Rosacea Flushing:
Types, Patterns & Systems
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Rosacea sufferers have more facial vessels or the vessels that they have are severely damaged. The result being that anything that stimulates facial dilation can not be handled easily or properly. Our goal is to help you understand vascular constriction which is the opposite of redness or dilation which rosacea sufferers experience.
Each of the following items is part of a complex interaction of several 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. A high temperature for some may be as early as 3:00 P.M.
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 flush".
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 to 9 hours being needed nightly.
Anxiety
(fight or flight) stimulates the sympathetic nervous system
Increase in internal body temperature stimulates the sympathetic nervous
system, whereas obviously a decrease in body temperature decreases the
sympathetic system due to the parasympathetic system calming the system.
The sympathetic nervous system is especially important to 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)
Increased number of blood vessels.
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. enter the blood stream quickly causing hyperglycemia (high glucose spikes). This rapid influx of sugar into the blood stream is a potent vasodilator.
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. instead of simple carbohydrates.
Fiber 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.
The proteins, fruits, and vegetables provide the body with so many nutrients
that are needed to repair the body tissue 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 is inevitably accompanied by exacerbation of the disease, a trying experience for a patient and physician. (Drs. 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 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, and 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 with the other half of testosterone in women being produced by 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 result being vascular dilation. Our desire is to minimize vascular dilation while exercising.
Exercise should be done moderately in a cool area keeping the body well hydrated with water to minimize the 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 a minute 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 blood constricts vessels.
There are a myriad of benefits of water for exercise and metabolic waste build up. 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.
Remember 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.
Hot shower/bath flushing - Obviously the skin is redder 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. In this state of "dehydration", the body is prone to flushing. Alcohol is a concentrated source of calories and is metabolized very quickly. This causes the blood vessels to dilate causing redness.
If you feel you need to drink alcohol at social functions or to relax, here are some recommendations to minimize the flushing effect:
Avoid beer as it is higher in carbohydrates, however, if you like 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 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.
It is better to drink small amounts of gin, vodka or whiskey, diluted with water instead of sugared soft drinks or mixes which also can stimulate the cardiovascular system. A good 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.
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.
This 3-year old daughter of a rosacean 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 internal thermostat -- causing constriction of vessels by decreased sympathetic activity to vessels (similar to taking a 'cool' shower). When the rosacea sufferer enters the warm office or home, the warmer 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 Lifestyle Changes 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 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, dryer.
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 and spend less time at the ENT or allergy doctor, and will reduce your allergy problem enough that you will see some reduction in redness of the face.
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.
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 is a progressive skin disorder 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.