What Causes Rosacea? Three Common Triggers and How to Combat Them.

rosacea causes red rash across centre of faceNo single cause of rosacea has been identified but recent research does suggest a number of potential triggers for the skin condition that affects around 3% of the population. Without knowing what causes rosacea it can be difficult to treat and this can lead to stress and depression in sufferers who worry over their appearance.

Luckily, many of the possible causes or factors exacerbating rosacea are responsive to treatment so, although there is no ‘cure’ as such for rosacea it is likely that patients can dramatically reduce the impact of the skin disorder by identifying their rosacea trigger(s) and treating it accordingly.

1. Rosacea as a Mite Infestation

One of the most recent findings in relation to the causes of rosacea is the increased presence of a certain kind of mite in the skin of sufferers. Naturally healthy skin, where the stratum corneum (the skin’s barrier) is intact and effective, is more likely to be able to defend against these mites and avoid conditions such as rosacea arising.

Demodex folliculorum and Demodex brevis were suspected in the late 90s as potential triggers for a variety of skin diseases, including rosacea, eczema and lupus discoides and the findings of Roihu and Kariniemi (1998) have since been confirmed by other dermatological research.

The identification of a bacterial cause for rosacea has never been satisfactorily demonstrated. However, dermatologists have found success in treating rosacea using antibiotics that it turns out are effective against a specific bacterium now isolated from Demodex mites.

causes of rosacea demodex mites in skin hair follicles
Demodex mites in the hair follicles, crawling on the skin and in close-up.

More Men with Mites and Rosacea

The 1998 study found a significantly higher proportion of men with rosacea with mite infestations (59%) compared to women with rosacea (30%) and the forehead (49%) was the most infested area of the face, followed by the cheeks (44%). The presence of these mites was associated with an increased level of immune system activity in these areas, prompting an inflammatory reaction thought to contribute to the severity of the rosacea.

Treating the infested hair follicles with antibacterial agents and reducing such inflammation would, then, be a way of combating this possible cause of rosacea.

Treating Demodex Mites for Rosacea Relief

Tetracycline and metronizadole are popular treatments for rosacea and these likely work by combating the bacteria found in the mites infesting the skin and hair follicles. Bacillus oleronius is one such organism and Staphylococcus epidermis has also been isolated in the affected skin of rosacea sufferers, possibly being transported by Demodex mites.

The reason for the vastly increased numbers of Demodex mites in the skin of rosacea patients is not known with any conclusiveness but it is suspected that ageing skin, the drying effects of wind and cold weather, changes in fatty acid distribution in the dermis and other mechanisms by which the skin is weakened are to blame. This would tally with the increased prevalence of rosacea in those over the age of fifty, especially in post-menopausal women.

2. Rosacea and Stress

The skin-stress connection has been noted time and again by dermatology researchers and many rosacea sufferers will have noticed that their symptoms become worse when feeling anxious, depressed and/or overwhelmed.

The reason for this exacerbation of rosacea when stressed is not fully understood but research published last month suggests that neurotransmitters can and do influence skin health (Madva and Gransterin, 2013). Taking a deep breath and meditating may be the best treatment for rosacea for some sufferers, rather than another application of steroid cream and antibiotics.

How the Nervous System Affects Rosacea

The way that this nervous system and skin connection works is thought to be mediated by the immune system as neurotransmitters affect mast cells and Langerhans cells in the skin. Catecholamines and other nerve signal transmitters are released as a reaction to sympathetic nervous system stress and it is these that then cause the skin to alter how cells function, producing the symptoms of rosacea.

Endothelial cells, which are the source of many inflammatory mediators, are heavily influenced by neuropeptides and neurotransmitters as are mast cells, meaning that the response of the skin to bacterial invaders, and other antigens is connected to stress rather than being a purely localised phenomenon.

