Causes of Flushing

One of the earliest symptoms of rosacea is flushing or diffuse redness. The flushing factor tends to be cause of comment and embarrassment for the rosacea sufferer. Facial redness or erythema is best defined as a lengthy flush of embarrassment or emotion in a social situation that may last for a few minutes to many hours. While for many others it is the more constant redness or blotchy flushed appearance that becomes the cause of embarrassment. The redness is generally located on the cheek area but can spread down to the chin, neck, or even upper chest. In some cases the forehead may also be involved. This redness can be associated with many things such as food, dust, environmental or chemical allergies, stress, over-exertion, exercise, alcohol, extreme heat, or cold. If the redness becomes more permanent or constant, one may suspect the skin condition known as rosacea.

Many rosacea patients definition of rosacea is a hot burning sensation 'of sensory feelings' like a sunburn. Other patients definition is the 'appearance that they personally view themselves and how others socially view their red sunburn appearance.' In the early stages of rosacea this redness may come and go. In the later stages of rosacea, the effect becomes more permanent. The facial redness or flushing may last anywhere from hours to days at a time.

Treatment of rosacea needs to begin with an understanding of what causes or influences your rosacea flushing. Effective skin care for rosacea must address the flushing issues. Rosacea sufferers have on average more facial blood vessels than the general population, or they have blood vessels which are more prominent or severely damaged. Consequently, anything that stimulates facial dilation cannot be handled easily or properly. We will attempt to help you understand vascular constriction and dilation. Dilation, or enlarging of the blood vessels, produces the flushing which rosacea sufferers experience. Understanding what causes the vessels to dilate will help you control the factors that aggravate a rosacea flush.

Each of the following Flushing Types is part of a complex interaction of one or more physiological systems.

Clock rosacea or systemic flushing- the body does operate on a clock! Universally, 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.

Flushing usually occurs when the body becomes fatigued and/or stressed which stimulates the sympathetic nervous system. The key to this is the autonomic nervous system (more specifically, the sympathetic postganglionic efferent nerves). Any activation of these nerves causes vasoconstriction of "body blood vessels" -- except in the "facial blush/flush areas" where it induces potent vasodilatation or flushing with the resulting "rosacea red face." Therefore, the rosacea patient desires treatment to alleviate the redness.

A typical rosacea sufferer would flush in the fifth grade even if the answer was known when the teacher asked a question, and obviously the flushing would be noticed by the other kids. Again, the sympathetic nervous system:

• Stress stimulates the sympathetic nervous system.
• Lack of sleep stimulates the sympathetic nervous system with a minimum of 8 hours being needed.
• Anxiety at work or home (fight or flight) stimulates the sympathetic nervous system.
• An increase in internal body temperature stimulates the sympathetic nervous system when "acid drinks, foods, and cigarettes or any rosacea triggers" are consumed.
• A decrease in body temperature and facial skin heat results when the parasympathetic system calms the body and brain over a period of time such as at night when sleeping. By consuming alkaline foods and drinks, the parasympathetic nervous system can very quickly take control of the body and brain stress as you will learn more about on this page and other pages.

The parasympathetic nervous system activates as quickly as possible for the 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) and a damaged immune system.
• Increased number of blood vessels to years of inappropriate skin care and rosacea treatments.

Heavy meal flushing and sugar/carbohydrate flushing - This 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 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. (which are very acidic with a low pH) enter the blood stream quickly causing hyperglycemia (high glucose spikes.)
• Carbohydrates are needed for energy and as a part of every meal; however, let's try to enjoy the baked potatoes, beans, corn, apples (fruit but still a carbohydrate), etc. as part of your rosacea diet instead of simple carbohydrates.
• Fiber (with a higher pH or "alkaline foods") 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 flushing. This results from a "better rosacea diet."
• The proteins of most fruits and vegetables provide the body and brain with many nutrients with a high ph that are needed to repair the body and facial tissue for the best "rosacea diet" while carbohydrates are needed for energy and is most often stored as fat.

Steroid 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 telangiectases. 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 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 treatment is inevitably accompanied by exacerbation of the disease, a trying experience for a patient and physician. (Dr. 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 the treatment of rosacea.

For information on steroid use, please see First World Congress of the International Academy of Cosmetic Dermatology.

Adrenaline flushing - This kind of vascular dilation is caused by an adrenaline rush or a large supply of adrenaline under pressure with immediate or instant flushing. It is the same as sympathetic nerves, 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.

Those that can not relieve stress as needed may experience fatigue, upset stomach, frequent headaches, and a flushing face. Long-term stress can contribute to family breakdown, job fatigue, with resulting long-term health problems such as depression, heart disease, high blood pressure, and rosacea.

