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  • From genetics to triggers: a close look at rosacea causes

From genetics to triggers: a close look at rosacea causes

Rosacea is a long-term skin condition. It causes redness, visible veins and inflammation on the face and cheeks. There are many types of rosacea and they all affect the skin in different ways.

It affects many people across the world. But while it affects so many people, the causes of rosacea are not well understood. Learn more about rosacea causes and triggers in this article.

Medically reviewed by Dr. Anand Abbot MRCGP Written by our editorial team Last reviewed 22-04-2024

What causes rosacea?

Research into what exactly causes rosacea is ongoing. Experts have come up with several theories on what could cause the condition.

Magnifying glass on women’s cheek with rosacea.

Scientists have identified 4 main causes: genetics, immune system differences, bacteria and Demodex mites.


One potential cause of rosacea is that it runs in families. One survey conducted by the National Rosacea Society found that over 40% of respondents had a family member with rosacea.

40% of people with rosacea have a family member who has it.

Later studies have tried to identify which genes are responsible. A 2018 study Trusted source National Center for Biotechnology Information (NCBI) Government Source Biomedical Research and Literature Go to source discovered several genetic features responsible for rosacea inflammation.

Immune system

People with rosacea may have different immune systems.

Ongoing research Trusted source PubMed Government Source Database of Biomedical Research Go to source found that people with rosacea have more of an anti-microbial molecule called cathelicidin.

This means that when the skin is irritated, the immune system overreacts and causes flushing and visible blood vessels.


Acne-like rosacea, also known as papulopustular rosacea, may be caused by bacteria that live in the gut. This type causes pus-filled bumps and spots like acne.

Heliobacter pylori (H. pylori) is a bacterium that causes stomach ulcers and gastritis. However, it has also been linked to other conditions.

One 2018 meta-analysis Trusted source PubMed Government Source Database of Biomedical Research Go to source showed that this bacteria is involved in rosacea development. They discovered people with rosacea had higher levels of the bacteria. This may increase inflammation and vasodilation in the skin.


Another possible cause is a microscopic mite.

Demodex folliculorum is a type of mite that lives on the skin of most people. It is usually harmless. High levels, however, can cause some skin conditions.

Microscopic image of a mite.

Research Trusted source PubMed Government Source Database of Biomedical Research Go to source shows that rosacea patients have higher levels of mites in their skin. This is especially true in people with acne rosacea. They found that people with rosacea have 15-18 times more mites than people who don’t have it.

It is believed that higher levels of Demodex disrupt the skin barrier. This sets off a chain reaction of inflammatory reactions.

Who is most likely to have rosacea?

Rosacea is particularly common in certain groups of people.

The skin condition is most prevalent in middle-aged and older people. Experts Trusted source Clinical Knowledge Summaries (CKS) Government Source Go to source estimate that symptoms usually develop between the ages of 30 - 50.

It is also more common in women. One study Trusted source PubMed Government Source Database of Biomedical Research Go to source found that 75% of people with rosacea were women. However, men are more likely to have severe symptoms.

Finally, it mainly affects people with fair skin. Although, it may be underdiagnosed in darker skin tones. This is because the redness is harder to spot in people with darker skin.

What causes a rosacea flare-up?

Some environmental factors can cause your rosacea symptoms to become temporarily worse. This is called a flare-up.

There are over 40 different rosacea triggers, from cheese to hot baths.

But, everyone’s skin is different. Your triggers won’t be the same as someone else’s. Here are some of the most common triggers.


One of the most common rosacea triggers is sun exposure. A survey conducted by the National Rosacea Society found that the sun triggered 81% of people’s symptoms.

Ultraviolet radiation (UVR) damages the skin cells, which can trigger the production of certain molecules. These molecules promote inflammation and cause visible blood vessels.

Sun protection is important, and not just for those with skin conditions. You should wear a 50SPF sun cream on high UV days and stay in the shade if you can.


