19 October, 2013

Rosacea and (lack of) sweating

A forum user named Drums has been writing quite a bit about this topic, and it rings home with me. Not only did I notice that I no longer was able to sweat on my face once rosacea really hit, I found it hard to sweat at all. I always wondered if this was a mere coincidence or somehow related to my burning face. The verdict is still out there, but a lot of people seem to complaint about this same problem, so I will try to make a summary of it all. 

In my own case, I remember that the first thing I used to do, once arriving at my High School, was to rush to the toilets and get some toilet paper to remove sweat drops from my lips, nose and forehead. Every day.  Like most students I had to bike to school. The first 3 years 30 km a day (back and forth) and later, when we moved to the city, only 30 minutes. But nevertheless, I always had sweat pearling down on my face and I hated it, as it ruined my make up. Now, I wished I still sweated like that, as I seem to have lost all capacity of facial sweating. Even after hour long bike rides or walks now, I might have a little bit of sweat on my back or under the arm pits but not one drop on my face (and very little overall). I do, however, have the ever present and easily worsened red burning face.

So could these two be related somehow? I honestly doubt its a straight forward cause and effect thing for bad rosacea sufferers, but I suspect the thinned epidermis and inflammation of the facial skin somehow might alter its normal way of functioning, and limits the sweating capability perhaps. On the other hand, there are numerous sports people and runners with perfectly normal (yet usually pale) skin, who wrote about this same problem. Most of them only seem to get really hot and flushed when they run or otherwise exercise intensely, not in every day normal life (like us 'rosaceans' do), but I found countless forum posts of such sportspeople complaining about a lack of sweat and an overload of heat and flushing. Perhaps the lack of sweating can cause flushing and burning in everybody therefore, in theory? Even those with otherwise normal skin? From reading through their posts, I did get the impression that most of these people have fair skin. Which could indicate they blush more easily than people with darker skin tone, and will also more easily show and notice increased blood flow to the face.

Colin Dahl, from the Australian Science institute, answered a forum question about sweating of the face in case of rosacea here. He wrote on Jan 27, 2010:

"Dear Sophie, It sounds like you are one of those people who can actually 
form sweat on your flush zones. In this case it is easier to tolerate hot 
temperatures, because although you get hot, you begin to sweat and cool your 
flush zone down. For other people the sweat evaporates almost instantly 
in flush zones, because their skin infrastructure is at the point where the 
heat generated is too great to be reduced by sweat. I was once one of these 
people who had trouble forming sweat and tolerating heat, and thus tried to 
avoid it. Unaware of the negative consequences. But as your skin infrastructure 
reduces, so does the heat generated. This enables the sweat to form and you should 
slowly notice more sweat forming as you reverse Rosacea. 
Best regards, Colin Dahl

It sounds like it is more common actually for rosacea flushers to no longer sweat on their cheeks (and often the rest of their faces either). On the other hand, the National Rosacea Society came with this information"A recent National Rosacea Society-funded study found that individuals with rosacea often produce greater nerve, blood flow and sweating responses than those without the disorder when exposed to increased heat or stress. In addition, an earlier NRS-funded study showed that the surface temperature of facial skin in rosacea patients tends to be warmer than normal skin."

Here are a few quotes and links (and I underline in red when people mention stuff like being red, having burning face and no sweating) 

Mjevic posted: "I know some people would appreciate this problem, but I find it irritating and am wondering if it could be dangerous. I never, ever sweat from my face, and only "glisten" everywhere else. It is definitely NOT a hydration problem, I drink plenty of water throughout the day and have to drink tons while working out. I live in the south with high temps and high humidity, so you wouldn't think this would be possible. Although my face doesn't sweat when I run outdoors, it does get extremely hot and turn red. A few years ago while training for a 15K and running in 85 degree heat, it got so red it felt like it was on fire. I got a wet cloth and draped over my face and the heat literally dried it up. I relayed what happened to my doctor and he just said that some people don't sweat. I haven't been very active over the past year but recently began working out again. I love my workouts (cardio and weight training) but afterwards my knees are burning hot. My face still isn't sweating but isn't burning either. Probably because I'm indoors at a gym. Has anyone had this problem, or know what causes it? I'm wondering what it's doing to the joints in my knees. I really need to drop some weight and really dont want to quit my workouts.

An_198444 responded: I've met someone else who also does not sweat. I believe her condition is probably a lot worse then yours, but she cannot bear to be anywhere where it can get too warm and constantly needs a fan on her. She even elected to move to a colder area of the country to accommodate her condition. I hope that helps. :)

MrLivingston111 does sweat and might have underlying rosacea from what he wrote: "This happens to me as well. My face will sweat until I wipe it off. I know that it is best not to wipe and I try not to but if I do, then the redness is even worse. Even if I gently blot my face, it ends up as dry as possible! Not even the slightest sheen or trace or oil. Once this happens then my face begins to turn from red to a shade that is closer to purple! It usually takes at least 2 hours to return to anything close to normal. I used to do cardio before work but my face would still so red that a few times people asked if I was sick HOURS later. I've read elsewhere that this can be a sign of rosacea. My mother has never been diagnosed with this but the same things happen to her. Both of us also have a red face from taking a hot shower. If you do sweat at all try to just let it run down your face. Maybe that will help. I have also put an ice pack on my cheeks but that doesn't stop the people who stare at you with concern in the gym!"

Plummm responded: "I'm glad I researched this problem. I have the same issue. I don't sweat at all.. but my face turns burning red. It's pretty embarrassing at times when I have to stand under the sun for any college purpose .. I have had friends come up to me and ask, "Are you ok??" My hands and feet turn hot as well.. I had asked my doc about this issue and its funny how people don't take this seriously. I hate it when they say its because of lack of hydration.. HYDRATION?? I drink gallons of water. I go to the gym 5 times a week and with the people who join me.. they will b perspiring like crazy and me?? I look as though I don't do nothing (besides the ugly red face)..hmm.. to cut things short .. I'm glad i read this post. "

i8plums responded: "thank you so much for posting this. I have the same issue and don't know what is going on. I just finished a relay race with a group of friends. I struggled through my leg because I felt like I was overheating. None of my other friends had any issues. Also, after 4 miles of running in the sun I was hardly sweating at the end and everyone else was dripping with sweat after their leg. Like you, my face always turns bright red. I easily overheat. I would call it "sun poisoning" because I can't be out in the heat or I get overheated, headaches, sometimes nausea. People always tell me to drink more water because I'm most likely dehydrated. When I'm in the sun I make a point of drinking water all the time, even when I'm not thirsty. so that is not the issue. I really appreciated Rich Weil's response. Dilation of blood vessels . . . interesting . . and something I would have never of thought of. Is there a cure for this or is it something we have to live with for our lifetime? I oftentimes feel the veins in my neck have a lot of pressure while working out or outside in the sun - does that have any relation to the dilation of my blood vessels?"

Rich Weil, MEd, CDE responded: "Muscles produce heat during exercise and the heat must be released. You either sweat or dilate blood vessels, or both, to do so. Some people simply sweat more than others. If you don't sweat much then the dilation of blood vessels, which carry the heat from the muscles to the skin surface, allows for the release of the fat. Typically the face turns red when vessel dilation is the main source of heat release. A cold wet towel will help with transfer of heat and may decrease the redness and the hot feeling. It's not doing anything to your joints."