Adult acne is adrenal related, in both men and women as a reaction to mental stress or body stress. In women, testosterone is produced by the ovaries and the adrenal glands. Obviously, 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. These glands produce testosterone directly or via peripheral conversion of DHEAS (dihydropiandrosterone sulfate), DHEA (dihydroepiandrosterone), and androstenedione which are the three major adrenal androgens. 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 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 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 resulting 'lactic acid being given off from the muscles' and facial vascular dilation or a "rosacea red face". Our desire is to minimize vascular dilation while exercising.

Exercise should be enjoyed and performed moderately in a cool area keeping the body well hydrated with "alkaline water" to avoid or minimize "rosacea 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 - you remember when you tried holding your breath for just 30 seconds with the result of your facial skin immediately turning pink or red.) Therefore, you can handle more vigorous exercise as your exercise training increases. Better cardiovascular shape and exercise means more oxygen in the blood and more oxygen in the blood constricts vessels. TThis is simply a good "rosacea exercise diet."

There are a myriad of benefits of water for exercise and metabolic waste build up of acid. Water is absolutely necessary for strong, flexible plasma membranes of all cells.

Cigarette flushing - Smoking, a vascular dilator, depletes the skin of vitamin C (essential for the formation of collagen), accelerates the cross linkage of collagen and the hardening of elastin and creates a trillion free radicals destroying the capillary structure. Smoking, which robs the skin of oxygen, is a potent initiator of telangiectasis. The smoker may have a variety of medical problems such as high blood pressure and mineral deficiencies which can cause the appearance of telangiectasis. All tobacco products are very "acidic with a very low pH of about 2.0 to 2.5" that sometimes results in oral cancer and lung cancer. The overall body and brain pH should be around 7.4 for healthy tissue, brain, and body functioning.

Consider what cigarette smoking does to the lungs. The lung tissue is less pliable, receiving less oxygen. A similar thing happens overall to the skin with the epidermis being less pliable and receiving less oxygen with the result being that the "Marlboro Man" has more wrinkles. More important the blood vessels are not as pliable and receive less oxygen, therefore compounding the problem. Stopping smoking is the answer for vascular constriction and is in itself a 'rosacea treatment' or a 'rosacea diet'.

Hot shower/bath flushing - The skin becomes more red 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.

Alcohol flushing - The best way to avoid this type of flushing or vascular dilation is not to drink any alcohol. All alcohol is fermented, but because beer and wines (red wine being the worst) are not further distilled, they can cause allergy redness for many rosacea sufferers. Alcohol is a diuretic which pushes water out of the body cells which lowers the body and brain pH. In this state of "dehydration", the body is prone to flushing due to the low pH of alcohol. Alcohol is a concentrated source of calories and is metabolized very quickly. This causes the blood vessels to dilate causing redness. And as the brain becomes more 'acidic or toxic' we forget that we can not drive an automobile as well and sometimes 'intoxication' causes problems other than rosacea flushing. A proper alcohol intake for fun and to prevent rosacea symptoms should be a part of your rosacea diet treatment and driving plan.

If you chose to drink alcohol, here are some recommendations to minimize the flushing effect:

• Avoid beer as it is higher in carbohydrates and has the lowest pH of an alcohol (usually in the range of 2.2 to 2.9), however, if you enjoy beer, drink your 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 sugars 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 to prevent rosacea symptoms. Wine usually has a pH from 3 to 3.8.
• It is better to drink small amounts of gin, vodka or whiskey with a 4.0 pH diluted with water usually with a pH of 7.4. When a jigger (usually a measurement of a 1.5 fluid ounce or 44 ml. or a shot) of alcohol is added to six ounces of iced water with a 7.4 pH, the results is a drink with a pH of 6.5 to 7.0 that relaxes the body and brain for social purpose as that is often the objective and to prevent the rosacea symptoms, slurring of speech and intoxication while driving. And you will find that 'fat accumulation' does not happen to the body. Whereas if the same alcohol is mixed with a diet coke or sugar coke or other 'acid' soft drinks with a pH of 2.5, the result is a 'very intoxicating drink' that adds rosacea symptoms, intoxication, and fat accumulation to our sides and frontal areas. An excellent 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 with a high pH to reduce redness as part of your "rosacea diet social life". For your future convenience, a "shot or jigger" is equal to 1 1/2 ounces, which equals 4.5 centiliters, which equals 44 milliliters, which equals 3 tablespoons.

