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Multiple interrelated factors likely contribute to rosacea, including: Genetic susceptibility 2 Immune dysregulation, with increased inflammatory signaling and increased numbers and activation of mast cells (immune cells that produce histamine) 2 Abnormal nerve-blood vessel interactions, frequently triggered by stimuli such as temperature change, exercise, sunlight, spicy food, alcohol, and stress 2,10 Imbalanced facial skin microbiome, with increased presence of Demodex species (ie, microscopic parasitic mites that live in human hair follicles as members of the normal skin microbial community) 2,10,11 4 How is Rosacea Diagnosed