Rosacea triggers: Understanding the causes of rosacea

7 Mar

One of the most distressing symptoms of rosacea is facial flushing and redness. This often occurs as a “flare-up”, which can be brought on by external influences known as triggers. An important and effective part of rosacea management is to identify and reduce exposure to triggers.

What causes rosacea?

The causes of rosacea are complex and incompletely understood. A combination of factors, including genetics, changes to the immune system and skin and gut organisms leads to redness of the face, skin tenderness and visible facial blood vessels.

A common symptom of rosacea is facial flushing. Blood rushes to the face causing uncomfortable heat and redness of the skin. Sometimes these flare-ups of flushing follow exposure to certain circumstances, activities or foods.

What are rosacea triggers?

Rosacea triggers are things that can bring on an episode of facial flushing and redness. They vary from person to person. Some of the more common triggers affect 75-80% of people with rosacea, but less common triggers may affect less than 10 per-cent.

Why triggers make rosacea worse

Triggers interact with receptors in the walls of blood vessels, which seem to be more sensitive in people with rosacea. When activated, they stimulate increased blow through the blood vessels of the face, causing redness and flushing.

Some triggers such as stress and diet can influence the types of organisms present in the digestive system. This can lead to circulation of inflammatory substances known to make rosacea worse.

Common rosacea triggers

Rosacea can be triggered by a wide range of triggers including environmental, emotional, dietary, and exercise-related. Medical conditions, medications and substances that irritate the skin can also trigger rosacea flare-ups.

According to research conducted by the National Rosacea Society (USA). The most common rosacea triggers are sun exposure, emotional stress and hot weather.

Percentage of people with different rosacea triggers

Stress can trigger rosacea

Being upset, angry, embarrassed, self-conscious or crying can act as triggers for rosacea

Emotional stress is one of the most common rosacea triggers. Sudden changes in emotion such as laughing, feeling angry, embarrassed or anxious can result in an episode of facial flushing or redness. Long-term emotional stress such as financial, relationship or occupational problems can predispose to flare-ups.


Sun exposure is the most common trigger for rosacea. People with rosacea should be careful to avoid sun exposure on the face by using sunscreen daily, wearing a wide-brimmed hat and staying indoors or in the shade when the UV index is high.

Rosacea food triggers

Chilli, cinnamon, pepper and spicy foods can trigger rosacea flare-ups.

Multiple foods and drinks have been shown to cause rosacea flare-ups. These can include

Spicy foods

Foods and sauces containing capsaicin (found in chillies, red capsicums) or cinnamaldehyde (found in tomatoes, chocolate, cinnamon and citrus)


Most commonly red wine, beer, gin, vodka, sparkling wines


Yoghurt, cream and cheese are relatively uncommon rosacea triggers.

Hot beverages

Drinks and food consumed at a hot temperature, including tea, coffee and hot chocolate

Additional rosacea triggers: medical, environmental, irritant and exercise

Medication and medical conditions

Rosacea is more common during menopause, and in people with a chronic cough.

Medications which can cause rosacea flare-ups include steroid creams and vasodilator medications, which increase blood flow. These medications include drugs used to manage migraines, blood pressure, heart conditions and anxiety.

Vitamin B3 in the form of niacin causes facial flushing even in people without rosacea. (Note that niacin is not the same as nicotinamide,which we sometimes recommend for prevention of skin cancers and solar keratoses.)

Skin care products

In rosacea, many skin products cause irritation and stinging of the skin. Ingredients commonly found in skin care products that can lead to worsening of rosacea include:

  • alcohol
  • fragrances
  • sodium lauryl sulphate (in many shampoos)

Astringents, toners, heavy foundations and waterproof make-up can all lead to rosacea flare-ups.

Skin irritants

Physical irritants to the skin including:

  • shaving
  • hot water
  • touching, rubbing and scratching the skin


Exercise raises body temperature and can trigger rosacea.

Weather conditions

Hot weather, wind and cold weather are all known to worsen rosacea.


Hot environments such as hot baths and showers, saunas, cooking in front of a hot stove, sitting near a heater or open fire.

