Rosacea: Why Me? Why Anybody? - Sydney, Australia
I was diagnosed with Rosacea recently, and it is...
The structure of this review
So I only recently made this review, but I've had rosacea for a number of years now, although I was only diagnosed with it by a dermatologist just last month.
In light of this, I will first do some backtracking and share my story, before I go into the treatments I have tried, ever and recently.
In fact, I had actually written up a 6 page document detailing the history of my skin, and how I got to be where I am right now. This is a Microsoft Word document, with footnotes, so when I get back home, I will try to upload the whole thing onto this site, if it will let me. In that case, everyone here will be able to read the entire document, footnotes included. If I cannot upload the whole thing as a single document, I will copy and paste the text into an update, but that way no one will be able to read the footnotes.
One last note before I hit post: this review is more like an online blog about my experiences with rosacea. I know realself.com is all about reviewing treatments, and I will be reviewing my treatments, but that will not be the main purpose of this review. That is because stories about my treatments will not be that exciting. Laser is out of the question at this point; it is far too expensive. The main purpose of this review is just simply to share my experiences of this horrible condition with others in the community, in the hopes that I may help some people.
As mentioned before, I will be backtracking until I get up to events of the present day. I am still actively looking for a treatment, and seeing plenty of dermatologists and doctors about this, so there is still plenty of up to date stuff to write about.
Also, for those of you reading this who have an unwanted tattoo and are considering laser tattoo removal treatment, be sure to check out my very own review on that too, which I started earlier this year. I think you can click on my username, which will take you to my page here on this site, and then you can click on my laser tattoo removal review called "Laser Tattoo Removal; Small Dense Black Chest Tattoo; Asian Skin".
The Story of My Face - June 9 2014
For the impatient reader, I will roughly describe the problem here before I go into how it came to be. It is important to note that my skin has not always been problematic. This problem is characterised by extreme but localised flare-ups of the rawest, deepest red and swelling on both my cheeks. It is accompanied by sensations of burning and stinging, as well as a feeling that my cheeks are somehow foreign to the rest of my face. The symptoms occur spontaneously and typically last for hours. At its worst, they do not subside for days. The initial occurrence of these symptoms is sudden, and as yet, unexplainable. Symptoms generally improve gradually over several months, but leaves behind splotches of redness, slight swelling and different skin texture in the affected areas. These splotches are, as yet, still unexplainable also. Gradually, the splotches fade from red to dark purple and/or brown over the course of years. However, another flare-up will once again start the aggravating cycle and thus bring the same symptoms all over again.
Now for the patient reader, I will outline as best I can how this all came to be . One day when I was 14 (in 2009), my face broke out with huge (about 1 cm in diameter) boil-like pimples on both my cheeks . I have no idea (or no recollection) of what caused this break out .
My mother bought me some acne medication from the pharmacist . As I recall, it was OXY 10. Although the product may have changed in the years since I used it, here is some information on the product taken from a pharmacists’ website :
Contains 10% Benzoyl Peroxide
…Initially apply cream to a small affected area once a day for the first two days. If no discomfort or reaction occurs, apply up to twice a day.
CAUTION: …If excess swelling, irritation, redness or peeling occurs, discontinue use. If these persist, consult a physician. Avoid excessive exposure to sunlight and other sources of ultraviolet (UV) light. Avoid prolonged use of this medication without consulting a physician…
Initially, this product seemed to work for me . However, I did not exactly follow the directions of use. I did not do a test patch and applied it extremely liberally , all over my cheeks, possibly for 2 or 3 days.
Some days later , I had a shower and experienced intense itching on my face. I felt my face, and was surprised to find that it was smooth. I thought immediately that the acne medication worked, and I was now pimple free (as I could not feel any pimples). I then liberally scratched the itch on my face.
When I got out of the shower and looked in the mirror, I saw that my face had turned bright red and had swollen immensely. I had no idea what had happened, but I reasoned that the acne medication was probably responsible. I also had no idea what the problem actually could be.
The redness and swelling at the time was characterised by a few noteworthy features. My face would look red raw and angry, puffy and swollen. Small white pimples also appeared on top of the red skin . The affected areas felt foreign and heavy, and a stinging and/or burning sensation would accompany .
In the following weeks, I may or may not have seen my General Practitioner (GP; hereon referred to as “Dr J” ) about it . However, Dr J probably did not give me a conclusive diagnosis that would lead to efficient and effective treatment at the time.
Eventually, the redness and swelling subsided over a few months. At the time, I was using oil-based moisturisers heavily , and so as the symptoms subsided, fresh acne and whiteheads appeared. However, these pimples were not of the kind described before . Rather, they were smaller pimples, quite probably caused by a build-up of oil and dirt in my pores.
What emerged after the redness and swelling subsided were a few differences between the affected and unaffected areas of skin. Splotches of redness/pinkness surfaced, which bore close resemblance to acne scars (I therefore concluded that they were left behind by the huge boil-like pimples that instigated this whole saga). Most of the surface area of my face was covered in these splotches, such that my whole face appeared red/pink unless one looked closely. The affected skin was also a different texture, and seemed to produce more oils than other areas. The affected areas were also slightly raised and puffy, and had enlarged pores (or pocked acne scars).
The subsidence of the flare-ups and its symptoms did not, unfortunately, mean its eradication. Over the next few immediate months and even years , I would randomly and spontaneously experience flare-ups, albeit not as extreme as initial flare-ups and absent the small white pimples. The affected skin was still a different texture, and the red/pink splotches still remained .
Over the next year after the initial flare-up, I had perhaps one or two more bad breakouts that resulted in the aforementioned boil-like pimples . I foolishly used OXY 10 to medicate myself, and once again experienced the same reaction. However, at that time, I was constantly flaring up anyway (albeit to lesser degrees of severity) so my reaction to OXY 10 made little difference. I finally decided that it was for the best that I dispose of OXY 10 and never use it again.
Despite disposing of OXY 10 , flare-ups would keep happening over the next few years. They happened both seemingly randomly and for a variety of reasons . Curiously, occurrences of flare-ups would be negatively correlated with sleep. That is, if I did not get enough sleep the previous night, a flare-up would occur the next day.
Over the years I became skilled at recognising what did and did not cause flare-ups , and my skin also began to gradually heal. The red splotches remained, however. I had always thought these to be acne scars , and treated them as such .
Gradually , things began to improve. Flare-ups would occur much less often , and the red splotches faded . Eventually, flare-ups caused by a lack of sleep the previous night were resolved if I slept for long enough the next evening. Furthermore, these flare-ups were not as painful and the redness and swelling would not be as extreme as before. By the end of last year (2013), flare-ups rarely occurred , and the splotches had faded considerably, such that they were no longer red/pink but rather a dark purple or brown colour. They were also less noticeable, and one could hardly notice them in most lighting situations except for under close inspection.
This year (2014) in April, an extreme flare-up (like those that happened back in 2009) occurred again. I experienced the same symptoms that I had not experienced for a number of years: extremely raw localised redness and swelling; burning and stinging pain; spontaneous occurrence and long-lasting stubbornness. Before this recent flare-up, I had been using an exfoliator every day for a number of consecutive weeks . This led me to think that over-exfoliation and sun exposure had caused my all-to-familiar symptoms.
When the flare-ups occurred, I stopped exfoliating and used a regular face-wash . To treat, I used a variety of moisturisers , gels and ointments . I used SPF 50+ sunscreen and tried to avoid excessive sunlight. I drank plenty of water throughout the day, and had plenty of sleep throughout the nights. None of this helped. However, about 4-6 weeks after the initial aggravation, I was able to find immediate yet temporary relief by splashing cold water onto my face.
I saw Dr J, this time making the consultation explicitly about my face. I told Dr J that I thought I had over-exfoliated and become over-sensitive to the sun, which made me sunburn easily. Dr J explained that this was not the case for a variety of reasons . Dr J thought I was having a reaction or rash to the many products I was using to treat my symptoms and advised me to stop using so many products and stick to just one . She also prescribed me a topical corticosteroid cream .
Following this consultation, I used only one moisturiser and applied corticosteroid cream twice a day on the affected areas. I noticed a significant improvement, and it worked extremely well in the first few days, such that the redness and swelling had significantly subsided and I did not experience any extreme flare-ups. However, by about day 5 of using the corticosteroid, its effectiveness waned. I continued use until day 6, and a week after my consultation, I did not apply anything. On this day , my face flared up again.
In the next few days I restarted use of the corticosteroid, in the hopes that it might work again like it had the previous week. Symptoms actually became worse. The redness, swelling and pain would return with such intensity that I felt like my face was burning itself off .
