Did you ever have to deal with rosacea? If you’re curious about this group of cutaneous conditions, suspect you might be dealing with something like that, or know what I’m talking about, bear with me! I’m sharing insights about the origin of rosacea, my struggles & successes while dealing with it, and tips that may get you on the right foot!
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Last updated: August 11th, 2022
Hi guys! This post is going to be a little different since I’m going to share with you my own (and recent) experience with several types of rosacea.
Rosacea includes several common skin conditions characterized by sporadic or persistent redness, usually in the central facial skin areas.
Here I go through some of the clinical and molecular features of rosacea. But, above everything, I hope that learning how the rosacea journey it’s been for me so far can be somehow helpful for you.
What types of rosacea are there?
There are four types of rosacea. The truth is that the molecular bases of each of these skin conditions are not entirely understood, although they share some commonalities in their clinical manifestations (mainly redness).
However, rosacea is a highly individualized disease. That means that the clinical symptoms, the molecular causes, and the triggers of the onset or flares of the disease vary significantly among different people, and the rosacea journey is different for everyone.
For example, you may develop one or more types of rosacea simultaneously. Also, rosacea can appear in any skin type (and color, I’ve got a medium skin tone) and anytime during adulthood. So better keep reading!
Let’s briefly see the potential molecular causes, triggers (and treatments) of the four major rosacea types.
1· Vascular rosacea (erythematotelangiectagic rosacea)
Some major causes
This type of rosacea seems to have mainly vascular and neural components. People with it develop enlarged/broken blood vessels (called telangiectasias) primarily on the cheeks, where they present varying degrees of persistent or intermittent (inducible) redness.
You might think: “I’ve got some isolated broken blood vessels on the cheeks – Do I have rosacea”? My answer is that you may have some couperose, which, from my perspective and own experience, is not the same as vascular rosacea. I see it more as a potential previous stage.
By that, I mean that having couperose increases your chances of developing vascular or other types of rosacea at some point in your life. When I narrate my own experience with couperose and rosacea, you will better understand my viewpoint.
Triggers
There are many (for rosacea in general).
Heat (such as hot showers or steam baths) may be a universal trigger.
Another major environmental factor that might make your rosacea flare is UVB from the sunlight: this type of ultraviolet light hits the epidermis and can damage epidermal cells (keratinocytes). When that happens, those cells release inflammatory molecules that stimulate angiogenesis in the dermis (the growth of new blood vessels).
Additionally, there is an increase in adhesion molecules in the old and new blood vessels. Hence they recruit more leukocytes from the circulation into the rosacea skin sites (via adhesion mechanisms).
That provokes rosacea flares, which might enter a vicious cycle and become long-lasting (aka, persistent redness or frequent flushing). Moreover, UVA light that gets directly to the dermis (and blood vessels) does not benefit the situation.
Other factors that may induce rosacea include alcohol, certain foods (such as spicy foods), or ingredients in personal care products. However, each rosacea skin has its particular triggers. Moreover, some people are sensitive to numerous factors. In contrast, others are resilient to flares upon many typical triggers.
Treatment
A few vascular laser sessions performed by a dermatologist to seal or collapse those suboptimal blood vessels may be the best option to keep this kind of rosacea under control. Even just one or two sessions can have a long-lasting, positive impact (depending on the severity of the rosacea).
2· Acne rosacea (papulopustular rosacea)
That variant of rosacea shares some features with and looks like common acne (see the image below).
A major cause
The excess of a bacteria called Cutibacterium acnes, which we all possess in our skin, is a crucial component of the pathogenesis of acne. Similarly, a mite that we all have in our skin, the Demodex mite, underlies the pathogenesis of this rosacea type (it lives within the hair follicles and sebaceous glands).
Treatments
Like everything in rosacea, this is highly individual. Some great options are the antibiotic/antiparasitic compounds doxycycline, ivermectin, or metronidazole. They kill the excess mites and diminish cutaneous inflammation (topical azelaic acid does the latter too).
3 · Phymatous rosacea
That presents with an enlarged, red nose (and usually cheeks).