And: "Dilation of blood vessels is a normal, healthy response to heat and other conditions. There's no need for a cure because it is a healthy condition. In fact, it would be just the opposite if the vessels didn't dilate; that would be an exceptionally serious problem. I don't know what's going on with the veins in your neck while outside in the sun. I suppose it could be prominent vessels, but I'm just not sure."

And: "There's nothing you can do to minimize the red face except keep a cold wet towel handy and a fan if possible. It will still happen, but maybe a little less. It's biological and you can't change the biological control of blood vessels dilating to help cool you off. Likewise, there's not much you can do to increase sweating if your body type is the type that cools itself off more with dilation of the vessels than with sweat. I don't know of any treatment that will increase sweat rate. As for headaches, if it's happening from dehydration then of course drinking more is important. Your urine should always be clear, and you should urinate at least 2 liters a day. If it's from overheating, then my idea about a cold wet towel and a fan nearby is a good suggestion if it's doable where you work out. I know my response isn't adding much that hasn't already been said, but the fact is, there's not much you can do about sweat rate and dilation of vessels in the face.

myhealthprobs responded: Hi I have also going through same problem of not able to sweat on my face. I use to sweat a lot on my face during my workouts in GYM but in between I was admitted to hospital due to fever and when I came back home and after that during workouts  I stopped sweating; when I work out really hard my face turns red but doesn't sweat, also my face became big and looks like I have put on lot of flab on my face.. Can anyone has a same issue please write."

vikingeyes23 responded: "OH MY GOD!!" I felt like I was the only one who had this condition. Which I know I wasn't. I cried when I read some of these posts. I am limited on the jobs I can apply for, because I can not work outside(when its real hot and humid) or in a building that has no air conditioning!!! Some of my family members do not understand this, and its completely frustrating!!! If I have to be either outside or in a building that has no a/c, I carry a spray bottle at all times. I call it my sweat in a bottle, it sounds gross, but its true, I can't sweat in my face so I spray the droplets of water to take the place of what I can't do. or I have one of those battery operated fans you fill with water and spray to cool my self this way too, And my face to get real red if I don't cool down in time."

SuttonPA responded: "I too suffer from this problem, I drink water ALL the time. My husband and I go to the Gym almost everyday, he leaves dripping and I leave RED in the face. I live in the South (it was 105 today) and going outside in this heat really leaves me exhausted. Red in the face and if I'm out too long I usually get a headache and nausea. And you are ALL correct people look at you like your a crazy...and should be Happy you don't sweat and my comment is NO WAY!!!"

Mamalazo replied: "Hi!i just recently noticed that I don't sweat anymore. I was diagnosed with pityriasis Rosacea for over a month now. My skin turned red and now some part of my skin is scaly. I felt very hot and my whole body would turn red especially my face. I just noticed yesterday at work we are so busy doing chores and all my coworker are sweating like donkey and me not even a drop of sweat. I'm starting to worry now..why I don't sweat anymore.the feeling is so irritating..I feel so hot and will turn red and very dry..what is this thing happening to me? Please help!!!"

Thistledown1973 responded: I actually knew a woman who was born without sweat glands and she had to spend all of her time during the summer in air conditioning, in front of a fan with moist cloths to dampen her skin, or submerged in the swimming pool. She was a long time friend of the family and her condition was extremely rare. However, not only do we sweat in different amounts, the the number of sweat glands each person has per square inch of skin varies radically. Also, different activities illicit different responses. For instance I can speed-walk and not sweat at all, yet I pour sweat turning a screwdriver to put together a cabinet. Go figure.

Antonov responded: "I was in good health earlier until the winter of 2008 when I had an attack of influenza and also had developed bronchitis infection. I recovered well since then. I used to sweat normally when I played or exercised before illness but since the attack my body temperature has gone down a little, I don't sweat like earlier. I don't sweat at all now. As others have described, my face too turns red. I drink up to 4 liters of water everyday summer or winter. What is your opinion and how could I recover and be normal?"

Rich Weil MEd replied: "If your sweating has stopped completely like you say then you should see an endocrinologist. This is not supposed to happen. Your face turning red is the way the body cools off, and is normal, but the fact that your sweating has stopped is a concern. Go ahead and see an endocrinologist. Your primary care doctor can refer you if your insurance requires a referral. Good luck. Rich"

Why you sweat more than your exercise buddy

"You're trucking along on the treadmill and as you reach for a towel to wipe off the perspiration on your forehead, you can't help but notice the guy to the right who's sweating so much. It looks like he jumped in a river. Why is it that some people sweat like crazy and some are barely glistening? 

First off, sweating is the body's way of cooling itself off and maintaining a healthy temperature. You're born with between two and four million sweat glands. Women have more sweat glands than men, but men's glands are more active. How much you sweat depends on your gender, the number of sweat glands you have (more glands equal more sweat), how hot it is, how intensely you're exercising, or how anxious you feel. The amount a person sweats also depends on how many sweat glands are activated and how much sweat is excreted from each gland. It turns out that fit men sweat significantly more than fit women. The same amount of sweat glands might be activated, but women produce less sweat from each gland. Fit people sweat more efficiently by sweating sooner during workouts, when their body temperature is lower. However, a sedentary person working at the same intensity will heat up a lot faster and possibly sweat more. Also, overweight people sweat more profusely than normal-weight individuals because fat acts as an insulator that raises core temperature."

If you don't sweat
"The medical term for an inability to sweat is anhidrosis or hypohydrosis. This condition can be very troublesome. If you don't sweat, your body can't cool itself and is prone to overheat, sometimes dangerously so. Some people are affected with this disorder in only one part of the body or in scattered patches, but it can also affect the entire body. If that's the case, you're at risk of overheating during hot weather, vigorous exercise or when performing demanding physical activity, leading to heat cramps, heat exhaustion or, most dangerous, heat stroke."

Could there be an underlying illness at work, which causes an inability to sweat?

There could be yes. The disease that causes a person to be unable to sweat normally is called 'anhidrosis'. It is also known as Adiaphoresis, Ischidrosis, and Hypohidrosis. It is caused by a lack of activity in a region of the brain called the sympathetic nervous system. Anhidrosis can be due to genetic factors, and it can also develop as a result of disorders that damage the body's autonomic nervous system. That system controls involuntary actions such as digestion, heartbeat, blood pressure, and body temperature. Among the medical disorders that can cause this damage are diabetes, alcoholism, Parkinson's disease, amyloidosis, Sjogren's syndrome, and small cell lung cancer. In addition, skin damage (especially bad burns) can reduce the ability to sweat. So, could our inflamed rosacea skin, with a thinned epidermis and affected nerve endings perhaps also cause this to happen? Apparently yes. Hypohidrosis is explained as the inability to sweat typically because the sweat glands are no longer functioning properly. It can affect your entire body, a single area, or scattered areas (such as the face), and possible underlying causes for it are health conditions that damage your autonomic nerves, such as diabetes. But any condition that causes nerve damage can disrupt the functioning of your sweat glands. This includes: alcoholism, Parkinson’s disease, multiple system atrophy, Sjögren syndrome, small cell lung cancer, Horner syndrome, which is a form of nerve damage that occurs in your face and eyes. But also skin damage and skin disorders. Skin damage from severe burns can permanently damage your sweat glands. Other possible sources of damage include radiation, trauma, infection and inflammation. Skin disorders that inflame the skin can also affect your sweat glands. These include psoriasis, exfoliative dermatitis, heat rash and other skin inflammations.

