Diagnosed with Rosacea…Now What?

It’s been over a year since my diagnosis with Rosacea and here’s what I’ve learned so far.

But first, let’s take a glimpse into my skin’s past.

I’m no stranger to breakouts…although my teenage years were relatively pimple free, my early twenties was a different story. Sleepless nights finishing assignments, coffee after coffee, and feeling the pressures of adulting…it was a recipe for acne. Cue the new obsession…skincare! Hundreds of youtube videos, reddit threads, and research papers later…I cured my acne.

Do you want to know what my secret was? Graduating college. Ha! Turns out stress was my skin’s main culprit. I’ll write a more in-depth blog about that whole ordeal too soon!

Weird Rash-Like Breakouts Formed

Fast forward to spring of 2023…I’m in a another stressful period of my life…getting married! Just months away from my wedding, I start noticing red splotches and pimple-like bumps all over my face. It was itchy and hot for a few hours and then it would disappear. I thought it could’ve been an allergic reaction but I went to the dermatologist and after approximately 1 second of showing him my photos, he diagnosed me with rosacea.

Initially, I was a little relieved to know that my problem had a name, while simultaneously being overwhelmed with this new diagnosis I knew nothing about. I was prescribed 15% Azelaic Acid and just like that, I was off to figure this out on my own. I didn’t know what my triggers were yet and so my whole beauty cabinet was like navigating a minefield. Which as someone who loves trying new product, this made me really sad. But I was determined to solve this so that on my wedding day, I would have clear skin. And luckily, I did have a rosacea-free face when I said “I do!”

But Spoiler Alert: I didn’t actually figure everything out. And I still haven’t! But I have learned a few things that I’ll share with you in case it helps you. But please remember, everyone’s skin is unique and what has worked for me, may not work for you, and vice-versa!

6 Things I’ve Learned About Rosacea

  1. Simple is best. The simpler the ingredients, the simpler the routine, the better. If you are trying to find potential triggers, go back to the bare basics of skincare. A gentle face wash and gentle moisturizer. That’s it.

  2. Niacinamide is a no-go for me. This is one of those things that if you look at the research states the opposite, but 1 minute scrolling on Reddit will tell you a different story. For me, it’s very disruptive to my skin, but that could be different for you!

  3. My two biggest triggers are alcohol and the sun. Summer time has been especially difficult living in Florida. Everyday spent outside or in the heat, results in a red itchy face with bumps. And with every alcoholic beverage, someone inevitably comments “your cheeks are so flushed!” It’s not the best.

  4. Gentle is better than aggressive. I used to be able to use potent acne targeted treatments, and now, it just aggravates my skin. So now, I opt for products that are approved for sensitive skin and don’t disrupt the skin’s natural barrier and ph levels.

  5. My skin loves oils. In fact, my skin prefers oil over moisturizer. It seems to be a common thread with other rosacea sufferers as well. Just make sure, you choose one that is non-pore clogging, like Squalane.

  6. Prescription Azelaic Acid is a win. At least for the pustules that come with rosacea, but use it gently. For example, don’t apply right out of the shower on raw, hot skin. Let your skin cool down, apply a moisturizer first, then the azelaic acid. Don’t use it everyday at first as it can be irritating! If you can use a lower dose than the Doctor prescribed, go for it!

My Rosacea Approved Skincare Items

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Not pictured is my prescription 15% Azelaic Acid by Taro and my prescription from Curology (tretinoin 0.01%, clindamycin phosphate 1%, and azelaic acid 4%).

What causes Rosacea?

There’s still more research to be done to find out what causes rosacea in the first place, but there are some promising finds I’ll share with you!

Cathelicidins

Cathelicidins are a type of anti-microbial molecule that is responsible for the body's ability to combat illness. Those who suffer with rosacea, not only have more of this molecule but have a different form of it as well. It causes the inflammatory response we see, such as flushing and pustules. But what causes cathelicidins to be different in rosacea patients? Read below.

Mast Cells

Mast cells play a direct role in the activation of certain types of cathelicidins when exposed to a neuropeptide called PACAP. Mast cells then produce enzymes that trigger the production of cathelicidins. PACAP also induces the release of histamine from mast cells.

So here’s the hypothesis breakdown so far…

An external stimuli activates your sensory nerves, causing the release of neuropeptides which then induce cathelicidin production in mast cells. Activating sensory protein receptors and initiating the inflammatory response seen in rosacea flare-ups.

This might be why some rosacea patients, including myself, see relief of symptoms when taking an anti-histamine, like Claritin.

It also could explain why following a low histamine diet can be beneficial, although it’s really not realistic long-term.

It also begs the question…is Mast Cell Activation Disorder (MCAS) and histamine intolerance related to all of this?

But what is causing this?

Gut Issues

The gut-skin-brain axis is real. AKA if you experience gut issues, you most likely have issues elsewhere in your body, like your skin. Some examples of gut issues would be SIBO, IBS, IBD, Crohn’s Disease, and Ulcerative Colitis.

Studies show that rosacea patients have significantly higher prevalence of having SIBO than the general population. After treatment of SIBO using the antibiotic rifaximin, rosacea patients saw an almost complete regression of their rosacea symptoms for at least 9 months!

What’s also interesting is that SIBO has been shown to be strongly correlated with MCAS and histamine intolerance.

Everything is related!

In Conclusion

Reflecting on my journey with rosacea over the past year, I've learned that managing this condition is all about trial and error. From embracing a minimalist skincare routine to identifying personal triggers, I've found that simplicity and the shade are my friends. While I haven't uncovered all the answers, I’m hopeful that the research will continue to expand! Understanding the potential underlying causes, such as gut issues and histamine intolerance, has been enlightening to say the least. To anyone struggling with rosacea, remember that everyone’s skin is unique, and finding what works for you is key. Here's to feeling good in our own skin!

Sources:

https://www.rosacea.org/patients/causes-of-rosacea/innate-immune-system

https://www.rosacea.org/patients/causes-of-rosacea/demodex-mites-and-microbes


Thanks for reading!

xoxo,
Hannah

 
 

I’m Hannah!

A homebody who strives to make the world a little more beautiful through design, fashion, & art.


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