I then saw Dr J and explained what had happened. I explained that I had followed all given instructions and that symptoms had gotten markedly better then significantly worse. I explained that I was able to find immediate but short-lasting relief from the redness, swelling and pain by splashing cold water on my face, but that this would last for a very short time. Dr J then said that it was not a rash, but perhaps I was merely prone to flushing, and that the red splotches were in fact prominent and dilated blood vessels. Dr J advised me to stop using the corticosteroid cream, and try to keep my temperature as low as possible. I was clearly dissatisfied with such a diagnosis, and Dr J admitted to being unsure about it. Dr J then posited that perhaps I may have Acne Rosacea, and wrote me a referral to a dermatologist, whom I am yet to see .
My experience with these flare-ups has given me a good idea of what typically happens. Something causes the initial intense flare-up, which is characterised by extreme, localised redness and swelling; burning and stinging pain; a feeling that the affected areas are foreign; spontaneous occurrence of symptoms lasting for hours; persistent redness even when not “flared-up”. Then, as weeks go by, the flare-ups become less intense and the persistent redness fades to small red splotches . Over time, flare-ups will occur less and less often, and the red splotches will randomly vary in their redness. The affected areas (now covered by red splotches) will be slightly raised and puffy looking, with a different texture and enlarged pores (or holes). Gradually, over years, the puffiness will flatten out and the red splotches will fade, turning dark purple and then brown. The skin will then appear (almost) normal, and the splotches will only be noticeable under close inspection. However, minor flare-ups will occur after a night of insufficient sleep, but these flare-ups are resolved easily and within a day.
At the time of writing this, I am at the stage where I have the red splotches that are quite visible and apparent, and vary in their redness from time to time. If my recollection and inference of past experiences is correct, it will take years to get back to where my face was before this most recent series of flare-ups.
I want to fix this. I cannot wait any longer. I want to find out what initially caused these symptoms, what keeps causing these symptoms, how to treat these symptoms, and how to cure my problem.
Just some background
What makes this particular update so salient is that I really don't fit the profile for your typical rosacea sufferer. Typical rosacea sufferers are Caucasian middle-aged women with fair skin and blue eyes. I'm a 19-year-old Asian male.
I had emailed the above document to him before my appointment, but I was told he had been on leave for two weeks prior to July 14, so he wouldn't have had any chance to read it properly (it's six pages long).
When I went into the room, he asked me a few questions (the only question I remember was how it felt when I flared-up, and I told him I feel a tingling sensation when it happens, then a painful burning sensation) and typed some notes. He then said that although I wrote that I wanted to fix this problem, I may not be able to.
He said it looks like I have rosacea.
He gave me a pamphlet about it, and prescribed me a gel, called brimonidine tartrate. I asked him what it does physiologically, and he said it constricts the blood vessels (which are what the "red splotches" are). I asked him if I would develop tolerance to it, and he said no. I asked him if there were any side effects, and he said there weren't any known, because the drug had only been on the market for about a year.
The consultation was curt and short, and I left feeling saddened that it was confirmed I have this incurable condition, at such an unusually young age. Yet at the same time, I was relieved that I finally knew what it was, and that I could go ahead and start treating it.
The quest for treatment thus began
I went to the compounding chemist in the area, which was just a 10 minute walk away from the clinic. I gave them the prescription, and they said they'd need to order the ingredient in, and it should be ready the next day. They said they'd call me later in the day with the price.
I then stayed in Chatswood, where I met up with two friends, and we had lunch and hung out for a while.
Later in the day, I got a call and was told that my first repeat from six of 30 grams would cost me ~$133. I legitimately begged her pardon, because I thought I had heard wrong. I then told them to go for it and make it up, and they said it should be ready tomorrow afternoon.
The next morning I changed my mind, and called them and told them to hold it off, as I was going to see my GP ("Dr J" from 'The Story of My Face') and ask her about it.
I did go and see my GP, and told her the news. I asked if she thinks I should go ahead with the brimonidine tartrate gel, because I was initially hesitant because of the price. She said that Dr Li was a good doctor and he wouldn't give me something that wasn't good. Just in case though, she gave me a prescription for Metronidazole, a topical antibiotic.
After I left, I think I changed my mind on the brimonidine gel a few more times, which must have really annoyed the chemist. In the end, I decided to hold off on it, and I went to pick up my script from the chemist.
I decided to give the Metronidazole a try, as I was told it was supposed to be much cheaper.
Forgot to mention what type of rosacea I have
Rozex Metronidazole 0.75%
There was some difficulty in getting this gel, because my local pharmacy's supplier didn't have it, so I had to look around for it. Also, it was a lot more expensive than I was told by my GP (it was actually ~$50.00 for 50 grams).
I already had my doubts about its efficacy, in light of the fact that I don't have the papules and pustules of acne rosacea. Furthermore, I was aware of the fact that this gel takes quite a while to work 2 or 3 months).
I used it for about 2 weeks, and I didn't seem to see any effect; it wasn't very exciting. It was a cold gel though, which felt really good.
Whilst I was using it, I did have flare-ups, and I kept getting them, which started to really annoy me.
In the end, I decided (last week on Wednesday 30/7/14) that I should give the compounded gel a try.
Brimonidine Tartrate 0.5% Gel
There are only a handful of medical science journal articles published out on the internet, and I have read the abstracts of them all. They are all glowing of this drug, and I will come back to these papers in a later update.
So on Thursday 31/7/14, I went to the same compounding pharmacy in Chatswood and gave them my prescription. They said it would be ready the Monday afternoon after (this week; 4/8/14).
So on that Monday afternoon, I went and picked it up.
That evening, at around 6 pm or a little after, I applied this gel on both of my cheeks. I was instructed to use a small "pea-sized" amount, but I admit I may have used a little more. Only a little, though; in no way did I pile the stuff on. Perhaps I used a pea-and-a-half size.
Within the hour of applying it, I went extremely pale and my face was cold wherever I had applied brimonidine. It was great, I was completely ecstatic and I was extremely excited. I finally thought: "I've found the one for me! I'm finally going to be free of redness!"
The next morning, I woke up ...
Side effects of Brimonidine Tartrate gel
I looked in the mirror and oh my goodness! My face was red raw and swollen! It was significantly more red and flushed than it was before I used the drug in the first place!
I did have an idea of what had happened though: if brimonidine constricts my blood vessels, it would only make sense that when the drug wears off, the body pushes back; and when there is no drug to push back on, the body over-compensates, and my blood vessels dilate even further, causing me to flush even more.
I then thought that I could calm the redness by putting more on ...
I then walked to the train station, full of anxiety. When I got to the station, I was feeling the burn of my face, so I decided to wash it with cold water in the bathroom, thus washing off the brimonidine I had applied about half an hour earlier. However, it didn't do much to help at all.
The next few days after rebound flushing side effect
I then went to the pharmacy to tell them the story and ask what I should do. They just said give it a couple of days, then start slowly applying smaller amounts. That wasn't much help at all, actually, and at that time I didn't tell them I was far too scared (and still am) that I'll have another rebound flushing episode.
Then my appointment came up and I went to the doctor. The GP said that I didn't seem to have had an allergic reaction, so my face was just flushed. That was some relief, I guess; because I wouldn't want to have to deal with an allergic rash or something. Apart from that, I asked the doctor what I should do, and was just told basically the same thing: start using it again but take it slow this time.
I went back home, and started researching (more; I had already done quite a bit of research about it, but everything I had read up to that stage was positive about this drug). I notice that when you look for bad things about something, you will always find it, but you have to look.
I started reading all these forums about Mirvaso (which is the US shelf name of this drug developed by Galderma, who also made my metronidazole gel) and was astonished to find that a lot of people had the same reaction that I had. I scrawled through hundreds of posts, each of them warning against the use of this drug. Some said that the effects of the drug started wearing off sooner with continued use (that is, they developed tolerance to it), which really scared me. Most of the posts said that the flushing they had after the drug wore off was a lot worse than ever before they had used it, and were complaining about how it was weeks and weeks since the last time they applied Mirvaso, but their face was still in worse state than before they ever used the drug. Almost everyone said that they regretted ever trying it, despite initially feeling absolutely ecstatic at its fast and excellent results.
So on that Tuesday evening, I had a shower and I cried. In the shower, I avoided hot water on my face, and instead blasted it with cold water (which in the past worked very well to get rid of redness, but was always only temporary). I got out of the shower and the redness had gone; my skin was its normal colour again. I wasn't excited, because I knew it wouldn't last very long.
