My experience with rosacea

Friday, April 24th, 2020

I remember my grandmother, who lived in New York City and didn’t see me frequently, commenting on my “pretty pink cheeks” when I was a teenager.  Neither she nor I realized they were a precursor to rosacea!  I did not even know what rosacea was until my early 40’s.

People are surprised when I mention I have had rosacea since my early 20s.  But now I know I have.  That rosy glow that gave away my first glass of wine of the evening was a trademark for me. But it would go away and I did not think much about it.

As the years passed, my rosy glow turned into a burning redness and made me work to avoid whatever caused it.  I learned initially it was red wine, bye bye.   Then a white wine created instant red triangles on my cheeks.  Goodbye to that too.  So far I am still safe with a frozen margarita or cold champagne but who knows what the future will bring.

When I started to practice dermatology, one of the dermatologists I worked with sidled up to me and said “I see you have rosacea”.   When I asked what made him say that, he replied, “I can tell when you have a stressful clinic, your face gets red and splotchy.”  LOL, can’t do too much about that, I thought to myself.

And just to show you how much it can hurt, once I tempted fate with a sip of red wine a friend said I “had” to try.  Within 20 minutes, a woman at the same dinner table asked me if “that” was a new beauty treatment.  “That” was me unconsciously rubbing my cheeks with ice from my water glass because they burned so much after a tiny bit of red wine.  We all got a laugh out of it.

Simply having chronically red cheeks does not mean you have rosacea. And having rosacea does not mean you have to have red cheeks all the time.

Rosacea is a reactive condition.  By that I mean, those of us with rosacea react to certain triggers by flushing or blushing, most commonly on our cheeks.  Over time, if you react or flush frequently, your facial blood vessels become permanently enlarged and don’t constrict after the trigger is removed.  Chronic inflammation from untreated rosacea can lead to pimples and pustules and, in the worst case scenario, the overgrowth of oil glands resulting in the WC Fields nose.

We know now that genetics and sun damage play a role in the development of rosacea, hence the frequency in British people, particularly in sunny climates.  We also know that certain enzymes are overly active in rosacea-prone skin and certain molecules act to block the activity of those enzymes.

The lining of the eyes can also have a rosacea-like inflammation.  Ocular rosacea seems to be less in response to a trigger but instead be chronic, manifesting in burning or dry eyes, or in a feeling that “something” is in your eyes.

Doxycycline, in large doses an antibiotic, in small doses is an incredibly effective anti-inflammatory for rosacea.  Accutane can reverse the pimples, pustules and oversized sebaceous glands.  Topical creams and gels can control early rosacea and lasers can reverse some of the enlarged blood vessels.

Your dermatologist or dermatology PA can help you treat your rosacea and reverse the damage it has caused.  Rosacea is a perfect condition to address via tele-derm during this COVID19 crisis.  In 6 weeks, people may comment on how great you look coming out of quarantine.  Stress, what stress!