Papulopustular rosacea during my 2nd trimester of my first pregnancy
Rosacea is a common chronic inflammatory skin condition affecting the face.
It is characterized by flushing, redness, pimples, pustules, and dilated blood vessels also called telangiectasia. People with rosacea often have irritated and highly sensitive skin, reactive to skincare products and makeup.
Before we break down the four subtypes of rosacea, let’s have a look at whom it affects.
Who’s the lucky bunch?
If you are fair-skinned woman in your thirties and your mother has it – then bingo! And oh, that’s me :-/
It’s more common in women than in men, and most frequently observed in fair-skinned individuals, especially of Northern European and Celtic origin. It affects one to ten percent of this population. So look around in your class or your work place, then at least one is suffering from rosacea.
Typically rosacea appears at the age of 30 to 50 and is associated with familial predisposition. So if your mother has it, then you are likely to get it too, but the genetic basis of rosacea remains unclear – that’s doctor-lingo for “We haven’t figured it out juuust yet”.
You are not alone! (WARNING: following section contains distressing details)
You might think that I now would refer to a support group for rosacea patients. But no.
Let me warn you, this coming section is not for the faint hearted:
The mite Demodex Folliculorum living in our hair follicles
The mite Demodex Folliculorum is considered to play a role in the pathogenesis of rosacea.
Demodex mites live in the hair follicles – in everyone – yes, in your hair follicles too! However people with rosacea have a significantly higher density of these charming bastards in their skin. The theory is, that the presence of these mites stimulate inflammatory reactions in the skin, hence the above-mentioned symptoms.
So when you feel your nose itch at night, then it’s just a little Demodex crawling from one hair follicle to another.
The four subtypes
Rosacea is divided into four subtypes:
- Erythemato-telangiectatic (persistent redness and telangiectasias = visible tiny blod vessels)
- Papulopustular (a.k.a. acne rosacea)
- Phymatous (thickened skin, typically of the nose, in Danish also know as ‘strawberry nose’)
- Ocular rosacea (eye irritation and blepharitis = infection in the rim of the eyelids)
The 4 subtypes of rosacea
I’m going to focus on the first two and most common subtypes.
Oh the joys of erythemato-telangiectatic rosacea
This tongue twister is the subtype I suffer from – in a mild form.
I’m predisposed to rosacea because my mother has is (this subtype as well) and my oldest big brother has the ocular subtype.
My rosacea flushing
People with erythemato-telangiectatic rosacea experience persistent redness of the central face (cheeks, nose and around the nostrils) and flushing. It’s is often followed by a warm, stinging and tingling sensation in the skin.
Flushing is typically triggered by heat, physical activity, alcohol consumption, sun exposure, emotional stress and spicy food. In the picture above, the flushing was stimulated by mechanical friction on my skin. See it happen here, in me My Rosacea Foundation Routine video.
Me in a nutshell… So after my 10 kilometres morning bike ride in the rising sun, I’m all flushed, radiating like a red light bulb. After three sips of alcohol I have purple-pink cheeks all the wrong places, which no foundation can cover. If I get nervous, I feel the redness blooming in my face like unwelcome weed.
Papules and pustules = lumps and bumps characterize this subtype. The papules and pustules arise due to the presence of a vast amount of inflammatory cells and factors around the hair follicle. And this strong respons from the immunesystem is thought to be an reaction towards the mite, Demodex Folliculorum, living in the hair follicles. Cute!
The inflammation around a hair follicle creating the papules and pustules. Present are inflammatory cells and inflammatory factors.
Papulopustular rosacea can be misdiagnosed as regular acne, however unlike regular acne, comedones (clogged pores) do not occur in rosacea.
My rosacea manifested as this acne form. It appeared out of the blue in the middle of my pregnancy with my first son. I consulted Professor Robert Gniadecki (professor in dermatology) who hypothesized that the sudden onset could be caused by the hormonal changes in my body. The lumps and bumps gradually faded away after 10 days, and I received no treatment.
Papulopustular rosacea during my 2nd trimester of my first pregnancy #nofilter
Especially aimed at moderate to severe rosacea, prescription creams such as metronidazole, azelaic acid, and doxycycline are recommended. The ocular rosacea is treated with cyclosporine 0.5% ophthalmic emulsion. See some impressive before/after photos here: http://www.rosacea.org/patients/treatmentphotos.php
The visible blood vessels and the underlying redness can be treated with laser or intense pulsed light therapy, however it often requires several sessions and later touch-ups as the skin condition continues to develop.
Products with green or yellow undertones can counteract the visible redness. However, I don’t use green or yellow primers, I prefer to use a medium to full coverage foundations and reapply the foundation in the areas needed. However, I haven’t found a foundation yet, that can cover my rosacea 100%. My flushing always shines through.
General skincare options
I personally prefer perfume and paraben free skincare products. Read my blog post on How to Manage Sensitive Skin and Sensitive Skin – Skincare products I Use to find recommendations for sensitive rosacea skin.
And as recommended by the National Rosacea Society:
”Non-soap cleansers may be the best option – they contain less than 10 percent soap, rinse off easily, and have a neutral pH that is closer to the natural pH of the skin. Washing with lukewarm water and blotting the face dry with a thick cotton towel may also minimize irritation.”
And read my latest edit My Skincare Routine, where I, step by step, go through the products I prefer to use to take care of my skin.
Caecilie Johansen (Medical doctor, Copenhagen, Denmark)
1. Odom R, Dahl M, Dover J, et al. Standard management options for rosacea, part 2: options according to subtype. Cutis2009;84:97-104.