Indeed, the next day (Wednesday 6/8/14), I was red again. I'm on the train to university, and I'm looking up histamine and flushing, whilst trying hard not to flush myself, as I often flush on the train as the train journey progresses. I went to university (I really didn't want to though) and went to the chemist to buy some antihistamine, which I thought would stop me from flushing. But it didn't work. It just made me drowsy and tired. So most of the day I probably just looked really drunk. I flushed up real bad towards the late afternoon (and I resisted the very strong temptation to use more brimonidine tartrate), and it was really embarrassing, but I managed to pull through. During the day I had also called the compounding pharmacy, and asked them what to do, and I was put through to this girl called Myra, who was rude, condescending, unhelpful and stand-offish. I called the only other pharmacy who compounds brimonidine tartrate, to ask if they had had anybody with the same reaction, and they said no, but that there were some reported cases in the literature of a side effect of flushing (which I knew of but was always intrigued as to why, because it is just so ironic). That pharmacist told me to call my dermatologist and ask him about it. So I got home, and dug around on the net some more. Then, once again, a one-time-a-day blasting of cold water to the face in the shower really helped calm the redness right down, but, as always, it was only temporary.
The day after this (Thursday 7/8/14), I decided to stay home (because I really did not want to go out; you know the feeling). I basically just relaxed all day, which was great! I called the dermatologist's clinic, and spoke with the nurse, told her my story, and she said she would get my dermatologist Dr Li to call me back the next day.
So the day after this (yesterday; Friday 8/8/14) I went to university, after two days of no drugs on my face. Flushed up a bit, especially when I spoke in class, but all in all, it wasn't so bad. I was still a lot redder than before I used brimonidine, though. I put on the metronidazole gel that day in the afternoon, only because the gel was cold and soothing, but also because I had some pimples on my face that I thought could be cleared up by the topical anti-biotic. As I was leaving university, the dermatologist called me, and I told him what had happened. He said he didn't know of any rebound effect, and told me to not use the gel for the time being. He also instructed me to apply steroid cream for 10 days to try and calm down the redness, and then wait a month and take it from there. He suggested that I could maybe have the compounding chemists dilute the gel from 0.5% to 0.1%, but he wasn't sure it was going to be any better for me.
I then went and saw two separate GPs the same day. The first GP didn't know what to do; the second one (who was supposed to be a "skin doctor") thought I had something called seborrhoeic dermatitis, which was a fungal skin condition. I told him that I didn't think so, but he insisted and he gave me this over-the-counter anti-fungal cream, and told me to use it for two weeks then go back and see him. I don't think I will do either.
That brings us to today.
Now that we're up to date
Firstly, I believe that I was in a remission phase from the beginning of last year up until April this year, because I didn't have many bad flare-ups at all, and even the blood vessels seemed to be shrinking and fading back away towards the end of last year. In this remission period, I could stay out in the sun all day, get drunk, go into a sauna, etc. and still not have a flare-up. That is the stage that I want to get back to.
Secondly, the main triggers for my flare-ups seem to be the sun, heat, stress and anxiety. With sun and the heat, thankfully it's starting to get cold, rainy and cloudy (I never thought I'd hope for bad weather, but in the last few months I have). Down here in Australia, the weather is extreme, and that is an understatement. This year we had one of our coldest Summers and our hottest Winters. In fact, it seems to have been Autumn ever since March, and we are almost at Spring now. With stress and anxiety, this is a vicious cycle, unfortunately. I get stressed and anxious about my potential flushing, which makes me flush, which makes me stressed and anxious about it, which makes me flush, which makes me stressed and anxious about it ... ... ...
Thirdly, I have only recently begun to want to stop using so many products on my skin. Natural is definitely the way to go. Furthermore, almost all of the skin care products have alcohol in them, which dilates the blood vessels and thus increases redness. So I will definitely be aiming to cut down on the products used.
I'll attach a photo showing all the different skin care products I've used since my most recent episodes of rosacea flare-ups starting in April this year. None of these have worked. At all.
A logistical note
I will (probably) not be uploading photos of my face here, unless I deem it to be helpful. The reason is, I just do not think it will be helpful to anybody, due to the fact that the redness of my face is always changing. Also, I am not exactly going to be waiting for that miracle treatment (as the brimonidine was supposed to be) that can show any results; I'm just basically going to be somehow waiting for my remission phase to start up again, and I'm hoping this season's cold(er) weather will help bring that along. In light of this, uploading photos that would ideally and supposedly show improvement over time (if there was such a gradual improvement) would in fact be misleading, simply because I will have no such gradual improvement. For example, this morning I was quite red, but after a shower where I blasted my face with freezing cold water, I'm not so red. My redness varies and depends on these kinds of things; temporary fixes, instead of a gradual and consistent improvement.
I think I may have mentioned earlier: laser treatment for my rosacea is out of the question.
It is just too expensive.
Cold weather is the best!
A (sort of) eventful day
So Saturday (two days ago) kicked off what will be a wet, rainy and cold week to come. A normal person would deplore this weather and wish for sun. A vascular rosacea sufferer like me, however, hopes and prays for days like this.
So it was raining today. Not pouring, but sort of a bit of a heavy drizzle. But when I was walking to class today, and everyone is struggling with their broken umbrellas, I'm just walking in the rain with a huge smile on my (not red) face.
Today should have been a day that I didn't have a single flare-up, and I hoped for that, because with each flare-up, rosacea gets worse - your vessels dilate more and you flush more easily.
But no, I was with a group of friends, and everyone was drinking, so I had a beer. Guess what happened next? I had thought I wouldn't flare-up because it was so cold, but I did still. What was worse was when I got on the train, and it was heated, I flared-up big time. But it was different, I have to say. I was aware of it, and people were staring, but I somehow calmed myself down, so the redness calmed down (a bit) too, but I was still pretty flushed.
I got back home and it calmed down.
I document this day because, strangely, I did not use cold water to calm my redness down, which is what I normally do. In fact, most times, I have to splash myself every hour, but today, I just thought I'd let it calm down by itself, and it worked (it may have been helped by the cold weather though).
Also, what I might add is that today I did something different. Normally, when I shower, when I get to washing my face and hair, I blast the cold water. The coldness really constricts my blood vessels and gets rid of the redness, but, this is temporary, lasting probably a few hours at most. I have been doing this ever since I got out of remission and started flushing in April this year.
Well, I didn't do that today. Instead, I washed my face and hair with hot water. Contrary to what I expected, I did not come out of the shower with a beet red face. Surprisingly, it was the same colour as if I had blasted myself with cold water. I found this most strange. Furthermore, it stayed as pale for a few hours, and still is the same colour (maybe just a little redder, but still quite pale; all you can see is my massive blood vessels that look like splotches or acne scars).
This has led me to think that rather than just heat being an aggravating factor in and of itself, perhaps extremes are. Just like with my reaction to brimonidine tartrate, I will always bounce back (or "rebound") stronger. So, blasting my face with cold water will constrict my blood vessels, but at I will rebound, especially if I enter a warm environment or come across my triggers. Basically, stay away from extremes. It will muck around with your blood vessels and make you more susceptible to flushing episodes.
2 Weeks Post BT Rebound
It has been 2 weeks since my reaction to brimonidine tartrate (BT). Folks in America call this stuff "Mirvaso".
My face still hasn't gotten back to where it was before I used BT, despite the recent cold weather.
I do not recommend BT, or "Mirvaso". I am of the opinion that, even if you do not get the rebound flushing side effect, you are still doing your skin an injustice. You are mucking around with your blood vessels on your face. This stuff is a quick fix, lasting 12 hours or less, and it is strong stuff. Messing around with your body in such a way cannot be good for it. Do not be pulled in by its temporary excellent results, because the rebound could be way worse, and does permanent damage to your face. Pushing and pulling at your blood vessels that are already out of whack is only going to make things worse.
On another note, this week has been wonderfully cold, which has helped. Also, today is a day that I did not splash myself with cold water every hour or so while out. Although I do admit that if it wasn't cold, windy and raining, I probably would have had to resort to splashing cold water on my face to cool it down.
Also, I bought a moisturiser today, which I will start using tomorrow. It is by Neutrogena and is advertised as fragrance-free and alcohol-free, although there is cetearyl alcohol listed in the ingredients. Strange. Anyway, I'll give it a shot because I haven't been putting any moisturisers on for a while and the weather is pretty dry.
I'm just thinking about remission - I want to get there again.
That Rosacea pamphlet that the dermatologist gave me
So I took a photo of that pamphlet that the dermatologist gave me, and I thought I'd share it with you. It's by The Australasian College of Dermatologists.
