Rosacea Review - Newsletter of the National Rosacea SocietyRosacea Review - Newsletter of the National Rosacea Society

The Anatomy of a Rosacea Flare-up

What happens when you aggravate rosacea? For those afflicted with this widespread disorder, contact with their personal trigger events -- which may include any of a wide array of environmental or lifestyle factors usually associated with flushing - can set into motion the physiological process whose outward signs are recognized as rosacea.

A variety of aggravating factors can cause a flare-up of rosacea symptoms. The heat connected with the sun, hot beverages or physical exercise may begin the process. Emotional factors such as stress, embarrassment or anger may also contribute. According to a theory proposed by Dr. Jonathan Wilkin in 1994 and now accepted by many dermatologists, the process appears to start as a vascular phenomenon, beginning with an increased blood flow that results in the "rosacea red" appearance of the facial skin.1

Some rosacea tripwires are irritating to skin, and can lead to fluid under the upper layer of the skin accumulating more quickly than the lymphatic system, which transports fluids throughout the body, can remove it. This can lead to the swelling, called edema, that affects some sufferers. This abnormal accumulation may provoke chronic progressive lymphatic damage -- a more permanent dysfunction that sets the stage for further abnormal changes.

Sun exposure can also contribute to lymphatic damage, causing degeneration of elastin, a type of connective tissue that supports the lymphatic system and helps it to function. Lymphatic failure results in a sustained inflammatory response -- the persistent redness that typically appears as rosacea progresses.

Rosacea's bumps and pimples are a further inflammatory reaction, caused by a combination of white blood cells and edema. These are often random and unpredictable.

The development of visible dilated blood vessels, called telangiectasia, represents a later phase of the vascular component of rosacea. One key cause may be that the breakdown of the connective tissue allows the vessels to dilate and become visible on the surface of the skin. New blood vessels also may appear when there is a space available for them to grow into.

Associated References

  1. Wilkin JK: Rosacea: Pathophysiology and treatment. Archives of Dermatology. 1994;130:359-362.