Different weather conditions can also cause symptoms.


icon heat

Hot weather can increase blood flow and dilates blood vessels, which can cause redness and flushing. Bacteria and skin mites also thrive in warmer temperatures, which can also lead to flare-ups.


icon wind

Wind exposure can relax and widen the blood vessels which can cause your face to flush.


icon cold

Cool temperatures can dry out and irritate your skin, which can make rosacea flare-ups worse.

Skin and hair care products

Looking after your skin is important when you have rosacea. However, some skincare products may irritate your skin and make your symptoms worse.

Common skincare ingredients that trigger symptoms include:

  • alcohol
  • fragrance
  • witch hazel
  • exfoliating agents (e.g. AHA and BHA)

Everyone’s skin is different. Always test a product on your neck before using it on your face.


Exercise is another common trigger of rosacea flare-ups.

Close up of woman tying her shoes up during exercise.

Physical exercise causes your heart rate and breathing rate to increase. It causes an increase in core body temperature and blood flow. This is what causes a flare-up.

If exercise is one of your triggers, you may need to modify your exercise regime. You could lower the intensity of workouts or change the exercises you do.

Food and drink

Your diet may also play a role in your symptoms. While everyone is different, some foods may aggravate your symptoms.

which foods and drinks trigger rosacea
  • Alcohol - your body produces chemicals like histamine to break down alcohol. This immune response triggers flushing and redness.
  • Spicy food - can make any stinging, flushing or burning symptoms worse.
  • Cinnamaldehyde - is a flavonoid that can increase blood flow in the face. Common foods that contain it include cinnamon, tomatoes, citrus fruits and chocolate.
  • Fatty food - can cause chronic inflammation, which may be a risk factor for certain types of rosacea.
  • Hot beverages (e.g. tea or coffee) - can dilate the blood vessels and cause symptoms.

You should keep a food diary and track your symptoms. That will help you find the foods that trigger your symptoms so you can avoid flare-ups.

Stress and anxiety

Another common cause of flare-ups is your mental health.

Research Trusted source National Center for Biotechnology Information (NCBI) Government Source Biomedical Research and Literature Go to source has found that your nervous system affects your skin. Chemicals produced by nerve cells (e.g. neurotransmitters) regulate cells in the skin.

When you’re stressed, more of these nerve cells are produced as parts of the nervous system are activated. This can activate skin cells responsible for blood vessel dilation and inflammation, which leads to symptoms.


Certain medicines can cause rosacea flares. Specifically, medications that affect your blood flow.

Vasodilators are a group of medications that dilate the blood vessels and improve blood flow. They are predominantly used to treat high blood pressure and other heart conditions.

However, there are many types of vasodilators, some of the most common include:

  • ACE inhibitors (e.g. ramipril)
  • calcium channel blockers (e.g. verapamil)
  • beta-2 receptor agonists (e.g. salbutamol)
  • phosphodiesterase inhibitors (e.g. sildenafil or tadalafil)

Because of the way they work, they dilate the blood vessels which can cause symptoms.

Some other medications may cause flare-ups, including topical corticosteroids and niacin (vitamin B3).

You should ask your doctor if they can adjust your treatment if you think it is causing your symptoms.


One of the most significant risk factors for rosacea is menopause. During menopause, hormonal imbalances cause many changes across your body. It also can affect your skin and your blood vessels. Both of these factors combined can cause skin inflammation.

How do I manage my rosacea?

You can manage your symptoms with both trigger avoidance and treatment. There are many treatments for rosacea available, both tablets and creams.

You can order rosacea treatments online at HealthExpress. Complete a quick medical questionnaire about your symptoms. Once reviewed by one of our UK doctors, treatment will be sent straight to your door.

Main takeaways

There are many theories for what causes rosacea. While we still don’t know the definite cause, there are still many ways to manage your condition.

Managing your triggers, taking care of your skin and using treatment are all effective ways to keep your symptoms under control.

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