Five Important Things I've Learned About Rosacea

I had another post planned for today, but I decided that I wanted to share about my recent diagnosis and struggle with rosacea. I know there have to be other rosacea sufferers out there, and probably even more who are unaware they have it.

Over the past 5-6 months I noticed a few changes:

  • I was developing more spider veins (telangiectasia) on my face, and new ones on my décolleté and upper arms. 
  • I had slightly reddened areas on my face and neck.
  • I frequently had tiny pimples on my cheeks (not an area where I ever had breakouts before). 

I attributed the spider veins to aging, the reddened areas to hot flashes, and the breakouts to irritation from either skincare products (tretinoin) or makeup. I didn't consider rosacea because I see a dermatologist annually and she had never mentioned any signs of it in the past.

A graphic of a woman who has rosacea

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I was wrong.

When I saw my dermatologist in March, I explained about the breakouts, and how I thought perhaps the tretinoin was responsible - even though I had used it for months without any issues. She examined my skin and surprised me by saying that I had rosacea. She was a little concerned about the telangiectasia on my décolleté and upper arms, and insisted that I have labwork done to check my liver to rule out any other causes. (The labwork was normal.)

She recommended that I stop using the tretinoin (I had already decreased my usage from seven days a week to every third day), and switch my laundry detergent to Tide Free until we got everything under control. She also ordered a prescription sulfacetamide cleanser for the breakouts, and told me to use it twice daily. Since my diagnosis, I have learned a few important things about rosacea, and I wanted to share them in hope that it will help someone.

1) Anyone can develop rosacea, but it's most common in women aged 30+ who have fair skin that flushes/blushes easily, blonde hair and blue eyes, and have Celtic or Scandinavian ancestry.

There is also evidence that it runs in families. I'm pretty sure my maternal grandfather had it. And it can worsen during menopause. A recent study found that rosacea patients had a 41% greater risk of high cholesterol (have it), 35% higher risk of coronary artery disease (have it), and a 17% greater risk of hypertension (have it). Other studies are showing an association with allergies (have them), GERD (have it), diabetes (I have insulin resistance), urogenital diseases, and female hormone imbalance. These are early studies, so further clarification will be needed, but it's still something to keep in mind. As you can see, I can tick off every "most commonly seen in" box!

A graphic with a photo of Kim from Enjoy the View and all of the risk factors for rosacea that she has

2) They don't really know what causes rosacea.

Some theories are:
  • The immune system may play a role. Some people with rosacea react to bacillus oleronius, and that reaction causes their immune system to overreact.
  • H pylori is common in people with rosacea, but there's no proof it causes it. (I was tested for this - I don't have it.)
  • Demodex (a mite that lives on everyone's skin) may play a role. It likes to live on the nose and cheeks, where rosacea is usually found - and people with rosacea have large numbers of this mite. But so do some people who don't have rosacea.
  • Cathelicidin (a protein that usually protects skin from infection) may cause the redness and swelling. How your body processes cathelicidin may determine whether you get rosacea.

3) Apparently, rosacea isn't just rosacea. There are four subtypes, and you can have more than one!
  • Subtype 1: neurovascular rosacea - facial redness and flushing
  • Subtype 2: inflammatory rosacea - bumps and pimples along with spider veins (I have this one)
  • Subtype 3: phymatous rosacea - enlargement of the nose, large pores, broken blood vessels (this one is rare)
  • Subtype 4: ocular rosacea - eye irritation, dryness, itching, sensitive to light, broken blood vessels on eyelid

4) Rosacea can't be cured, but it can be managed.