A major cause
It seems to be related to an exacerbated activity of the sebaceous glands in those areas. That goes hand in hand with an over-activation of the cutaneous immune system. Altogether can end up causing damage to the tissue architecture. And if left untreated may be pretty disfiguring (the skin might get stiff or sclerotic).
Seek treatment
Therefore, if you have something like that (see below), get an appointment with your dermatologist ASAP.
4· Ocular rosacea
That may affect an eye or both. It usually leads to eye stinginess, dryness, and redness. And can even cause vision problems if left untreated.
Some major causes
On the one hand, it seems to have a vascular component. On the other hand, the Demodex mite might be causing trouble on the eye surface.
Seek medical treatment ASAP
People with this type of rosacea may take a while to recognize that there might be something serious going on in their eyes. Ocular rosacea might not be easily diagnosed, even by a trained physician. So, if symptoms persist, insist.
What types of rosacea have I gone through?
Since I was a little child, I had these cute rosy cheeks that everyone seemed to adore. Well, now I know those rosy cheeks contained fragile blood vessels. Eventually, when I grew up, some enlarged capillaries became visible (couperose showed up). Years after, the visible blood vessels and redness became more evident.
I would describe mine as a mild case of vascular rosacea. I do not have marked facial redness or get any prominent flushes (upon sun exposure or other potential triggers). My face gets reddish when I run, dance, or get warmer showers or steam baths (I avoid those). But nobody sees that as strange or too much.
I have also undergone papulopustular rosacea. That may be not so odd for someone with oily skin on the T zone (the rest of the skin on my face is balanced, not dry at all) and medical history of severe, inflammatory acne in that same area (beside the couperose).
And I am still dealing with minor ocular rosacea that, honestly, I hope will disappear. I am that optimistic 🙂 By the way, my vision in both my eyes is now optimal.
How did it all start and unfold?
Based on my own experience with those skin conditions, I believe psychological stress can trigger the onset of rosacea. To me, there is a clear link between both. And actually, there is growing scientific evidence that supports that.
Some years ago, in 2014, I went through an incredibly stressful period at work: I sure had continuous cortisol spikes almost every day for months. I had trouble sleeping well, and I was continuously anxious. I was bullied at work consistently and lost my job at the end of that year.
Back then (in 2014/2015), I noticed more visible blood vessels in places where I had not seen those before, like my nose or chin (aka, the progression of vascular rosacea).
I also started getting some bizarre acne spots (that was the onset of acne rosacea). However, since, as an adult, my skin had been prone to acne, I was not too concerned about them.
Later on (in 2015), I realized that my upper eyelids were swollen in the morning when I woke up. Moreover, my right eyelid sometimes remained as if it was “falling” throughout the day.
By then, I used to clench my jaw pretty hard while sleeping (due to post-traumatic stress disorder and nervous tension), so I considered that was the cause of that eyelid phenomenon. Nonetheless, those were the first signs of ocular rosacea.
Fast forward about a year and a half (in 2016/2017), and I got a terrible acne rosacea breakout. Aside from the typical papules and pustules (with whiteheads), the skin on my nose became swollen.
The whole thing was almost as traumatic as the severe acne breakouts from years before. Thanks to the skillful dermatologist that treated me, my skin was under control in about a month or two.
Some months later (already in 2018), I was misdiagnosed several times with conjunctivitis (years later, I would learn it was ocular rosacea instead).
I used prescription eye drops with an antibiotic and a corticoid (tobramycin and dexamethasone). But my right eye did not recover well. Eventually, it started to feel watery most of the time, the “falling” eyelid became aggravated, and that eye looked slightly smaller than the left eye.
Meanwhile, I went to a regular check-up with the gynecologist and had extensive blood work done: all my systems, including my hormonal and immune systems, seemed fine.
At that moment (early in 2019), a new doctor told me that my eye symptoms could be due to an allergy (they prescribed me something for that).
The next doctor said there was nothing to be alarmed about, just a bit of a dry eye. By that time, my right eye’s cornea (the eye globe surface) turned red at times – only it was not red the day I had my medical appointment –.
My acne rosacea was totally under control. That means that my face did not scream rosacea. I did not know then that my journey through doctor’s offices would still take a while.
