COPING WITH
rosacea
Lifestyle Management for
Rosacea Patients
rosacea.org
Introduction
Rosacea (pronounced “roh-ZAY-sha”) is a
common but poorly understood disorder of the
facial skin that is estimated to affect more than
415 million people worldwide. It is a chronic
but treatable condition that primarily affects the
central face – usually the cheeks, nose, chin or
forehead – and is often characterized by flare-ups
and remissions.
Patient surveys indicate rosacea often begins
as a facial redness that may come and go, and
might be mistaken for extended blushing or sun-
burn that doesn’t go away. Over time the redness
becomes more persistent, and tiny visible blood
vessels may appear. Without treatment, bumps
and pimples are common and in advanced cases,
the skin may thicken from excess tissue, espe-
cially around the nose. In about half of patients,
the eyes may also become irritated and appear
watery or bloodshot.
Although rosacea cannot be cured, its symp-
toms can be controlled and its progression
arrested through long-term medical treatment
and lifestyle modifications. This booklet from the
National Rosacea Society (NRS) is designed to
help you moderate or eliminate those lifestyle
and environmental factors that may aggravate
your individual condition.
TYPICAL AREAS FOR ROSACEA SYMPTOMS
How Is Rosacea Diagnosed and Treated?
Rosacea is typically diagnosed through the iden-
tification of individual signs and symptoms, called
phenotypes, that may develop during the disease
process.
A diagnosis of rosacea may be considered in the
presence of at least one diagnostic sign – either
persistent redness of the central facial skin or,
less commonly, thickened skin in the central face
(known as phymatous changes, often on the nose).
Two or more major signs may also indicate rosa-
cea, including bumps and pimples, flushing, visible
blood vessels, and eye irritation. Secondary signs
and symptoms, such as burning or stinging, swell-
ing, and dry appearance, may also develop but are
not diagnostic. Physicians must rule out other
possible causes of rosacea-like symptoms – such as
lupus, steroid-induced rosacea or seborrheic derma-
titis – before confirming the diagnosis.
While rosacea cannot be cured, its symptoms
can be controlled through medical treatment and
lifestyle modifications. The first step is to visit
a dermatologist who can provide a professional
diagnosis and work with you to develop a treatment
plan specific to your symptoms. Because the under-
lying disorder is chronic and cannot be cured, it’s
important to consistently use medications as they
are prescribed even after the reduction or remission
of symptoms is achieved.
Surveys indicate women are more likely to experience signs and
symptoms on the cheeks and chin, while men are more likely to
have redness and swelling of the nose.
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Identifying Your Individual Rosacea Triggers
Rosacea “triggers” are the factors that cause a
flare-up of signs and symptoms, such as redness
or bumps and pimples. There are a wide variety of
potential factors that may trigger a rosacea flare-up
in various individuals, ranging from certain weather
conditions to particular foods. As rosacea and its
symptoms often vary for each patient, keeping a
diary is a systematic way to determine which trig-
gers affect your individual case. Track diet, weather,
emotions, and activities like exercising, socializing,
work-related tasks and household chores. Write
down when you experience rosacea symptoms, as
well as their intensity and duration.
To help determine your personal rosacea
triggers, the NRS offers a “Rosacea Diary”
booklet that provides an easy
format for identifying which
environmental, dietary and other
factors may affect you. Obtain a
copy online at rosacea.org, or by
writing or calling the Society.
An NRS survey of rosacea
patients identified the most
common triggers. While the
range of potential triggers on
this list may seem overwhelm-
ing, remember that every patient isn’t affected by
each trigger, and there is no need to avoid triggers
that don’t affect your individual condition.
There are a wide variety of potential factors that may trigger a
rosacea flare-up in various individuals.