I hope it helps :)
Some pervading thoughts
Today was a sunny day in the middle of a rainy week. I actually don't like the sun, because the sun's heat makes me really flushed. But anyway, a few posts ago I had indicated that I wanted to stop using cold water as a constant quick fix to my flushing episodes. I didn't want to break that today, but I needed an exception today. I walked from the train station to uni (which is about 20 minutes) in the midday sun, and I became quite red. I went to the bathroom and I wanted to try calm it all down WITHOUT water, so I got some folded paper I had and just fanned my face. It worked a bit. And then I went to class, and the moment I sat down, I full flushed. Like, big time. BUT, as I've noticed in the last few days, when the big flare-ups happen, I am able to calm myself down (a little bit) just by the power of my psychology. Whereas before, I would flare-up, and get really worried about it, then people would start staring at me, and I'd go even redder. Now, I can sort of tame the redness down a bit, instead of being full flushed for hours (or until cold water), I go full flushed, then calm down a bit to "not-so-flushed".
But that was the dealbreaker. After that class, I rushed to the bathroom before my next class straight after, and resorted to the cold water.
I might add, I tried that moisturiser today. It wasn't bad, but I got this stinging feeling in one part of my face, although I can't work out whether it was due to the moisturiser or not, because I'd gotten that stinging feeling before I started using the moisturiser.
Now to the part that is the namesake of this post:
I think I may have mentioned in an earlier post that this time last year I was in a period of remission from my rosacea symptoms. That is, I could get drunk, stay out in the sun for hours, go to a sauna, sprint a marathon, and NOT GO RED. Also, you could hardly see my blood vessels; only if you looked REALLY REALLY closely.
I've been thinking recently: how on earth did I get there? If I knew, if it was something I did, you can bet your bottom dollar that I'll do it again in a flash. I've been really analysing that time of my life, and I've come up with a few points that I think are relevant in that they may be able to explain the lack of rosacea symptoms.
Firstly, it was cold back then, and the winter last year was actually a winter. This winter, it wasn't even cold, raining, or windy. It was hot and sunny.
Secondly, I was (mentally) in a better place last year, especially the second half of last year. There was very little stress: I had just quit my job to focus on my studies; I didn't have to worry about tattoo removal (which I am currently going through, be sure to check out my other review here); I had a hell of a lot more self-confidence than I do now; I had a really great friend whom I saw almost every day at university (she has since dropped out); I wasn't thinking or worrying so much about my face (and why would I, back then I looked fine, I looked normal).
Thirdly, I was physically more fit, and I was doing a lot more exercise. This is only important because back in April, when I first presented to my GP with my rosacea symptoms, she ran a blood test for lupus and it came back negative for that, but we found out that I had really high cholesterol.
Fourthly, I wasn't using all these different and harsh skincare products. I think, if I remember correctly, I was just using one type of facewash, twice a day. I have a high suspicion that my most recent relapse into rosacea (back in April; that is, when I got out of remission) was caused by my frequent use of an exfoliant. I'm not sure about this, and maybe some doctors would disagree with this, but it's what I think. I mean, I was exfoliating harshly every day, sometimes twice a day, for weeks and weeks and weeks on end.
Anyway, I think nowadays, stress and anxiety about my rosacea is exactly what triggers it. For example, I could be fine at night, and then as soon as I think about my face, bam! I flush up. It's like a panic attack; a positive feedback cycle. It's vicious and nasty.
So here is what I'm going to try to do in the next few days. I'm gonna try to stop worrying about it. Literally, stop thinking about it, and perhaps that will help in not making me flush up, even when I'm alone. This stress is really making me very tired anyway. Also, I'll try and get some cardiovascular exercise done, in order to get the blood pumping nice and evenly to the rest of my body, and not just my face. Third, I'm gonna try and continue not to resort to using cold water on my face to calm down my flushing, because resorting to extremes like that is much like the BT: it will cause a rebound if you continue to push and pull on your blood vessels.
Until next time.
An Update on Just Then
I just wanted to say that I just used a different facewash. I think it is an important departure from my usual routine, and perhaps it will also have some different results.
I had been using Cetaphil Gentle Skin Cleanser ever since a few weeks after the (re)start of my rosacea woes, back in about April or so. I don't doubt that most of the people reading this would know or have heard of Cetaphil; it is dermatologist recommended, soap free, pH balanced and all this other stuff. Sure, it doesn't dry out the skin, but it doesn't really give it a good enough clean either. Now, I'm 19 years old, fresh out of puberty and my face is still producing quite a bit of oil, so I need a facewash that can deal with that. The upside of Cetaphil is that it is very gentle. The downside is, it still leaves your face pretty greasy.
Right now, I've got a few pimples on my face. These aren't really that big of an issue, and I'm confident that they are just caused by a build up of dirt and oil in my pores (that is, just how 'normal' pimples are caused) and they are not pimples from a more advanced subtype of rosacea.
These pimples are adding to my redness, and it's really hindering my choice of what I put on my face in terms of moisturisers and other things. It's also stopping me seeing what is really going on with my face. I really want them to clear them up, and I know that they will and should clear up by themselves in a few days' time. But using Cetaphil is just keeping my face greasy and it is not helping at all.
So I used this facewash that I always used to use since about 6 years ago. It's called Biore, and it cleans really well.
I'm hoping that using this will help clear up the pimples on my face so I can get a clearer picture of what's going on and treat accordingly if necessary.
Right now is about 20 minutes or so since I got out of the shower, and my face is feeling quite clean. It's tight; and I hope this Biore won't dry out my face.
We will see tomorrow how it goes ...
Unexpected and Rapid Improvement
So as I said on Wednesday evening, I started using a different facewash: Biore facial wash (I think it's called). Before that and ever since April, I had been using Cetaphil Gentle Skin Cleanser, but it's a little too gentle in that it doesn't clean at all; your face is left just as oily as it was before.
As such, I had sprouted some pimples/acne, especially on the right side of my face. The infection from these pimples were really adding to my redness, which I certainly DID NOT need.
So after I first washed with Biore, I looked in the mirror and noticed immediately that there were quite a few red 'bumps', especially on the right side of my face. I thought these were just dilated blood vessels, but I was convinced that they were in fact 3D.
Fast forward a few days, and the pimples have cleared up significantly. What's more, I seem to be less red throughout the day, and I'm only flushed up in the morning when I wake up (and that's saying something).
It is really strange, but this facewash seemed to curb redness as well. Perhaps it was the excess oil on my skin that was keeping in the heat?
Anyway, I do have to caution that I fell ill on Thursday (and still am) so I've stayed home (and out of the sun) for the last few days. Also, the weather has been quite cold(er) in the last few days. So, there are confounding variables in my improvement: I've stayed at home and it's been cold.
That having said, this facewash really has allowed my pimples to clear up by themselves, which has helped a lot. Also, this facewash was what I was using at the start of my remission phase this time last year, so it might just be the magic, who knows.
If indeed this facewash is the cause of my improvement, that would mean that my diagnosis is not simply just subtype I rosacea. It would suggest that part of the redness is in fact caused by some kind of topical inflammation/infection.
That would be strange indeed, so I'm probably wrong about that.
Whatever the case, things seem to be good now, so I'll just keep using this facewash twice a day. But we'll see what happens when I go back to university on Monday (tomorrow).
Some new thoughts
So I've been using that new facewash (Biore) for about a week and a half. It has helped a lot with the redness, for unknown reasons. However, it does not stop / prevent flare-ups, unfortunately.
But, when I flare-up, it seems to be less painful now. I'm not sure why. Also, when I'm just sort of mildly flushed (as in, not full flare-up, but just a bit), the sensation isn't a burning one anymore - more like a stinging sensation. I'm not sure if this is an improvement, but I'm sure that I have the capacity for that burning sensation, so I'm not 'cured' of the burning just yet.
I want to talk a little bit about my most recent bad flare-up that happened on Wednesday (it's Sunday today). Before this, I hadn't had one of flare-ups for a while, mainly because I've been at home a lot and had been using Biore (which I thought was actually doing something vascular). So I went to the library to study, and as soon as I walked in, I felt so self-conscious; I mean, I thought everyone was looking at me, when obviously they were not. I sat down and I immediately flared-up. And then everyone started looking at me.
After that, I went to the bathroom and used my old and trusty cold water trick - splash some cold water on your face. It didn't work, surprisingly.
But anyway, what I want to get at with this is that it was, in my opinion, entirely caused by STRESS. Stress is what is causing most of my flare-ups these days, I think. I stress about stress and I stress about flare-ups, and then I get one and stress even more. I really think I just have to relax, or try to.
