May 10, 2020 Rosacea Causes
Rosacea affects over 16 million Americans. Despite this, it is one of the least understood skin conditions. Numerous studies have found multiple factors that could cause rosacea (Vemuri). However, what scientists call the multifactorial pathogenesis of rosacea only serves to make it an even more mysterious condition. We’ve compiled all the possible causes of rosacea into one complete guide. Although these potential causes have scientific backing, remember that scientists don’t yet know what the main cause of rosacea is.
What Causes Rosacea?
Rosacea causes span multiple factors, including the weather, what you eat, genetics, and whether you smoke or not, among others. A common thread in all these reasons is they all cause some form of cellular stress or inflammation. Scientists believe understanding how these factors inflame the cells (especially skin cells) may one day lead to the root cause of rosacea.
Scientists suspect genetics may play an important role in rosacea. In a study published on the Stanford Medicine website, researchers identified two areas on the genome associated with having rosacea. What this means is that rosacea may be a genetic condition triggered by abnormalities in the genome. If you have rosacea, you may have the gene markers these researchers identified hidden away in your genetic code.
Getting rosacea could be linked to your family history. If you have anyone in your family tree with rosacea, it could have been passed on to you. One study found that “the existence of genetic traits that underlie rosacea is expressed by a positive family history for rosacea” (Buddenkotte). However, like all genetic traits, this is not always the case. You could have a family history of rosacea but not get it. It is also possible that you do not have a family history of rosacea but develop it regardless.
Some research has found a link between the gut bacteria Helicobacter pylori and rosacea. In one study’s research findings, scientists found that an h.pylori infection led to the development of rosacea. These findings suggest a connection between the two. Furthermore, when the h.pylori infection was treated, the rosacea also improved. Although this study found a direct link between this bacteria and rosacea, it still does not explain rosacea in people with no bacterial infections (Yang).
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4. Autoimmune Response
Some immune responses may be responsible for some types of rosacea. For instance, some drugs that treat inflammation are found to be effective in treating rosacea. This points to a link between inflammatory response and the onset of rosacea.
Some studies have identified the antimicrobial peptide cathelicidin LL-37, part of the body’s natural defense mechanisms, as a possible cause of rosacea (Steinhoff). When an autoimmune response is overblown, it can lead to inflammation and a rosacea breakout. In such cases, treating the autoimmune response could improve the rosacea.
Some skincare products can cause rosacea breakouts or make it worse. A study conducted by the National Rosacea Society that polled women with rosacea identified the following ingredients as potential culprits:
- Witch hazel
- Eucalyptus oil
The survey also found that exfoliating agents and other harsh skincare products can cause rosacea or make it worse.
Environmental factors are a rosacea cause that play an important role in how the condition develops. One study found that environmental factors played as important a role as genetic factors in the formation or worsening of rosacea (Aldrich). Another study found that rosacea is a photo-aggravated disorder – in other words, it is made worse by exposure to UV rays (Murphy).
Taken together, these two studies show a strong link between exposure to environmental factors and the onset or worsening of rosacea. Exposure to strong winds, humid weather, and cold has also been linked to rosacea breakouts.
More women seek treatment for rosacea than men. These figures could mean that if you are a woman, you are more likely to get rosacea than a man. However, the National Rosacea Society suspects these figures could be because more women seek treatment for rosacea than men. This means that whether you are a man or woman, it may be possible that there’s a fifty percent chance you could get rosacea (Gether). As such, gender is not considered a strong risk factor for rosacea.
Where your ancestors come from could be the cause of your rosacea. If your ancestral roots are in North or Eastern Europe, this could be why you have rosacea. Scandinavian countries, England, Scotland, Ireland, and Lithuania tend to have elevated levels of rosacea in their populations compared to other countries in the south and west of Europe. One reason is that people from these countries tend to have fair skin, something scientists believe is a risk factor for rosacea.
Smoking is a critical factor in the inflammation of cells. People who smoke regularly tend to have heightened cellular inflammation compared to those who do not. This effect could explain why people who smoke are more likely to have rosacea, as one study found (Kucukunal). In the study, which only sought to find a correlation between smoking and rosacea, the results indicated that test subjects that smoked regularly had a higher incidence rate of rosacea.
Eating certain foods can be what causes rosacea flare ups. Such foods are considered rosacea triggers and comprise foods to avoid with rosacea (Weiss).
- Heat-related foods: hot (temperature) foods and drinks.
- Alcohol-related foods
- Capsaicin-related foods: any foods made with hot peppers
- Cinnamaldehyde-related foods: including cinnamon breads, cookies, and others (Gowder).
Some studies found a link between Demodex mites and rosacea (Gonzales-Hinojosa). Demodex mites live harmlessly on everyone’s skin. However, when one of them dies, bacteria living in their gut are released into the skin, triggering an immune response characterized by redness.
Scientists believe that as we age, Demodex populations rise and subsequently lead to more bacteria getting released into the skin. This cause is supported by evidence that some antibiotics targeting the bacteria released by Demodex mites significantly improve rosacea symptoms.
Allergic reactions can trigger rosacea. When the body encounters foreign particles or other stress factors, it can mount an allergic response that triggers a rosacea breakout. Scientific evidence suggests that such allergy-like reactions may cause the body to have an autoimmune response, leading to inflammation. Although currently poorly understood, it is thought that anything that causes an allergic response, whether food, environmental factors, or psychological stress, can cause a rosacea breakout.
13. Neurovascular Disorders
Scientists consider rosacea a neurovascular disorder because it affects both the nerves and blood vessels in the skin. When you have rosacea, your skin may have visible broken skin capillaries, which causes blushing.
One study found that in rosacea, the body is unable to regulate components of the neurovascular system properly (Del Rosso). This dysregulation causes tiny blood vessels near the skin to rupture, causing visible red blushing. However, since this was observed in subjects with rosacea, it is not clear whether rosacea leads to neurovascular disorders or the other way round.
Psychological or emotional stress can lead to rosacea breakouts. Some people with rosacea may experience reciprocal breakouts. That is, a breakout causes stress, which leads to further breakouts. Although the underlying mechanism of this link is still poorly understood, doctors know that reducing stress factors and living a more balanced life can help improve rosacea. They also know that ongoing stress and the pressures of life can lead to more breakouts.
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About the author
Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the ...