Recent research has shown that wearing face masks can aggravate rosacea.

Identifying your triggers

Most people with rosacea aren’t affected by all triggers. There's no need to avoid a trigger unless it causes worsening of rosacea symptoms, so it's useeful to work out exactly what triggers affect you.

It can be helpful to keep a “rosacea diary” to record information. Each day for 2-3 weeks, record factors such as:

  • Weather conditions: sunny, hot, windy, cold, dry, humid
  • Food and drinks: hot/spicy foods, hot drinks, alcohol, fruits and vegetables
  • Activities: exercise, hot baths and showers, hot environments
  • Emotional state and stress
  • Products used on the face
  • Medications (oral and topical, including rosacea treatments)

Keep note of rosacea symptoms, number and severity of flare-ups. Relating the rosacea symptoms to the potential triggers can help you identify the main triggers in your case.

Taking daily photos of your face can also provide useful information about how well treatments and avoiding triggers has worked.

Managing your triggers to prevent a flare up

Some measures are recommended for everyone with rosacea:

  • Reduce sun exposure
  • Establish a skin care routine using products that reduce inflammation and moisturise the skin

Other measures need only be taken if a particular trigger is known to cause or worsen rosacea.

Management of rosacea triggers
Trigger Suggested management
Sun exposure

Stay in the shade or inside during hours when the ultraviolet index is greater than 3

Wear broad spectrum, low-irritant, non-fragranced sunscreen. (We often recommend using a children’s sunscreen)

Cover up with a broad-brimmed hat and sunglasses


Maintain a healthy diet

Exercise regularly

Find an activity you enjoy and do it daily

Practice mindfulness and meditation

Improve communication in your relationships

Relieve financial stress where possible

Food and drinks

Monitor the effect on your rosacea with different types of alcohol and reduce how much you drink. Red wine is the most common alcohol trigger of rosacea.

Reduce or avoid hot spices such as black or white pepper, chilli, cayenne, hot paprika and cinnamon.

Drink hot tea and coffee at a lower temperature, or reduce the number of cups of tea or coffee each day

Identify and avoid specific foods that aggravate your rosacea. Examples include tomatoes, cheese and other dairy products, citrus fruit, chocolate, soy sauce, vinegar, eggplant, liver, spinach, dried fruits, processed or smoked meats and Vegemite

To encourage a healthy range of gut bacteria, eat a diet high in fibre and add fermented foods such as sauerkraut, kimchi and kefir. Reduce high glycaemic index foods such as sugar, white bread, potatoes, white rice, cakes and confectionery


Keep cool while you exercise:

  • Exercise in an air-conditioned gym or in a pool
  • Exercise in the early morning or evening when the temperature is cooler

Drink plenty of water, spray your face with water, wear a cool damp towel around your neck

Incorporate regular breaks and reduce exercise intensity if you feel hot

Bathing, showering and cleansing

Have lukewarm rather than hot baths or showers

Avoid spas and saunas

Don’t rub, scratch or pick at your face. Avoid touching it as much as possible since this can transfer irritants.

Don’t use rough towels or sponges.

When shaving, use an electric shaver or a single pass with a sharp razor.

Skin care products

Moisturise your skin daily.

Avoid any products that contain alcohol, fragrance, witch hazel, menthol or eucalyptus.

Always use unscented products formulated for sensitive skin.

Choose products that contain anti-inflammatory ingredients and/or protect and repair the epidermal barrier. These include nicotinamide/niacinamide, colloidal oatmeal, panthenol, allantoin, feverfew, gingko biloba and aloe vera.

Rosacea is manageable, once you know your triggers

Reducing or eliminating triggers substantially reduces the number of flare-ups.

Research by the National Rosacea Society has shown that:

  • Altering the diet is successful in reducing rosacea symptoms in 95 per cent of food-triggered cases
  • Stress management techniques reduce flare-ups in 67 per cent of cases

Prescription medications and laser treatments are effective in reducing rosacea symptoms, but managing triggers is the heart of rosacea management which helps control symptoms for most people.

References and recommended resources

  • National Rosacea Society (
  • American Academy of Dermatology (