Feeling flushed and frustrated? Canada’s top skin experts offer their advice for relieving your rosy cheeks.
No, I haven’t been on vacation. I haven’t been skiing or lying on a
beach – and I have not been drinking. My face is just red. It’s red
when I step out of the shower, have a hot cup of tea or some spicy Thai
food. It’s red when I exercise, when I’m excited or stressed, when it’s
hot, cold or windy. My face is just red. And so are the faces of the
two million other Canadians who have rosacea.
I’ve always been a blusher, but at first it didn’t bother me.
I never needed to resort to rouge and thought my persistently pink
cheeks looked rather healthy, in an outdoorsy kind of way. But then the
red began to spread. By age 22, my skin constantly looked irritated,
and somewhat sunburnt. It was blotchy and bumpy and anything I put on
it, from cleanser to sunscreen, only made matters worse. The first
doctor I went to treated me for acne, the second, for eczema. Finally,
when I was 24, a dermatologist diagnosed me with rosacea. I was told
rosacea is a common, chronic and progressive skin disorder for which
there is no cure.
“It
seems to be fundamentally a vascular problem,” says Dr. Richard Thomas,
a Vancouver-based dermatologist. “Essentially, if you never blush, you
probably don’t have rosacea. Quite often people with the disorder can
remember blushing since childhood.” While it’s an extremely frustrating
condition, it can also be quite serious. About 58 percent of sufferers
develop ocular rosacea and may have dry, itchy, watery eyes or swollen
eyelids.
If left untreated, rosacea can cause permanent
disfigurement to your face, impair your vision and, in rare cases, even
lead to blindness. Fortunately, it is a condition that can be
effectively treated and controlled.
Rosacea can affect anyone between the ages of 20 and 70, although it
tends to be more common in women and those with fair skin. “There are
still a lot of unknowns with rosacea,” says Dr. Paul Cohen, a
dermatologist in Toronto. “We don’t really know what causes it, other
than it’s often genetic and tends to occur in certain skin types. The
first thing you need to do is confirm the diagnosis – just because you
flush easily doesn’t mean you have rosacea.” Other conditions, such as
acne, lupus and dermatitis, have similar symptoms.
Generally, you should see a dermatologist if:
- you find yourself flushing in response to common
rosacea triggers, such as hot beverages or extreme temperatures, and
your cheeks, nose or chin regularly appear red.
· your face is easily irritated by skincare products and often feels
itchy or hot.
- you develop pimples in the form of small, red, solid bumps
(the “acne” associated with rosacea seldom appears as blackheads or
whiteheads).
- your eyes feel gritty and often appear bloodshot.
- you notice tiny blood vessels (telangiectasia) appearing on the surface of your skin.
As
the condition progresses, your skin may become permanently red.
Eventually you can develop rhinophyma (a problem more common in men) in
which fleshy bumps form on the nose, giving it a bulbous appearance.
“Most
people in the early stages of rosacea are simply at the level other
people apply blush to get to,” says Dr. Anne Curtis, head of the
Dermatology Laser Centre at Sunnybrook and Women’s College Health
Sciences Centre in Toronto. “The problem is, as the years go by the
pinkness deepens. The blood vessels that have been asked to open over
and over again each time you flush start to stay open and enlar ge to
the point where you can see them on your face.” Curtis says this is
usually when people seek medical attention.
Talking Treatment: The
sooner you seek help for rosacea, the better your chances of slowing
its progression. "Historically, when dermatologists treated rosacea it
was just 'avoid the things that make it worse, '" says Dr. Lisa
Kellett, a laser surgeon and cosmetic dermatologist in Toronto. "I
always laugh at that because they're things like wind, cold, heat and
exercise - so what are you supposed to do all day?" While she says it's
important to identify your individual triggers, there are now better
solutions than hiding out at home. Kellett says there are primarily
three treatments for rosacea sufferers: topical, oral and laser. Tried
individually or in combination, they can help relieve some symptoms and
possibly prevent the disorder from getting worse.
Topical: When I was
first diagnosed with rosacea, I was prescribed a topical antibiotic and
told to apply it to my face twice daily, something I did religiously
for about seven years. There are basically three to choose from:
metronidazole, sodium sulfacetamide and azelaic acid, all of which do
essentially the same thing. "Topical treatments are pretty effective if
you have mild to moderate acne associated with your rosacea," says
Winnipeg-based dermatologist Dr. 'Victoria Taraska. "That component
we're very good at treating and controlling. Where we're not as
effective is with the redness and flushing - that's the most difficult
part to manage." I personally didn't notice much change to my skin with
the topical treatment and recently stopped using it, something Curtis
doesn't recommend. “Although some people don't notice a striking
improvement, we tend to encourage them to keep on it anyway," she says.
"We hope that we're at least slowing the p rogression, even if we
haven't made a huge impact on reversing things."
Oral: Oral
antibiotics, such as tetracycline, are another treatment option, and
one I have yet to try. They are usually effective at relieving more
severe acne symptoms associated with rosacea. Some also have
anti-inflammatory properties that may relieve redness. "If a patient
has severe redness, I might put them on oral antibiotics for two to
three months to see if their skin responds," says Curtis. Sometimes you
can maintain any improvement you experience from the oral an tibiotics
with topical treatments, she adds. Oral antibiotics are also used to
treat ocular rosacea.
