Most people know rosacea is a condition of the skin, but did you know it can affect the eyes as well? My rosacea actually started as a rash around my eyes. Over time, it spread to the rest of my face and even to my ears and down my neck. Eventually, my eyelids started to swell and I would awaken in the morning with crusted over eyes. The eyeballs themselves were looking more and more red, bloodshot, and felt constantly irritated, dry, and scratchy. By mid-afternoon, I was having blurry vision. I’ve always had auto-immune related dry eyes, so I was used to some of these symptoms, but after my first rosacea flare, it felt like my eye issues just ramped up in severity. This was more than my typical dry eye.
Yes, this is a picture of my very own eye. Not pretty. When my eye problems continued even after initial rosacea treatment, I made an appointment with my ophthalmologist. He agreed this was rosacea involvement and after examining my eyes, he told me I had a condition called blepharitis as well. Blepharitis is an inflammation of the eyelids and it goes along with rosacea. Even now, I can’t really tell how much is dry eye and how much is rosacea. The doctor assures me it doesn’t really matter anyway because it’s all connected.
Treatment for me included oral antibiotics (which was already prescribed from the dermatologist), antibiotic eye drops for a week, continued use of gel lubricating drops which I had been using prior to my appointment, and a morning and evening routine of ten-minute hot compresses to the eyes followed by eye scrubs with an over the counter product. (From ophthalmologist instruction in the past, I had learned to thoroughly wash my eyes along with my entire face and then to use a washcloth with additional gentle cleanser to the eyes. I’ve also used hot compresses in the past for my dry eye condition.)
After sticking to this routine for two weeks, I did see some improvement. At first, the eye scrub product felt very abrasive to my eyelids, but I stuck with it and let the product do its work without applying too much pressure. I have noticed some breakage of the eyelashes and even some eyelashes which have fallen out. (This will be a follow up discussion with the eye doctor.) I get up very early to go to work, so sticking to the ten-minute soaks in the morning was the most difficult part of the routine. (Lately I’ve slacked off of this in the morning just due to the time constraint and I definitely have noticed some regression in my eyes.) I am really enjoying the soaks at night. It has become part of my routine to unwind at the end of the day and it does feel so soothing to my eyes. I’ve made it a little more fun by using the time to listen to my favorite YouTube dermatologist videos during this time. In the mornings, I was using the time to prepare for the day by listening to praise and worship songs. I’m definitely getting back to this.
At a follow up visit with the ophthalmologist, a steroid eye drop was added into my routine, twice a day for a week and then down to once a day as needed. Overall, I am glad I went to the ophthalmologist. There was not any one thing that was a miracle worker, but all these things together have given a bit more improvement in my eyes. The whites of my eyes are still quite red. I asked the doctor about Lumify eye drops which I had seen in stores. Unfortunately for me, although they whitened my eyes pretty immediately, the result did not last more than about an hour. They’re expensive also. I do believe the steroid eye drop has helped a bit with the discomfort during the day. I’ve noticed I’m not thinking quite as often about how uncomfortable they feel.
If you are in a rosacea flare and you think your eyes are possibly affected, I would encourage you to seek out an ophthalmologist. Be prepared for some work on your part, but with some diligence which you can begin to view as self-care (you might actually enjoy it!), your eyes can improve! This eye stuff has caused me to think a lot about eyes. As a believer in Christ, it reminds me of Psalm 17:8, “Keep me as the apple of your eye; hide me in the shadow of your wings.” To be the apple of someone’s eye is to be completely cherished! I’ve also heard it explained before that this expression of being the apple of someone’s eye comes from the tiny reflection we can see of ourselves when we look in someone’s eye who is also looking at us. So, when we ask God to keep us as the apple of His eye, we are yearning for God to keep his close eye on us! It may seem like you are super focused on what you are going through right now, but take some time to think of the big picture and put things in perspective. We are never outside of God’s eye and we are cherished by Him more than we can even comprehend.
This rosacea journey has prompted the question of “what is true beauty?” As women and for even very young ladies, we are taught through the world that our beauty is what others decide. People might say it is beautiful unblemished skin, perfect facial features, long, lustrous hair, and a toned body. And when that doesn’t fit into our world, we feel ugly, unaccepted, and it even causes us to hide from others. Why have we allowed society to determine our definition of beauty?
Why do we try to hide our not-so-perfect features? Why can’t we see beauty in the midst of acne, rosacea, hair loss, bodies that don’t function like they do for others, bodies that we wish were different? Being forced to go without makeup during rosacea challenges, helped me to find my true beauty. Beauty can be found in the things we don’t like so much about ourselves. It’s in the imperfection that beauty shines through. We are hard on ourselves, but if we were to ask others, they would say it’s our unique features that are so beautiful. When we look at other women and think, “I wish I looked like her”, she might be thinking the same thing about the very thing in you that you don’t like so much!
