Topics Discussed Below
- Misconception: Most rosacea sufferers just have a few triggers
for flushing
- Heat trigger
- Warmth trigger
- Physical activity trigger
- Main problem with this misconception
- References
I. Misconception: Rosacea
Sufferers just have a few Triggers for Flushing
If one actively reads
the rosacea literature or visits a general physician, he or she
will quickly realize that physicians incorrectly assume that rosacea
sufferers just have one or two triggers for facial flushing. Physicians
often infer that these triggers are just a nuisance or minor inconvenience.
These physicians may instruct their patients to watch out for the
obvious major triggers -- stay out of 90-degree heat, be careful
in the mid-day sun, take some breathers during strenuous exercise,
or let thermally hot foods cool down. I wish that rosacea was just
that simple; however, rosacea sufferers who have progressed to the
moderate or severe stages can have 20 to 50 different triggers to
avoid each and every day! It is a huge mistake for general physicians
to think of trigger avoidance as a minor nuisance. Rosacea specialists
point out, "People don't realize the variety of minor things
that can increase blood flow in the face, causing aggravation of
rosacea." (43)
The list of common rosacea
triggers is quite extensive - heat, warmth, physical activity, sun,
exercise, wind, cold, stress, anxiety, embarrassment, crying, laughter,
happiness, excitement, bending over, laying down, overheating, warm
overhead lighting, smiling, foods (thermally hot or spicy), large
meals, beverages, oral dilators (medications & natural supplements),
spontaneous triggers, topical skincare products (moisturizers, sunscreens,
facial cleansers, anti-acne products), etc.....
Now, we get to the really
overwhelming part. In real life, most of the above-listed triggers
can occur dozens of times every single day. Below, I have
listed three very common triggers (heat, warmth, and physical activity),
and some of the daily, real-life scenarios that occur with each
of these triggers.
II. Heat Trigger
Environmental heat is
one of the biggest triggers for rosacea flushing. (14, 24, 44) Physicians
often assume that rosacea sufferers just have to avoid hot, 90-degree
environments. Well, it just ain't that simple. It often means that
rosacea sufferers must also avoid:
- Indoor or outdoor temperatures greater than 85 degrees.
- Heat from inside a hot car.
- Heat from showers and baths.
- Heat from a hair blower.
- Heat radiating from an oven, fireplace, dishwasher, dryer,
iron, or clothes freshly dried in the dryer.
- Heat from reading lights, overhead lights, bathroom lights,
or table lights.
- Heat inside cafeterias, restaurants, and small rooms with no
air circulation.
- Body heat in crowded places such as elevators, subways, fast
food restaurants, crowded malls, and movie theaters.
- Heat associated with thermally hot foods, soups, and beverages.
- Steam radiating from hot foods (or from draining liquid off
foods).
- Humid or sticky environments.
- Heat associated with sunlight (outside in the fresh air, or
in rooms exposed to the morning and afternoon sun).
It is important to stress that heat-induced flushing can occur within
seconds or minutes of exposure to the heat source. For example,
simply walking across a parking lot (i.e., from your car into the
grocery store) can induce a major flush. Sitting down inside of
a hot bus, taxi, or car for 30 seconds can induce a severe flush
that can last for several hours. Stepping into a hot store in the
mall for 30 to 45 seconds to check out a great outfit can induce
a major flush. Entering a small, hot room such as a kitchen, bathroom,
or bedroom can also be a nightmare for rosacea sufferers. I have
personally experienced all of these heat triggers.
III. Warmth Trigger
The general rosacea literature
routinely warns sufferers to avoid extreme heat, but rarely ever
addresses flushing to warm environments. This is a very big oversight
because in my experience, and in agreement with thousands of reports
from other rosacea sufferers, this is one of the most frequent causes
of facial flushing.
What is the difference
between heat and warmth? Well, I consider heat to be any environment
above 85 degrees Fahrenheit (a temperature that makes many
people, including people without rosacea, uncomfortable); whereas
warmth is any environment in the range of 70 to 84 degrees
Fahrenheit (a temperature that is comfortable for most normal
people). Flushing to warm environments can become disabling because
rosacea sufferers can encounter warm environments almost everywhere
they go, during any time of the year. It is quite common for a room
to be 74 to 78-degrees (i.e., classrooms, bedrooms, bathrooms, shopping
stores, grocery stores, malls, gyms, entertainment places, etc).
