What Is Rosacea?

Papulopustular rosacea

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:
  1. Erythemato-telangiectatic (persistent redness and telangiectasias = visible tiny blod vessels)
  2. Papulopustular (a.k.a. acne rosacea)
  3. Phymatous (thickened skin, typically of the nose, in Danish also know as ‘strawberry nose’)
  4. Ocular rosacea (eye irritation and blepharitis = infection in the rim of the eyelids)
rosacea 4 subtypes

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

My rosacea flushing

Symptoms

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.

Triggering factors

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.

Papulopustular/Acne Rosacea

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

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

 Treatment options[1]

Medical treatment

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

Laser treatment
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.
 
Cosmetic options
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.”
 
I hope you found this blog post informative. Watch my video The Rosacea Lowdown and My Rosacea Foundation Routine.
 
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.
 
XO
 
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.

7 Comments

  1. Lyssa
    7. November 2016 / 23:39

    Hi, you’re the first case I’ve seen with rosacea looking so similar to mine! I’m a bit of a difficult case though, I’m 22 and I’m 27 weeks pregnant. My skin has become more and more inflamed as the weeks go by. Mostly on my right cheek. It’s the same rosacea you’ve got, and it’s such a pain! In my case, I’m the only one in my family who has rosacea as far as I know. Did you find your rosacea during pregnancy reduced after you’d had your baby? I’ve read that breastfeeding does the same thing though-did you notice any change with that(if you breastfed).
    Thanks

    • 11. November 2016 / 10:08

      Hi Lyssa,

      my papules emerged suddenly (around week 20-something) and untreated they faded after 3 weeks. However, the redness in my cheeks has been persistent ever since. Breastfeeding didn’t affect my skin. Both in my second and third pregnancy my skin has been fairly calm, a little more prone to redness flare-ups and one or two episodes of minor papules. XO

  2. Zari
    10. February 2017 / 20:02

    Nu spørger jeg måske dumt, men hvis jeg får permanent hårfjerning med laser i ansigtet, er det så muligt at dræbe de der mite Demodex Folliculorum.

    Hvad bruger du egentlig af produkter til din hud lige pt? Tror jeg bruger alt for mange.

    Bruger:

    – Kiehl’s washable cleansing milk (rens)
    – rønsbøl skin tonic (er en facemist med niaciamid)
    – Elisabeth arden superstart skin renewal booster (serum med mælkesyrebakterier)
    Og beauté pacific super booster 3 (creme med a-vitamin)

    Har samme rutine om morgenen. Dog bruger jeg enten Kiehl’s ultra facial creme eller clinique Redness solution creme istedet for super boosteren fra beauté pacific.

    Er på SU og føler lidt jeg bruger for mange penge på hudpleje selvom mange af produkterne er drøje i brug.

    På forhånd tak

    På forhånd tak

  3. Katrine
    18. July 2017 / 12:04

    Hi Cæcilie,

    My friend recommended your blog to me, first to learn more about EDC and second, to read about rosecea. About 6 weeks pregnant my cheeks started blossoming – not the pregnancy glow I was hoping for.
    I’m now 18 weeks along and my right cheek is full of bumps and has this not so lovely redness to it. I never used to have problems with redness and my skin has always behaved resonably well. I went to my GP today and he reluctantly prescriped metronidazol 1% creme to me.
    I am wondering if I should start the treatment or wait until the pregnancy is over? My fear is that the redness and bumps will spread or get worse. My real fear is that my skin will look like my moms sister with time- she has a really bad case of rosecea.

    I am minding the sun and taking care og my skin, using many of the products you recommend.

    Thank you for a really informative blog!

    • 18. September 2017 / 13:02

      Hi, sorry I just noticed your comment now. You must near your due date soon? How’s the state of your skin now?
      Metronidazol can be used under certain circumstances, such as when your GP sees the need for treatment. My papulose rosacea flare up (in my first pregnancy) subsided after a few week – without any treatment. My redness on my cheeks has been chronically visible ever since. Just a cosmetics concern that I manage with concealer or foundation.

Leave a Reply

Your email address will not be published. Required fields are marked *