Rosacea actually gave me confidence to not feel like I have to cover up every blemish. Why does society look at acne, for example, differently than it looks at any other medical condition? Why must one feel like she must cover visible imperfections to feel accepted? It’s actually really freeing to run to the store and not really even care what someone might think of that big cyst on your forehead! By not constantly covering every single skin condition, we force society to think about its reaction to visible health conditions, and perhaps we might even change what society considers true beauty.
And yet, it isn’t Rosacea that tells me I’m beautiful. It’s God, Himself! He just used this journey to be a teaching moment for me. He tells me in I Peter 3:3-4 that “your beauty should not come from outward adornment, such as elaborate hairstyles and the wearing of gold jewelry or fine clothes. Rather, it should be that of your inner self, the unfading beauty of a gentle and quiet spirit, which is of great worth in God’s sight.” This encourages me to dig into His Word so my heart can be changed by God and others can see that inner beauty shine outward. He made you and me in HIS Image, too! Celebrate today how God made you, ladies! He does not make mistakes, and in Psalm 139, He tells us we are fearfully and wonderfully made! I challenge you today to love how God made you, full of blemish and full of beauty all at the same time. There is no one else like you, so embrace those attributes you have that are yours alone. It defines your true beauty!
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After some initial treatment, I started to feel hopeful that Rosacea could possibly be managed and I wouldn’t suffer with this awful rash forever. About one and a half months into my treatment, I went in for a scheduled major surgery and as a result, suffered a mild lupus flare along with an exacerbation of my rosacea including redness and small pustules. I had suffered with cystic acne as a teenager and young adult and large cysts were starting to pop up after my surgery, which I had not had in a long time.
During my recovery, I was plagued with digestive issues and the surgeon recommended I stop the Doxycycline which I was taking for rosacea. (I see now that my digestive problems were not from the Doxycycline, but from the surgery itself. More healing time helped me.) Stopping the antibiotic contributed further to my rosacea setback. I noticed the biggest change in my eyes. They were looking puffy again, even the eyelid margins felt swollen, and they were feeling very scratchy, irritated, and were much redder than before my surgery.
A follow up appointment with the dermatologist confirmed that the anesthesia and drugs used during the surgery as well as the physical stress of the whole ordeal caused my rosacea to flare. She put me back on a form of Doxycycline which is timed released and a lower dosage than my initial treatment. She wanted to keep me on the lowest dose to keep my condition managed. I also discussed my desire to use Tretinoin to see if it would help the acne portion of the rosacea and the fact that it also helps with anti-aging was a plus for me at fifty! She said I could start the cream very slowly, once a week at first, but cautioned that it could worsen rosacea.
This combination along with the basic skincare I was using (see my earlier post) and the continued use of topical Soolantra began to settle my skin. The Tretinoin seemed to help with the acne portion. My eyes felt only slightly improved, and shortly after this, I consulted with an ophthalmologist (a future post coming soon!) I do not like being on an antibiotic for any length of time. An antibiotic kills off your good bacteria as well, so I’ve started taking a probiotic. The dermatologist explained that there is not much treatment available for the eyes afflicted with rosacea and oral antibiotics is the targeted treatment for this.
Tretinoin caused peeling of my skin, so for the first week, I only used it one night. (Do not exfoliate this peeling skin, but rather use a good moisturizer and it will resolve.) Then the second week, I increased to twice a week, and so on until I had worked up to every night. At that point, I noticed that when I had to wear a mask in public due to Covid, my face felt like it was burning under the mask. I decided to cut my Tretinoin use back. When I returned to my dermatologist, her preference was to put me on Azelaic acid instead. She said intermittent use of the Tretinoin would not give me the benefit of a nightly use of Azelaic acid. My skin immediately loved the Azelaic acid, however, I began to notice some mild acne. I’ve only recently started back on the Tretinoin once a week because I like how it makes my skin look. Remember, I have oily skin, so dryer skin types with Rosacea may not tolerate Tretinoin.
As you can see, it takes working with your doctor to manage a stubborn condition such as this. Life events can trigger Rosacea. There will be backwards steps, but just as I learned as an EDS Mama, Hope Always! And if you are right at the beginning of a Rosacea journey, know that you will get improvement with proper management.
The very first thing one should do when faced with a skin condition is consult with their dermatologist. You cannot self-diagnose because what you see could be a million different things. Even my dermatologist took some time to reach a diagnosis for me. In my case, when my skin did not respond to the initial treatment of what the doctor thought was dermatitis, I underwent a skin biopsy which gave definitive answers. I have no scar from the procedure at all and a diagnosis allowed me to get treatment right away for rosacea, so I would do it all over again.
