The doctor took one look at my face, glanced down at his notes, and audibly sucked the air through his teeth. He delivered a considered yet slightly backhanded prescription: “Especially given the nature of your profession, I think it’s best you take time off for two weeks to allow everything to calm down.”
Whether he was referring to the pressures of modern journalism or the expectation as a beauty writer to have perfect skin, I’ll never truly know, but I lean towards the latter. That particular appointment was over three years ago, during a pre-#skinpositivity era when Facetune ruled social media with a heavily filtered fist, and few of us blinked an eye when presented with plasticky airbrushing. An appreciation for “real,” unadulterated skin was not a thing.
My doctor had deduced that showing my face in the beauty industry, with a crowd of plague-like pustules camping out on my chin and nose, was not a good look. Given that I’d arrived at the office on a balmy June afternoon with a scarf that Lenny Kravitz would be proud of wound around my face, I can see why he came to that conclusion. During those two weeks I dodged most social interactions, seeing only my sister, boyfriend, and local supermarket staff.
A course of antibiotics quelled the angry rash, my skin smoothed out, and I returned to the office with residual redness — evidence of where the pus-filled lesions had formerly lived. Unfortunately, though, they were to be loyal tenants. Clusters of stinging, burning, pinpoint pustules began to spring up all over my chin and around my mouth every month or so. Frustratingly, every doctor I visited remained baffled. Prescription-strength steroid cream became my crutch, and my Google image search history was quite literally a sight for sore eyes.
As I sobbed in the taxi on the way to the airport (taking public transport was out of the question because my face), I decided that enough was enough.
The unpredictable and tough-to-conceal nature of my flare-ups put me on edge at the best of times, but a sudden eruption the week before my wedding this summer led to tear-sodden pillows and much wearing of polo necks, even though it was the height of August. The second instigator was a throbbing outbreak that bloomed all over my chin just before jumping on a long-haul flight to say my final goodbyes to a relative. Juggling work deadlines with family illness and nick-of-time travel planning triggered a sustained anxiety spike, and the evidence was writ large on my face. It just so happened to be World Mental Health Day and, as I sobbed in the taxi on the way to the airport (taking public transport was out of the question because my face), I decided enough was enough.
Using the funds from my first freelance paychecks, I booked in to see dermatologist Dr. Alexis Granite almost as soon as my plane touched down. She perused my gory selfies and sent swabs to be tested to rule out a staph infection (negative). She admitted that it wasn’t often that she was stumped, but it was looking likely that I had a subtype of rosacea — a long-term skin condition associated with facial redness and flushing — called papulopustular rosacea (PPR).
Dr. Alia Ahmed, a psychodermatologist at skin clinic Eudelo, says that this form of rosacea can be especially tricky to spot as it’s often confused with acne or dermatitis. Dr. Ahmed explains that PPR only represents around 3% of rosacea cases and is characterized by “background redness with inflamed papules and pus-filled spots (pustules) that appear only in the center of the face.” Unlike the blackheads and overproduction of sebum associated with acne, PPR spots have a notable lack of comedones (small skin-colored bumps or under-the-skin spots), and skin is more likely to be tight, dry, and itchy rather than oily.
Stress and anxiety can play a key role in aggravating inflammatory skin conditions such as rosacea, as well as acne.
Like other subtypes of rosacea, PPR is triggered by extremes in temperature, hot drinks, alcohol, spicy food, wind, sun exposure, exercise, and stress. For context, my husband is half Thai so chilies go in everything, and I love nothing more than a sweaty, windswept workout followed by an evening glass of wine. I can curb my enthusiasm for these rosacea propellers in some aspects, but I’m also not about to cease doing, drinking, and eating all the stuff I enjoy for fear of a flare-up. I know I’m not alone: Completely switching up your lifestyle to keep your skin in line is a commitment not many of us are willing to undertake.
With this version of rosacea, the more recognizable markers — visible blood vessels or a “butterfly” redness pattern — often aren’t there. Misdiagnosis (or receiving no diagnosis at all) can make living with the condition even more stressful, as flare-ups and resulting dark spots escalate. But if rosacea evades even medical professionals, how can you tell if you’re affected? And what sort of toll might it take on your mental health? I started by enlisting a couple of derm-approved coping strategies, one practical and one emotional, but both essential in my book.
Firstly, I learned just how much of an impact stress can have on skin and that, for me, the connection is a strong one. That said, taking your anger out on a flare-up by way of picking and scrubbing is counterproductive. According to consultant dermatologist Dr. Anjali Mahto, stress and anxiety can play a key role in aggravating inflammatory skin conditions such as rosacea, as well as acne. The key is to start small. “Try to spend time relaxing and doing something calming every day — whether that’s reading a book, participating in activities such as yoga or meditation, or even just talking with friends and family,” Dr. Mahto told me. “Making sure you get enough sleep and exercise is also important for your emotional wellbeing and therefore your skin, too.”
Infuriatingly, the root causes of rosacea remain poorly understood, and there is no cure. But that in no way means that you’re on your own.
In regard to redness and inflammation, London-based consultant dermatologist Dr. Justine Kluk also recommends identifying key triggers, prioritizing therapy if you’re struggling emotionally, and switching to simple skin-care staples. Basically, try to physically and metaphorically treat your skin with as much compassion as you can muster — which, of course, is often easier said than done. For the former, Dr. Kluk advises massaging a gentle cream or gel cleanser into your face morning and night, wearing SPF 50 sunscreen every day (mineral sunscreens may be tolerated better than chemical formulas), and applying a moisturizer at bedtime and before sunscreen to help soothe the skin and support the vulnerable skin barrier.
Infuriatingly, the root causes of rosacea and its subtypes remain poorly understood, and there is no cure. But that in no way means that you’re on your own, nor do you have to live like a monk in an effort to keep it “contained.” Seeing a dermatologist was a game-changer for me, but specialists can be expensive. In that case, knowing how to talk to your general practitioner about skin is important; in fact, I wish I’d asked my doctor sooner. Dr. Ahmed recommends talking to yours about how you’re feeling overall, in addition to the dermatological symptoms. “Don’t underestimate the impact that your skin can have on your quality of life,” she says. “Rosacea is a complex condition and it’ll take time to find a treatment plan that works for you, so develop a mental health toolkit, too.”
For me, this includes incorporating low-impact workouts into my routine to nix stress and stay fit and strong without prompting a cortisol- or sweat-induced flare-up. Being stricter about my formerly lax sleeping habits during the week especially has resulted in fewer pustule parties, and talking more openly about my skin situation helps across the board. The ever-advancing technology in long-wear foundation undoubtedly improves my day-to-day confidence, too.
While my pustular piques have by no means retreated, having the aforementioned healthy management strategies to put into action makes me feel more empowered in the skin I’m in — even when it’s temporarily on fire.
This story was originally published on Refinery29 UK.
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