When a physician like Dr. Day repeats that alcohol and spicy food are rosacea trigger without qualifying this with MAY be a rosacea trigger, it may appear to a novice that one must avoid alcohol and spicy food to avoid a rosacea flare up. My comment is that not all rosacea sufferers have a rosacea flare up with spicy food because where Dr. Day got this information is from anecdotal reports the NRS collected that showed that some rosacea sufferers reported they ate spicy food and had a flare up. Not every rosacea suffer reports having a flare up after eating spicy food. The same is true for all the proposed triggers. Not everyone who goes out in the sun who has rosacea gets a rosacea flare up. Not everyone who has rosacea suffers a rosacea flare up after drinking alcohol.

I am not pretending to be a dermatologist. Your point is well demonstrated by your example of pretending to be a dermatologist, but Dr. Day doesn’t say that the triggers may cause rosacea but simply repeats the NRS list of triggers without qualifying it. If a dermatologist repeated your explanation of triggers as clearly as you have, that is exactly what my point is all about the anecdotal reports. Some rosaceans report such and such is a trigger for them. When you look at the 18 diet triggers proposed by the NRS which are the following:

Foods:
Liver
Yogurt
Sour cream
Cheese (except cottage cheese)
Chocolate
Vanilla
Soy sauce
Yeast extract (bread is ok)
Vinegar
Eggplant
Avocados
Spinach
Broad-leaf beans and pods, including lima, navy or pea
Citrus fruits, including tomatoes, bananas, red plums, raisins or figs
Spicy and thermally hot foods
Foods high in histamine

Beverages:
Alcohol, especially red wine, beer, bourbon, gin, vodka or champagne
Hot drinks, including hot cider, hot chocolate, coffee or tea

Now lets just take the first two, liver and yogurt. What if Dr. Day had mentioned these two items as a rosacea trigger instead of mentioning alcohol and spicy food? Would it have as big an impact? Why does alcohol and spicy food always come up as the big rosacea triggers? Because more rosaceans report these two as the most on a poll collected by the NRS. These two MAY trigger a rosacea flare up. But she doesn’t say may, she says these two are rosacea triggers. All I am trying to do is help rosacea sufferers know that rosacea triggers are not an exact science. I am trying to help my fellow rosacea sufferers to see that as you clearly demonstrated pretending to be a dermatologist that triggers are an individual thing.

The problem with anecdotal trigger reports is that when a rosacea sufferer says ‘I was drinking coffee and I got a rosacea flare up,’ there is no clinical study on this. What else might this rosacea sufferer who reports drinking coffee also have consumed that contributed to the flare up? Who knows? That is why the reports are anecdotal. The study I cited ruled out caffeine as a rosacea trigger and reported that heat causes flushing and it was clinically researched, not anecdotal. I agree we need more research clinical studies.

Let’s both pretend we are dermatologists for the day.

We both see a patient who has been diagnosed by his GP as having rosacea but referred to us for treatment guidance.

Your patient asks about triggers and you say:

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“All the rosacea triggers are purely anecdotal and are not set in stone and therefore might not be true or may be unreliable. The only one that has been scientifically tested and proven is that if you drink a hot cup of coffee at 60C then it’s the heat that will cause you to flush and not the caffeine”

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Now I see the same patient and triggers are discussed. I would say:

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“Many of the main rosacea triggers have been clearly identified over the years from our experience of dealing with rosacea patients and individual research, together with input from patients themselves through the various surveys and questionnaires that have been performed on the subject. It is well known and there is considerable evidence to support this, that two of the main most common rosacea triggers are exposure to strong sunlight and stress, followed by heat of any kind, extremes of weather and temperature changes, certain skin care products, hot spicy foods and alcohol of any kind”.

“You may find that all of these or just some of these are individual triggers for your own rosacea but it is important to try and identify which ones affect you. Avoidance where practical and possible is recommended but sometimes simple solutions can help e.g. wearing sunscreen or a hat in the sun, switching to red wine instead of white etc. All this is pretty well documented but of course you could find that as well as having the common triggers you may have your own unique ones, especially with certain foods which will require some experimenting on your behalf to identify and resolve”.

“Once we find a treatment to get your condition under control you may find that some of the initial triggers reduce in their severity of response or even disappear completely”.

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So Brady which comments sound false or unreliable? Which ones appear more accurate and helpful? By the way I thought caffeine could be a trigger for some sufferers and this being the case it might not necessarily be the temperature of their coffee which is the problem? More food for thought I suspect? Maybe another clinical study?

When a doctor mentions rosacea triggers based upon a list compiled by the NRS or other source without explaining that triggers are anecdotal it implies to a rosacea newbie that these triggers are set in stone and surely must be true. The truth of the matter is that trigger avoidance isn’t an exact science except for the one trigger that was indeed investigated with the Wilkin report that concluded:

“It is concluded that the active agent causing flushing in coffee at 60 degrees C is heat, not caffeine.”

