What is rosacea and can you overcome its incurability?



“Why are you blushing?”

Walking through my high school’s corridors, it wasn’t uncommon to see a face spotted with acne. I felt comfortable among my peers because I knew I wasn’t alone in my suffering. This was until I was approached by one of my teachers for not taking ‘proper’ care of my skin.

She ranted and raved about the necessity of sun safety and the horrors of ageing that would appear if I “continued this behaviour”. I was confused and embarrassed; why was I the only one being called out? What was different about my experience of teenage acne?

Looking for more skincare recommendations? Head over to our Beauty section.

Following this public roast, I suffered extreme anxiety over my skin. It was rare for me to go anywhere without caking on makeup to mask the redness that flushed my cheeks. If I caught myself in a mirror, I would spend hours examining and prodding my enlarged pores, tiny red pimples and visible blood vessels. And when I experienced a flare-up that mimicked a brutal sunburn, I wouldn’t leave my room. 

My mother deemed it hormonal acne and attempted to explain the problem away. After much convincing, I finally saw a doctor. What we thought could be solved with some expensive skincare and birth control was actually the incurable skin condition rosacea. Common rosacea triggers are certain foods and beverages, emotional stress/anxiety, vigorous exercise, and heat. People often mistake rosacea for acne, eczema, sun damage, or an allergic skin reaction

As I’ve gotten older, I’ve learnt how to minimise flare-ups and practice good skin hygiene. I’m yet to try laser treatments or prescriptions in fear of wasting money on the impossible, so I spoke with Melbourne-based dermatologist Dr Belinda Welsh to better understand rosacea and whether treatment is achievable. 

Right off the bat, Dr Belinda tells me that rosacea is difficult to detect in patients because there are no diagnostic tests to identify it. “In 2021, we still don’t understand rosacea in terms of its pathophysiology as well as we would like. The definition of rosacea is still evolving, and the classification is still evolving.

“The other thing that’s been more of interest in the last few years is this concept that there may be other conditions that are associated with rosacea. There does seem to be associations with bowel conditions, the cardiovascular and the neurological, but exactly how these tie in is unclear. Is rosacea skin limited? Or, is it a marker of more systemic inflammation?”

Many people with rosacea tend to look both inwards and outwards in search of a cure, but there’s no clear solution to date. With this information in my pocket, I decided to ask Dr Belinda the pressing question: is rosacea at all curable? 

She sighed and answered with honesty. “We can’t cure it, but I can definitely manage it to get it under control. It takes time and patience and sticking to the plan, but we can get there. Optimism is number one in its treatability.” 

Rosacea is a phenotype, meaning that it’s variable and will present differently in each individual. A dermatologist can help you determine your specified plan of attack, but Dr Belinda has provided me with some general steps on practising good skincare and minimising those embarrassing flareups. 

“Yes, skincare is really important. But because rosacea skin is already inherently sensitive, people often inadvertently make it worse by the things they are putting on it in an absolute desperate attempt to calm it down,” she explains. Because of this, Dr Belinda often supplies her patients with a four-step plan:

  1. Education. Learning how to minimise flare-ups by avoiding direct contact with sunlight and understanding good gut health.
  2. Minimise and simplify your skincare. Dr Belinda suggests stripping it back using a gentle cleanser (like Cetaphil or the La Roche-Posay Toleraine range) and sunscreen (must protect against UVA and UVB). Then, you can put makeup on if you like. And in the evening it’s a gentle cleanser and a simple moisturiser. 
  3. Control the inflammation with medical treatment. Her favourite? An oral antibiotic like Doxycycline in combination with a topical product like Soolantra.
  4. If your redness persists, it can be addressed with laser treatment. 

Despite this nifty list, people are still disheartened when they don’t see immediate results. In fact, studies state that three out of every five people with rosacea avoid face-to-face contact because the emotional effects of the syndrome are so crippling. 

“Rosacea can have devastating impacts on people’s quality of life. [It can impact their] self-esteem, confidence, professional interactions at work, depression, anxiety [and result in them] feeling stigmatised because of their appearance,” Dr Belinda tells me.

“It’s [seeing a therapist about your mental health] worth trying to pursue because I think when you start getting stressed about your skin, it becomes difficult to break the cycle. There’s no easy answer, but it’s not like it’s a condition we can’t treat. People need to actively seek help because there are options and treatments.

“If you go to your general practitioner, you can get 10 sessions of counselling and sometimes controlling anxiety from a psychological point of view can control your flushing. Get enough sleep and wear makeup if that gives you some level of confidence,” she suggests.

And if you’re worried about navigating makeup as a rosacea sufferer, Dr Belinda has given it the all-clear. “I’m fine with any makeup that works for you and doesn’t irritate your skin. There’s no kind of serious rules around it.”

Rosacea may be incurable, but that shouldn’t leave you feeling doomed. Like Dr Belinda says, “optimism is number one in treatability”, and many treatments exist that can help you minimise flare-ups and bid farewell to skin anxiety. So, let’s suss out our management plan. 

To learn more about rosacea, head here.

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