching by reducing the immune system response. Topical and oral steroids are prescribed for a variety of reasons but in every case the goal is to suppress the immune system response thus reducing the impact of severe swelling, itching, redness papules and pustules. If you suppress the response you initiate a lessening of the symptoms. The theory being that if minimize the body's response, the body will have the chance to enact its own healing. The reality doesn't always meet this goal. The process is a finely tuned choreographed procedure. Used for a short one to two period of time, it can be effective in reducing the intensity of the skin's response but if used any longer, the skin reacts in a worsening of the symptoms. There is also a danger in suppressing the immune system that the skin becomes more vulnerable to bacteria, germs, and the effects of the sun. The appearance of steroid induced rosacea can be startling, the facial skin becomes a dark, flaming red color, and papules become large and prominent, there may even be scaling and peeling of the skin.
Adrenaline Induced Flushing
This is a hormone released vascular response resulting from an adrenaline rush. Facial skin flushing resulting from an Adrenaline rush is a hormone released systemic flushing. An adrenaline rush may result from a perceived threat, fear, high intensity exercise or excitement. The nervous system is activated through the release of adrenaline and hormones, our pulse rises, senses become sharper, our muscles tense and the immune system begins to shut down.
Exercise induced facial flushing occurs due to the cardiovascular system being stimulated to work harder causing vascular dilation. To control facial redness during exercise, keep the body well hydrated, exercise in a cool environment- an air conditioned exercise room or if outdoors, exercise during the cooler times of the day. Doing short sets of exercise followed by a cool down period of lesser intensity exercise will also help.
Cigarette induced Flushing
Smoking decreases oxygen flow causing the blood vessels to work harder to supply blood to the skin and vital organs.
Hot Shower/Bath Flushing
Heat and steam from bathing and hot showers causes vascular dilation and skin flushing. To minimize this type of flushing, one can either use cooler water temperatures when bathing or utilize the benefits of warmer water to open the pores and then rinse with cooler water to cool the body and reduce the flushing.
Alcohol flushing occurs from the high amounts of fermented sugars and carbohydrates in the alcohol, and the dehydrating effects of alcohol as a diuretic. When the body becomes dehydrated one is more likely to experience flushing and facial skin redness. The sugars and carbs in alcohol are simple carbs which are high in calories and metabolize quickly in the body resulting in vascular dilation, skin redness and flushing.
To reduce this type of flushing, one may choose to avoid alcohol altogether, or one can minimize the flushing effects by careful choice of alcohol. When drinking beer, choose domestic brands over foreign beers, and light beer over the darker ales.
When drinking wine, choose white wine over red to reduce flushing.
Dilute or mix vodka, whiskey or gin with water rather soda or juice to reduce the higher sugar content and minimize flushing. Gin tends to cause less stimulation of the cardiovascular system than whiskey or vodka. Hydrate or chase the alcohol with water to further reduce facial flushing.
Hot/Cold Weather Facial Flushing
The high temperatures and humidity of summer are potent vascular dilators causing flushing and facial skin redness. When it's necessary to be out in the heat, this can be difficult to avoid. A cooling cloth such as Endura cool placed around the neck or head can help reduce the skin temperature to the face and head and reduce the facial redness and flushing.
In winter time, entering a warmly heated room results in a facial flush as the colder air outside resulted in the blood vessels constricting to conserve energy and the ensuing heat upon entering the building causes the skin to flush. One can minimize this effect by reducing the shock of heat or cold air with a slow transition to the changing temperature or wearing a scarf when outdoors and adjusting to allow the skin to heat or cool at a slower pace.
Food Allergy Flushing
Dietary adjustments are believe by some not to have any impact on your skin but common sense will tell you that is not always the case. In some instances you may have an allergic sensitivity to some foods or beverages, in which case, managing or reducing exposure can be the solution. The other way in which diet can play a role in skin care treatment is in achieving a pH balance in your body. The skin is the first to show the effects of a pH imbalance as it is the largest organ in the body. Balancing acidic foods with alkaline foods can be helpful not only in balancing the body's pH but also you skin.
Symptoms of a food allergy include facial redness in the area of the nose, ears and cheeks. Keeping a diary of the foods or beverages consumed can aid in identifying those items which are responsible for this allergy induced vascular dilation.
Other foods cause vascular dilation but may not be an allergy related response. Foods that cause facial redness and flushing include carbohydrates high in calories such as breads, pastas, cakes, candies and foods high in sugar content. Spices, vinegars, seasonings, hot peppers and meat marinades result in a vascular dilation facial redness, burning and even stinging on the lips. Citrus juices, citrus fruits, tomatoes, raisins, bananas, figs, cheese, dairy, chocolate, eggplant, avocados, spinach, red plums, vanilla, soy sauce, yeast extract, liver, lima beans, peas and navy beans are all likely to cause flushing and facial redness.
Pollen and Contact Flushing
Pollen counts and mold spores are higher from late spring through the fall. The weather apps on your phone or local weather station list daily the more troublesome pollen offenders in your area, whether it is grasses, weeds, or flowering plants. The effects of pollen flushing include skin redness, watery, itchy eyes and nasal congestion.
Ocular rosacea is a common variant of rosacea. The symptoms of ocular rosacea include redness on the eye surface and in some cases extending to the eyelids. The eye area may appear swollen or inflamed. One may experience a burning sensation or a feeling that there is sand or grit in the eye itself. One may in some instances experience pain in the eyes or sensitivity to light. Eye rosacea can include the symptoms of many eye conditions such as conjunctivitis or pink eye as it is sometimes called. Other related eye conditions include blepharitis, iridocyclitis, iritis, hypopyoniritis, and in extreme instances keratitis.
The eyes may appear bloodshot with the eye lids having a swollen appearance. One may experience small inflamed bumps on the eyelids or you may find that your eyelashes have a tendency to fall out.
The most often heard complaint with rosacea affecting the eyes is an inflammation in the corners of the eyelids possibly including crusting or scaling. This crusting or scaling is often confused with the skin condition seborrhea dermatitis.
Finding proper treatment can be difficult – while a dermatologist may understand the complexities of treating the facial skin of rosacea, they lack the training and expertise required to address the symptoms of rosacea involving the eyes. To address the symptoms of eye rosacea, an ophthalmologist would be recommended. Keep in mind though that while they specialize in the treatment of ocular conditions including those involving rosacea, they may not always be aware of the skin symptoms of rosacea and therefore may not link the involvement of ocular and skin in the same condition making it challenging to co-ordinate a treatment plan.
When an asthma attack occurs, the muscles of the bronchial tubes constrict due to an increase in inflammation and mucus making it harder to inhale oxygen and exhale carbon dioxide. The excess carbon dioxide causes the face to flush and the facial skin to turn red. Asthma flushing while not a true rosacea flush is a common condition experienced by rosacea patients. Typical asthma triggers include pollution, strong odors, perfume, household chemicals, molds, pollen or fungus, dust mites, animal dander, tree, weed or grass pollen.
The primary goal is to minimize flushing and facial redness by managing the vascular construction and dilation process.
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.