‘I would sit in front of the mirror in the morning and cry. I felt I looked dirty and I was worried that people would think I didn’t wash.’
Frances Batten, 33, is a medical secretary and mother-of-three from Somerset.
Having never had any issues with her skin before, she was diagnosed with rosacea in 2015.
‘What they didn’t tell me was that this was just the beginning of a horrendous journey that ended with my skin literally bubbling and blistering all over my face, so that I looked like I had been attacked by a swarm of bees,’ she recounts.
Rosacea went on to take over her life, leaving her depressed and lacking in confidence.
But she was far from alone. Rosacea affects approximately one in 10 people in the UK, with cases have risen over the course of the pandemic, making it the country’s most searched for skin condition.
The condition has the potential to have hugely debilitating results.
It’s a long term condition that is characterised by redness that comes and goes, usually on the face.
It’s most common in white skin but for people with non-white skin, symptoms may present differently and can include hot skin, burning and/or stinging, unidentified discolouration of the face, or dry patches of skin that appear swollen.
This can make it harder to get a diagnosis.
‘The first signs of rosacea are usually redness across the cheeks, nose, forehead and chin,’ explains Leading Consultant Dermatologist and founder of Dr Ophelia Skin, Dr Ophelia Veraitch.
‘It can also manifest as tiny, broken blood vessels that don’t go away and/or small pink or red inflamed bumps that sometimes contain yellow liquid inside.’
Other symptoms can include: dry skin, swelling, especially around the eyes, yellow-orange patches on the skin, sore eyelids or crusts around roots of eyelashes – this could be blepharitis, for which you should see an optician, and thickened skin – mainly on the nose.
This chronic condition can be very difficult to treat, as it is different depending on the individual.
Why have rosacea flare ups increased?
Rosacea has been exacerbated during the pandemic due to various factors.
‘For example, stress is a well known aggravator of many skin diseases, including rosacea, explains Dr Mark Hudson-Peacock, consultant dermatologist at Canterbury Skin & Laser Clinic.
‘And we all know how much higher general stress levels have been during the pandemic. Stress can also lead to changes in behaviour including smoking more and drinking more alcohol.’ These are all stressors.
‘The mask wearing of the last two years has also taken its toll on many skin conditions, and rosacea has been one of them,’ continues Dr Hudson-Peacock
‘The increased warmth and humidity under the mask, the frictional effects of the mask rubbing on the face, and the reduced amount of sunlight hitting the face may all have influenced the activity of rosacea in those individuals with the disease, and might have contributed to new cases presenting as well.’
This was certainly the case for Sarah, aged 35, from Glasgow.
She had never had any issues with her skin before, yet in May 2020, she found that her skin was often flushed and hot.
‘A couple of months into the pandemic, I noticed that my cheeks were always really red and warm to the touch.
‘At that point, I was really stressed because of targets at work and the pandemic. It was also a heat wave and, as well as wearing masks, I was out in the sun a lot.’
All of these things can be triggers for rosacea.
Since then, Sarah has had an official diagnosis of rosacea from a dermatologist, but she had to go private for this, after her doctor prescribed her an acne cream that she found out could have exacerbated the problem, after doing some research online.
‘It’s uncomfortable and I do feel self conscious about it as it looks like small broken veins, rather than just redness. I feel like it ages me.’
What causes rosacea?
The causes of rosacea are largely unknown, which is hugely unhelpful, but there are many known aggravators including sun, diet, lifestyle and environmental factors – from spicy food and alcohol to UV light and a change in temperature.
Stress is also another major factor, causing up to 79% of flare ups, and women tend to suffer from rosacea more than men.
It is worth paying attention to these triggers, and treating early.
‘Rosacea can burn itself out in some but can certainly get worse in many,’ explains Dr Hudson-Peacock.
‘This is especially likely if the triggers are not addressed and the many treatment interventions not embraced as required, to dampen down the inflammation.’
According to skincare brand Bossface, genetic predisposition is also a major factor, with one in three people who seek treatment for rosacea having a family history.
Another factor in women can be hormone imbalances, often as a result of pregnancy, menopause, or use of birth control pills.
And, for some, it can be worse in winter.
‘Sudden changes in temperature is one of the triggers for Rosacea,’ explains Dr Veraitch.
‘Low temperatures cause the blood vessels in the skin to contract, to preserve the temperature in the core of our body.
‘When you then go inside to a warm, heated environment as is often the case in winter, then you get a rebound dictation of these blood vessels which can look like flushing and feel like burning.’
‘The presence of Demodex mite on this skin is also implicated.’
Research has found that Demodex mites are found much more frequently in rosacea patients than those without the condition.
It’s thought that these most likely multiply in the environment of increased blood vessels and the connective tissue changes of rosacea.
This can also cause eye problems.
‘I felt like people were staring at my face’
As well as the physical discomfort, rosacea can have a huge impact on people’s day-to-day lives and mental health.