2
Most Common Rosacea Triggers
While the list of potential rosacea triggers in
various individuals may be endless, a survey
of 1,066 rosacea patients found that the most
common factors included the following:
PERCENT AFFECTED ROSACEA TRIGGER
Sun
81% exposure
Emotional
79% stress
Hot
75%
weather
57% Wind
Heavy
56%
exercise
Alcohol
52% consumption
51% Hot baths
46% Cold weather
45% Spicy foods
44% Humidity
41% Indoor heat
Certain skin-care
41%
products
36% Heated beverages
25% Certain cosmetics
15% Medications
15% Medical conditions
13% Certain fruits
10% Marinated meats
9% Certain vegetables
8% Dairy products
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Coping with Common Rosacea Triggers
SUN EXPOSURE
Sun exposure is known to be the most common
trigger for rosacea. It’s very important to protect
your skin as much as possible. Here are a few tips:
• Stick to the shade.
• Wear a hat.
• Wear sunglasses.
• Avoid peak sunlight hours.
• Apply sunscreen regularly.
Choosing a good sunscreen is important. There
are two types of damaging solar rays: UVA rays
age skin; UVB rays burn it. Surprisingly, not all
sunscreens protect against both. Look for non-
chemical sunscreens that contain zinc or titanium
dioxide and deliver UVA/UVB protection with an
SPF of 30 or higher. A formula designed for sensi-
tive skin, such as a convenient mineral formulation,
can help reduce the possibility of irritation. Also
avoid direct sunlight by wearing a wide-brimmed
hat to shade your face.
STRESS
Emotional stress ranks high on the list of triggers
for many rosacea sufferers. Fortunately, in an NRS
survey of more than 700 rosacea patients, 67 percent
found that they were able to reduce the number
of flare-ups they experienced through stress man-
agement techniques. Here are a few methods for
dealing with stress in your day-to-day life:
• Practice yoga.
• Try meditation.
• Develop a fitness routine.
• Maintain a healthful and nutritious diet.
• Sleep more.
Improving communication in relationships, reduc-
ing financial burdens and easing workplace pressure
are additional steps you can take to reduce stress.
WEATHER
Hot weather, humidity, harsh wind and cold are
some of the top triggers for many rosacea patients.
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If weather conditions affect your rosacea, consider
using the following strategies to avoid a flare-up:
Apply sunscreen daily, year-round, regardless of
whether it’s sunny or cloudy, as the incidental expo-
sure you get walking to your car or running errands
can be just as damaging to skin over time as a day
at the beach.
Stay in a cool, air-conditioned environment
on hot, humid days. If this is impossible, those
affected should sip cold drinks and try not to over-
exert themselves. If necessary, chew on ice chips to
lower facial temperature, or spray your face with
cool water.
Combat cold by covering your cheeks and nose
with a scarf. In winter, rosacea sufferers also may
don a ski mask when participating in outdoor
sports or activities, as well as cover up on windy
days. If these conditions aggravate your rosacea,
limiting your time outdoors in cold weather may
also help.
Use a moisturizer daily. According to many
dermatologists, moisturizer is a key for preventing
the burning, stinging, itching and irritation often
associated with rosacea, as well as building a strong
moisture barrier to help keep out impurities and
irritants that may aggravate sensitive skin.
FOODS & BEVERAGES
Steaming hot soup or coffee, spicy nachos, a glass
of wine – no matter how appetizing they sound,
these foods and beverages may be a problem for
some rosacea sufferers. Hot liquids may cause
flushing. Spicy foods like hot sauce or salsa can
raise a sweat, and alcoholic beverages may trigger
flare-ups in many cases. These tips will help you
select rosacea-friendly meals:
Monitor how your rosacea reacts to alcoholic
beverages. Alcoholic beverages – especially red
wine – often induce flare-ups in rosacea sufferers.
If alcohol aggravates your condition, reduce your
intake or avoid alcohol entirely.
5
A wide-brimmed hat and UVA/UVB sunscreen with SPF 30 or
higher may help reduce flare-ups from sun exposure.
Avoid “hot” spices such as white and black pepper,
cinnamon, paprika, red pepper and cayenne, which
are common rosacea tripwires.
Reduce the heat in beverages. Decreasing the
temperature may be all that’s necessary to keep
enjoying coffee, tea and hot chocolate, for example.
Or try reducing the number of cups you drink from
three or four to one or two instead.
