Each of the following items is part of a complex interaction of several systems.

Clock rosacea or systemic flushing- The body does operate on a clock!
Universally, hospital physicians have known for years that the lowest body
temperature of the 24 hour day is at usually around 3:00 A.M. while the
highest temperature of the day is around 8:00 P.M. The average rosacea
sufferer does not have hospital waking and sleeping hours therefore their
temperature lows and highs may vary 3 to 5 hours each way. A high
temperature for some may be as early as 3:00 P.M. Flushing usually occurs
when the body becomes fatigued and/or stressed which stimulates the
sympathetic nervous system. The key to this is the autonomic nervous system
(more specifically,the sympathetic postganglionic efferent nerves). Any
activation of these nerves causes vasoconstriction of "body blood vessels"
-- except in the "facial blush/flush areas" where it induces potent
vasodilation or flushing with the resulting "rosacea flush". A typical
rosacea sufferer would flush in the fifth grade even when the answer was
known when the teacher asked a question, and obviously the flushing
would be noticed by the other kids. Once again the sympathetic nervous system.

Stress stimulates the sympathetic nervous system
Lack of sleep stimulates the sympathetic nervous system
Anxiety (fight or flight) stimulates the sympathetic nervous system
Increase in internal body temperature stimulates sympathetic
nervous system,
whereas obviously a decrease in body temperature decreases.

The sympathetic nervous system is especially important to rosacea patients
who tend to have either:
Genetically weak blood vessels
Damaged blood vessels from years of sun
Damaged support system for blood vessels (collagen-elastin of skin)
Increased number of blood vessels.

Rosacea sufferers have more facial vessels or the vessels that we have are
severely damaged. With the result being that anything that stimulates
facial dilation "cannot" be handled easily or properly.

Heavy meal flushing and sugar/carbohydrate flushing- This flushing is
caused by more stress on the digestive system with a resulting larger blood
flow to the digestive system and with the residual blood being heavier to
the face. Therefore, three small meals with breakfast being the most
important and grazing in between meals is better for limiting this kind of
flushing, however it
is important to keep the daily calorie intake within one's calorie budget
to maintain your ideal weight. The type of food that you eat is also very
important as various foods stimulate blood flow differently. Simple
carbohydrates, sugars, and alcohol enter the blood stream quickly causing
hyperglycemia (high glucose spikes). This rapid influx of sugar into the
blood stream is a potent vasodilator. Fiber intake decreases the amount of
food that the stomach has at one time and prolongs digestion, therefore
there is not the sudden influx into the blood stream with the resultant
flushing.

Steroid flushing - When a rosacea patient is erroneously treated for a
prolonged time with topical steroids the disorder may at first respond, but
inevitably the sign of steroid atrophy emerge with thinning of the skin and
marked increase in telangiectases. The complexion becomes darcopper-like
hue. Soon the surface becomes studed with round, follicular, deep
papulopustules, firm nodules, and even secondary comedones. The appearance
is shocking with a flaming red, scaling, papule-covered face. Steroid
rosacea is an avoidable condition which in addition to disfigurement is
accompanied by
severe discomfort and pain. Withdrawal of the steroid is inevitably
accompanied by exacerbation of the disease, a trying experience for a
patient and physician. (Drs. Gerd Plewig and Albert Kligman).

For information on steriod use, please see First World Congress of the
International Academy of Cosmetic Dermatology.

Adrenalin flush rosacea - This kind of flushing is caused by an adrenalin
rush or a large supply of adrenalin under pressure with immediate or
instant flushing. It is the same as sympathetic nerves, but it is hormone
released. Stress is the body's reaction to a perceived threat. Adrenaline
and hormones are released, and the nervous system is activated, sharpening
our senses, but simultaneously our pulse rises, our muscles tense and our
immune system begins to shut down. Those that can not relieve stress as
needed may experience fatigue, upset stomach, and frequent headaches, and a
flushing face. While long term stress can contribute to family breakdown,
job fatigue, with resulting long term health problems such as depression,
heart disease, high blood pressure, and rosacea. Also, adult acne is
adrenal related in both " men and women" as a reaction to mental stress or
body stress. In women testosterone is produced by the ovaries with the
other half of testosterone in women being produced by the adrenal glands.
Obviously, estrogen smooths out the testosterone produced by the ovaries,
but when the estrogen level drops several days before the menstrual
periods, sometimes resulting acne occurs especially when the adrenal glands
over produce due to stress or fatigue. Likewise, the adrenal glands can be
stressed continually in both men and women resulting in too much testostone
with the resulting over stimulation of the sebaceous glands. The adrenal
glands produce testosterone directly or via peripheral conversion of DHEAS
(dihydropiandrosterone sulfate), DHEA (dihydroepiandrosterone), and
androstenedione which are the three major adrenal androgens. Similarly, in
the male an over abundance of testicular testosterone especially with
overly stimulated adrenal glands causes the overly stimulated sebaceous
glands. Quite often more stress is placed on the adult after puberty, with
the current stressful period of having gameful employment, progressing in
employment and marriage, child raising and the resulting continuing
financial problems which causes stress of great magnitude. While we can not
produce more estrogen to level out the testosterone, we can drink much more
water which will help relieve stress and assist both acne and rosacea. Also
getting more sleep enough sleep
and finding ways to relax will help relieve stress and reducing the
adrenalin reaction that follows. You will read considerably more about
stress under Lifestyle changes later. Also, there within, you will find
many ideas on limiting your stress.

