{"id":12176,"date":"2026-03-21T18:09:14","date_gmt":"2026-03-21T09:09:14","guid":{"rendered":"https:\/\/miragen.clinic\/neurogenic-rosacea\/"},"modified":"2026-07-10T21:24:16","modified_gmt":"2026-07-10T12:24:16","slug":"neurogenic-rosacea","status":"publish","type":"page","link":"https:\/\/miragen.clinic\/en\/neurogenic-rosacea\/","title":{"rendered":"Neurogenic Rosacea"},"content":{"rendered":"\n<div class=\"wp-block-group has-custom-color-4-background-color has-background has-global-padding is-layout-constrained wp-container-core-group-is-layout-e96bc7c8 wp-block-group-is-layout-constrained\" style=\"padding-top:240px;padding-right:var(--wp--preset--spacing--superbspacing-small);padding-bottom:240px;padding-left:var(--wp--preset--spacing--superbspacing-small)\">\n<p class=\"has-custom-color-6-color has-text-color has-link-color wp-elements-637eeb30a61609d8739a5c5fa7780e5b wp-block-paragraph\">Conditions<\/p>\n\n\n\n<h1 class=\"wp-block-heading has-text-align-left has-custom-color-1-color has-text-color has-link-color wp-elements-f9ad69880724f9e5242981a1204f54af\">Neurogenic Rosacea | Flushing and Burning Triggered by Heat<\/h1>\n<\/div>\n\n<div class=\"wp-block-group has-custom-color-2-background-color has-background has-global-padding is-layout-constrained wp-container-core-group-is-layout-1b17c90e wp-block-group-is-layout-constrained\" style=\"margin-top:0;margin-bottom:0;padding-top:var(--wp--preset--spacing--superbspacing-xlarge);padding-right:var(--wp--preset--spacing--superbspacing-small);padding-bottom:var(--wp--preset--spacing--superbspacing-xlarge);padding-left:var(--wp--preset--spacing--superbspacing-small)\">\n<div class=\"wp-block-rank-math-toc-block has-custom-color-5-color has-custom-color-11-background-color has-text-color has-background has-link-color wp-elements-9e5f5774fb6a910a79d3ab5d05732dc9\" style=\"padding-top:var(--wp--preset--spacing--superbspacing-xsmall);padding-right:0;padding-bottom:var(--wp--preset--spacing--superbspacing-xsmall);padding-left:0\" id=\"rank-math-toc\"><h2>\ubaa9\ucc28<\/h2><nav><ul><li><a href=\"#sec-1\">1. What is Neurogenic Rosacea?<\/a><\/li><li><a href=\"#sec-2\">2. Why Do Sensory Nerves Become Hypersensitive? \u2014 The TRPV1 Vicious Cycle<\/a><\/li><li><a href=\"#sec-3\">3. Differences from Emotional Flushing<\/a><\/li><li><a href=\"#sec-4\">4. Differential Testing<\/a><\/li><li><a href=\"#sec-faq\">Frequently Asked Questions<\/a><\/li><\/ul><\/nav><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When I ask people with severe flushing about situations where their symptoms worsen, the most common answer relates to temperature. In particular, many people say, &#8216;My face turns red just by being exposed to heater air.&#8217; <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In such cases, there is a high possibility of <strong>neurogenic rosacea<\/strong>, which does not respond well to typical rosacea treatments. We will explain what neurogenic rosacea is and what tests are used to distinguish it. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h2 id=\"sec-1\" class=\"wp-block-heading\">1. What is Neurogenic Rosacea?<\/h2>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\"\/>\n\n\n\n<p class=\"wp-block-paragraph\">The skin has <strong>heat sensors (TRPV1)<\/strong> that detect temperature. These sensors are originally designed to respond to heat above 43\u00b0C, but in some <a href=\"https:\/\/miragen.clinic\/en\/rosacea\/\">rosacea<\/a> patients, these sensors are produced in much higher quantities than normal.<sup><a style=\"color: inherit;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22189789\/\" target=\"_blank\" rel=\"noopener\">1<\/a><\/sup> Not only are there more sensors, but the response threshold of each sensor is lowered, causing them to activate even at temperatures like heater air or warm food. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When these heat sensors are activated, substances called CGRP and Substance P are released from the nerves.