Only rosacea experts, who have spent quality time with their patients,
know how frustrating and disabling warm room-induced flushing can
be for sufferers. These experts stress that warm indoor temperature
is a strong trigger for rosacea flushing. (45) Other medical experts
document that their rosacea patients flush suddenly and intensely
to warm rooms. (24) In agreement with the above, Dr. Soybe points
out that many of his rosacea patients complain of flushing or aggravation
of rosacea symptoms when exposed to warm environments. (14) Drs.
Drolet and Paller stress that facial flushing to warm environments
may often be present during the childhood years. In their practice,
they have seen numerous cases of children who flush intensely to
this seemingly harmless trigger. (46)
In addition to warm rooms or environments, several other warm conditions
may induce flushing:
- Warmth associated with your face against a pillow or side of
a couch.
- Warmth under bed sheets, blankets and comforters.
- Warmth under sweaters, flannel outfits, heavy shirts, and coats.
- Warmth from a scarf around the neck.
- Warmth experienced while wearing a smock at the hair dressers,
or suits and lab coats at work, etc,.
- Physicians who really understand rosacea caution, "Even
holding the telephone receiver against your face for a while can
raise the local temperature and irritate sensitive rosacea skin"
(2)
- Warmth from another person - i.e., snuggling, hugging, or laying
beside a loved one such as a spouse, child, or baby.
Rosacea sufferers often
report that the single most distressing flushing trigger
is the body warmth of loved ones. This means that some rosacea sufferers
cannot lie down with a loved one on the sofa without rosacea flushing.
Others report that they cannot snuggle next to their child or baby
for long periods of time without intense facial flushing. Most sufferers
report that they cannot lie next to their spouse in bed without
waking up to an inflamed burning face. Do we know of any other
disease that can handicap people like this?
IV. Physical Activity
Trigger
Physical activity is a
big trigger for flushing. The medical literature usually warns rosacea
sufferers to avoid strenuous exercise such as aerobics, jogging,
and weightlifting. But, in real-life, physical activity-induced
flushing means much more than this. In real life, any form of mild
physical activity can cause facial flushing and rosacea progression.
Flushing can be triggered by basic activities such as:
- Walking up two or three flights of stairs.
- Walking for more than a couple minutes at places such as malls,
grocery stores, shopping centers, etc,.
- Carrying groceries to your car, or into your house, as well
as unpacking them.
- Pushing around a shopping cart.
- Working in a garden or weeding around the house.
- Mowing the lawn with a push-mower or raking leaves.
- Cleaning around the house (vacuuming, mopping, and cleaning
the floors and bathroom).
- Playing with your child.
- Carrying your child.
- Bathing your baby or child.
- Playing or walking with your pets.
- Carrying luggage or suitcases.
- Taking the trash out.
- Any form of sport including basketball, baseball, softball,
football, and soccer. Even just tossing the baseball around with
your child, or innocently kicking the soccer ball can trigger
moderate flushing.
- Gentle calisthenics.
- Simple stretching exercises, or bending over for more than
a few seconds.
- Being intimate with a loved one.
V. Main Problem with
this Misconception
If physicians do not realize
how disabling this disorder is for moderate to severe sufferers,
they will continue to be satisfied with the standard rosacea therapy
(and continue to instruct their patients to avoid all of their flushing
triggers). As one can see from the above list, even if a rosacea
sufferer just has one single trigger such as warm environments,
he or she can have dozens of daily triggers for facial flushing
and rosacea progression!
VI. References
2. Torresani, C. Clarithromycin:
a new perspective in rosacea treatment. Int J Dermatol
37: 347-349, 1998.
14. Sobye, P. "Aetiology and pathogenesis of rosacea".
Acta Derm Venereol 30: 137-157, 1950.
24. Gratton, D. The many faces of rosacea. J Cutan Med Surg
2 Suppl 4: S4-S4, 1998.
43. National Rosacea Society. "Rosacea Review". Fall.
1996. Drake,L.
44. Landthaler, M., D. Haina, W. Waidelich, and O. Braun-Falco.
Laser therapy of venous lakes (Bean-Walsh) and telangiectasias.
Plast Reconstr Surg 73: 78-83, 1984.
46. Drolet, B. and A.S. Paller. Childhood rosacea. Pediatr
Dermatol 9: 22-26, 1992.
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