Identify and avoid any foods that aggravate your
individual condition. Some rosacea sufferers
have reported a wide variety of foods that trigger
flare-ups in their individual cases. Examples have
included tomatoes, cheese and other dairy prod-
ucts, citrus fruit, chocolate, soy sauce, yeast extract
(though bread is OK), vinegar, eggplant, liver, spin-
ach, broad-leafed beans and pods, and foods high
in histamine or niacin. While you may be sensitive
to one or more of these foods or something else,
it isn’t necessary to avoid them unless they cause a
flare-up for you. Keeping a diary of what you have
consumed and when your condition flares can help
identify and avoid what may be an issue for you.
EXERCISE
In an NRS survey, 56 percent of rosacea patients
said heavy exercise exacerbated their skin condi-
tion. Unlike other rosacea triggers that might
be easier to forgo, physical activity is essential to
leading a healthy lifestyle. Incorporating exercise
6
into a weekly routine can help maintain good
health while allowing a chance to let off steam and
socialize. If you want to work out without causing
a flare-up, the key is to find an activity that is low
intensity and won’t cause you to overheat. Walking,
swimming, yoga and Pilates are some options to
consider. Even then, take these precautions:
Incorporate breaks into your exercise routine, or
try exercising for shorter, more frequent intervals.
For instance, exercise for 15-20 minutes three times
a day, rather than all at once.
Try to stay as cool as possible. Drape a cool, damp
towel around your neck, drink cold fluids, and keep
a bottle filled with cool water to spray on your face.
Run a fan or air-conditioning or keep a window
open for a breeze while working out indoors to
avoid overheating.
Choose early morning or evening hours when it’s
cooler for outdoor exercise. Don’t forget to protect
your face from the sun.
BATHING & CLEANSING
Rosacea sufferers often must modify their approach
to facial cleansing and bathing. The following tips
can help you adopt a personal-care routine that
soothes and calms your facial redness:
Avoid hot water, hot tubs and saunas. These can
bring on flushing and aggravate your condition.
7
Begin or end each day with a gentle facial cleans-
ing. Gently cleanse your face to remove any makeup
or dirt accumulated throughout the day. Use a mild
cleanser that is not grainy or abrasive and spread it
with your fingertips. Rinse your face with lukewarm
water to remove all dirt and soap, and use a thick
cotton towel to gently blot the face dry.
Never pull, tug, scratch or treat your face harshly.
Avoid any rough washcloths, loofahs, brushes or
sponges.
Let your face thoroughly air dry before applying
any medication or skin-care products. Let your
face rest for a few minutes before applying topi-
cal medication. Then allow the medication to dry
completely for five to 10 minutes before applying
any moisturizer or makeup.
Men should use an electric shaver rather than a
razor. If a blade is preferred, never use a dull blade
that requires extra scraping for a clean shave. Avoid
shaving lotions or toners that burn or sting.
SKIN CARE PRODUCTS
Consistent, gentle skin care and effective use of
cosmetics can make a visible difference in manag-
ing rosacea and improving the look of your skin.
The key is to use products and techniques that
minimize irritation.
Look for products that are noted as appropriate
for sensitive skin and avoid any products that sting,
burn or cause irritation. In an NRS survey, many
patients cited the following ingredients as triggers
for irritation: alcohol (66 percent), witch hazel (30
percent), fragrance (30 percent), menthol (21 per-
cent), peppermint (14 percent) and eucalyptus oil
(13 percent). Other practices for avoiding flare-ups
from skin-care products include:
Choose fragrance-free products whenever
possible.
Test new products first. Before using a product on
your face, try it on a patch of skin in a peripheral
8
area, such as the neck. If you have a reaction, avoid
the product and note the ingredients.
Keep it simple. The more ingredients and products
you apply to your skin, the higher the likelihood
that an ingredient or product may
aggravate it.
COSMETICS
While medical therapy can address the underly-
ing physical aspects of rosacea, makeup can help
instantly improve the look of your skin and boost
your self-confidence about your appearance. Here
are some makeup tips to help you look and feel
your best:
A green-tinted base can help visually correct red-
ness and even out skin tone. Get one with UVA/
UVB protection and you’ll also help shield skin
from sun exposure that can aggravate rosacea. A
protective base has another bonus, too: it helps your
makeup last longer.