‘I have witnessed many people with lowered self-esteem when suffering from symptoms of rosacea,’ says Sarah Donaldson, founder of Sarah Louise Aesthetics and independent nurse prescriber.
‘Rosacea does not discriminate in terms of age, ethnicity or gender, therefore we have witnessed an influx of younger patients presenting with increased concerns over changes in their skin that have not been present before,’ she continues.
‘In today’s society where image and complexion are the pinnacle focus of our online world, clear and radiant skin has never been so highlighted as a perception of beauty.
‘When people are confronted with rosacea type skin conditions it can create severe self-confidence issues and image insecurities, in all demographics.’
For some, it can be debilitating.
One of Sarah’s clients is Hazel, aged 65. Her rosacea started in her mid-40s, after sadly losing her whole family.
‘The stress of dealing with it all was just too much,’ explains Hazel.
‘I got fibromyalgia first, but then I noticed my face was always bright red. I was sent to dermatology, where they discovered I had lupus. This caused the rosacea.’
Hazel was given laser treatment, which she didn’t respond well to and which ultimately, made her condition a lot worse.
I stopped going out because I didn’t like the way I looked,’ she says. ‘If I did have to go out, to the shops or something, I would pull up my hood and put my head down, so that nobody could see my face.
‘I felt like people were staring at me, wondering why my face was like that,’ she says. ‘I used to have to get a taxi to go anywhere as I didn’t want to go on pubic transport, in case anyone saw me.’
The mental impact of this was devastating for Hazel. However, in 2017, she finally got help, when she went to see Sarah, who offered her effective treatment in the form of chemical peels.
She couldn’t believe it but they worked.
‘I’m so grateful as it made me feel like I had my life back, and I could go out and see friends and family again. I even got married in 2018.’
‘The doctor told me that my flareup was because of stress’
For Frances, the condition ‘erupted’ when she started a new job, on top of having three young children.
‘After diagnosing me with rosacea, a dermatologist told me that the sudden flare up was likely due to stress.
She was prescribed two types of topical antibiotics that didn’t work and was then put on an oral antibiotic called Tetracycline.
‘Eventually it did clear up my rosacea although I was left with very dry skin on my forehead,’ she says.
However, at the start of 2016, Frances’s mum was diagnosed with terminal liver cancer and four weeks later she died.
‘After my mum’s death, which came as a real shock to all of us, I had a second flare up of rosacea that was about 80% worse than the first one,’ she explains.
I took two more courses of antibiotics and this time my skin did not improve. It seemed to be getting worse, not better.’
By this stage, Frances’s nose was so swollen that she could see it in her vision.
‘By now I looked like a burns victim and my skin was so sore it hurt to even smile,’ she says. Her rosacea was ruining her life.
‘I would sit in front of the mirror in the morning and cry. I felt I looked dirty and I was worried that people would think I didn’t wash.
‘I lost all my confidence. Looking back, I was clearly very depressed. I was crying most days. I felt helpless and hopeless.’
Finally, her sister came across Kalme products, a range that was free of chemicals and made with capers.
‘She’d just read about them in an article on rosacea and was insistent that I try them.
‘It took about four to six weeks to completely clear my skin. The results were incredible.’
Finding a treatment that worked has changed Frances’s whole existence.
‘Rosacea might only be a skin condition, but it effects every aspect of your life and for naturally shy people like me, it’s impact is devastating,’ she says.
How to treat rosacea
It’s clear that, untreated, rosacea can have a huge impact on the lives of its sufferers. So where to begin?
Start by identifying any triggers – such as spicy food or alcohol – and avoiding those. It is also advisable to wear at least SPF30 every day and make sure you’re keeping well hydrated.
There are lots of products out there for rosacea – it can just be difficult to find the right one.
Dr Mark Hudson-Peacock explains that patients with rosacea typically have sensitive skin that can be irritated easily, by many products.
‘It is important to find products that have been designed to help those with rosacea with typically sensitive skins and there are many out there to explore,’ he advises.
‘These do not need to be expensive, although can be depending on what brands you seek out. More expensive does not necessarily mean better.’
‘Usually we advise patients to stay clear of any products that have alcohol or perfumes that could irritate this skin and compromise the barrier of the skin,’ adds Sarah Louise.
‘Make up wipes are a big no-no for patients with rosacea. In substitute we suggest using gentle cream cleansers to remove make up and cleanse clean skin.’
Rebecca Dallimore, founder of natural skincare brand Scintilla suggests using ingredients such as Aloe Vera, Cucumber extract and Avocado oil, all of which contain antioxidants, enzymes and vitamins that cleanse, revitalise and calm upset skin.
‘And, using a cleanser and face cream after potentially irritating circumstances such as sun exposure, exercising and sweat, alcohol or even menstruating, gives a dose of kind ingredients that will help keep redness and discomfort down,’ she advises.
If in doubt, it is always preferable to seek the advice of an expert in the diagnosis and treatment of rosacea.
Help is out there – but, if your GP can’t help, it could also be worth considering going to a specialist dermatologist who may be able to offer alternative, cosmetic treatments.
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