Paula's Choice RESIST Super-Light Daily Wrinkle Defense moisturizer/sunscreen lying on a wooden table

  • Sun protection 24/7/365. This one is a no-brainer for me. I always wear sunscreen, avoid midday sun whenever possible, wear sunglasses, and try to sit in the shade. When we go to the beach, I'm even more careful. My favorite facial sunscreen is Paula's Choice RESIST Super-Light Daily Wrinkle Defense SPF 30.
  • Figure out your triggers. Most people who have rosacea will have "flares", when it gets worse. If you can figure out the things that make yours worse, you can try to avoid them. It could be things like sunlight, becoming overheated, exercise, cold air blowing on your face, eating spicy foods, stress, alcohol, and more.
  • Use mild skincare products and be gentle when caring for your skin. Now that my bumps are under control, I use the prescription cleanser in the evening and CeraVe Hydrating Cleanser in the morning.
Bottle of CeraVe Hydrating Cleanser lying on a wooden table

5) There is a difference between a hot flash and rosacea flushing.

This one was difficult for me since I was having both. Once I started paying attention, I could see/feel the difference. When I have a hot flash, it travels all over my body, and I start to sweat immediately - especially my face and neck. When I have them during the night they interrupt my sleep. I keep a fan running at night year round because it helps me cool off. I spend the nights alternating between huddling under the covers because I'm cold and throwing everything off because I'm drenched in sweat. Fun times.

My flushes come on gradually. I start feeling a weird sensation in my chest and head - similar to what I've felt when given contrast for a CT scan. Then my cheeks will feel hot, and my face, neck, and décolleté turn bright red. There's no sweating - I just feel like I'm smothering. If I'm bending over or walking up stairs when it happens, my heart will race and I get out of breath. When I'm not flushing, those activities don't bother me at all.

Now that I know that I have rosacea, I can look back and see signs of it (or signs that it would occur) from years ago. My skin has always been sensitive and flushed easily. Chemical sunscreens sting my face. But because of the timing, when I started having flushing episodes, I just assumed I was having the motherlode of hot flashes!

Niacinamide 10% + Zinc 1% from The Ordinary lying on a wooden table

I also think I was unwittingly treating it, and that's why it took so long for the symptoms to become noticeable. Niacinamide has been shown to help with the effects of rosacea, and I have been using Niacinamide 10% + Zinc 1% from The Ordinary, as well as a couple of other products that contain niacinamide for quite some time.

First Aid Beauty's Anti-Redness Serum on a wooden table with the lid and box sitting beside it

I have also used First Aid Beauty's Anti-Redness Serum for over a year. It contains colloidal sulfur and caffeine, both of which will reduce redness and help with the symptoms of rosacea. I cringe to think what my skin could've looked like if I hadn't been using these products!

Keep in mind that there are different treatments for the different subtypes of rosacea, so it's important to see a doctor to find which one is right for you. My dermatologist told me that once my skin calmed, we could do laser treatments for the telangiectasia if the look of them bothers me. Right now, I can usually cover them fairly well with makeup. However, if I continue to get them, I can see that being more difficult. The other issue would be whether or not insurance covers that type of treatment. I'm guessing not, since it's a cosmetic issue.

I've really been watchful, trying to discover my triggers so I can reduce my flares/flushing. Alcohol can be one of my triggers, but as long as I only have one or two beers, I'm okay. Anything with a higher percentage of alcohol will bring on flushing a lot more quickly. I love spicy food, and luckily I'm able to eat most things I enjoy without any issues. Becoming overheated is a big trigger for me, so I'm going to have to be careful this summer and when we visit Lulu in Florida. I'm also pacing my housework and using a fan when I exercise. I'm hoping this won't limit my summertime walks, but I'm thinking it might, so I'll be using the treadmill more often.

I need to stop being diagnosed with things! I'm starting to get embarrassed when I go to a doctor's office and have to list all of my issues. I just keep telling myself that it could always be worse, and I have so very much to be thankful for in my life. It helps. My heart goes out to those who suffer with rosacea - it can have a devastating effect on your self-image and social life. If you think you might have rosacea, you can read more about it, where is there is also a physician finder.

Be sure to check out my other posts about rosacea:
OTC Treatment for Rosacea Symptoms: Prosacea
Aloe Vera and Rosacea

I would love to hear from some of you who have rosacea. What are your triggers? How do you manage the flares?


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