Causes and Risk Factors of Rosacea

Rosacea is caused by inflammatory redness and dilation (widening) of tiny blood vessels near the surface of the skin, typically on the face. 

Experts believe that it occurs due to a combination of an inherited predisposition and environmental contributors. Rosacea can be aggravated by a number of triggers, including stress and sun exposure. If you have rosacea or a family history of rosacea, knowing the causes and exacerbating factors can help you manage your condition.

Common Causes 

The characteristic skin appearance of rosacea is believed to occur due to inflammation and vascular changes. A range of manifestations occurs, including facial bumps and redness.

Telangiectasia, the appearance of small blood vessels near the surface of the skin, develops due to dilation of the vessels. Other signs, such as dry, red, or swollen eyes or eyelids, burning sensation of the skin, or skin irritation can occur as well. 

Since all of these manifestations fall under the umbrella of rosacea, experts have attempted to identity a common causative link.

Neurovascular Inflammation

According to the National Rosacea Society, research examining the cause of rosacea has focused on neurovascular inflammation. This is a reaction caused by a sequence of events due to nervous system and immune system dysfunction.

When you have rosacea, sensations in the skin and/or eyes may instigate an inflammatory response, with dilation of the capillaries near the skin. Vascular dilation is also often associated with a flow of inflammatory cells. This can cause redness, bumps, telangiectasia, and discomfort. 

Infections 

Research also suggests that infectious organisms and/or a susceptibility to certain skin infections could also play a role. Helicobacter pylori, bacteria that causes gastrointestinal infection, is associated with rosacea, although it isn’t clear how the bacteria may cause skin manifestations.

And a mite, Demodex folliculorum, normally found on the skin of healthy humans, is found more often and in larger quantities on the skin of people who have rosacea. It isn’t certain whether the skin changes of rosacea make a person susceptible to the mite, or whether the mite irritates the skin, causing rosacea.

Associated Conditions

Rosacea is associated with a number of systemic inflammatory diseases such as inflammatory bowel disease (IBD), diabetes mellitus, depression, migraine, heart disease, and rheumatoid arthritis. 

Inflammation and vascular reactions can fluctuate among people who have rosacea, which could explain the variation in skin and eye manifestations. Many people with rosacea have some of the visible effects all the time due to a prolonged hyper-reactive neurovascular reaction, with occasional flare-ups.

Genetics 

Typically, rosacea tends to affect adults, although it can occur in children. The skin condition is more prevalent among people who are fair-skinned. 

You have a higher risk of rosacea if you have family members who also have it. And research showing that the condition is more likely to be shared by identical twins than nonidentical twins suggests that there is a genetic component.

There have been several genes associated with rosacea. Alterations in genes associated with skin pigmentation, inflammatory proteins, and regulation of immunity have been found among people with rosacea. A large study using data from 73,265 people found seven gene abnormalities that were associated with rosacea. Some of the gene alterations are also seen in celiac disease, Crohn’s disease, and ulcerative colitis.

Lifestyle Risk Factors 

There are a number of environmental triggers and habits that cause flare-ups of rosacea. Some are direct skin exposures and others are ingested food and drinks.

Common triggers include:

• Sun exposure
• Alcohol 
• Smoking or exposure to secondhand cigarette smoke
• Spicy food
• Stress
• Lotions, creams, or soaps
• Skin infection

You might develop worsening effects of your rosacea due to some or all of these triggers, but you might not necessarily be sensitive to all of them. And your own triggers may change over time. 

A Word From Verywell 

Rosacea is a skin condition that may have constant skin manifestations well as occasional flare-ups. You may have a hereditary predisposition to the condition, and it can be exacerbated in response to certain triggers. 

Because rosacea can be associated with systemic medical conditions, you might have some additional testing as part of your diagnostic medical evaluation to see if you also have another condition as well.