Another episode of mine backs this up. So on Friday, I went to uni. It was raining, and I saw a 'friend' (who has had some history with me, suffice to say) at the train station. I just went up and talked to her. The strange thing was I think any other day, if I was distracted by the possibility of a flare-up, I would have flushed right then and there. Instead, I just acted cool and we talked normally, without me being especially quiet in an attempt to avoid a flare. Anyway, we hopped on the train and chatted, and the train started filling up. There was an unusual number of passengers on the train that morning, and I'm certain that, any other day, I would have flushed badly just at that. But I didn't. There was no stress that morning. Just none at all. And I didn't flush. I'm sure that if there was any stress, I'd totally flush, but there wasn't, so I didn't.
Also, as of right now, I sometimes feel that stinging sensation on my face, but when I look in the mirror, I'm not (that) flushed. It's weird. Anyone know what this stinging sensation could be?
And last night, I went out to a birthday party and had alcohol. I didn't flush, although I had that stinging sensation and I was pink (like I was before and am all the time) because of the dilated blood vessels, but I didn't flush. That's strange. Again, no stress last night, I had a great time beginning to end.
But still, the fight against the pimples / acne goes on. It seems every time some pimples fade away, new ones pop up. I will have to be more vigilant, though, such as watching my diet, getting more sleep, drinking more water and cleaning more. I want to get rid of these pimples, because, as I said, the pimples are adding to a lot of the redness, and if I can get rid of that, it should be better.
Also, I want to exfoliate, for two reasons. Firstly, it will help get rid of the huge pores and generally clean my face better. Secondly, I want to see if I will have a reaction to it.
I'll post again if I have any news.
I Exfoliated ...
Today I had NO flare-up, and I normally do on Wednesdays, which is good. I did sort of come close though; I mean, I felt it bubbling up, but somehow was able to regain grasp of my mojo and beat it back down. It's mostly psychological for me. If I worry about a flare-up, I'll have one, and when I do, I'll worry more, and it gets worse.
So this evening I exfoliated, because I wanted to see what would happen.
The product I used is by Biore, (I think it's Japanese). It's the same one I was using every day, sometimes twice a day, way back earlier this year (which I believe brought about my relapse into rosacea). It's called "Biore Pore Unclogging Scrub", and the ingredients are as follows:
AQUA; SODIUM COCOYL ISETHIONATE; GLYCERIN; GLYCOL DISTEARATE; SYNTHETIC WAX; ETHOXYDIGLYCOL; PEG-6 CAPRYLIC/CAPRIC GLYCERIDES; SALICYLIC ACID; CERA MICROCRISTALLINA; CETYL ALCOHOL; PEG-12 DIMETHICONE; SODIUM HYDROXIDE; SODIUM LAUROYL LACTYLATE; PROPYLENE GLYCOL; DIAZOLIDINYL UREA; MENTHOL; BENZOPHENONE-4; CI77510; IODOPROPYNYL BUTYLCARBAMATE
Ok, I actually spent a good five minutes typing that out, so I hope it helps someone...
Just some background; I used to love this product about 8-10 months ago. Then April and rosacea happened, and I think (as I said above) it was caused by over-exfoliation. I don't know. Nobody knows (at the moment) what causes rosacea.
Anyway, it feels good to use. I think it's the menthol that's in it, it feels pretty good, just like the standard Biore facewash (that I had recently started to use).
I wasn't going to use it just yet, because some pimples haven't cleared up completely yet (they are getting there, but not quite yet); however, I was impatient.
I got in the shower, and used it. Scrubbed for a bit (maybe too hard [?]). Rinsed with warm water. I got out and went to mum (whom I still live with; I'm 19 and studying; don't judge) and told her I exfoliated and we'll see what happens.
Fast forward about an hour and I feel that redness coming in. And indeed, I look in the mirror and my face is redder than it was before, redder than it would have been if I hadn't exfoliated (I'm sure).
I want to note, of course, that it is redder only in the areas that are affected by rosacea. Wherever I have no rosacea it is fine.
But, I mean, you live and learn, and I'm sure it will die down soon (because it isn't that bad, just a little redder, not like the reaction to BT). Also, I'll use it again in a few days (and maybe scrub a little less hard) and see how it goes.
Anyway, I need you all to read my next post, which I'll write up right now, and it will appear immediately below this one. It is (kind of) really important.
I question my diagnosis
I had known about rosacea before I was diagnosed. If you are familiar with my story, you will know that I have had these symptoms for years now, and was only diagnosed less than 2 months ago. Man it's been a long 2 months though ...
I always knew that my skin didn't look like the skin typical people with rosacea had. Before my diagnosis, I had inquired as to what it could be and in my internet searching I came across rosacea, but I discounted it because it just didn't seem to match my intuitions. Even in the dermatologist's office, when he showed me a pamphlet with a picture of a rosacea sufferer, I immediately said "It doesn't look like that!"
Regardless, I came to accept it, as the red splotches could only plausibly be dilated blood vessels and the redness could only plausibly be flushing.
But recently, I have come to doubt the diagnosis. You may recall that I wrote about how I recently changed the facewash I use from Cetaphil to Biore facewash (not the exfoliator, but just the normal facial foam cleanser) and that this made a huge difference. I was less red; my face felt clean. I was less red enough and clean enough (I mean, all oil and that washed away) to be able to closely inspect my skin.
What I've been seeing, now that I have the clarity of cleanliness, is that these red splotches that are supposed to be dilated blood vessels under the surface of my skin, are 3D. I mean, they are actually raised. I can only seem to see this straight after a wash; perhaps the oils normally disguise them, I don't know. It isn't only one time I have seen this. If I look closely enough after every wash, I see them. They're raised. They're bumps, tiny bumps. They aren't pimples, though. Because I have pimples too and they don't look like that. Anyway, they are these tiny bumps. I don't know what they are, but they are accounting for a significant amount of redness.
Furthermore, if my memory serves me correctly, I have seen them before in the long history of my facial skin problems. I'm not sure what happened in the past, but they did seem to go away.
Now, these bumps were the main reason I was so keen on using the exfoliator. I was thinking that exfoliation could help me get rid of these bumps and give me a clearer picture of what is going on. Instead, I'm now redder than before ... figures ... maybe I aggravated everything? That's most likely.
Time will tell.
Anyway, that has given me enough to question my diagnosis. I do grant that I flush, and I flush badly, and have all the same flushing-type symptoms as rosacea sufferers, but what on earth are these bumps and why are they there? I'm sure that the bumps are accounting for most of my redness ...
I'm going to book an appointment with a GP and get a referral to a different dermatologist to check it out and get a second opinion on it. I'll also be asking him/her about vascular laser treatment and how it works, etc. I have to go to a dermatologist about my tattoo removal anyway.
I'll keep you all posted.
I wanna preach to y'all
Answer: Dilated blood vessels.
Question: Who is in charge of your blood vessels?
Answer: You are.
It's all in your head.
Everyone, these last few days have been a little strange for me. The flushing has gone down, and now all you can see is huge dilated blood vessels, but it's not flushed, because you can see white skin in between the splotches (which are blood vessels, apparently).
I've tried to keep my stress levels low in the last few days, and that has apparently had a huge effect.
Today I was in the sun, in class, etc. Things that would normally make me flush. But no flush. Because no (or little) stress. I mean, people stare at my face (because of the blood vessels) but now I'm just like whatever and let them stare. Don't worry about it.
I'm thinking that back before these last few days, just being in the sun would make me stress that I'm going to flush, which would make me flush. But it isn't the sun per se, it's the stress. Maybe.
Don't stress! Just don't. I've said this before: if you stress about flushing, you will flush, and then you will stress about your flushed face, and it will be worse. Just don't start that cycle.
Don't stress about stress. Because what can you do then?
Relaying assistance from another helpful user
Baley (another realself user) had been doing some internet searches and came across a site that talked about Asians and an enzyme disorder that causes flushing.
I won't post the site here, because it will be removed, but just do a quick search on the net yourselves with the key words "facing acne".
Anyway, she says that Western doctors often misdiagnose this enzyme disorder for rosacea, when it is not.
About that, I have heard of such a thing from class, but I don't think it is a disorder as such. Rather, all Asians are simply missing the ability to break down a certain type of enzyme. It mainly manifests in Asians flushing when drinking alcohol, due to the inability to break down some enzyme in alcohol. It's actually called "Asian Flush Syndrome". But the flushing is only when you drink alcohol, not normally. That's all I know. I may be wrong, and Baley and I could be talking about completely different things, but there you have it.
I hope it helps :)
Got drunk last night; didn't flush or flare-up
No stress though, so maybe that's it? Or it was just a cold night?
I don't know. It's pretty strange though, isn't it?
Today was weird. It was completely sunny, even pretty warm in temperature, and I was out and about. No flushing. I was a bit pink, but didn't flush.
This is all weird, isn't it?