Taking certain medications, particularly those known as anticholinergics, can result in reduced sweating. These medications have side effects that include a sore throat, dry mouth, and reduction in perspiration. "No specific treatment exists for anhidrosis. Be careful to prevent your body from overheating: wear loose clothing when it's warm, don't overdress in cold weather, stay indoors on hot days, and be aware of your activity level." This article mentions that "Many diseases that irritate or inflame the skin also affect the sweat glands" "Anhidrosis can occur with a number of skin disorders, including psoriasis; exfoliative dermatitis, which is marked by severe skin scaling; heat rash; scleroderma, which causes hard, tight skin; and ichthyosis — extremely dry, scaly skin."

Here are a few more statements from sports people about their inability to sweat and their red faces, and then I will switch to rosacea people writing about this phenomenon. 

Memartha wrote: "I've had this problem for a while, but I'm sick of it and it's cramping my style. When I exercise and get hot, my face turns BEET red and it does not sweat. My neck is sweating, my back, chest, etc. but not my face. It happens mostly in warm weather (60 degrees or above). I couldn't finish my usual run today because I was just too uncomfortably hot. I read somewhere that it's the blood or blood vessels coming to the surface of the skin, trying to cool me off, but it isn't working! I will not be able to run outdoors again until it cools off if I can't figure this out. Does anyone know why my face won't sweat??" Several posters then suggested she might have rosacea.  
Sneezles wrote: "My whole body turns bright read when I exercise or if I'm out in the heat for too long. I am also fair-haired and freckled and have suffered this my entire life and I don't have rosacea. DS#3 came in just before lunch and had been working on the fence line for 3 hours and he was red from head to toe. I always just thought it was a normal thing for fair-haired and freckled!"

ChocolatePam replied: "I have rosacea which is triggered by exercise (also hot foods/drinks, the sun, alcohol - for me personally). When I exercise my face will not sweat, while the rest of my body will. It doesn't matter how hot it is outside (and I live in the South), my face won't sweat - it just turns bright red. I always assumed it was related to rosacea, but you may want to ask your doctor. For this reason, I try to exercise after work when I'm not going out later. It can be annoying, especially if you constantly get remarks about how red your face is.I also use a cream in the mornings (I can't remember the name), and it seems to help."

In this article, Eskimopie writes: "My face gets BRIGHT red
when working out, help! So much so that I can see other gym goers sneaking peaks...of concern or disdain, I don't know. Though I try to exercise pretty hard and am starting a running program, I'm not gasping for air or about to keel over. But my face makes it look like I am. I'm fair skinned and a redhead who blushes easily. Is this ok? Or am I pushing too hard without realizing it? Any tips on minimizing this (or the embarrassment?"

Sammies1girly replied: "Ha! After I run, especially, I am as red as a beet. Makes me a little self conscious and one old man asked me if I needed oxygen or something...you're there to get a good workout, so just ignore everyone's stares ; ) "

Cassieleo wrote: "I am the SAME way! I turn beet red and it doesnt go away for a while after working out! I also am not a huge sweater, no matter how hard im working. So here I am hardly sweating, with a beet red face LOL! So your not alone! LOL!"

Margonadeau: "I'm the same way. I was on my tredmill at home and my Aunt stoped by and i was so red she thought i was having a stroke. When I go to the gymI go about my business and let them look."

In this article one writer also complaint about not being able to sweat during exercise and turning red.

Carriej82 wrote: "no matter how hard I workout, no matter how tired I am, how high my heart rate, or what activity I am doing I don't sweat!?!? my face turns super red but I never actually sweat. is that normal? is there something wrong with me? does anyone else have this problem? I mostly workout in the morning, I drink a bottle of water, sometimes 2 before I workout... during the workout I will drink another bottle of water. I will try drinking more water before working out. My face isn't wet at all just red. I suppose my armpits might get a tiny bit "Clammy" but that is it... no where else. And I know I am working out at a good level because I have the link armband from the biggest loser and it has me in a vigorous activity level."

Nightingale wrote: "I have googled my 'problem' and found some explanations, but would like to know if anyone else has the same problem and how they deal with it. I do a lot of walking and I also do ciruit type training classes. I would class myself as being pretty fit. While the rest of my body sweats during exercise, my face does not. It turns a dark red/ puce colour. I generally feel okay, just extremely hot in the head, and the colour takes hours to die down. Is there anything I can use while I exercise to cool my face down, and is there something I can do to get this issue resolved, do you think? Thanks in advance for any replies :)"

Outcast IRE replied: "I get like that sometimes , will feel perfectly fine while exercising and the face would be real dark red.... the only thing that helps me is a long cold shower afterwards not exactly ideal in winter, seems to help it die down quicker."

Darlene M wrote here: "I don't sweat but get severely overheated. I am 57 years old, female and in pretty good health. Really only issues I have are seborrheic dermatitis and some IBS sx. However, I have never really sweated...if it is really hot and humid, I sweat slightly on the back of my scalp. I use an antiperspirant, but only to prevent itching in my armpits. Even during menopause, I did not get night sweats or typical hot flashes with sweating. Instead, I just got horribly overheated without the relief and cooling down brought about by sweating. This problem primarily affects me when I exercise or do anything physically strenuous. If the temperature is not below 70 degrees, I overheat terribly. I myself cannot usually tell if I am overheating because the normal things one goes by or missing...usually profuse sweating. By the time I am overheating, my face and chest are bright red, I feel weak and sometimes just pass out. I have to be careful in the summer time to only walk at night or when it is cooler. I drink lots of water but have to simulate sweating by putting cold water all over my body surfaces. It has been very limiting when I have lived in very hot climates, something I want to do more of. I am wondering both if there is anything I can do to help me sweat more and also want to be sure there is not something more that I should be concerned about...such as more serious medical conditions that the hypohidrosis is part of. My 78 year old mother also does not sweat and has never even used an antiperspirant. She has some serious medical conditions (CADASIL...cerebral auto somal dominant arteriopathy and sub-cortical infarcts with leukoencephalopathy) that half my family members also have, but I do not. Any input would be greatly appreciated!"

Elena wrote here: "I love sports that involve running and physical movement. Ever since I was little I've always wondered though why I'm almost the only one beet red and not sweating. Everybody around me in a sport is complaining about sweat and I'm not sweating at all. I used to find it as a blessing not getting sweaty while running or doing a sport, but now it seems like everything is increasingly getting harder for me. I can run and run and run and I don't sweat and my muscles don't get tired, the only reason I have to call quits is because I'm so hot that I get dizzy and things start to get blurry. I've been researching this and the only thing that comes up is anhidrosis. I don't think that's what I have because I do sweat a bit in high temperatures but that's about it. My main questions our why don't I sweat while sprinting for 1 hour straight and why do I get so red?"

Evangelina replied: "You are most likely dehydrated. Doing that much physical activity requires that you drink more water, because you lose it very quickly. It is recommended to drink 64-72 oz of water a day (or about 8 glasses)."

Sjögren's syndrome patients also write about their inability to sweat and red faces

Woolygimp wrote on the Sjogren forum: "[..]Anyway, now that I'm physically active again. I've realized that I don't sweat.  I get hot flashes almost every time I get hot/nervous and they make me incredibly uncomfortable and are sometimes almost painful. I even remember almost completely passing out from heat exhaustion a few years ago after a short run in paintball gear.   This really sucks, and it's also tied into to my dry skin.  My face produces no oil. at all.  I've taken thyroid medication previous,  but it had a weird effect and I actually felt like I was burning up.  Again, no sweating.  And for some reason I really didn't even realize I wasn't sweating; I just figured I couldn't tolerate heat or was having heat flashes. Today, I spent a lot of time out in ~95 degrees, in the sun, moving furniture and heavy equipment and no... no sweat.  I had to walk inside and wet a towel and throw it over my shoulders just to keep going, definitely uncomfortable. Blah.............         