Immediately having a diagnosis, I stopped all my natural, botanical skincare products I was using. This was hard for me because I always thought that natural was better, but as I learned about my condition, I realized even natural products could be exacerbating my condition. I learned that essential oils and botanicals can irritate my sensitive skin.
Two things turned my skin around quickly: Soolantra and antibiotics. My dermatologist prescribed Soolantra, which is an ivermectin lotion. People with rosacea have a higher than normal level of mites on the skin. They don’t know if this is a cause or effect of rosacea. Because my eyes were affected (they were swollen, red, and goopy in the mornings), my doctor prescribed two months of an antibiotic. Within days of starting this regimen, I started to see major improvement. (Stay tuned for another post on my eye involvement as I recently had to visit an ophthalmologist.) I’ve always hated sunscreen, but my doctor advised that I also needed to start using it as the sun was making my rosacea worse. I started watching YouTube videos by Dr. Dray, a dermatologist who is diligent about incorporating sunscreen into a daily beauty routine. I actually look forward to applying my sunscreen every morning; it has become a part of self-care for me.
These are the products I used for my own rosacea. I wash morning and night with Cerave foaming face wash for oily skin. I have oily skin along with rosacea and I was noticing that as my skin got oilier as the day went on, I would get more symptomatic with burning, itching, and redness. CeraVe has parabens in it, which I have always tried to avoid, but I’ve started to change my thinking on skincare products as I’ve had to adapt to what works for my skin. Things I avoid like the plague now include the sun, essential oils, fragrance, and botanicals. Now I see that as soon as I add in a product with essential oils or botanicals, my skin reacts. In the morning, after washing with the CeraVe foaming face wash, I apply my prescribed topical Soolantra. After that, I apply sunscreen. You can read down further for my initial sunscreen experience, but I am constantly trying new ones. Soon, I will post a review of many different brands. I have stopped using any make up on my skin especially with all the mask wearing. Because my eyes have been affected, the only make up I really use is mascara. On a very special occasion, I may use some eyeliner or eye shadow but I love how using no make-up makes it quick to get ready in the morning! I have little eyes with fair eyelashes, so I feel like I need the mascara. If I had big eyes with lush eyelashes, I would go sans mascara in a heartbeat!
At night time, currently I feel like I need an extra product to break down the sunscreen (although when I was first diagnosed, I did not use this product, just the CeraVe Foaming Face Wash.) Even though I have oily skin, I am loving using Habo Lado Cleansing Oil first. It breaks down the sunscreen and mascara and rinses cleanly away with plain water and it has no added fragrance. After that, I use the Cerave Foaming Face Wash and follow with Cerave moisturizing lotion applied to damp skin. The lotion says it is for Normal to Dry skin, but it just feels so soothing on my sensitive skin. I love it. I do not use any moisturizer in the morning because the Soolantra feels like it moisturizes well before my sunscreen application. I did try Neutrogena moisturizer for Sensitive skin and although I liked the lightweight feel of it, it burned my skin when I applied it and I quit using it. I also tried using Neutrogena Ultra Hydrating Gentle Cleanser in the morning and since it also stung my skin, I quit using it. Some people, including Dr. Dray, do not wash their face in the morning, but I find I am oily when I wake up, so I continue to wash twice a day.
Sunscreen has been a huge challenge for me with oily skin. I’ve always hated it. I do wish I had started using it earlier, however, because I have lots of sun damage on my neck which is photosensitive and the deep wrinkles remind me I have started too late. I am still trying to find a sunscreen I like. I first tried Cerave 50 SPF and it left me with a white cast, but did not seem to break me out. I do find the zinc oxide is calming to my skin and even helps with the acne that comes along with rosacea for me. Currently, I like LaRoche Posay Anthelios 50 sunscreen all over my face and neck as a base. It has a liquid, milky texture which I like. I learned from Dr. Dray to use tinted sunscreens as a makeup. Currently I seem to be liking Replenix UltiMATTE Perfection 50+ Tinted Sunscreen which I layer over top of the LaRoche Posay sunscreen on my cheeks, nose, and forehead. I am excited to try a Purito brand sunscreen soon which is supposed to be good for oily skin. I will keep you posted.
And that is it for starters! The biggest piece of advice is to keep it simple! Less is more! Cleanse, moisturize, and apply sunscreen along with any topicals your doctor prescribes. Take some time to test products. If you try too much at once, you will not know what works and what irritates your skin. Be realistic. Rosacea has no cure, so don't be surprised if it is not gone completely. I would say, for me at this point, it is simmering beneath the surface. And remember, I am no doctor so always, always, ask your doctor what is right for you.