My rosacea seems to be getting better, like it did a few years back, as if it were just a cycle.
Rosacea shouldn't be getting better, should it?
Still, I'm questioning my diagnosis.
I've booked an appointment with a GP for Friday. I'll ask him what he thinks, but I'll also get him to write me a referral to a dermatologist.
The Start of Remission? Or just Misdiagnosis All Along?
But again, I tried really hard not to be stressed, such that I almost stressed about being stressed, which is a really vicious cycle for me.
Anyway, no stress at all seems to equal no flushing at all, despite some (intuitively normal) triggers such as the sun's heat and alcohol consumption.
Could this be the start of a remission from my symptoms? Or was I just misdiagnosed all along? If I don't have rosacea, what is it that I have?
Self-control is ironic
To relate this, it seems that the harder you try not to stress whilst you are under cognitive pressure (and this could be anything in everyday life, such as trying to memorise a telephone number), you will stress.
That's a little bit unfortunate.
But what can you do?
Don't even try not to stress. Don't even think about stress. Just focus on whatever cognitive load you have at that time. That is, just get on with life.
I saw a GP today
This new GP is probably one of the best I have ever seen. He was attentive and receptive and genuinely cared about me.
Anyway, he said that I looked fine right now, to which I replied that my face is the best it has been for a while (I've been detailing my improvement over the last couple of weeks in the above updates). He said that if I presented to a dermatologist now, without any photos of my flare-ups or serious flare-ups (which I don't have because when it [my rosacea] was bad, I just wanted to push it to the back of my mind), he/she would not be able to do much in terms of diagnosis.
Furthermore, I explained to him that I really question my diagnosis of rosacea, because of both my unexpected improvement because of a new facewash, as well as the so called blood vessels being seemingly raised on the surface.
The GP reasoned with me then, and made some very good points. It may be that nobody yet knows exactly what my diagnosis is, and there could be many doctors who would just guess and guess and guess at it. He advised me to maybe just not worry so much about finding out what it is, because it wouldn't result in any more than small satisfaction and perhaps personal closure. What's more, it may be likely that each doctor would have a different diagnosis and way of treatment, which could result in a lot of side effects.
Long story short, he basically just said keep the stress low, and try not to use that many products because of all the chemicals. He said seeing a dermatologist when my symptoms are not at the worst would not help the specialist diagnose me at all, and so would be worthless.
A note about stress and treatments
I know that in these last few updates have all been about me nagging on about how you shouldn't stress because that will make your rosacea worse. I know that to some of you, it will elicit reactions like anger because you think it's just too fantastic, this whole stress thing, and that I should just shut up and stop running my mouth and spreading rubbish. I'm not here to contest any of that. But I do say that for those who think my words have no worth because the whole cut your stress and it'll do your face good thing is too good to be true, I say to you that you have fatally misread and misunderstood what I've been trying to say. I am not arguing that cutting stress is the golden treatment or magic cure (that would be rather absurd indeed); all I'm arguing is that lowering your stress levels will make you flush less. It is well known that emotional stress is a huge trigger for rosacea. It is even more well known that stress (including embarressment) causes flushing in people that do not have rosacea. So with that clarified, I shall continue discussing stress in relation to rosacea, free from any worries that I am being misinterpreted.
First though, I wish to make a digression to another topic that has been on my mind for quite some time. It concerns topical treatments for rosacea. In fact, it concerns all topical products. Ever since just after my reaction with brimonidine tartrate, I had formed the view that too many topical products cannot be good in the long run (or, in my case, even the short run). So, as you may have read, about a month ago, I stopped all topical products and used only one facial cleanser. It's just a bunch of chemicals. You're putting chemicals on your skin, and your skin is reacting to it (obviously, because if it wasn't reacting then it would have no effect and be useless). I may have said all this earlier, but back then I was probably referring only to products like brimonidine tartrate. Now, I mean to advise against overuse (or even any use) of any topical products unless absolutely necessary (like sunscreen if you go to the beach, for example). Just let your body do it's own thing, without any unnatural interference from any foreign chemicals.
Now, we'll turn to stress. I want to share with you all an observation I made just last night. But first, I'll set the scene. Yesterday would have to be one of the most acutely stressful days I have had in recent history. The thing is, the precipitating circumstances had absolutely nothing to do with me. The stress came from the people I was with; that is, it's contagious. So basically I was stressed out about what this other person was stressed out about. That is, I was stressed out about something that had nothing to do with me (or my face). I didn't flush. My ears flushed though (they always do), but not my face. That leads me to infer that flushing in the face is specific to certain types of stress, specifically, certain types of distress. Because you don't flush in the face when you go on a rollercoaster, right?
Moral of the story is, don't think about your face, because when you do, you'll probably stress about your face. And then you will flush. And then you will stress about your flush. Which will make your flush worse.
What these last few months have revealed
I just wanted to say how important these last few months have been for me, since the relapse of my symptoms in April.
I had, as you know, written up a document called 'The Story of My Face' which I completed on June 9 this year and later posted up above. I had also posted every single relevant detail about my face right here on realself. This thorough documentation, I have been told, has been helpful to others and will be helpful to others in the future. I'm very happy that my diligence and informational generosity has and will help others. But I want readers to know right here and right now that this is also a journey for me; I constantly learn new things as I document them, often spontaneously like a philosopher in the act of his or her masterpiece. Furthermore, my documentation of previous salient experiences is a platform for additivity and reflection, which is most helpful for me.
So, I would now like to say that I have learnt new things since previous posts. Particularly pertaining to (you guessed it -) stress and triggers. I now have a refined and updated list of known triggers for my flare-ups.
Previous list of known triggers
- Sun (the heat, not spectrum rays)
- Alcohol (consumption)
Updated list of known triggers
- Stress (particularly embarressment; stress about my face and subsequent social anxiety)
The where-now update
It has been more than 6 weeks since my horrible experience with brimonidine tartrate (sold as Mirvaso in the states). I am glad to say it looks like my face has settled down considerably since then, as much as I can confidently say that it is roughly as it was before I used brimonidine tartrate in the first place. It has, however, definitely done permanent damage: there are now visible blood vessels where there were none before.
Flushing has been down in the last few weeks. In fact, flushing has been rare in the last few weeks. Again, I think that is to do with keeping my stress down, but perhaps we shall never know.
My steady baseline is now a pink colour, and the red splotches are back (splotches are thought to just be dilated blood vessels). Pink is better than red, I guess, but I'd still rather a normal skin colour.
It seems like history is repeating itself (again), as I expected. I've been here before. I've had this and done that. I know how it goes and how it will end. If my inference from past experience serves me correctly, it should perhaps be years before my skin gets back to where it was this time last year (where I rarely or never flushed; my skin looked normal; you couldn't spot any blood vessels except under very close inspection).
As such, I hesitate and will refrain from saying I am in a remission phase until this background pinkness dies down completely, the dilated blood vessels shrink significantly, and flushing becomes rarer and rarer.
Also, given the current state of things (and things are good at the moment), I will refrain from posting updates unless it's about something important. Simply because there's really not much or nothing to post about.
I hope everyone keeps well.
Red Again: Rebound + Sunburn + Stress
So I'm red again :(
Yesterday I met up with one of my teachers to discuss some class work that I wasn't understanding.
He bought me coffee (which was really nice of him; it was a large as well) and insisted we sit in the sun (which wasn't so cool).
Anyway, we talked and sat in the sun over coffee for over an hour. I didn't go red straight away, but an hour after that, I was pretty red.
I want to make a note of what I think the causes were.
Firstly, coffee contains caffeine and caffeine is a vasoconstrictor. That is, it constricts your blood vessels, the same as what Mirvaso or brimonidine tartrate would do. So it would follow that if I had rebound flushing from brimonidine tartrate, I would also have the same side effect when caffeine's vasoconstricting effects wore off, and that's exactly what happened. When I was having the coffee, and for about an hour or so later, I was pretty not-red (and looking alright; almost 'normal'), but when this vasoconstriction wore off, bam! I wasn't as red as I was when the rebound flushing for brimonidine tartrate hit, but I was certainly a lot redder than I was before coffee. Not only that, but I don't drink caffeinated drinks very often, so I have very low tolerance for it, and they hit me bad. For the rest of yesterday, my heart was pounding, I was dizzy, I had headaches and felt physically sick. But anyway, that's the rebound flushing side of it.
Secondly, I got sunburnt. Sitting in the sun for over an hour, no shade, the sun shining mostly on my left side. I know that some of the redness is from sunburn because it looks like sunburn and my left forearm is also sunburnt. I know some of you are reading this and thinking why I didn't put on any sunscreen, and the answer to that is that I did not anticipate to be sitting in the sun, I thought we'd be sitting in a classroom or something. Anyway, the left side of my face is slightly redder, and stings a bit, whereas the right side is not so bad. And, the left side of my face is hotter and feels 'heavier'. Now is a really good time for some (pure) aloe vera gel, but alas unfortunately I do not have any.
