In Part One of this series on rosacea – a common skin condition – we looked at rosacea symptoms and Subtypes 1 through 4, helping you to decode your sensitive skin. In Part Two, we focus on groundbreaking discoveries in rosacea research that are helping to clarify rosacea causes and triggers. As with any skin problem, identifying the causes of rosacea is key to understanding how best to the treat the condition.
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The Burning Question – What Causes Rosacea?
Dermatologists have spent decades studying rosacea causes and triggers, helping to create a clearer picture of the skin issue. Despite these efforts, however, the wider medical community has yet to agree on how to prevent and treat rosacea.
There is no single cause of rosacea. Instead, myriad factors play a role in rosacea outbreaks.
Such factors include:
- Sun exposure (UV) damages the integrity of healthy skin.
- Hyper-reactive immune response in the skin, causing abnormal elevation in inflammatory mediators.
- Genetics (subtypes of the condition can run in families).
- Women are three times more likely to experience rosacea then men.
- Reactions to certain medications.
People with fairer skin, typically those of Northern European descent, are more likely to develop rosacea.
Rosacea is also linked to chronic, systemic, inflammation arising from several different internal and external sources.
Rosacea Causes and Triggers
Skin specialists recommend that people with rosacea pay close attention to how their symptoms respond to different environmental and dietary stimuli. This can help sufferers identify rosacea causes and triggers, so as to avoid or minimise such triggers in the future. Decreasing rosacea triggers can temporarily reduce the likelihood of flushing.
According to the University of California Davis, common rosacea triggers include:
- Hot humid environment
- Hot drinks
- Spicy foods
- Eating a large hot meal
- Certain medications
- Sun and wind exposure
- Emotional stress.
New Discoveries in Rosacea Research
The dermatology community has spent decades carrying out scientific research into rosacea causes, triggers, treatment and prevention. While we can’t list all of this research, we can offer an overview of the more recent discoveries about rosacea. More insight into this research is also offered in Part Three.
What Causes Rosacea Flushing and Spots?
Mild to moderate rosacea is associated with red spots that emerge when the skin is aggravated by heat and that disappear later in the day. This form of rosacea is sometimes referred to as Rosacea Type 2 – Papulopustular Rosacea.
Acne vulgaris breakouts look similar to Rosacea Type 2 but are caused by a bacterial infection, typically with Propionibacterium acnes (also known as P. acnes). Infection with this bacterium can lead to the formation of pustules (spots filled with pus) which take time to heal.
Consider how your skin looks when you step out of the shower. Do you see flushing and small red spots on your forehead and cheeks?
This Zwivel online article offers additional help in understanding the difference between rosacea and acne vulgaris.
Given that acne and rosacea can have a similar appearance, dermatologists strongly recommended that anyone with symptoms has a consultation with a Certified Professional. A professional consultation can help determine the cause of sensitive skin and spots.
Rosacea Causes – Demodex Mites
In 2016, The Dermatology Times shared new findings about the causes of Rosacea Type 2 – Papulopustular Rosacea. New research found that a skin mite called “Demodex” was present to a much greater degree in skin affected by rosacea. Rosacea sufferers had up to ten times the population of Demodex mites on their skin compared to people with healthy skin.
In skin that was already sensitized, the presence of the Demodex mite was seen to cause an over-reactive immune response. This response prompted the release of histamine, triggering inflammatory processes that resulted in spots and skin damage.
The following video is of an interview with Doctor Fabienne Forton, a Dermatologist and researcher from the Université libre de Bruxelles. Doctor Forton discusses our current understanding of how the Demodex mite contributes to Papulopustular Rosacea with Frank Powell, a professor at the UCD Charles Institute of Dermatology. Professor Powell is currently conducting research into rosacea causes and treatments.
Dandruff and Rosacea – What’s the Connection?
Do you have dry skin at the corners of your nose and around your hairline and eyebrows? If so, you’re not alone.
Image By Roymishali – Own work, CC BY-SA 3.0
The American National Rosacea Society reported recently that flaking skin, resembling dandruff, is the most common skin condition to occur alongside rosacea. A dermatologist may diagnose this dry skin as Seborrheic Dermatitis, a skin condition thought to affect 1-5% of the general population, typically affects young people, especially young men.
Rosacea Causes – A Gut Feeling
Research is well underway to investigate the theory that gut flora imbalance plays a role in chronic skin conditions. In 2004, researchers at the University of Warwick looked at the effects of increasing gut transit time, i.e. how fast food moves through the digestive tract. In one patient, increasing transit time led to a complete remission of rosacea symptoms.