Choose oil-free foundation and concealer. Look
for an oil-free foundation that offers the level of
coverage you need, from sheer to full. And for both
foundation and concealer, choose your shade care-
fully. Foundation should match your natural skin
tone as closely as possible, while concealer should
be just one shade lighter than your natural skin
tone.
Go easy on blush if you use it at all, since rosacea
skin already tends to have a lot of color. Choose
sheer blush formulated for sensitive skin and apply
sparingly with a clean brush, sweeping it from the
apples of the cheeks toward the temples.
Opt for extra-gentle eye makeup. Eyes are sensi-
tive to begin with, and if you suffer from ocular
rosacea, it’s especially important to treat the skin
arounds your eyes gently. Select products designed
for sensitive eyes that have been ophthalmologist
tested; hypoallergenic, fragrance-free formulas may
be ideal. Mascara and eyeliner should be easy to
9
apply and remove without pulling or tugging on
the eyes.
MEDICAL CONDITIONS AND DRUGS
Physicians have found that some underlying health
conditions and medications can stimulate a flush-
ing response and trigger rosacea flare-ups. Others
may mimic rosacea’s signs and symptoms. The fol-
lowing conditions should be ruled out or treated by
your doctor to help bring flare-ups under control:
•
Hot flashes associated with menopause have
brought on rosacea’s first appearance in some
women.
•
Seborrheic dermatitis, a chronic inflammatory
skin disorder, is the most common skin condi-
tion to occur at the same time as rosacea. It can
look like powdery or greasy scales on the face
and other parts of the body and have a burning
sensation.
•
Allergies to seasonal irritants or product
ingredients may cause redness, irritation or
inflammation.
•
Systemic diseases, such as high blood pressure,
have been identified as causes of rosacea flare-
ups. When flushing is accompanied by itching,
breathing difficulties or diarrhea, seek medical
attention.
•
Fevers, coughs and colds, although intermittent,
may provoke the flushing that begins a rosacea
flare-up.
•
Vasodilator drugs are used to treat cardiovascu-
lar disease because of their ability to dilate the
blood vessels, which may result in redness or
flushing in some patients.
•
Long-term use of topical steroids has been
found to aggravate rosacea or induce rosacea-like
symptoms. The good news is that effective treat-
ment of rosacea-like symptoms due to topical
corticosteroids is usually very simple: stop using
the medication.
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Comorbidities
Comorbidity is the occurrence of two disorders or
illnesses in the same person, at the same time or
one after another, and does not necessarily mean
that one causes the other. Recent research has
found that rosacea patients have a higher inci-
dence of a growing number of potentially serious
conditions.
Gastrointestinal disorders that occur more often
in patients with rosacea include celiac disease,
Crohn’s disease, irritable bowel syndrome, ulcer-
ative colitis and gastroesophageal reflux disease
(GERD). Associated cardiovascular disorders
include high cholesterol levels, coronary artery
disease and high blood pressure. Other conditions
include thyroid cancer, basal cell carcinoma and
brain cancer; allergies, respiratory diseases, diabetes,
urogenital diseases and female hormone imbalance;
Parkinson’s disease and Alzheimer’s disease.
While rosacea patients’ overall risk for these dis-
eases is still very low, it’s reasonable for people who
are diagnosed with rosacea to seek a general health
examination if appropriate.
Managing Psychological and Social Aspects
of Rosacea
Even though you may find your self-confidence
and self-esteem are suffering as a result of your
appearance, you can turn the situation around by
taking appropriate action to bring your rosacea
symptoms under control.
The first step is to accept that you have a medical
condition, rather than denying it. Although rosacea
is not life threatening, it is a chronic disorder with
flare-ups and remissions. Although this fact cannot
be changed, you can personally take control of your
condition and restore your appearance by complying
with long-term medical therapy and avoiding those
lifestyle factors that aggravate your individual case.
11
In NRS surveys, 90 percent of rosacea patients
said rosacea’s effect on personal appearance had
lowered their self-esteem and self-confidence,
and 52 percent said they had avoided face-to-face
contact because of the disorder. Among those with
severe symptoms, 51 percent said they had even
missed work because of their condition.