Third, stress. Some aspects of my personal life really stressed me out yesterday, and I guess I shouldn't have let it come to that. But I am confident that this stress will pass soon.
All in all, I had been improving a lot up until yesterday, so I'm really disappointed right now. Think of it like snakes and ladders: I'd had climbed up a ladder, and now I've just slid down a snake. And somehow the snake is longer than the ladder...
I really hope that in a few days time this redness will clear up and it'll be where it was before Friday. I'll let you all know how it goes.
A Week After Coffee-induced Rebound Flushing and Sunburn
So it has been one week since that day that I spent an hour in the sun, drinking coffee, which caused sunburn (on the left side) and rebound flushing respectively.
The sunburn has since died down, on the left side of the face as well as the left forearm. However, I will note that the left side of the face is actually still noticeably redder, because the blood vessels seem to be more visible and more dilated on the left side than on the right side.
The rebound flushing has caused systemic damage all over though. I mean, I'm still way redder than I was before last Friday, and I think it might take another few weeks to get back to where it was before last week. Which is a shame, because I'd come such a long way up until then.
Oh well. Lessons learnt: don't consume caffeine if you haven't built up a tolerance; and don't stay out in the sun for an hour.
When I improve significantly, I will probably make an update about it.
So I've documented in the last few updates how I had a recent relapse into a state of deeper persistent flushing (brought about by, in my humble opinion, rebound flushing from caffeine vasoconstriction and sun damage).
This died down, but once again, I saw (most clearly after washing) that a lot of redness was attributed to these sort of 3D bumps (I had brought this up earlier in the review, as well as with a GP). This is what made me doubt that I had rosacea, because dilated blood vessels should not be bumps.
However, a couple of nights ago I looked up pictures of acne rosacea. There were some close-ups on the net, and I saw that those sufferers' skin looked like mine: a different texture where the redness is (sort of like leathery-looking texture), bumps that look like mine (though a lot, lot bigger), and of course the redness and red splotches (which are blood vessels [?]).
Perhaps I have acne rosacea? That's not what the dermatologist said. But, in accordance with the ideas of the last GP I saw about this, is there really any point in persistent wondering about my diagnosis? It is what it is, right? I mean, know enough to choose the right treatment that kind of works, right?
Anyway, to the extent that I do have some kind of topical rash or acne or whatever, I've been using an exfoliation product (which contains salicylic acid; the same product I listed the ingredients for in some post above) once daily for the last few days, and will for the next few days. Maybe this will help. We'll see. I certainly haven't had an adverse reaction to it, which is good, but when I come out of the shower after using it, the skin that is affected by rosacea is all shiny and a completely different texture to unaffected skin. Maybe it is a different texture all the time, but after exfoliation it is just more apparent.
Read my next post; it's important.
I missed something way back
In June I had written up a document called "The Story of My Face" which I brought to my dermatologist and to my GPs. I also posted this up here back in August; you can check it out above.
But I hadn't included the fact that I was also using a (fragranced) moisturiser both before and during the start of flare-ups (I literally just remembered this morning that I hadn't documented this before).
This is critical. I had always thought that it was my over-exfoliation around this time that had caused the rosace (to come back). But perhaps it may actually have been a combination of the two factors: over-exfoliation and this moisturiser (but they are both of the same brand). Or perhaps it was just the moisturiser.
The moisturiser I had used back then is Biore Nourish Moisture Lotion with SPF 15. There is no ingredients list on the tube, but it definitely smells really nice, so it must be have fragrance in it (I know that that conclusion is epistemically flawed, so sorry but come on, cut me some slack).
I just had a look on the internet (for the ingredients list) and people have posted reviews on the product (where I found that some have said it has no fragrance in it, despite it smelling really nice), so I had a read of them. A few of internet users actually posted that it burned their skin and their skin became really red and sensitive and sore.
That is exactly what happened to me.
So I'm thinking that maybe this product might have played a large part in my rosacea. Perhaps the exfoliation wore down my skin's defenses, and this moisturiser hit quite hard.
I'm not just thinking aloud pointlessly here; this is actually rather plausible, given the fact that there is replicated anecdotal evidence (the best evidence that we can get) of similar reactions to this product.
I haven't used the product for a long time (since about late May) and I don't think I'm in a hurry to start again, in light of revelations of what it could possibly do to harm me.
If anyone has any ideas on this, chip in. But I'm glad that I've remembered this and have no documented it, as well as made a mental note on it.
Stay strong guys. If there's anything that could constitute a take-home message: please don't pile excessive amounts of chemicals on your face; it's probably not a good idea.
I will label some thoughts I've had in the last few weeks/days (whatever, I lose track of time).
I'm now up to or feeling up to experimenting with different ways to try and kick this rosacea (or whatever I have) back into the remission I was in this time last year.
I do note, however, that in this so-called remission phase, I was still flushing, only not as bad, and not as long-lasting, and when I wasn't flushing, I wasn't red at all and you could hardly see the blood vessels.
Now, I mentioned in my last post a week ago that I'd exfoliate every day for a while and see what that does. I've been doing just that for over a week and, well, it certainly hasn't harmed me, but I'm not sure that it's made a huge positive difference either. The exfoliating product I'm using is the same brand as the facewash (Biore), although they were both manufactured in different nations (exfoliator in Australia and facewash somewhere in Asia). The facewash is really strong; it really dries my skin out, but leaves it really clean. But a few hours after the wash, my face gets really oily (probably some kind of rebound effect). The exfoliator is less strong and less drying, but obviously, it is an exfoliator, and exfoliates.
So I'd been exfoliating at night, and using the facewash in the morning. But a few days ago I started going back to the Cetaphil in the morning, as I felt the Biore facewash was just too drying.
Now, I had posted in an earlier update that when I stopped using Cetaphil and went to Biore to wash, I had noticed a significant improvement, but I cautioned that the reduction in redness may also be because of lowered stress levels. It turns out now that the change in facewash product really made little or no difference to the redness; I'm back to using Cetaphil (at least in the morning) and I'm still as red (or pink, nowadays) as I was before I switched back. It was rather silly of me to say that changing your facewash product can amount to a change in redness. The Cetaphil wash does, however, not wash as well; my face is pretty oily throughout the whole day. I'm not actually sure which is better: oily face or dried skin face. But anyway, we'll give this a shot for a while and see how it goes.
So it has been Cetaphil wash in the morning and Biore exfoliation in the evenings for the last few days. I'm not actually sure that exfoliation is doing me any good at all, as I mentioned above, so I think I may stop doing it every day. I still have some pimples, and I'd thought that the exfoliation would help get rid of those, as well as curb the oiliness, but it hasn't done much.
I will now (starting tonight) try Cetaphil in the morning and Biore facewash in the evenings. We'll so how that goes.
That closely resembles what I was doing before/during remission. Obviously when I was well into remission, rosacea was a distant memory and I didn't really care about what products I was using.
Also, I do remember that just before my remission phase, I had used fresh lemon on my face (details are in a footnote on The Story of My Face, but footnotes weren't able to be copied to the post on this site). This was because I thought the red splotches (now probably blood vessels or something else) were acne scars, and I'd read that using lemon juice is great for acne scars. Anyway, I've been trying really hard to think back to that time, and I remember quite a bit about that now. I'd use lemon on my face after a shower in the evening, and leave it on overnight. I'd wake up the next morning and wash my face with Cetaphil and go to uni. I did that for a few weeks, and sometime during this period, I used the Biore Facial Moisture Lotion (the one which has been said by others to make your skin 'burn'). I may be recalling incorrectly here, but I do remember that around this time, I became pretty red. About as red as I become now when I flush. I had always thought that it was the lemon juice and its strength of acidity and whatnot. But I didn't seem to see any improvement in what I thought were acne scars, so I suddenly stopped everything (apart from washing, of course). I stopped using the lemon; I stopped using the moisturiser. And then... there came remission (as I remember it).
So two implications arise from this recollection. Firstly, applying lemon to the face may do some good, any good at all. Secondly, the Biore Facial Moisture Lotion is a product that I will most definitely use ever again. Not only has it been shown to cause facial redness in me, but others have also posted about it doing the same thing. Indeed, it is very probable that this product is what brought on a relapse of my facial redness in early April this year. But it is strange that, even though I have not used it for many months, I still have not seemingly recovered yet, although other products have since also damaged my skin.