The next ophthalmologist (at the emergency room) told me she did not know what I had – she only said I did not have a dry eye. And the following one said I had blepharitis (an eyelid inflammation). According to the latter, some standard (non-prescription) drops & cleaning towels were enough, the appropriate treatment.
In the summer of 2019, I had just moved from Barcelona to Madrid. While working in front of my computer, I noticed blurry vision. My right eye used to get dry, and the situation was unbearable.
The following ophthalmologist told me to see an eye surface specialist: thank God! My right eye’s cornea deteriorated due to the constant inflammation and precipitated blurry vision. Additionally, I had excess Demodex mites on my eyelids.
See? Ocular rosacea can lead to additional eye conditions. I am thankful I finally found a doctor who helped me recover the integrity of my right eye’s cornea. But the issues with my ocular rosacea wouldn’t end up there.
The solutions: how did I manage to keep rosacea under control?
Acne rosacea
For my breakout in 2016/2017, the dermatologist prescribed oral doxycycline and topical ivermectin (Soolantra). That helped get rid of the excess Demodex (and inflammation).
She told me to use a peeling with 15% glycolic acid and salicylic acid every night. And when the acne was nearly gone, she recommended me a scrub with salicylic acid to keep the acne-prone areas clear (I used it several times a week). In the morning, I applied a moisturizer rich in squalane and glycerin (w/o fragrance). And sunscreen.
Bear in mind that my skin is pretty oily. Other people with rosacea would probably not tolerate this type of routine. I kept that skincare procedure for months. After a while, I swapped the rich moisturizer for a lighter one (with less squalane and more humectants, such as trehalose).
My skincare routine right now (July 2021) remains similar: only I do not use the peeling every night anymore. I apply it about three nights a week. And I use the salicylic acid scrub just when required, now only once a week (or less).
That may be because recently (in 2021), the dermatologist prescribed me a small dose of oral isotretinoin per week.
Isotretinoin (a retinoid) regulates sebum production and the sebaceous glands within the hair follicles – including those in the eyelids. It also stimulates cellular turnover. Thus, it helps avoid acne-causing microorganisms overgrowth (so I don’t need the salicylic scrub that much).
A tip if you have acne: do not dry your face with a towel. Use clean tissue or gauze instead. That helps keep the acne-causing microorganisms at bay. I still do it.
Ocular rosacea
This part has been the most challenging. My eye surface recovered (by the power of topical anti-inflammatory drops, such as cyclosporine), and my eyelids got cleaner (due to superior hygiene initially accompanied with topical antibiotics).
But, in 2020, my eyes were not well yet. So I agreed with the ophthalmologist on several IPL (Intense Pulsed Light) sessions to treat the rosacea on my cheeks, followed by sebum extraction from my eyelids (aka, a cleanse).
That was supposed to help. But after a couple of sessions, it did more harm than good: I developed a big stye on my right eyelid (I am still dealing with the remainder of it today). Of course, the stye did not help with the overall eye inflammation.
I consulted then with the dermatologist. She prescribed antibiotics: oral azithromycin and topical metronidazole for the lash line. The stye got better fast: after two months, it was almost gone, and the ocular rosacea improved.
I have continued to use metronidazole – I will until there is no rest of the stye. Simultaneously, my eyes keep improving.
Now my right eye bothers me slightly and occasionally. I use some preservative-free hyaluronic acid eye drops when they feel stingy. I also avoid hot showers and certain sunscreens that make my eyes sting.
Vascular rosacea
The redness on my cheeks slightly improved with the IPL (in 2020). But I could only get rid of it (for the most part) after a couple of vascular laser sessions in 2021.
The dermatologist could even aim at some enlarged blood vessels I had close to my eyes. Removing the inflammation around those capillaries has also helped with the ocular rosacea.
I might need some occasional vascular laser sessions in the future. But the situation has improved.
So that’s my journey. I’m happy now! As you can see, rosacea can be challenging. But there is light at the end of the tunnel.
Rosacea skin and eyes tend to be sensitive, and the unexpected triggers and flare-ups can be highly frustrating. It may affect your self-esteem. Also, some of the medical treatments are costly.
I encourage you to find medical help immediately if you suspect you are in that place. And expel from your mind that rosacea is an incurable disease.
I will be pleased to answer any questions below.
Love,
María
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