Scarlett replied: "My Sjogren's symptoms started over 20 years ago. For 10 years my sweat glands and oil glands did not work at all. I was on Salagen for about 5 years.  During that time my sweat glands and oil glands started overproducing and even though I stopped taking Salagen 6 years ago I still have the problems.  I don't know which is worse - the glands not working or the glands overproducing. When my sweat glands didn't work I could not keep my temperature down.  It was hard for me to be outside on hot days and I would also get hot flashes when nervous (couldn't understand why).  Taking warm or hot showers would cause my temperature to go through the roof.  I started taking cold showers and it helped tremendously.  I would definitely recommend it."

Woolygimp replied: "The dry skin on my face is my worst "symptom".  When you weren't sweating or producing oil did you have severely dry skin?  Mine on my face has to be moisturized several times a day and it's not nearly as elastic as it once was. And slabbing on a ton of moisturizers doesn't exactly help my complexion either.  So it's lose/lose. It's just downright uncomfortable sometimes.  When it's super dry, I literally feel the skin being stretched when I smile and stuff.  And this is coming from someone who has has always had really good skin, there's just nothing I can do it to keep it from dying out. When I was on evoxac I noticed moisture coming through the skin again, maybe it was oil but I think that's why it helped so much.  At times while taking the medication, my skin felt like it use to, or has at certain times when I'm not experiencing symptoms temporarily.   I would do anything to make THAT dryness go away permanently as it's definitely the most bothersome..."

Snooki (who says in her banner that she has/uses Sjogren's, Lupus, Hashimoto's, fatigue, MGUS, peripheral neuropathy Restasis, Plaquenil, CellCept, Meloxicam and Synthroid) replied: "I hear you! I don't sweat either. Last year I went to the gym to workout and my face would get really red right away. I'm sure people thought I had high bp (instead of my low bp).  At the time I didn't mind it because I was cold all the time otherwise; it was a treat to be warm.  But now it seems to have progressed to my not wanting to exercise to that point plus I just started reacting to sunlight.  This is a real problem, so I'm working up to trying to exercise through it.  Once you lose muscle tone, it's hard to get it back.  I can still walk a lot, but that's not enough exercise for me. It seems like if Evoxac can evoke sweating, the sweat glands must still work.   Unfortunately, both salagen and Evoxac give me severe stomach cramps, but maybe they would go away if I kept taking them :(   Anyway, I hear your pain."

Deeindiana replied: "The inability to sweat was actually the first symptom of SjS for me -- I just didn't know it. I haven't been able to sweat for years. On a hot day when my husband looked like a wet rag but felt cool, my armpits were dry as a bone, my face was beet red and I felt like I was boiling inside. Of course, I didn't know anything about SjS then. I just thought I was a wimp. So did everyone else. I still have the same problem, so when I'm going to be in a hot environment I take a water bottle and discretely wet myself down to stay cool. I took Salagen for a short time and did notice a little improvement with saliva and sweat. But when the med ran out and it was time for another dose, the sudden/extreme dryness was actually painful. I've decided to try to manage without the Salagen for now. Deb"

Psoriasis patients also mention an inability to sweat sometimes

Ericcc123 wrote: "I have P that covers 15 - 20% of my body. Anyways I'm having this problem where I don't sweat. I drink plenty of water and eat pretty healthy and I don't know what the problem could be. Now before I go see a doctor about it anyone have any idea what this could be? I did a little research and I'm thinking I may have Miliaria too; the sensation I get is stinging needles sensation and itchy.

Some responses were: "I have a problem of not sweating when I work out but I don't lose my balance or vision or anything. My face turns bright red which is great when I work out on a lunch hour! You should see a doctor with the other things you mentioned. Keep us posted." "I don't think it's your P that's making you not sweat. I sweat all day everyday. I get that stingy, bees all over my body sensation most of the time when I get angry, emotional, or when I work out. And I work out daily (military will do that for you). So I try to go through life like a robot and not get mad or emotional. Sucks but what else can you do, when every time you get angry or embarrassed you start to freak out cause you itch from head to toe. I hate it. Worst feeling ever that's for sure."

Now over to the rosacea patients: how many report lack of sweating?

dubmustang wrote here: "Do any of you have the sweating more than normal problem? Every time i get anxious and get a full on flush going, i start sweating on my face and neck, nowhere else. Clearly, this is very disturbing to me and I don't know how to stop it. I'm about to have my 3rd IPL treatment and have been sorta disappointed with the success so far but am keeping at it. Ill soon have my 3rd. This anxiety sweating is killing me though. Anyone ever had this and what did you do?"

Dryfairskin replied: "I don't sweat at all when flushing, in fact the type of flush can determine what condition you suffer from. A flush with sweat could be a symptom of something other than rosacea. cant remember the various conditions it could be but google it. Remember rosacea just really means red or something along those lines in latin. so what causes it may vary in different people ie some people suffer from demodex mites, ibs and others just have a genetic skin type ie irish skin which is prone to redness. also other conditions can resemble rosacea ie, lupus seb derm carninoid etc."

Jennfra writes here on The Rosacea Forum: "Face doesn't sweat anymore. I just got of the elliptical and then walked and I can sweat other places but not my face. My face use to be oily too and that isn't even there. I use to be someone that would sweat a lot, especially around my hairline and forehead and now, nothing, or maybe I am to afraid to push myself in case I flush. Does anyone else notice a decrease in sweat on their face? I don't have this problem on any other part of my body. Just curious..Thanks..Jen"

RedKen replied: "I've noticed that I don't sweat as much as I used to. Before rosacea just walking along the street on a hot day, or going into a building with the heating turned up would have the sweat running down my face. But now I only sweat via exertion. Entering a hot room will now cause me to flush, but no sweating. Weird"

Melissa W replied: "Hi guys, My face does sweat when I work out or am hot (still and I hope always) but unfortunately, lots of rosaceans have a similar issue."

Drums replies: "Dear Jenn, My reason why you no longer sweat from your face is because we are back to the secretions thingy as in my reply to redhotz. I realize that it may seem a ludicrious statement to say what i said but I am speaking the of the reality of the way it is. Rosaceans have to realize that this is what is actually happening. If you take the case of sweating for example the precursor of sweat cannot be formed at the moment of pre- sweat because the component parts of the would be sweat are not in a utilizable form because the original components were not created during digestion. The result of these malformed secretions are therefore incapable of forming the sweat. Not only are they incapable but furthermore these malformed secretions are irritating and toxic causing the rosacea like symptoms and furthermore cannot leave the body as an excretion. People need to realize that what they eat eventually goes to into making numerous secretions. A healthy body is totally dependent on one initial thing and that is true and proper digestion. One can believe they are eating healthy but if the digestive process cannot do its thing then! Add it up for yourselves; eyes=blepharitis, skin=sebum, nerves=neuro rosacea, but really any part of the body even parts that cannot be noticed outwardly will also be affected so to me rosacea is a serious condition. If you look at tumors they are found mainly in sites that would produce an excretion; breasts=milk, womb=menstruation, I just ask myself how much convincing the rosacea community needs. Sorry Jenn my rant bit was not aimed at you I just somehow get carried away with it all sometimes."