Stress Relief as Rosacea Remedy

Skin conditions other than rosacea are also thought to be connected to stress, including psoriasis, atopic dermatitis and acne and it may very well be that future therapies for such skin disorders involve a psychological element in addition to topical anti-inflammatories and immune system modulators.
rosacea causes stress and meditation relief

3. Helicobacter pylori and Rosacea

The association between Helicobacter pylori (Hp) and rosacea has long been suspected but tests for overgrowth of this stomach infection are usually only carried out at the request of patients aware of the connection. Hp infection that is successfully treated with antibiotics has resulted in improvements in rosacea symptoms in some patients but few studies have been carried out to elucidate the relationship between the infection and rosacea.

Peptic Acid Disease and Rosacea

One small study did, however, looked at dermatology outpatients presenting with both rosacea and symptoms suggestive of acid peptic disease and found a significant correlation with Hp infection (Bhattarai, et al (2012). These patients were tested for Helicobacter pylori using the SERION ELISA IgG serological test with 17 of 26 patients (53.8%) enrolled found to be infected with Hp.

Of the 26 patients, 14 were men and 12 women, three patients had Grade IV rosacea and 14 had symptoms of acid peptic disease.

Treating Hp Infection to Relieve Rosacea

The researchers conclude that rosacea can be considered a possible extra gastric symptom of Hp infection which could mean that treating a key cause of peptic ulcers, overgrowth of Helicobacter pylori, may also help prevent rosacea symptoms arising or reduce the severity of the skin condition.

Conventional treatment for Hp infection usually involves a proton pump inhibitor and two antibiotics taken for a week with around a 70% success rate. A second round of such therapy, sometimes with an additional antibiotic, usually eradicates the infection in the remaining cases, with successful treatment seen in around 90% of cases.

Symptoms will usually then dissipate and the gastric mucosa will begin to heal. Severe and chronic cases may leave lasting lesions in the stomach but the symptoms will be significantly lessened and patients whose rosacea was connected to the infection will see improved skin health as a result of such therapy.

Natural Helicobacter pylori Treatments

Natural treatments for Helicobacter pylori infection include Manuka honey at a medicinal strength, along with other natural antibiotics such as oregano oil, clove oil, thyme and cinnamon. Ginger may also inhibit the growth of the bacteria and help with gastrointestinal symptoms and general inflammation.

Broccoli (sulforaphane) supplements may also be helpful in combating Hp and providing rosacea relief, as might prebiotic and probiotic supplements to restore good bacteria and crowd out the bad bacteria.

Natural Rosacea Treatments

Along with the treatments outlined above for those whose rosacea is connected to Helicobacter pylori infection, a handful of other natural remedies have been proposed for the skin condition. Niacinamide (a form of vitamin B3) is one such remedy and a small number of face creams now contain this vitamin based on the findings that it can help improve the skin barrier (the stratum corneum), help maintain skin’s moisture balance and reduce skin sensitivity which can be a problem for rosacea sufferers.

Vitamin B3 deficiency has also been linked with rosacea but there is no evidence, currently, suggesting that oral niacin supplements may help the condition. Indeed, these may actually cause facial flushing and exacerbate the symptoms, depending on the form taken.

rosacea remedy green tea face mask

Green Tea for Rosacea Symptoms

Green tea is another proposed natural rosacea treatment, based on its antibacterial properties and ability to penetrate the skin and improve response to intense pulsed light therapy for skin conditions. As a significant source of polyphenolic antioxidants, green tea may exert a positive effect on the integrity of skin cells and improve immune system function in order to calm inflammation and cellular damage in the facial skin of rosacea patients. A green tea facial cleanser, mask or compress could offer a natural rosacea remedy that is simple to make at home.

Soothing Rosacea Naturally

Oatmeal compresses are another possible remedy for rosacea, as is aloe vera gel or cream. Aloe vera juice is also often recommended to be taken internally to soothe the gut and calm rosacea symptoms from the inside. There are a number of other natural products being touted as cures for rosacea, including feverfew and liquorice but, so far, there is no clear evidence supporting their benefits for the skin condition.

