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The following is an excerpt from Rosacea 101: includes the Rosacea Diet
by permission of the author:

The NRS does not distinguish tripwires from trigger factors using both terms to mean the same thing, which can be anything that MAY produce a rosacea flare-up. [252]

What is the difference between a Trigger, a Tripwire, a Flareup, and a Flush?

“… Rosacea tripwires are factors that may cause a rosacea sufferer to experience a flare-up—a more intense outbreak of redness, bumps or pimples . While the list of potential tripwires ranges from weather to emotions to foods, nearly all are related to flushing. As a rule, anything that causes a rosacea sufferer to flush may trigger a flare-up.…” [253]

Note these typical definitions of rosacea:

“Rosacea is a chronic skin condition involving inflammation of the cheeks, nose, chin, forehead, or eyelids. It may appear as redness, prominent spider-like blood vessels, swelling, or skin eruptions similar to acne.” [254]

“Rosacea is a chronic facial eruption, most commonly seen in Caucasian adults, characterized by erythema of the central face, papules, pustules, telangiectasias and periods of exacerbation and remission.” [255]

See Appendix V—Rosacea Defined for more information.

The above definitions do not mention flushing. You can see what the definition is targeting and it isn’t flushing. The definitions center on the inflammation and redness and ignore flushing. It would be good to remember that what the problem is and has always been is rosacea, not flushing. Flushing aggravates rosacea and can be a chief concern. However, some may be more concerned about sensitive skin than flushing. Yet as the previous chapter points out about flushing, many rosaceans center their therapy on trigger flushing avoidance. Remember that trigger avoidance also includes other factors than just flushing and this is what this chapter is about. It includes not only triggers for flushing but also triggers that cause a rosacea flare up which might not include a flush. Sometimes rosacea is referred to as ‘adult acne’ and Dr. Kligman says is not such a bad idea. [256] The disease looks like acne. However, because flushing isn’t associated with acne and is one of the key factors differentiating acne from rosacea, flushing emerges as a top concern for many with rosacea by avoiding anything that may trigger a rosacea flare-up thinking that flushing is the only trigger. Not so. There are many other triggers in this chapter that are detailed that have nothing to do with flushing. Flushing factors may be getting more of the limelight but rosacea is the stop light. Making a list of potential trigger factors may be helpful but they are not set in stone. There are no lists of proven rosacea trigger factors that in every case produces a rosacea flare-up. In fact there is no proven single flushing factor that in every case produces a rosacea flare-up in every rosacean! Any flushing rosacea trigger factor or tripwire only MAY produce a rosacea flare-up, no matter who makes up the list. And one must remember this important point: Not all flushing produces a rosacea flare up. You may have a flush and later your face can calm down and the redness subsides. Try to relax. Not all flushing produces a rosacea flare up. Really.

There is no evidence that every case of flushing produces a rosacea flare-up. You may simply just flush. If you carefully read what the NRS says about flushing remember that “As a rule, anything that causes a rosacea sufferer to flush may trigger a flare-up.” See the previous chapter on Flushing. This ‘rule’ doesn’t say a trigger will in every case produce a flare-up. Trigger and flushing avoidance is simply one way to control rosacea. It sometimes works but don’t become obsessed with this treatment excluding other treatments or make it your primary concern. If you recall in Chapter 5, there are several treatment options to choose. Trigger and flushing avoidance is just one way to go. Nevertheless, there are a number of trigger factors to consider. Remember that these trigger factors MAY NOT produce a rosacea flare up. You have to determine if any of the factors listed below trigger your rosacea. I repeat:

There is no trigger factor list ever made that lists a single trigger that in EVERY CASE will produce a rosacea flare-up in every rosacean. Name a trigger factor that does this to every rosacean. You can’t. What triggers rosacea in one may not trigger it in another rosacean. It is the X-Factor.

Diet Triggers

Chemical Triggers

Comprehensive Trigger List

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End Notes

[252] Coping With Rosacea, National Rosacea Society, page 1


[253] Coping With Rosacea, National Rosacea Society, page 1


[254] Medical Encyclopedia Powered by A.D.A.M., Merck & Co., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare; Review Date:5/3/2006
Reviewed By: Michael S. Lehrer, M.D., Department of Dermatology, University of Pennsylvania Medical Center,
Philadelphia, PA. Review provided by VeriMed Healthcare Network.; http://tinyurl.com/3dzook

[255] Emerging Concepts in Rosacea Management The Antibiotic Paradox: Benefits and Risks of Using Antimicrobial
Oral Antibiotics for The Systemic Treatment of Rosacea James Del Rosso, D.O.

[256] “It is interesting that the original term for rosacea was “acne rosacea”, which has more features in common with acne than currently realized. If the “acne” portion had been retained in the later works, rosacea might have received much greater investigative attention.” A Personal Critique on the State of Knowledge of Rosacea Albert M. Kligman, M.D., Ph.D. Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A.

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