Jennfran: "Drums, I think you may be right after thinking about this. I have noticed no secretions on my face and only until rosacea started. I use to sweat so much on my face and cannot believe how I do not at all now, big difference. G-d this means I have to eat good...I love food..lol :) How much is that cd on ebay :P ??? Thanks alot..Jenn".

Drums replied: "Dear Jenn, Well what do I eat? Firstly let me say I aim for totally animal fat free diet as especially not eating beef/butter/cheese and lamb as it's a guarantee for rosacea. (Scarlet Nat: this has been debated and disputed for a very long time on the forum; is Drums diet a good one of not and does it improve rosacea yes or no. the verdict is still out there). But even pork fats or any fats will calculate into rosacea. I do however use small quantities of olive oil and occasionally duck fat derived from a home roasted duck. As I seem to be able to tolerate these without them calculating into Rosacea. Again I don’t use these on consecutive days and it probably works out at either or once a week.Over the years I have posted in the original cure thread and recently to Grace in the“quick question about Drummond”(SNS) thread. I have tried to speed up my transit time and been successful. At the moment I get up then have glass of water then porridge made with skimmed milk n sprinkle brown sugar after which I sit and drink half a teaspoon of bi carbonate soda in cup of warm hot water. Then 6am off to work drink water till lunch then lunch now is pre-soaked muesli that’s with skimmed milk. I may have it warm by heating in microwave I may add pinch spice like cinnamon or just eat it cold. Muesli needs to be pre-soaked cause otherwise it dries up the gut and compacts.So in effect two thirds of my food is totally fat free although oats does contain tiny amounts of fats. Everyday I eat the same for breke and lunch my evening meal though varies on this I will keep you posted but I believe I eat well and can be happy with it. Its when one gets invited out for foodies and are seduced socially into eating the foods on offer is where one can become a victim to rosacea. One important phenomenon to avoid is “washing” this is where say you go and eat a piece of cake then drink some warm coffee or tea. The result of what happens is the hot drink separates the fats from the cake which then floats on top in your stomach.Creating this situation, which happens also after eating fatty foods, not  only causes acid indigestion but total improper digestion of the fats. which calculates into rosacea. Its getting late! but American rosaceans are disadvantaged because they drink coffee as a national drink and every cup of coffee is equal in acidity to a glass of red wine."
Angelina wrote about her inability to sweat, rosacea and anhidrosis: "I realized fairly recently, that I really don't sweat like other people do. My face has never even got moist in dry hot rooms - I would just burn and millions of bumps would appear. I always thought this was because I have fair, "rosaceal" skin, but someone told me that this is actually a condition... anhidrosis. Has anyone heard of this? or do you know if there is a treatment that can make one sweat more.... (!)?"

Meg replied: "I have actually been diagnosed with anhidrosis at The Mayo Clinic in Rochester, MN. It is an autonomic nervous system dysfunction. Thus far, I have found no treatment. However, I think there could be treatments depending on the cause and extent of your anhidrosis. The top dr in the country for this is Dr. Robert Fealey at Mayo. He runs a sweat lab where they can test you. Hope this helps".

And: "My anhidrosis is total body, according to the sweat tests I've had done. My face has severe painful flushing, which is also an autonomic nervous system dysfunction. So, I think they are related. I do not have traditional rosacea, more the severe flushing, which as I said is extremely painful. I believe the flushing and anhidrosis started around the same time and are related. [..] Unfortunately, nothing has helped, traditional or untraditional. I have tried RLT, innumerable photoderm, other lasers, topicals, prescription meds and many alternative txs, too. I think my case is very rare and is sort of a cross between Erythromelalgia (EM) and severe vascular rosacea."

Tioh2001 replied: ""Not sweating normally is just another symptom of demodex site. The acarid removing soap and the zhongzhou ointment the site sells are the products I've used with great success. Sometimes, I am absolutely astonished at how beautiful my skin is now compared with how disfigured and painful it used to be. I am not cured of demodex/rosacea, but have gotten to the point I now rarely have any blemishes (thanks to the zz ointment) and my flushing is greatly reduced (thanks to both the zz ointment and using a red/infrared light every day). Also, check out this thread.. It has amazing before and after photos from using the zz ointment. Good luck to you."
mites. The mites so block the follicles in the skin that not only does sebum not flow normally, but sweat does not flow normally either. I would just burn and millions of bumps would appear....You are describing classic symptoms of demodex. I can certainly relate to your description. I have always known that my extreme flushing and burning was made even more extreme because of my inability to sweat on my face. Once I began treating myself for demodex I have very slowly regained some ability to sweat on the face (and I'm sure this has been one of the factors in reducing my flushing). For instance, everyday now after my 10 minute walk from the train station to my office, I have sweat on my upper lip! I'm still getting used to this, after decades of never sweating on my face. Demodex can be a difficult parasite to treat. The best place to start is reading the

(Note from ScarletNat, these creams can be very tough on the skin, so please be careful, and demodex seems so far mostly connected to the p&p, subtype 2 sort of rosacea, less so with flushing. Science might catch up on this later on, but what I understood from all my dermatologists so far, is that they don't suspect demodex to play any or any major role in subtype 1 rosacea, with only erythema, flushing and burning. Of course, they might always be wrong..).

Update 2: Ivermectin as a demodex treatment does by now seem to improve rosacea redness, read more about this here.

Chelsey replied: "I've had rosacea for close to ten years and very shortly after it's onslaught, I noticed that my face wasn't sweating anymore. I'm pretty sure it used to sweat before developing rosacea. After many IPL and various other treatments, I've finally gotten my rosacea to the point where I can do some light to moderate exercise on a treadmill and while I sweat along my hairline and my neck and throat, my face remains perfectly dry. I never had the "p&p" type of rosacea before so I've never considered treatment for demodex. Thanks, Heather, I'm going to read those links and learn more about it. Meg, is your anhidrosis related to rosacea or a separate condition? Does it just affect your face? Glad you asked that question Angelina, I've been wondering about this for quite some time."

Strive replied: "I've wondered about the relationship between not sweating on the face, and rosacea, also. I sweat on my forehead, but nowhere else on my face. I only have rosacea symptoms from below my eyes to my chin."

Phlike29 responded: "To be honest its quite hard to know, for the last few years I go out of my way to avoid getting hot enough to actually sweat. If I remember correctly then I sweat of my forhead but nowhere esle on my face."

GJ replied: "An inability to sweat from the head is (more often than not) one of the consequences of sympathectomy(ETS). A number of patients have developed rosacea-like problems post surgery. The layman can only conclude that the facial vessels must dilate more often and for longer ( a red face) to compensate for the absence of sweating as a mechanism of heat loss. After a stretch, the unaccustomed exertions of the vessels causing them to become damaged (a permanent red face)...."

Simply Red wrote: "When exercising on my treadmill, I have noticed that my forehead and temples will sweat, but my cheeks and nose (the problem areas) never do. IMO there is a definite relationship to the inability to sweat the heat out and my rosacea problems."