Lasers & light: About
four years ago, I was horrified by the appearance of small, bright red
blood vessels on my cheeks and chin. Although friends and family said
they didn't notice them, I wanted them gone. That was when I went for
my first laser treatment, which worked for a while. "With laser
treatments, you're turning back the clock, but never stopping it," says
Curtis. If you decide to try lasers, you may have to repeat the
treatment every few years. I recently decided it was time for another
round and was surprised at how much had changed since my last laser
experience. “The nice thing about lasers now is they don't have to
bruise," Kellett told me during our initial consultation. "You may be
red afterwards and it may last for a couple of days, but I treat
newscasters in the morning, then see them on the evening news."
She
explained there are a number of options for rosacea suffers, including
Intense Pulse Light (IPL) and Pulsed Dye Lasers (PDL). "For someone
like you I'd use the V-beam (a PDL) to combat the redness," Kellett
told me. An IPL uses a band of light and can target different colours,
such as the red in blood vessels, or the brown in freckles. A PDL is a
single wavelength that can be adjusted for different durations to get
rid of background redness or to target individual blood vessels.
When I first had a PDL treatment a few years ago, I was left
with small, raised purple bruises scattered across my face, which
disappeared in a few days. This time, I went to work immediately
afterwards with what looked like a mild sunburn. The treatment itself
took only a couple of minutes. I simply strapped a pair of goggles over
my eyes while Kellett explained the procedure. "The laser will spray
you first with a cryogen spray that cools the surface of your skin. It
still allows the beam to hit the blood vessels underneath and heat them
up enough to close them off," she said. "There is no bruising and
damage as the superficial layer of the skin remains intact. It feels
snappy, and it's bright, but it's not that bad." To me, the procedure
felt like a series of tiny pinpricks from a really cold needle. Because
laser treatments are gentler than in the past, it can take anywhere
from one to five sessions once a month for complete results.
Costs
range from $300 to $700 a session, depending on what you're having
done. Risks are few, but in rare situations there can be scarring or
pigment changes. "You just want to make sure you go to someone highly
qualified who does it all the time," says Kellett. She adds that there
may be other benefits to laser treatment - you may notice your pores
appear smaller afterwards or, in some cases, the appearance of fine
lines may be reduced. "With repeated treatment you're actually getting
some stimulation of collagen in the deeper layers," explains Curtis.
"So you're getting a side benefit of rejuvenation at the same time,
although it's very subtle."
From day to day:
Regardless of what stage your rosacea is at and whether or not you’re
being treated for it, what you do to your skin on a daily basis can
make a big difference in both its appearance and the rate at which the
condition progresses. “Rosacea is a chronic problem that will wax and
wane,” Cohen says. “It’s important to be educated about potential
triggers and adopt habits that will help prevent your rosacea from
flaring.” This may mean revising your skincare regimen. “Basically,
it’s about avoiding a lot of things, such as strong exfoliants,” says
Kellett. “Look for products that are made for sensitive skin – although
even then it doesn’t mean you aren’t going to get red. A lot of my
patients turn red just from washing their faces with water.” She
recommends doing a patch test with products before spending money on
them. Get a sample and apply it to your arm three times a day for three
days. If nothing happens, repeat the test, but on your jawline. If
you’re still okay, buy the product.
Fortunately, there are many ingredients that can be calming to
rosacea-prone skin. "Keep things simple and use products with
anti-redness and anti-inflammatory properties," says Leanne McCliskie,
education manager for the International Dermal Institute's education
centre for skin therapists in Toronto. Some of the ingredients she
recommends include aloe vera, chamomile, lavender, red raspberry,
Canadian willowherb and avena sativa (oats). "Antioxidants, such as
vitamin C, are also good because they fight free radicals and can
protect your skin from further damage," she says. As for daily care,
McCliskie says there are three important steps to follow: cleanse,
moisturize and apply sunscreen. "Start with a gentle cleanser that is
pH balanced so it won't strip your skin of natural oils. Then apply a
moisturizer to restore and protect your skin's barrier function,
followed by sunscreen - rosacea can be aggravated by the slightest sun
exposure."
Off to the Spa: For
many women, fitting in a regular facial is an important part of their
skincare routine. Although I’ve noticed a growing trend in “rosacea
facials,” I’ve been reluctant to give them a try. Many years ago I had
an unfortunate experience that left me looking as though I’d had a
close encounter with a swarm of bees. My dermatologist at the time told
me to forgo facials, and I hadn’t had one since. But McCliskie says
rosacea sufferers shouldn’t be denied the benefits of facial
treatments, which can help protect the health and integrity of skin.
“People tend to think of them as a luxury, but they’re a necessity,”
she says.
She recommends having a treatment about every six to
eight weeks. “Skin cell turnover is about one a month, so that’s when
it is important to have a deep cleanse.” Just ensure the person
performing the treatment has the training required to recognize and
respect your condition. McCliskie says there should be a detailed
consultation prior to the treatment, as well as a follow-up afterwards.
“It shouldn’t be just ‘Lie there and relax.’ It should be about passing
knowledge on to the client.”
When I had a treatment with
McCliskie, she did a through assessment of my skin beforehand and told
me that a pressure point massage would be good as it wouldn’t
over-manipulate my skin or increase blood flow like a regular massage.
She also didn’t use hot steam, hot cloths or heavy creams and used a
microfoliant, which is gentler than an exfoliant. Your face shouldn’t
hurt or be red at the end of a treatment, McCliskie says. And, to my
delight, it wasn’t.
Red relief: Now that
I’ve resumed laser treatment and learned more about the other options
available to me, I’m hoping that by next year’s holiday festivities I
won’t be preparing for parties while worrying about what shade my skin
might adopt for the evening. Maybe for the first time I won’t be so
flushed that others end up asking me if I’m feeling all right, or if
I’ve had too much to drink. In fact, maybe next year I’ll even have to
apply a little rouge.
From Glow Magazine, Winter 2004/2005, text by Sydney Loney
