Rosacea — the chronic inflammatory condition producing persistent facial redness, flushing, and sometimes small red bumps — has well-characterized triggers and an underlying vascular and immune biology that varies in intensity.
The classic triggers:
- Heat — hot showers, hot rooms, exercise. Direct vasodilation.
- Alcohol — especially wine and beer. Vasodilation plus histamine.
- Spicy food — capsaicin activates TRPV1 receptors triggering vasodilation.
- Sun — UV worsens rosacea both acutely (visible flushing) and over time (persistent redness).
- Stress and cortisol — anxiety and chronic stress reliably worsen rosacea flares.
- Hot beverages — coffee and tea, even without caffeine.
Underlying biology: The mechanism involves dysregulated innate immunity (elevated cathelicidin), altered vascular reactivity, and often overgrowth of Demodex mites in skin follicles. Two's 2015 comprehensive review synthesized the pathophysiology (Two, 2015).
Systemic inflammation modulates severity. Elevated hs-CRP correlates with rosacea severity — women with higher chronic inflammation have more frequent and severe flares. Gut microbiome studies also show characteristic patterns in rosacea patients.
Treatment: topical (metronidazole, ivermectin, azelaic acid, brimonidine), oral (doxycycline, isotretinoin), and laser (broad-band light for persistent redness). Trigger management remains foundational.
Blood work: hs-CRP, omega-3 index, vitamin D.