Outside or in, environmental factors can be red flag for rosacea patients

October 1, 2006

National report - As most dermatologists know, it's no accident that the skin on the most consistently covered-up parts of the body is typically in the best shape. External elements ranging from the sun and wind to temperature extremes can take their toll on even the healthiest of skin, but when conditions such as rosacea are present, the elements can wreak particular havoc.

Most of the conditions that cause a passing flush in the absence of rosacea can be counted on to trigger a serious flare-up for rosacea patients, says Margaret E. Parsons, M.D., an assistant clinical professor at the University of California, Davis.

"Any condition that makes someone flush easily, causing 'rosy cheeks,' seems to flare rosacea," she says. "These can include getting overheated from exercise or hot weather, cool wind or drinking alcoholic beverages. Another trigger can be warm drinks or soups from the heat near the central face."

Severe weather

The survey of 683 rosacea sufferers found that 88 percent of respondents living in areas with severe weather reported that their rosacea worsened following outdoor activities during cold periods, and among those living in areas with milder weather, nearly half said outdoor activity in cooler months caused flare-ups.

Exposure to wind was cited as the biggest culprit in flare-ups, with 79 percent of all survey respondents citing this as a trigger factor. And when accompanied by bitter cold, wind can complicate matters even further for rosacea sufferers, as the dryness of the cold air can make the skin more sensitive and vulnerable to a rosacea flare.

Even indoor temperatures can play a big role in flares, and the survey found that high indoor heat aggravated rosacea in 57 percent of those living in severe weather areas and 63 percent of those in moderate or mild climates.

In addition to exposure to any of the elements, abrupt changes from hot to cold, or vice versa, can also exacerbate rosacea, and a typical wintertime scenario of coming in from the bitter cold and warming up by a hot fire could be the perfect recipe to trigger a flare-up.

And while hot weather can exacerbate rosacea, photodamage from the sun itself can be a problem.

"Sun damage that causes increased formation of blood vessels can contribute to the set-up for rosacea," Dr. Parsons says.

Preventing flare-ups

Perhaps the most basic way to prevent such element-induced flare-ups is to simply avoid exposure to weather extremes. In the summer, patients can avoid getting overheated by taking such measures as exercising in a gym with a regulated temperature, or gardening outdoors early in the day when the weather is cooler.

In the winter, layering clothes can be helpful.

"When there is cold, dry air blowing with winter winds, a scarf protecting the face can be helpful so the wind does not directly hit the skin," Dr. Parsons adds.

As with all other patients, rosacea patients should make it a particular point to use sunscreen and sun hats to prevent sun-related flare-ups.

"Sunscreen and hat use is important in order to decrease actinic changes of the skin, including blood vessel formation," Dr. Parsons says.

"Also, some of the products with zinc oxide or titanium dioxide are themselves soothing to the sensitive skin of many erythematotelangiectatic or eczematous rosacea patients," she adds.

Such patients should try to use mild, non-irritating cleansers or nonsoap cleansers, and gentle moisturizers can be beneficial for drier skin that is easily irritated or easily flares.

And if there is a stronger sebaceous component, patients may require a skincare program that avoids emollients.