Drummond (aka Drums) responded: "Yes there is lots you can do to make yourself sweat more but the first thing is to ensure you are properly hydrated because the chances are at the moment you are unconsciously dehydrated. being dehydrated is causing your body to have a low acid p.h.and when this situation is in place the electrical impulse to sweat becomes unfunctionable so sweating cannot be initiated naturally even on the hottest day. The acidic condition of your body becomes self perpetuating once you stop sweating. Another factor that prevents sweating is when your first stomach is full of food. It is only when food reaches the second stomach and is fully digested can there be any possibility of sweating being initiated.But as your body is too acidic your rate of digestion is slowed down. if you ever sweated before then recall after wakening in the morning how you would soon begin to sweat. ONCE people get rosacea they suddenly become fearful of sweating this thereafter is the death nell for rosaceans. Every night early on I eat some fat free sugarless chilli biscuits then in the early waking hour i get under the blanket as the chilli helps to initiate sweating, i stay under the blanket until i sweat like a pig approx thirty minutes. then i sit on the edge of the bed until the sweat dries on my face then i have a shower but i must not allow the sweat on my face to become removed.This ensures i keep my acid mantle on my face so to prevent any attack from mites. Three TIMES A WEEK I have vegi curry to maintain my opening and functioning of my seb glands. if you learn to listen to your body when you were ok before every time you ate food you would perspire slightly but now you don't, so you don't realize until its gone. SWEATING IS THE FINAL PART OF DIGESTION. But if you have these skin problems then your digestion cannot be working so good and so you probably don't feel like you once did. TRY THE GUY FAWKS SWEATING SYSTEM!.
yes before i did not sweat even in my car on the hottest day with the heater on at full for thirty minutes, but now since got mysef cured i can sweat but i can only sweat naturally through moderate exercise or as above through eating the curry etc. ONCE IN HOT SUMMER, (this was when i had really bad rosacea) i was working in the loft space and a small red spotty area on my forehead did actually sweat, the amazing thing was that the area that sweated healed like normal skin this phenomenon got me thinking. had i burst open my blocked seb glands so after that i started to find ways to sweat. The thing is its paramount our bodies must biologically function exactly like the planet we used to live on.  drummond"

Froggirl wrote: "One thing i do know though is that dry skin can cause problems sweating, in the above thread i posted a link to an interview with an Australian derm who say: "In dry skin the barrier that is formed by the outer part of your epidermis doesn't function as well. That barrier also becomes disrupted in some way which we don't quite understand, and so you can't sweat as well. You can't keep yourself as cool. And often that sweat gets trapped within the epidermis and causes inflammation and irritation to your skin." Obviously dry skin has nothing to do with anhidrosis, which is a nervous system dysfunction but it might explain why so many of us notice we don't really sweat on our rosacea skin. So his recommendations for most skin problems are trying to get us to stop using harsh products and soaps on our skin and hair and to increase the humidity of our environments and avoid overheating our homes and ourselves, particularly at night. So all things that it can't hurt to try."

Y-gwair wrote: "There is very definitely a link between anhidrosis and flushing, the small peripheral nerves that control sweating also control small blood vessels, resulting in dysfunction in both. Even if the loss of sweat glands is not directly of those on the face, the fact that the body is not being cooled as efficiently as if would if all sweat glands were functional means that it will try to compensate by losing heat by blood vessel dilation via the face instead. From what I've gathered since I became aware of my autonomic problems, flushing disorders are primarily due to sudomotor dysfunction and will only be relieved by drugs that control vasodilation or address underlying hormonal triggers of poor thermostatic control. Topical applications of whatever kind are absolutely useless (and there's no way on earth in which mites could possibly affect the process of autonomic sweat production). Unfortunately drugs that promote sweating such as pilocarpine also increase vasodilation (I think taking pilocarpine was one of the things that triggered my severe erythromelalgia, which started with swelling and burning in my tongue and esophagus), so this approach is no help either. Thermoregulatory sweat testing in patients with erythromelalgia

And: "The body has a much better way of ridding itself of 'toxins' than via sweat, we also have a large organ called a liver and most of us also have a pair of kidneys. They all do a much more efficient job than the sweat glands. Another medication that people have been finding helpful for anhidrosis secondary to autonomic problems is Pyridostigmine (Mestinon), which is being used off label in both the US and to a lesser extent in the UK for orthostatic disorders. I'm not holding my breath to try it, as my experience with pilocarpine means that I probably can't tolerate it either but, for the record, there are two different medications that can help disorders that make difficult to sweat.

Rosacea patients who report to be less red when they sweat in their face

Melissa W. can sweat in her face and writes how exercise and sweating makes her skin look pale and calm: "When my skin is dry it is a trigger for flushing as it lowers my flushing threshold since it is compromised. I also find moisturizing helps. I find sweating to be beneficial for my rosacea- at least for the flushing part. Not sure about the p&p part. But I feel much better for sweating every day so I make sure I do. Stress is also a big trigger for me as well as not staying well hydrated. As for the temperature change check out this article. It will explain the reasoning behind it. Melissa"

And: Article: 'Moderates exercise may help your rosacea'. "I always feel better after I workout and while I am sweating (on my face) my face remains sort of pale as long as I have cool air blowing on it. I think my face is better for it and wonder if anyone else has this experience."

Kristina B asked Melissa:  Hi Melissa, Do you have a fan directed on your face when you're exercising to get the cool air? You know, your post made me realize that I haven't exercised enough to work up a sweat for ages! - v. bad, but really vigorous exercise always made me go very red, and I'm just scared to try at the moment. My skin's so dry that the thought of sweat sounds strangely appealing, though..
    Melissa replied: "Hi Kristina, As long as I keep the room cool and have some air
    getting to my face it remains calm. When we go away and workout at the hotel gyms I get red in the face because there is no control of the cool air like that. But when I am in my home environment I workout everyday without any issues and I always feel better for it. When I'm done my face always looks better than when I first start. And I am sweating on my face despite the cool air on it but my face is remaining pale and calm. I am convinced that it is good for our rosacea as long as we can keep the temp comfortable. Best wishes, Melissa"

    Meg replied: "I am also sensitive to both hot and cold. When I went to the Mayo clinic, they described this as a form of thermoregulatory dysfunction. Thyroid issues can definitely play a part in this. So can autonomic nervous system dysfunction. One of my symptoms is a cold body and a hot face that flushes and burns. Another issue is anhidrosis, or lack of sweating. I did not realize I had stopped sweating until I went to Mayo and was tested. I agree with Melissa, its smart to get tested. Unfortunately, very few places can do the autonomic and the sweat tests, but thyroid tests are available everywhere. Hope this info is helpful, Meg"

    Mt6031 wrote about how running decreases his flushing: "My flushing has dramatically decreased since losing weight (12lbs) and since i began running again. I run seven miles a day five to six times a week. When I sweat it seems to make my skin better and prevents flushing. I first noticed my rosacea when I got out of shape four years ago and then i avoided working out because all the websites say exercise is usually a trigger for flushing. Once in awhile my ear will flush but it is usually from something I ate...has anyone else seen improvements due to exercise?"

    Miki replied: "I find that when I sweat it calms my skin down but running and all
    types of high intensity exercise is out of the question."

    Lakan replied: "I have noticed that while I run it helps my flushing, the sweating also feels very nice and calming on the skin but its a very fine line for me. If i run too fast or too much it will make me flush and burn but if i run slowly and take some breaks and just walk then run slowly again it helps me.. Sometimes when i get a flush from stressing out in front of the computer i can sometimes run the flush of, haha."