<sup><a style=\"color: inherit;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24229632\/\" target=\"_blank\" rel=\"noopener\">2<\/a><\/sup> CGRP dilates blood vessels, causing <strong>flushing<\/strong>, while Substance P creates <strong>stinging and burning sensations<\/strong>. This is <strong>neurogenic rosacea<\/strong>. <\/p>\n\n\n\n<figure class=\"wp-block-image alignwide size-large\"><img decoding=\"async\" src=\"https:\/\/miragen.clinic\/wp-content\/uploads\/2026\/06\/trpv1-mechanism-diagram-EN.jpg\" alt=\"An illustration showing the mechanism of neurogenic rosacea. The left side compares the process where heat stimulation activates TRPV1 receptors in normal skin to release CGRP and Substance P, while the right side shows the process where much stronger flushing and burning occur in skin with TRPV1 overexpression under the same stimulation. \" class=\"wp-image-9232\" title=\"Neurogenic Rosacea TRPV1 Mechanism Diagram\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Typical erythematotelangiectatic rosacea is primarily caused by immune responses. Demodex mites or UV rays stimulate the skin&#8217;s immune pathways, causing inflammation, and treatments like antibiotics or Soolantra block these pathways. In contrast, because the core of neurogenic rosacea is <strong>nerve hypersensitivity<\/strong>, conventional treatments targeting immunity have limitations.<sup><a style=\"color: inherit;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41404901\/\" target=\"_blank\" rel=\"noopener\">3<\/a><\/sup>  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Approximately 10\u201315% of all rosacea cases are of this type.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h2 id=\"sec-2\" class=\"wp-block-heading\">2. Why Do Sensory Nerves Become Hypersensitive? \u2014 The TRPV1 Vicious Cycle<\/h2>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\"\/>\n\n\n\n<p class=\"wp-block-paragraph\">In addition to the increase in the number of receptors, the sensitivity of individual receptors also increases. Substances like prostaglandins or bradykinin produced in inflammatory environments directly sensitize TRPV1, and a low pH (acidic environment) also lowers the threshold. The more inflammation persists in the skin, the more sensitive the sensors become.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There are several pathways through which overexpression begins.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>UV rays<\/strong> are a primary example. The face is an area exposed to UV rays daily, and recent research has confirmed that UV rays directly increase TRPV1 expression.<sup><a style=\"color: inherit;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41809119\/\" target=\"_blank\" rel=\"noopener\">4<\/a><\/sup> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Demodex mites<\/strong> are also a cause. When the skin barrier weakens, byproducts of Demodex mites penetrate the skin, causing an inflammatory response, which further increases TRPV1 expression.<sup><a style=\"color: inherit;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37606610\/\" target=\"_blank\" rel=\"noopener\">5<\/a><\/sup> This is also why Demodex treatment is fundamental to flushing management. We have covered Demodex treatment in detail in the <a href=\"\/blog\/&#xC218;&#xB780;&#xD2B8;&#xB77C;-&#xC774;&#xBC84;&#xBA55;&#xD2F4;-&#xD06C;&#xB9BC;\/\">Soolantra article<\/a>.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The real problem comes next. When TRPV1 is activated, nerve growth factor (NGF) is released, which produces more TRPV1 through TRKA receptors.<sup><a style=\"color: inherit;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37606610\/\" target=\"_blank\" rel=\"noopener\">5<\/a><\/sup> It is a vicious cycle: more TRPV1 leads to easier activation, more nerve growth factor is released, and TRPV1 increases again. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Once this cycle begins, it reinforces itself, so it does not improve easily just by avoiding triggers.