If every trigger was investigated as coffee was the list might be reduced. The first three on the NRS list, liver, yogurt and sour cream are an example of how anecdotal this list is:

http://www.rosacea.org/patients/materials/triggers.php

Another survey, which is anecdotal said the the most common triggers were:

Sun exposure
Emotional stress
Hot weather
Wind
Heavy exercise
Alcohol consumption
Hot baths
Cold weather
Spicy foods

http://www.rosacea.org/patients/materials/triggersgraph.php

The above survey listed this as ‘the most common factors’ by percentages and ‘spicy foods’ was the eight most common. Maybe a clinical study will be done on spicy foods eventually.

I think I can detect a certain amount of sarcasm in your reply?

I actually said previously “The list of rosacea triggers has been around for many years (before NRS) and the main ones pretty much common knowledge so it’s not correct to say they are purely anecdotal.”

Sure there probably hasn’t been any clinical trials carried out on the common rosacea triggers but then why waste time and money on something which is obvious, unless of course they can provide clues to the cause of the condition? Many of the common triggers are now very well documented with sufficient evidence to prove this – let me quote from an excellent article by Larry Millikan MD, “While the origin of rosacea has yet to be determined the co-factors are well-known: The sun is the primary trigger, followed by stress, heat, alcohol, spicy foods, exercise, hot baths, cold weather, hot drinks and skin care products”.

You can call them “purely anecdotal” if you want but to me “anecdotal” means “unreliable or untrustworthy – based on rumour”. I will say that the main triggers mentioned above are fact and known and accepted by all those who are involved with rosacea.

By the way I did also say previously “We all know that some people can have their own unique rosacea triggers”.

Hope this helps you and any of your fellow rosaceans?

I know of one clinical study done on coffee as a rosacea trigger which concluded it was not coffee but instead heat was the trigger for flushing.

Oral thermal-induced flushing in erythematotelangiectatic rosacea.
Wilkin JK; J Invest Dermatol. 1981 Jan;76(1):15-8.

Since you are so sure about triggers not being anecdotal, please site the clinical studies on other rosacea triggers to show that they are not anecdotal. It would be helpful for me to know about these studies so I can understand them better.

The NRS says that the trigger list they come up with were ‘compiled from patient histories’ which are purely anecdotal since there was no control group, placebo controlled, double blind, peer-reviewed studies done on any of the triggers in the list.

It would be helpful for all rosaceans to know how you can show that a rosacea trigger proposed on any list of the NRS, ASG, or any other isn’t anecdotal that is established in a clinical study as a rosacea trigger. The reason why the triggers are anecdotal is that when one reports to the NRS that they had a rosacea flare they were eating liver or yogurt. So the NRS puts these down on the list of rosacea triggers. There are no clinical tests substantiating that liver or yogurt is a rosacea trigger. This goes for everything on the list with the exception of coffee. The NRS carefully says “Hot drinks, including hot cider, hot chocolate, coffee or tea” and doesn’t say that coffee is a trigger because of being aware of the above cited study done by JK Wilkin who is the chairman of the NRS Medical Advisory Board.

There has never been shown one rosacea trigger that will cause a rosacea flare up in every rosacea sufferer. As the NRS explains the trigger list is “trigger factors that may affect various individuals.” The NRS clearly says “Identifying these factors is an individual process, however, because what causes a flare-up for one person may have no effect on another.”

So please educate me and my fellow rosaceans how you can prove that “it’s not correct to say they are purely anecdotal.”

Most physicians refer to NRS trigger lists and figures for rosacea? They might be what happens in America but I don’t think that’s that the case in the UK and most probably much of Europe. When I was diagnosed with rosacea in 97 I joined the ASG because rosacea was under their wing and at the time I had never heard of the NRS and I expect my GP and the dermatologists I saw hadn’t either. Through my dermatologist and the information that the ASG made available, then I learnt much about the condition with much of this being sourced from the UK. The Face Forward Magazine they published 2 – 3 times a year contained some excellent information on rosacea, some of which I have never seen published elsewhere since.

The list of rosacea triggers has been around for many years (before NRS) and the main ones pretty much common knowledge so it’s not correct to say they are purely anecdotal. We all know that some people can have their own unique rosacea triggers and it’s down to the internet with the likes of the NRS and the tireless work of David Pascoe since in making these available.

Yes I agree with Auburn and they crammed a fair bit in the 7 minutes. If I am going to criticise then they should have mentioned that rhinophyma is still relatively rare and there was no mention of the drug Clonidine which can be very effective at controlling the rosacea flushing. As you know I am a fan of Aloe vera gel as a topical and I am always disappointed when it is ignored because it can be helpful.

We can all be different but fortunately alcohol isn’t a trigger for me and I don’t wear sunscreen mainly because they irritate my skin. I still think in some cases that the sun in moderation can be beneficial.

By the way I wonder if that 14 million Americans will ever change because it’s been that number for years? I wonder who worked that out?

Thanks

Peter

When she talked about topicals, she failed to warn people against using steroid creams to treat rosacea but, overall, she offered very good info.