So I'm thinking of trying lemon again, for the sake of experimentation.
I am so confused. I keep looking up facial skin problems and images of rosacea or acne rosacea on the net, but what I find still doesn't look like what I've got.
Furthermore, when I'm not flushed (which, thankfully, is most of the time nowadays), all you can see on my cheeks is this HUGE network of massive red blood vessels. This is so bad that my face looks red anyway. Does any other rosacea sufferer have this?
Every day is a struggle. A struggle to prevent flushing. Every morning I wake up worrying about how I look and how I will look. It is torture. I don't want to care, but I do and I must.
It doesn't help that my case is so variable or gives the appearance of that. Different lighting makes me look wildly different, and it can often result in me misjudging my own appearance.
But this morning, I woke up with every intention to go to class. I got ready, had breakfast, washed, and was just about to get changed when I took a final look in the mirror and finally listened to it: the mirror was telling me it was not my day today. And it wasn't. I guess it's not my day every day, but today was particularly like that.
I still question my diagnosis, and this makes me so unsure. I am not even close to 100% certainty that I have (only) rosacea and not something else. This does actually matter, contrary to what my last GP said, because I may be missing out on an opportunity for treatment or perhaps even a cure. It seems that after everything, I'm back at square one, not even knowing what is wrong with me.
You all stay strong, and I'll try.
So last night I made a small change to my routine: I stopped the nightly exfoliation and went back to the normal Biore facewash. Now, when I was exfoliating, I'd come out of the shower and see that the affected areas were quite irritated and shiny, slightly swollen. I thought that when I stopped exfoliating, it wouldn't be like this. But even with the Biore facewash (no exfoliation), I got out of the shower and the affected areas were all shiny and smooth looking. This further suggests that something topical is going on, and it isn't just a matter of blood vessels.
I do have some good news, though. I wrote earlier that after a thorough wash, I'd notice that the red splotches on my face appeared to be 3D bumps (though not pimples). I'm glad to say that I feel that these are now dying down.
Bad news though, in the last two days, baseline redness seems to be rising, which is a worry. I will have to make some more changes to work out why this may be.
When is the last time you woke up, looked in the mirror, and decided that today was your day? I cannot remember the last time I did this, and it is heartbreaking.
Put Lemon on Face
Just then, I got out of the shower and rubbed a cut half of lemon on my face, on the affected areas.
I had some doubts about whether tonight was the night to do this, as before the shower I became extremely flushed - more flushed than I'd been in a long time. There may be a few reasons for this: I am extremely sleep deprived, and these last few days have been extremely stressful for me.
But anyway, I got out of the shower and I wasn't that red anymore. I don't know why it is, but after a wash (with facewash), I always look way less red, and then it gets redder from then on. Anyway, I cut the lemon in half, and rubbed it in my skin. I'm going to keep it on overnight, and wash it off tomorrow morning.
It stung, as expected, but it wasn't too bad.
To be perfectly honest with you readers, I don't actually know why I'm doing this. It is clear that the red splotches that I had previously thought were acne scars are not, in fact scars, but dilated blood vessels. So lemon should not actually lower any redness. Lemon should not actually help at all, and may, in fact, hinder.
But I'll give it a try for a while, unless something really bad happens, of course.
What I'm really trying to do is, simulate as much of what I was doing around the time of my remission phase last year, and see if I can bring about remission just by doing what I was doing at that time.
Lemon was one of them. Another was using that Biore exfoliator (as well as another one by Biore, which I am yet to buy again). Another was drinking tonic water. I used to drink a lot of tonic water back then. I still love it. I've got a glass of it right now, with a slice of lemon in it. Delicious. But I was also consuming nicotine back then. I'm not sure if I should go back to that, but if I'm really desperate and crazy, maybe I will. Maybe it had some effect.
The lemon may, I think, help with whatever is going on topically on my face. There is something going on with the rosacea affected areas, that goes beyond just blood vessels. The affected areas produce much more oil, and are particularly susceptible to acne (note, this is NOT the p&p's of acne rosacea subtypes, I don't think). Also, the affected areas are swollen, and feel 'weird' 24/7. The skin does not feel like other areas of the skin, especially after a wash and especially when I'm in the sun. So we shall see if the lemon can do anything for that.
I now need to go to sleep. I've had a pounding headache all day, and I had next to no sleep last night.
The less sleep I get, the redder I seem to be the next day. I don't know why this is, but it is what it is.
1 Day Post Lemon
So last night I rubbed lemon on my face.
This morning, I woke up and washed it off and saw that there was no adverse reaction that I could see. Redness was about the same.
BUT: I really feel that just one lemon-rub has really curbed the oiliness in the rosacea-affected areas of my skin. Where usually, those areas of my skin would be extremely oily, they weren't so much, and stayed that way for the rest of the day.
HOWEVER: for the whole day, I really did feel like my face was burning and it kind of stung the whole day. But when I would go to the mirror, it wasn't that bad. It was just a stinging feeling, and a little redness. But the redness is probably from the lack of sleep, which happens to me.
I have a job interview tomorrow morning, so just in case, I didn't use the lemon tonight, but I will start again tomorrow night.
I just think my skin has to acclimatize (so to speak) to the lemon, and maybe the stinging feeling will go away, and I will see it doing something (hopefully).
Got impatient, (re)started Metronidazole Treatment
In the last two days especially, the use of the lemon became focused on and motivated by trying to get rid of some pimples on my skin, as well as curbing the oiliness in the rosacea-affected areas.
Yesterday I had lemon on my face, and I washed it off and then applied some Sorbolene cream (because the time before when I had put lemon on, it stung the next day) and then afterwards I went out with a friend (alcohol was consumed) and came back home, had a shower and got out. I was totally disappointed to see some new pimples sprout out. So I decided, to hell with the lemons (for now at least), give the topical antibiotic a shot to try and get rid of the pimples.
The pimples are a persistent problem. They really add to the redness unnecessarily.
Also, in the last few days, the redness has gone UP. I don't like this, I don't like it at all. I almost look purple sometimes. This is very bad.
I'm not really sure what caused it, but it may have been my continuing variation of the facewash products I use, or the addition of lemon juice, or increased stress and decreased sleep, or any combination of those.
This morning I just thought of what a long hard battle this is, and if laser would be efficable.
I remember one time when I was about 15/16, I was visiting my grandparents and my grandpa said that I had a spotty face. Well. He certainly got that right, bless him.
But then it all went away (sort of). How? Why? How long does it take?
These are answers that I don't know but really want to find out. And when I do, I'll be sure to share it with you.
I can't help but feel that this rosacea of mine is becoming an obsession.
It's all that's on my mind most of the time. I'm always keen to stare at the mirror when I'm alone.
I'm worried that they could be papules and pustules associated with the acne rosacea subtype.
If so, my life just got a whole lot worse.
Sleep... Get Some!
You know, when everything is better, we reflect on how dramatic and upset we were when things were not so great. We think: "hey, it wasn't so bad, what was the big deal?" This is a fallacy; if it wasn't so bad, we would not have felt like it was.
I write that now as I read over the last few updates before this one. I notice that I was really desperate, and I remember back to that day; I was really desperate.
But now things have gotten a lot better, I'm quite happy to say.
However, that does not mean that my previous anxiousness (when things were pretty bad) is unjustified. It definitely was justified.
You may have guessed, I stopped using Metronidazole after about two days from writing an update informing all that I'd be trying it out again. I got bored with it, and realised that I only went back onto it because I was so desperate to try something, just something, that could help me at that time.
Anyway, shortly after I posted the last update, I realised all this, and decide to work out why my rosacea had gotten so much worse that I'd resort to trying anything to improve. I realised that I had documented everything (luckily and thankfully), so all I needed to do was read back over the last week or so.
I did this (sort of 'meta-analysis' of updates, if you will) and realised that it was nothing topical that was causing the rosacea to become worse.
So I reflected. It was true that that week had been extremely stressful for me, and that I did not get a lot of sleep. I reflected deeper: I always remembered that sleep was negatively correlated with flare-ups (that is, the less sleep, the more likely a flare-up).
So I simply tried to get more and more sleep. It may be that I have been sleep-deprived the whole year, and still have some catching up to do.
But I noticed an improvement straight away.
I have since been trying to get a lot of sleep every night (at least 9 hours), and this improvement has lasted.
Also, to solve the oiliness problem, I am now exfoliating twice daily.
I know that I had previously thought this to be the cause of rosacea (that is, over-exfoliation causing rosacea), but I now no longer think that. I now think it was that Biore moisturiser.
Anyway, the take-home message is this: get (more) sleep. You will be thankful for it in many ways. You will feel more energetic, refreshed, and you will look a lot better.