<\/p>\n\n\n\n<figure class=\"wp-block-image alignwide size-large\"><img decoding=\"async\" src=\"https:\/\/miragen.clinic\/wp-content\/uploads\/2026\/06\/logo-added-9236-EN.png\" alt=\"A cycle diagram showing the TRPV1 vicious cycle process. It illustrates the self-reinforcing loop from TRPV1 activation to CGRP and Substance P release, NGF secretion, and additional TRPV1 production, as well as how UV rays, Demodex mites, and skin barrier damage trigger this cycle. \" class=\"wp-image-9248\" title=\"TRPV1 Vicious Cycle Diagram\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h2 id=\"sec-3\" class=\"wp-block-heading\">3. Differences from Emotional Flushing<\/h2>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\"\/>\n\n\n\n<p class=\"wp-block-paragraph\">Symptoms of the face turning severely red in specific situations appear commonly in both neurogenic rosacea and emotional flushing. Although they look similar, the causes differ. <\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-custom-color-5-color has-text-color has-link-color has-fixed-layout\"><thead><tr><th class=\"has-text-align-left\" data-align=\"left\">Item<\/th><th class=\"has-text-align-left\" data-align=\"left\">Emotional Flushing<\/th><th class=\"has-text-align-left\" data-align=\"left\">Neurogenic Rosacea<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>Sweat<\/strong><\/td><td class=\"has-text-align-left\" data-align=\"left\">May accompany<\/td><td class=\"has-text-align-left\" data-align=\"left\">Not present<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>Sensation<\/strong><\/td><td class=\"has-text-align-left\" data-align=\"left\">Heat sensation<\/td><td class=\"has-text-align-left\" data-align=\"left\">Stinging \u00b7 Burning \u00b7 Soreness<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>Main Triggers<\/strong><\/td><td class=\"has-text-align-left\" data-align=\"left\">Tension, emotion, stress<\/td><td class=\"has-text-align-left\" data-align=\"left\">Heat, spicy food, alcohol<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>Pathway<\/strong><\/td><td class=\"has-text-align-left\" data-align=\"left\">Sympathetic nerves \u2192 Blood vessels + Sweat glands<\/td><td class=\"has-text-align-left\" data-align=\"left\">Sensory nerves TRPV1 \u2192 CGRP \u00b7 Substance P<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">The key distinguishing point is the <strong>presence or absence of sweat<\/strong>. If sweating accompanies the redness, it is highly likely to be emotional flushing. However, the absence of sweat does not necessarily confirm neurogenic rosacea, so objective differentiation through <a href=\"https:\/\/miragen.clinic\/en\/autonomic-nervous-system-test\/\">HRV testing<\/a> and <a href=\"https:\/\/miragen.clinic\/en\/tewl-test\/\">TEWL testing<\/a> is required.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h2 id=\"sec-4\" class=\"wp-block-heading\">4. Differential Testing<\/h2>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\"\/>\n\n\n\n<p class=\"wp-block-paragraph\">For flushing that suddenly worsens in specific situations, we identify the cause through autonomic nervous system testing and TEWL testing.<\/p>\n\n\n\n<ul class=\"wp-block-list has-custom-color-5-color has-text-color has-link-color wp-elements-0d11f23fa0c9c41b3950b20556535bba\">\n<li><strong>Sympathetic hyperactivity + Normal TEWL<\/strong> \u2192 <a href=\"https:\/\/miragen.clinic\/en\/emotional-flushing\/\">Emotional flushing<\/a> is suspected<\/li>\n\n\n\n<li><strong>Normal autonomic nerves + Elevated TEWL<\/strong> \u2192 Neurogenic rosacea is suspected<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-dots\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">References<\/h3>\n\n\n\n<ol class=\"wp-block-list has-custom-color-5-color has-text-color has-link-color has-superbfont-xxsmall-font-size wp-elements-337b11c04df15259caa75d121737d7e6\">\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22189789\/\" target=\"_blank\" rel=\"noopener\"><em>Sulk M, Seeliger S, Aubert J, et al. Distribution and expression of non-neuronal transient receptor potential (TRPV) ion channels in rosacea. J Invest Dermatol. 2012;132(4):1253-62.   <\/em><\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24229632\/\" target=\"_blank\" rel=\"noopener\"><em>Steinhoff M, Schauber J, Leyden JJ. New insights into rosacea pathophysiology: a review of recent findings. J Am Acad Dermatol. 2013;69(6 Suppl 1):S15-26.   <\/em><\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41404901\/\" target=\"_blank\" rel=\"noopener\"><em>Wu C, Zhang K, Guo Y, et al. Clinical Characteristics and Serum CGRP Level Differences Between Neurogenic Rosacea and Non-neurogenic Rosacea. Int J Dermatol. 2025;64 Suppl 2:42-51.   <\/em><\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41809119\/\" target=\"_blank\" rel=\"noopener\"><em>Xie Y, Hu Y, Huang J, et al. UVB Upregulates Inflammatory Cytokines in Rosacea Cell Model by Promoting the Expression of TRPV1 and TLR2. Immunotargets Ther. 2026;15:571037.<\/em><\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37606610\/\" target=\"_blank\" rel=\"noopener\"><em>Lee SG, Kim J, Lee YI, et al. Cutaneous neurogenic inflammation mediated by TRPV1-NGF-TRKA pathway activation in rosacea. J Eur Acad Dermatol Venereol. 2023;37(12):2589-2600.   <\/em><\/a><\/li>\n<\/ol>\n<\/div>\n\n<div class=\"wp-block-group has-custom-color-6-background-color has-background has-global-padding is-layout-constrained wp-container-core-group-is-layout-4c3b03bf wp-block-group-is-layout-constrained\" style=\"padding-top:var(--wp--preset--spacing--superbspacing-xlarge);padding-right:var(--wp--preset--spacing--superbspacing-small);padding-bottom:var(--wp--preset--spacing--superbspacing-xlarge);padding-left:var(--wp--preset--spacing--superbspacing-small)\">\n<h2 id=\"sec-faq\" class=\"wp-block-heading has-custom-color-4-color has-text-color has-link-color wp-elements-6c5240743790f75cfa3f74d5b830658c\">Frequently Asked Questions<\/h2>\n\n\n\n<hr class=\"wp-block-separator has-text-color has-custom-color-5-color has-alpha-channel-opacity has-custom-color-5-background-color has-background is-style-wide\" style=\"margin-top:var(--wp--preset--spacing--superbspacing-xsmall);margin-bottom:var(--wp--preset--spacing--superbspacing-xsmall)\"\/>\n\n\n<div id=\"rank-math-faq\" class=\"rank-math-block\">\n<div class=\"rank-math-list \">\n<div id=\"faq-1\" class=\"rank-math-list-item\">\n<h3 class=\"rank-math-question \">Is there anything I can do at home first?<\/h3>\n<div class=\"rank-math-answer \">\n\n<p>It\u2019s safest to reduce clear triggers for you, such as heat, alcohol, and spicy foods, and to maintain gentle cleansing and moisturizing. If you add several new products at once, it\u2019s hard to tell what caused irritation, so it\u2019s best to make only one change at a time. <\/p>\n\n<\/div>\n<\/div>\n<div id=\"faq-3\" class=\"rank-math-list-item\">\n<h3 class=\"rank-math-question \">How is the HRV test performed?<\/h3>\n<div class=\"rank-math-answer \">\n\n<p>It is a non-invasive test where a sensor is attached to a finger and measurements are taken for 1 to 5 minutes. You can check the balance between the sympathetic and parasympathetic nervous systems numerically. It is a non-covered (out-of-pocket) test, and the cost is approximately 10,000 to 30,000 KRW.  <\/p>\n\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Conditions Neurogenic Rosacea | Flushing and Burning Triggered by Heat When I ask people with severe flushing about situations where their symptoms worsen, the most common answer relates to temperature. In particular, many people say, &#8216;My face turns red just by being exposed to heater air.&#8217; In such cases, there is a high possibility of [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-full-width","meta":{"_miragen_jsonld":"","footnotes":""},"class_list":["post-12176","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/miragen.clinic\/en\/wp-json\/wp\/v2\/pages\/12176","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/miragen.clinic\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/miragen.clinic\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/miragen.clinic\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/miragen.clinic\/en\/wp-json\/wp\/v2\/comments?post=12176"}],"version-history":[{"count":18,"href":"https:\/\/miragen.clinic\/en\/wp-json\/wp\/v2\/pages\/12176\/revisions"}],"predecessor-version":[{"id":13016,"href":"https:\/\/miragen.clinic\/en\/wp-json\/wp\/v2\/pages\/12176\/revisions\/13016"}],"wp:attachment":[{"href":"https:\/\/miragen.clinic\/en\/wp-json\/wp\/v2\/media?parent=12176"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}