Although these recommendations can help to minimize flushing, still the best thought is "not to drink any type of alcohol". Even though alcohol sedates, it can prevent a good night sleep as the alcohol stimulates the brain when the brain has its normal pH of 7.4 altered to an acidic range of 7.2; in addition, when the brain pH is lowered to 6.9, the social life ends forever as intoxication is excessive, rosacea terminates, and the sleeper does not awaken "ever". This would be a very "sad social rosacea diet plan" or a lack of good planning and control.

Kristin, the 3-year old daughter of a rosacea sufferer flushes from enjoying the snow for only an hour. She also flushes with laughter, anger, and playing hard during the summer. Obviously, she does not use alcohol, tobacco, coffee or harsh soaps, etc. However, she does have the genetic propensity for rosacea and may develop rosacea if her skin is abused by all of these elements during the next several decades.

Chilly or 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 our internal thermostat which causes 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 higher 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 flushing.

Food allergy flushing - Food allergy flushing is not rosacea, although many people with rosacea also have food allergies. A food allergy can cause redness, flushing, itching and fluid-filled pustules to appear on the skin. Food allergies can also cause itching, tearing and a discharge from the eyes. Please consider 'food allergy testing' from your Ear, Nose & Throat (ENT) doctor to confirm which foods you are allergic to as you may not be familiar with them. Some of the worst items are cantaloupes and various melons as well as beef, pork, and chicken while fish very rarely causes a flushing problem. Asthma and eczema may be triggered or worsened by food allergies. For more information on food allergy flushing see our Food Allergy Rosacea Alkaline Foods page.

Pollen and contact flushing - Spring in most countries is the time for pollen and mold spores as trees, plants, and grass are providing pollen for self-production with the result that it affects many rosacea sufferers. Also, some areas have enough warm weather and proper vegetation for pollen and mold spores year around. You may even see mold spores growing in your bathtub or shower. Of course you need to keep all spores cleaned out of the home. Clorox liquid is very good and may be diluted by using half Clorox and half water if the full strength smell is offensive to you. Another good cleanser is "Clorox Clean-Up" which disinfects and destroys many allergens and has a much nicer fragrance.

The simplest and least expensive way to decrease pollen and contact flushing is simply bathing and shampooing your hair every night to get the small 'sycamore' type clinging pollen balls off the body and out of the hair. If allowed to remain on the body and hair during your sleep time, the pollen gets in your pillow which means that you are inhaling pollen during the night. Allergy 'mold spores' begin to grow in the home at humidity levels higher than 60% to 65% depending on the amount of dust, dirt, plants, etc. available for the food source of mold spores that many of us are allergic to. Also, the purchase of a dehumidifier for summer use to reduce the amount of humidity will reduce the mold spores while at the same time making the air more comfortable as the air has less humidity and therefore, drier.

Brush dogs regularly and bathe them frequently, depending on their outings or at least once per week. Brush and wipe cats down with a 'damp wash cloth' as they will tolerate the 'damp wash' and you can enjoy your cat much more.

Frequent vacuuming of the home which ideally should be 2 to 3 times per week with a good quality vacuum cleaner will help to eliminate dust, pollen, mold spores, etc. Also, change the air filter in your home every week using the very best quality filter if you have severe problems with allergies. This will also give you the benefit of not having to dust as often. You will feel better, reduce your allergy problem, and reduce facial redness.

Asthma 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 can result from a food allergy, air borne 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.

Warm Spring weather flushing - With the warmer weather comes a desire to spend more time outdoors enjoying the sun, relaxing on the beach or on the porch can be a wonderful way to relieve stress. Reducing stress is an important factor in controlling rosacea. The outdoors can be a wonderful way to achieve stress reduction as long as we take care not to create a situation that worsens our rosacea.

These are some of the primary types of flushing, and there are other types of rosacea flushing such as sun exposure flushing, drug medication flushing or drug/sun sensitivity flushing, laughter flushing, allergy/histamine flushing, etc. The goal is to decrease vascular dilation through vascular constriction which will minimize flushing of any type.

Rosacea sufferers may have more facial blood vessels than the average, or their vessels may be severely damaged. The result is that facial vessels easily or properly handle the dilation. There are various factors that cause rosacea facial vessels to dilate or contract. Our goal is to help you understand the most common causes of vascular dilation/flushing and what you can do about it. Likewise, you will find that The International Rosacea Foundation is an organization with a mission much like that of Rosacea-Ltd III which is to help the rosacea sufferer after they have gone through long periods of trying to figure out their rosacea problem by themselves.

Rosacea is a progressive skin disorder that continues to worsen unless treated. 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.