    Paul H. wrote about a drug called Vassopressin, to affect the sweating/flushing: "Hi, I was just wondering if there has been any research on the possible link between Vassopressin and Rosacea? I now there are different variations of this condition but I was wondering if someone could have a read of this link and tell me what they think? Its interesting points about blood vessel dilation and hydration control. Its use in temperature regulation. I have been battling with extreme flushing for the last 10 or so years. I don't sweat much at all and it feels like I need to around the face area. Instead my face tends to burn and flush. I came across this a few years ago before I knew of this website. Im always looking for answers :) Please let me know what you think. Kind Regards [..] Getting back onto the Vassopressin subject it really does interest me any research that may have been conducted between this hormone and the skins ability to handle temperature? From what I understand the body creates it within the Hypothalmus which is the brains temperature controller. The use of calcium (I dont seem to handle calcium very well, i know alot of people dont) and its direct effect when Alcohol is introduced into the system. I know flushing is very common with drinking as well, there is also different variations of Vassopressin inlcuding Lysine, from which I know there have been a few claims on the internet that Lysine missing in our digestive systems is responsible for Rosacea. I find it very interesting and I hope someone may be able to prove or disprove this theory.  I am no Doctor, just a suffer of this condition. Sometimes I wonder which is the better qualification. Paul"

    Peteroche replied: "Very good post mate ...... Drummond is onto the exact same thing. And I have no doubt about it myself ...and that's were our focus should be from now on for people whos only symptoms is Flushing. Flushing and sweating are all part of the same thing when it comes to hydration control. Every other avenue I went down has been nothing but a waste of time ......[18 years now ]"

    Are there ways to increase face sweating?

    When searching for ways to increase sweating, preferably on the face, I didn't come across much. Well, apart from tips like running in the sun, adding lots of clothes to heat up and increase your exercise rate. For us, heating ourselves up by wrapping up in clothes or getting too hot otherwise, is clearly not a sensible option to stir up facial flushing :/ Some people do find that exercise, for instance steady walking, prevents them from blowing up their flushing or redness, but does allow some of their body at least to sweat. 

    This article states: You can't increase the number of sweat glands on your face, so you can't make it sweat more. You were born with X number of sweat glands, and that's that. However, if you want to increase the heat you feel on your face and head, just wear more clothing (eg. hat, scarf, etc.) or wear less clothing on your body so it balances your body temperature out a little more. I don't recommend wearing more clothing on your head, though, since it could cause you to overheat since you can't sweat. You can cool down your face so it doesn't overheat by splashing cold water on it." I wonder if this is true. How come a lot of us were able to sweat prior to rosacea and then all of a sudden can't afterwards? Did the rosacea just eat up all those sweat glands that we were born with? It seems more sensible that they altered them or shut them off somehow?

    In this article the same question is asked. Someone suggests drinking a lot of water before exercising. "Drinking more will likely do it. Years ago (about 35) I learned to increased my fluid intake every day and not just when exercising. It increased my sweating accordingly it appears. I drink far more than most athletes that I know". Someone replies: "That's actually a genetic thing. You can have surgery to STOP sweating, but nothing out there will make you start. Unless you're abnormal, you sweat enough and just have to develop heat tolerance. Worst case scenario, they actually make water bladders you can pump up - the water pressure will squirt it out of the mouthpiece. Carry one and douse yourself every 5 miles."

    Another person just sprays water on her face to mimic sweat and to cool down: "I don't sweat either. My face gets this alarming shade of red and when I used to take aerobics classes the instructors would make me sit down.When I was in high school I ran cross country. I'd run two miles in 18 minutes and get to the finish dry. One meet had the second place finisher accusing me of taking a short cut because, and I quote 'there is no way she ran 2 miles! She's not even sweating!' My face was beet red, but I was dry. And unbeaten, BTW. It's genetic for me. My mom had the same problem. I squirt my water on my face when I feel like I'm overheating, but it doesn't happen often. I'm not sure how my body keeps from overheating but it's rare. And I drink an average of 80 ounces of water per day."

    Another reply: "You can only reduce the amount of activity of your sweat glands, and that's through barring the nervous system from getting the sweat glands to react. http://www.medhelp.org

    Here is an interesting thread about flushing and sweating

    In it Dr. Joseph Butterfield describes the flushing mechanism and the role of sweating in it all. He said:

    “Well, flushers that sweat…the flushing tends to be cholinergic nerve discharge, which is not typical of mediator-induced flushing, which is more typical of mast cell disease. There are two different kinds of flushes — the sweaters and the non-sweaters.” He then explains all this: "Why does it matter whether or not you sweat when you flush? Why is that so important in trying to distinguish between mast cell-related flushing and other causes of flushing? In this article, I’m going to try to answer those questions, and while we’re at it, I’ll share some of the fun facts I’ve dug up on the subjects of sweating and flushing.

    For instance, did you know that as we age, the number of sweat glands that we have decreases? This effect is most easily observed in our feet. One study found that below age 30, healthy participants had 213 sweat glands per square centimeter in their feet. Between age 30 and 59, the number went down to 199, and over age 59, the average was 123 sweat glands per square centimeter. That means that between age 29 and 60, we may lose over 40 percent of the sweat glands in our feet! Also, younger people have higher output of sweat per sweat gland. So, it’s not surprising that older people find it harder to regulate their bodily temperature — they’ve got fewer and less efficient sweat glands to work with.

    Flushing 101 
    The term “flush” was first coined in 1882 by Dr. E.J. Tilt, who was searching for a short, expressive way to refer to this phenomenon. Reference. Dr. Christain Nasr defines flushing as: “…Episodic attacks of redness of the skin together with a sensation of warmth or burning of the face, neck, and less frequently the upper trunk and abdomen. It is the transient nature of the attacks that distinguishes flushing from the persistent erythema of photosensitivity or acute contact reactions. Repeated flushing over a prolonged period of time can lead to telangiectasia and occasionally to classical rosacea of the face.” Telangiectasia and rosacea are familiar terms to many of us with mast cell-related diseases. However, just to refresh your memory, telangiectasia is the term used to describe dilation of previously existing small or terminal blood vessels, while rosacea describes chronic dilation of blood vessels in the nose and connected areas of the cheek. Reference. The physical mechanism underlying flushing involves “an increased amount of saturated hemoglobin, an increase in the diameter or actual number of skin capillaries, or a combination of these factors.” Reference. The most common causes of flushing are fever, hyperthermia (heat-related illnesses such as heatstroke or sunstroke), emotional blushing, menopause, and rosacea. Reference.

    Flushing vs. flushing and sweating
    While there is some overlap between the mediators produced by the various conditions that cause flushing, it’s not hard to see how a physician could pin down the cause of flushing if he or she were able to figure out what specific mediators were involved.And while there are very benign causes of flushing, such as changes in temperature, emotional state, or exertion, as well as eating spicy food, flushing can also be a symptom of a serious physical condition. But what about that “cholinergic nerve discharge” that Dr. Butterfield mentioned? What is that, and how can we tell the difference between that and mast cell-mediated flushing? The sympathetic nervous system’s neurons release acetylcholine, which causes both sweat gland activity and dilation of blood vessels. Reference. So, when you see someone both sweating and “turning red,” you are probably witnessing flushing that is due the cholinergic effects of the sympathetic nervous system. In contrast, when histamine is released by mast cells in the skin, it has the effect of dilating blood vessels, but the histamine does not have an effect on the sweat glands. Reference. So when we see flushing without sweating, it’s more likely to be caused by histamine release in the skin, whereas when we see flushing and sweating together, it’s more likely to be caused by the release of acetylcholine by the sympathetic nervous system. There’s only one caveat to this explanation: When a person is going into shock, they will often begin sweating profusely, and as we know, anaphylaxis can send someone into shock. Reference. So, sweating in the later stages of a mast cell crisis is to be expected — it’s only in the early stages that we expect flushing without sweating."