The good news is that emotional health is
generally restored when rosacea symptoms are
successfully addressed. Seventy percent of rosacea
sufferers responding to an NRS survey said their
emotional well-being improved when their rosa-
cea was effectively treated, and most also reported
improvement in their professional interactions and
social lives.
It also may help you to know that you are not
alone. It’s estimated that more than 16 million
Americans suffer from rosacea, although many
may not be fortunate enough to realize it and seek
treatment.
If you find yourself the subject of stares or com-
ments during a flare-up, try turning this awkward
situation into a positive educational opportunity by
openly discussing your condition. Recognize that
most people are unaware of rosacea, so take into
account that most reactions are simply caused by
curiosity and ignorance, rather than any negative
intent.
Through medical therapy, lifestyle changes and trigger
avoidance, you can minimize rosacea’s impact on your life.
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Take the initiative to explain the condition
to people you see regularly – especially your
employer and co-workers, who may have real
concerns about whether the condition will affect
your job performance or their own health. Put
to rest the common misconceptions that rosa-
cea’s symptoms are caused by poor hygiene or
excessive drinking, or that the disorder may be
contagious. Pass along educational materials on
rosacea if appropriate.
Through this approach, you can transform
potentially negative situations into constructive
opportunities to create understanding and even
help others who may unknowingly suffer from
this condition.
It’s important to take care of your mental
health after being diagnosed with rosacea. This
might mean sharing that you have the condition
with family, friends and co-workers, and working
to raise awareness. Join the rosacea community
by becoming a member of the NRS or an online
support group, and help fight the feelings of
isolation so common among rosacea patients.
PANTONE
This booklet is made possible by an educational grant
from Cutanea Life Sciences, a specialty pharmaceutical
company whose mission is to develop and supply innovative
technologies to treat disorders of the skin and subcutaneous
tissue, including rosacea. As part of its commitment to
improving the lives of those who suffer from this widespread
disorder, Cutanea supports the National Rosacea Society’s
efforts to raise awareness and provide education on rosacea.
Learn more about the company at cutanea.com.
Published by
The National Rosacea Society
196 James Street
Barrington, IL 60010
Telephone 1-888-NO-BLUSH
www.rosacea.org
© 2018 National Rosacea Society. Printed in U.S.A.
Join the National Rosacea Society!
The National Rosacea Society (NRS) is the world’s largest organization dedicated to improving the lives of the
untold millions who suffer from this widespread but poorly understood disorder. Through education and advocacy,
our mission is threefold:
To raise awareness of rosacea
•
To provide public health information on the disorder
•
To encourage and support medical research that may lead to improvements in its management, prevention and
•
potential cure.
Why Should I Join?
Annually contributing members are the lifeblood of our efforts to expand important medical research on this
often life-disruptive condition. Individual donations are used to support the NRS research grants program unless
designated otherwise, and with each donation this program grows stronger and more significant. When you join
the NRS, you help the millions around the world affected by rosacea – as well as yourself.
What Do I Get If I Join?
As a new member, you will receive a New Member Support Kit that includes a booklet on rosacea and materials to
help you identify and avoid your rosacea triggers. You will also receive your first issue of a one-year subscription to
Rosacea Review, an NRS newsletter with new information on rosacea, features and case histories on its effective
care, and reports on rosacea research. In addition, you will have access to mailings of new educational materials,
free product samples, discounts and opportunities to participate in research.
How Do I Join?
Joining is easy. Just fill out the form below, or visit https://www.rosacea.org/join. Membership is a donation of any
amount and is tax-deductible in the U.S. A minimum donation in the amount of $25 is suggested.
Name:
Address:
City: State: Zip Code:
Email: Phone:
Mail this form to: National Rosacea Society, 196 James Street, Barrington, IL 60010.
The National Rosacea Society is a nonprofit organization that is tax exempt pursuant to Section 501(c)(3) of the Internal Revenue Code.
Individual contributors may designate the use of their donations for program services other than grants for medical research studies by noting
so on their check.
