For some it’s an easy diagnosis, for others it’s not so simple. But whatever is causing your rosacea, the condition can be tricky to manage if you can't work out what’s setting your skin off into a flushed, itchy, irritated downward spiral.

Once you have rosacea there’s unfortunately no cure, so along with consulting a skin specialist or your GP for an accurate diagnosis, working out your triggers is essential in managing this commonly neglected condition.

While there are lots of theories from genetics to stress, we investigate some of the more common culprits with the help of some in-the-know experts…

Stress

While stress can take a short-term toll on the skin, it can also aggravate perpetuating conditions like rosacea. Stressed skin manifests itself in the form of increased redness and flushing, sensitivity, breakouts and dryness.

Stress activates the sympathetic nervous system; it is said that rosacea sufferers may also have an underlying dysfunction of the parasympathetic nervous system. So along with paying more attention to relaxation, meditation and decreasing stress levels to help calm the nervous system, what can be done practically?

"Take a step back on actives, replace any exfoliating acids with moisturising polyhydroxy acids and replenish the skin's barrier with peptides and ceramides,” recommends Advanced Aesthetic Doctor Dr Catharine Denning. “It's also wise to limit sun exposure and wear sunscreen every day; wear a hat to protect skin from being in direct sunlight when out and about.”
 
As rosacea is a medical condition, Denning says that diagnosis and flare-up management should be overseen by a GP or dermatologist, especially during a flare-up phase.

Hormones

According to Hormone Doctor Sohere Roked, hormonal rosacea can be triggered by changes around the cycle or the peri menopause. “It is due to hormonal fluctuations and the stress that can accompany this. Rosacea can become more frequent in women with age,” she says.
 
One of the most common menopausal symptoms is hot flushes, which can trigger rosacea flare ups. While rosacea itself isn’t a symptom of the menopause, she believes there is a link between hormonal changes and the menopause.

So how do you tell if your rosacea is hormonal? Roked tends to go on the kind of symptoms as an indicator, and prefers to start from the inside when calming down a rosacea flare-up.
 
"There are many good products that can be used topically; however I work more from the inside,” she confirms. “I look at balancing hormones, reducing stress and eliminating potential dietary triggers."
 
Roked recommends that you see a good skin specialist for an effective topical skincare regime, monitor if episodes happen at certain points in the menstrual cycle and look for dietary triggers.

“With my patients we may try supplements like vitamin C, E and D which can improve the skin – we also work to balance their hormones,” she says.

Skincare products

If you have rosacea, the products you use could make all the difference between skin that’s cool and calm, or angry and irritated.

It pays to read the label and make informed choices, to avoid upsetting your skin even more. Simple, natural products with as few ingredients as possible are definitely the way to go; test a product on your neck before using it on your face.

EV Expert and rosacea sufferer Dr Anna Hemming of Thames Skin Clinic often recommends ZO Skin Health Rozatrol to her patients. “It’s a soothing redness relief cream which increases exfoliation sensitively, calming the skin with advanced amino acid complexes and antioxidants that reduce inflammation and damage caused by daily oxidative stress,” she says.

So what ingredients should you avoid?

Essential oils: Some of the more stimulating essential oils may make your skin itch and burn – the most common culprits include peppermint, eucalyptus and menthol, the latter which has a sensitising effect on the skin.

Alcohol: In a survey conducted by the National Rosacea Society, 66 per cent of respondents cited alcohol as a trigger for irritation. In fact, some skincare experts recommend that everyone avoids this drying ingredient, even those with so-called normal skin. In particular, look out for and swerve ethanol, isopropyl alcohol and alcohol.

Tretinoin: This retinoid may sometimes be prescribed to treat rosacea that presents with bumps, however those with super-sensitive skin – and that’s likely to be you if you are a rosacea sufferer – will probably find that tretinoin only makes things worse.

Glycolic acid: This exfoliating acid may be a skin superstar, but unfortunately it’s anything but for the rosacea sufferer. Don’t be tempted to try it, as it’s way too stimulating for red, irritated skin.

Fragrance: According to studies, fragrance or highly scented ingredients can cause more allergic contact dermatitis than any other ingredient. Reach for fragrance-free products to reduce the risk of irritation.

Witch hazel: While it does have its benefits, witch hazel can also cause irritation, especially as it’s often mixed with alcohol in the distillation process.

The weather

It’s certainly been a blazing summer so far, but sun exposure, heat, humidity and extreme temperatures can also contribute to a rosacea flare-up.

So how best to deal with the hot sun? Not all sunscreens protect against both UVA and UVB rays, however those containing a physical block and an SPF of at least 30 will be effective. However, a single application won’t last all day, so you'll need to be vigilant and reapply at some point if outside for extended periods of time, or in the water.

Ideally you should limit your sun exposure between 10-4pm when the sun is at its strongest. And don’t think you don’t need to bother in autumn or winter; you should apply sunscreen daily, all year round – whether it's sunny or cloudy.

Talking of winter, the cold and wind can also be troublesome: according to a survey by rosacea.org, 46 per cent said cold weather aggravated their condition, and 57 per cent said they were affected by wind.

So if the winter weather impacts your rosacea, take care to protect your skin – cover your face with a scarf if possible and limit time spent outdoors.

Your lifestyle

Your daily habits can impact on your rosacea, and you won’t be surprised to hear that alcohol is a major culprit. If you flush when you drink a glass of wine, it could be your rosacea making itself known. But what triggers one person may not be enough to upset another’s skin.

Research has found that alcohol increases the production of inflammatory cytokines, which in turn can lead to vasodilation – a widening of the blood vessels – along with inflammation.

It’s about finding your individual triggers; red wine is known to be more of a trigger than white wine, beer and liquor in that order. Consider keeping a diary and note what you drink and any reaction.

It also helps to sip slowly as this will lower your cumulative alcohol intake, resulting in less vasodilation. Chilled drinks will also cause less blood vessel expansion than room temperature alcohol.

And alternating with a glass of water between drinks helps dilute the alcohol and prevent some of the changes happening in your system. Or better still, order a mocktail – no one will be any the wiser.

Certain food ingredients should also be eaten in moderation (or avoided) as they may cause a flare up: spicy foods including pepper, chilli and salsa used in Mexican, Thai or Indian dishes are especially risky.

While exercise is an essential part of a healthy lifestyle, intense exercise such as cardio, or exercising or running outdoors can cause a flushed face due to increased blood flow to the skin. If you can, try to work out indoors or in cooler, shady spots.

Heat treatments such as saunas and steam rooms – even hot baths and central heated environments – can also cause rosacea to flare up. Studies have shown that people with rosacea produce greater nerve, blood flow and sweating responses than people without the disorder when exposed to increased heat.