    An attempt towards a conclusion

    So, all in all, it seems a certain chunk of rosacea patients have dry skin and problems with sweating, especially on their faces. This could be a result of the dry skin of rosacea and its inflammation, affecting the sweat glands somehow. I also think that the heat of the expended blood vessels and the amounts of blood going through the small vessels in our faces, dampens any moist pronto. Keeping the indoor air humid always helps me in terms of reducing flushing and making my skin appear less dry. Less dry skin = less flushed skin here. It would be good to try and get a bit of sweat going on on your faces, but only if it doesn't make you flush too bad, obviously. There are many suggestions done in the  quotes above here and some might work for some of you, and some might not. I have no idea yet how to improve the sweating on your face, as do think it would help us not to get so flushed and overheated. As the first section of quotes told us, even people with normal pale skin complaint about getting red faces when they exercise and don't sweat. Good luck everybody :)

    For those who want to read more on rosacea and lack of sweating, here are some more threads on The Rosacea Forum and elsewhere:

    *Lack of sweating? 
    *Sweat and flush
    *Feel like tearing my face off :(
    *Drummond - re fats and sweating
    *Flushing and the autonomic nervous system in rosacea
    *Running and decreased flushing
    *Overheating with fibromyalgia
    *About a little boy who can't sweat and has to be kept cool and on fans by his parents in fear of death
    *Article on 7 yr old girl who can't sweat and is in serious condition
    *A yahoo question from someone who can't sweat
    *About the sydrome that prevents you from sweating
    *Forum; can't sweat
    *Sarcoidosis forum, who can't sweat anymore?
    *Anhidrosis, I can't sweat 
    *Naturopathy in New York; I don't sweat
    *Health and fitness, I don't sweat is something wrong with me
    *Why can't I sweat anymore?
    *Lowcarbfriends, why am I not sweating?
    *Bike forum, i don't sweat and get red
    *Runners world, I can't sweat
    *Marks Daily Apple; Why can't I sweat anymore?
    *Dr. Weil on no sweating


    Starlite replied on The Rosacea Forum on this blog post: "Wow, you did an extensive study there Nat. Thank you for all your hard work! I found this comment remarkable and it rang bells for me, especially since I have been watching the videos below the quote.

    "Drummond (aka Drums) responded: "Yes there is lots you can do to make yourself sweat more but the first thing is to ensure you are properly hydrated because the chances are at the moment you are unconsciously dehydrated. being dehydrated is causing your body to have a low acid p.h.and when this situation is in place the electrical impulse to sweat becomes unfunctionable so sweating cannot be initiated naturally even on the hottest day. The acidic condition of your body becomes self perpetuating once you stop sweating. This guy is amazing and fun to watch. :) He talks about the importance of moving the lymph system, which supplies the fluid for sweating, and how when it is acidic the interstitial environment gets blocked and fluids can't flow properly. Fluid can not flow with out the full spectrum of essential minerals and being well hydrated. You can absorb water into the cells with out those minerals. There are five parts to this series which can be found at his channel. Watch for the new member "Bookwatch," they are posting good info on getting alkaline and adding in minerals with black strap molasses and/or maple syrup. I thought I would just post the links to the other four parts of this talk post above.

    Detoxification The Art & Science Part One

    Detoxification The Art & Science Part Two

    Detoxification The Art & Science Part Four

    Detoxification The Art & Science Part Five

    Thanks for your imput Starlite!! :)

    And another very interesting reply to this post, from Oxfordrebel in this rosacea forum

    "Thanks Nat. Very, very interesting. It's like people with a certain autonomic nervous system predisposition are susceptible to this. While I do sweat (except my cheeks) everywhere when I exercise vigorously, I have noticed that I have never in my life struggled with armpit sweat or back/butt sweat in workplace or normal social environments like many of my friends do (I think we all know people like this). I just don't sweat unless I am exercising intensely in a warm enough environment. When rosacea first mildly appeared for me back about 5 years ago I remember being in New Orleans with a co-worker and we both started eating po-boys with tons of horseradish sauce on them. There was a wall mirror next to our table and I noticed that he began sweating on his face while I just turned red -- it was one of my first experiences of feeling a flush. So we need to turn this nervous system signalling ability (or as Drummond calls it, "secretions") back on. When it's off, it causes flushing, tingling, itching, stinging, and burning in those rosacea areas where it should be perspiring (or at least releasing the heat....I think normal skin can actually release mild heat short of actual sweating). It's like it's stuck in the off position. Fascinatingly, it seems that certain foods or the avoidance thereof could allow it to turn back on (i.e., whether its fats, protein, carbs, or sugar....and everyone on here has different opinions on same). I.e. it appears that Drummond is saying that if he avoids fats and his rosacea lesions clear up, then at that point he is able to sweat in those skin areas through things like chili peppers, spicy veggie curry, or getting under the blankets, etc. (just referring to his posts)

    I know many on here feel that Drummond is controversial, but I do think his insights are very relevant. A few months back I was out of town, away from work, and very relaxed -- I went for a run and I noticed that I did start to perspire very mildly in the middle of my cheeks, where my rosacea is (like you Nat from your pictures on your blog). What this tells me is that 1) certain types of food and the digestion thereof, and 2) stress (i.e., sympathetic nervous system arousal levels) -- these two things greatly affect how the parasympathetic nervous system signals. If the parasympathetic nervous system is not signalling correctly, you will not feel good, bottom line. Wiki it and read about the paraympathetic system. All reasons why I think dermatologists are basically worthless for this condition, unless you just want to find ways that might help you manage topical symptoms. I want the root cause!!!! And I am convinced that this is an autonomic nervous system/digestion disorder (and of course, the stomach, small intestine and large intenstine are fully wired with the nervous system, so in a way it's not even two separate things, but one thing....just like the brain and gut are not truly separate....I used to have to poop like 3 times in 30 minutes if I was about to give a speech or something similar). Sorry if I am rambling. Thanks again Nat. I'll keep expirementing."

    My reply: "Love your post Oxfordrebel, thanks so much. Very interesting what you wrote (also about the sudden cheek flushing) and I think its correct to say that a lot of people with rosacea problems have underlying autonomic nervous system and digestive issues. I know I have both and my belly can be so swollen often, people think I'm in early pregnancy :) Its been checked a few times and is some mild case of colitis but none of my derms apart from a great German one, seem even remotely interested in this connection. Its very frustrating, as I also am convinced this flushing is not ther cause and root and disease itself, but an expression of other auto-immune /or central nervous system/or hormonal/digestive issues/ inflammation issues in the body. The lack of sweating must be placed into this puzzle but I have no idea where exactly and if lack of sweating increases the flushing or if its the other way around and the affected rosacea skin and the flushing prevents us from sweating. Wished more dermatologists would try to look into this broader approach, because right now the only ones doing so are naturopaths and other natural doctors, with very mixed results and often not a fully scientific approach (no judgement passed, I had years of treatments with natural docs, but as an academic I would also love to see some more science based research). Another note, I also know people who perspire a lot and who also get very red :S Usually they are a bit overweight though (add high blood pressure to the problem then), but not always. Just wonder if being able to sweat properly can protect your from a red face."

    It seems such a catch 22, everything I can think of that would induce facial sweating can also make you more flushed :/ Exercise, heat, spices.. Most rosaceans already have the hyperactive and extensive blood vessels, I doubt that will reduce once someone starts to sweat again.. Unless the only just recently started to flush? These herbs are supposed to help induce flushing.

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