Exercise flushing is caused by the cardiovascular system pumping harder and
faster due to exercise. While keeping the body in good shape by burning
calories and toning muscles, exercise should be done moderately in a cool
area with the body well hydrated with water to minimize the redness. The
body,
hydrated well with water, will result in less redness. The body should
adapt slowly over time to the exercise so that the body is aerobic (with
oxygen) instead of anaerobic (without oxygen causing redness). Therefore,
the body can handle more vigorous exercise as your exercise training
increases. Better cardiovascular shape and exercise means more oxygen in
the blood and more oxygen in blood constricts vessels. Also, there is a
myriad of benefits of wate for exercise and metabolic waste build up. Also,
water is absolutely necessary for strong, flexible plasma membranes of all
cells. See more details in the Lifestyle Changes.

Cigarette flushing - Smoking, which depletes the skin of vitamin C,
essential for the formation of collagen, accelerates the crosslinkage of
collagen and the hardening of elastin and furthermore creates a trillion
free radicals, which destroy the capillary structure. Smoking, which
additionally robs the skin of oxygen, is a potent initiator of
telangiectasis. Also, the smoker may have a
variety of medical problems such as high blood pressure, and mineral
deficiencies, which can cause the appearance of telangiectasis. Remember
what cigarette smoking does to the lungs. The lung tissue is less pliable,
receiving less oxygen. Well, a similar thing happens overall to the skin
with the epidermis being less pliable and receiving less oxygen with the
result being that the 'Marlboro Man' has more wrinkles. Most importantly is
that the blood vessels are not as pliable and receive less oxygen therefore
compounding the problem. Usually, noticeable smoking symptoms are not
visible to the lungs nor the face as blushing is minimal for weeks, months,
or years, however, there is continual
damage to the lungs and the skin that is very hard to regain. Also,
remember that most smokers do not have rosacea as we think the rosacean
population is large, however, it is quite small in comparison to the census
for all children and adults in the population.

Hot shower/bath flush rosacea- Obviously the skin is redder by the
stimulation of hot showers/baths or hot weather. Overall, it is better to
shower in tepid water below body temperature of 98.6 or in the range of 85
to 95 to cool the body.

Alcohol flushing- The best way to avoid this type of flushing is not to
drink any alcohol! All alcohol is fermented, but because beer and wines
(red wine being the worst) are not further distilled, they can cause
allergy redness for many rosacea sufferers. Alcohol is a diuretic which
pushes water out of the body cells. In this state of "dehydration", the
body is prone to flushing. Alcohol is a concentrated source of calories and
is metabolized very quickly. This causes the blood vessels to dilate and
cause redness. If you feel you need to drink alcohol at social functions or
to relax, here are some recommendations to minimize the flushing effect.
Avoid beer and wine. Instead, drink "very, very small, weak portions" of
gin, vodka or whiskey, ideally with water instead of sugared soft drinks or
mixes which also can stimulate the cardiovascular system. Or simply use
another glass, and mix the drink to "cut" it in half with twice as much
water. Small amounts of gin are less stimulating than vodka or whiskey to
many drinkers. You should "chase" any alcoholic drink with water, and water
again in between drinks. Although these recommendations can help to
minimize flushing, still the best thought is not to drink any type of
alcohol.

Chilly or cold weather flushing - These flushing flare ups result from
coming in from the chilly cold into a room where the normal room
temperature ranges from 70 to 75 degrees. While the rosacea sufferer is
outside in the cold weather the cardiovascular system is pumping hard as it
normally does,
however the extremities such as the feet, hands, ears, nose get less blood
supply than the rest of the body and are directly exposed to the cold along
with the facial skin. Its partially due to direct contact, but it is more a
cause of conservation of heat by internal thermostat -- causing
constriction of vessels by decrease sympathetic activity to vessels. When
the rosacea sufferers come into the warm office or home with normal
temperatures, the warmer temperatures quickly warm the facial skin areas
and extremities while the cardiovascular system is still in a moderately
high exercise mode. The rosacea sufferer should try not to enter the cold
if possible or minimize the extreme cold exposure by
warming up the car prior to use, wearing a facial mask/hat/scarf depending
on length of exposure and severity of cold temperatures, or whatever else
can be done to minimize cold exposure. After being exposed to the cold for
a long period, prior to arrival in the warm office or home, try to slow
down the exercise walking, etc. so the cardiovascular system will not be as
stimulated. If possible enter slowly at a foyer or vestibule, or
corridor,take a break in that area by reading a newspaper, etc. for five
minutes, or reviewing plans for the next few hours, etc., then proceed
slowly into the warmer office/home with the normal temperatures to minimize
flushing.

These are some of the primary types of flushing, and there are other types
of rosacea flushing such as sun exposure flushing, drug medication flushing
or drug/sun sensitivity flushing (see list later under Lifestyle changes),
laughter flushing, allergy/histamine flushing, and the list goes on and on.

Rosacea is a progressive skin disorder unless treated. The blood vessels
continue to grow with age and when stimulated and damaged by
stress,food/drinks, dehydration, weather, sun exposure, abrasive
soaps/exfoliating medications, hot bath, exercise, etc.

Ralph Bass