This research suggests a link between skin inflammation and Small Intestinal Bowel Overgrowth (SIBO). SIBO is a gastrointestinal condition where food stays too long in the gut, creating conditions that fuel the growth of pathogenic organisms. This can then lead to a leaky gut and inflammation.
Other research suggests that a diet rich in fiber and fermented foods supports healthy gut flora and can reduce SIBO incidence and inflammation. More research is needed to establish the benefits of eating adequate amounts of fiber for skin conditions such as rosacea.
Rosacea and oily skin
There can be a lot of confusion about skin oiliness or dryness in rosacea as in early stages (Rosacea Subtype 1) the skin can appear dry, at least to the naked eye. In more severe cases (Subtypes 2 and 3), a combination of skin flakiness, dryness, and oiliness is likely.
Rosacea sufferers often report a tight feeling in the skin immediately after cleansing. This is typically followed later in the day by an oilier complexion on the forehead and cheeks, where spots appear. The level of skin oiliness depends on sebum production, which itself depends on key factors including genetics, gender and age.
Read about Christine’s experience of Rosacea Treatment
Skin oiliness increases after puberty, with sebum production higher in most men due to higher testosterone production. After menopause, many women experience a rapid decline in sebum production, which can leave skin feeling very dry.
Sebum is crucial for maintaining the skin’s pH balance. The skin must remain slightly acidic to regulate the population of good bacteria. A rise in pH can, therefore, lead to the overgrowth of bad P. Acnes bacteria, resulting in spots.
Contrary to popular belief, excess sebum alone does not cause rosacea or acne. Instead a healthy skin barrier relies on a critical balance of lipids in sebum. Without a healthy skin barrier, other factors can come into play.
Research published in 2016 helped to identify the molecular differences in skin lipids. The paper presents evidence that the mixture of fatty acids making up sebum may influence skin barrier integrity in people with more severe Papulopustular Rosacea.
Rosacea Causes – Immune Function
The research into skin lipids also clarified the activity of the outer layer of the skin, called the stratum corneum. This protective layer of skin is often mistaken as ‘dead skin’, but the researchers found that the skin cells (called keratinocytes) are very much alive. Critically, these skin cells appear capable of communicating with emerging cells and the immune system.
Proper communication with the immune system is important for skin health. This is because the inflammatory cascade, and histamine release, occur in response to a perceived attack on the body, not just an actual attack. Due to the close connection between every cell, an increase in sebum production can be seen as a natural response to help counter the effects of inflammation. Unfortunately, for those with skin conditions related to problems with sebum, this can create a vicious cycle. Sebum excess may trigger other disruptions causing more inflammation, immune system disruption, and further excess sebum production.
In this video interview the one reasons why so many rosacea suffers have an oily T-zone and very dry cheeks.
A face-to-face consultation using a 7-Point Skin Analysis is one of the best ways to determine skin oiliness. Contact Medico Beauty today to arrange a consultation and for a limited time receive a 5% discount on your first online order at www.medicobeauty.com
Is Rosacea Connected to Other Diseases?
Researchers continue to investigate the relationship between rosacea and other diseases. Especially relevant is a Danish study published in 2016, which found that people with rosacea were at least twice as likely to have type 1 diabetes, celiac disease, or rheumatoid arthritis.
In conclusion, as with many skin diseases, rosacea has a complex array of causes linked by a single key factor: inflammation. New discoveries like those outlined above have helped to evolve our understanding of rosacea at the cellular and molecular level. As a result, treatment recommendations have evolved to include advice on improving the health of internal organs and digestive health.
The precise impact of internal inflammation on skin health has yet to be fully investigated and explained. However, the majority of studies strongly indicate that poor digestive health due to poor nutrition negatively affects rosacea.
Problems with the gut, such as a “leaky gut“, can cause secondary issues such as an over-reactive immune response. In a series of online articles, Doctor Axe provides insight into the symptoms, causes, and effective treatment of this complex issue.
Unfortunately, the advice given by medical professionals including General Practitioners and Dermatologists can vary widely. This can result in both confusion and delays in developing effective treatments. Rosacea sufferers in particular are often overwhelmed and confused by information found online.
In Part Three of this article series you’ll discover natural treatments for rosacea that address the root causes of the skin condition. Such treatments recognize the importance of considering both individual needs and circumstances to help you achieve healthy skin.
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