Lifestyle and Dietary Remedies for Rosacea

Patients with rosacea may not know precisely what is causing their skin condition but it is likely that they will see some benefits from the following lifestyle and dietary changes:

  • Reducing sun exposure and using sun lotion
  • Avoiding, where possible, excessive heat, saunas and exercise that causes facial flushing
  • Stress reduction through meditation, yoga and other such activities
  • Removing spicy foods, coffee, garlic and onions from the diet
  • Protecting skin from harsh winds and extreme cold
  • Including more vitamin C-rich foods in the diet to boost collagen production and promote healthy skin
  • Stopping smoking (which prematurely ages the skin and reduces the effectiveness of the skin’s barrier)
  • Using pancreatic and digestive enzymes to help gut function
  • Avoiding alcohol due to gut damage, nutrient depletion, capillary damage and facial flushing
  • Increasing consumption of foods containing B vitamins such as whole grains, broccoli, nuts, avocados, spirulina and nutritional yeast.

There may be no single known cause of rosacea but it does seem likely that patients can improve symptoms where one of the above triggers is identified. Other dermatology researchers are investigating the possibility that vascular disease is tied to rosacea and this may lead to new treatments for the common skin condition.

Without knowing what causes rosacea those touting miracle cures should be viewed with caution and patients will likely find most benefit from improving general health and the integrity of the skin rather than spending money on expensive face creams and rosacea remedies unsupported by any evidence.


Roihu T, Kariniemi AL., Demodex mites in acne rosacea. J Cutan Pathol. 1998 Nov;25(10):550-2. https://www.ncbi.nlm.nih.gov/pubmed/9870674

Jarmuda S, O’Reilly N, Zaba R, Jakubowicz O, Szkaradkiewicz A, Kavanagh K., Potential role of Demodex mites and bacteria in the induction of rosacea. J Med Microbiol. 2012 Nov;61(Pt 11):1504-10. https://www.ncbi.nlm.nih.gov/pubmed/22933353

Madva EN, Granstein RD., Nerve-derived transmitters including peptides influence cutaneous immunology. Brain Behav Immun. 2013 Mar 18. pii: S0889-1591(13)00135-9. https://www.ncbi.nlm.nih.gov/pubmed/23517710

Bhattarai S, Agrawal A, Rijal A, Majhi S, Pradhan B, Dhakal SS., The study of prevalence of helicobacter pylori in patients with acne rosacea. Kathmandu Univ Med J (KUMJ). 2012 Oct-Dec;10(40):49-52. https://www.ncbi.nlm.nih.gov/pubmed/23575053

Zandi S, Shamsadini S, Zahedi MJ, Hyatbaksh M., Helicobacter pylori and rosacea. East Mediterr Health J. 2003 Jan-Mar;9(1-2):167-71. https://www.ncbi.nlm.nih.gov/pubmed/15562747

Draelos ZD, Ertel K, Berge C., Niacinamide – Containing Facial Moisturizer Improves Skin Barrier and Benefits Subjects With Rosacea, Cutis 2005; 76:135-141. https://www.ncbi.nlm.nih.gov/pubmed/16209160

Freedman BM., Topical polyphenolic antioxidants reduce the adverse effects of intense pulsed light therapy, J Cosmet Laser Ther. 2009 May 27:1-4, Plastic Surgery Associates of Northern Virginia, McLean, Virginia, USA. https://www.ncbi.nlm.nih.gov/pubmed/19479604

Emer J, Waldorf H, Berson D., Botanicals and anti-inflammatories: natural ingredients for rosacea. Semin Cutan Med Surg. 2011 Sep;30(3):148-55. https://www.ncbi.nlm.nih.gov/pubmed/21925368

Pazyar N, Feily A, Kazerouni A., Green tea in dermatology. Skinmed. 2012 Nov-Dec;10(6):352-5. https://www.ncbi.nlm.nih.gov/pubmed/23346663

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