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This is What Happens When You Damage Your Skin Barrier
I’ve always considered my face the perfect product guinea pig. I’ve been fortunate enough to never suffer from severe sensitivities or acne, so trying out a new product or treatment never phased me. Those sheets you fill out before a facial explaining your concerns or past diagnoses? It’s a long list of N/A for me. Well, until four months ago.
In a beauty editor’s worst nightmare scenario, I came in contact with an ingredient in a mask that, low and behold to my knowledge, did not agree with my skin. I washed off the mask to find my skin bright red, tight, and stinging, and kind of like I had sat outside in the sun for five hours without SPF. I splashed my face with water, applied a cooling mask (which immediately stung), and put an ice pack to my face. After a few hours, my skin returned to a pink state, and I shrugged thinking it was just a bad reaction and that was that... But then the side effects continued. Over the next few weeks, my normal go-to products stung or burned, I was breaking out more, and I was blotchy. I started treating my skin with more anti-acne products, thinking I was dealing with a bout of blemishes. Finally, after a few weeks of trail and error, an itchy, pimply rash on my forehead that would not go away sent me to the dermatologist's office. Enough was enough.
I explained everything to my dermatologist, Dr. Patricia Wexler, as it happened. The reason my skin was freaking out? I had completely compromised my skin barrier.
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She told me that the skin barrier holds high levels of ceramides that protect the immunologic and homeostatis health of the skin, which keeps out bacteria, allergens, and maintains moisture. "In your case, inflammation and an immune response caused this barrier impairment and the loss of moisture from your skin," she said.
The side effects of this, she explained, tend to be inflamed, dry skin, which is exactly what I was dealing with. To make matters worse, my impairment triggered an eczema response, to which I figured was acne and started treating as so. The result of that bad idea? Even more irritated skin because I was sucking whatever moisture I had left out of my face.
Now, allergic reactions aren't the only cause of barrier impairment. Atopic dermatitis (eczema), according to Dr. Wexler, is actually the suspect. "Other causes of barrier impairment include excessive washing with soap, dust mite proteases, infections such as staph aureus, and topical allergens," she noted.
The fix was completely transforming my beauty routine, cutting most of my serums, oils, and favorite cleansers out and swapping them for mild (read: less likely to irritate and with little actives) formulas that were heavy in moisture to build up my barrier once again. I also had to cut the acne products because they weren't doing anything for the rash of eczema on my forehead.
Dr. Wexler recommended a gentle micellar water, like Simple's Micellar Cleansing Water ($9; target.com), Eucerin Eczema Relief Creme ($8; walgreens.com), a prescription for my rash on my forehead, Elta MD Clear SPF Broadspectrum 46 ($33; dermstore.com), and SkinMedica HA5 Rejuvenating Hydrator ($178; dermstore.com). And that, my friends, was all I was told to use. I was also instructed to pat all my products on my face, instead of rubbing which could trigger a histamine response.
Over six weeks, the redness faded, the rash on my forehead completely cleared up, and my skin felt and looked like my moisture levels were rising. The stinging subsided, and I started to feel more confident not wearing foundation or concealer on the weekends because my tone was getting back to normal.
So am I cured? Maybe, but maybe not. According to Dr. Wexler, patients that have barrier issues could have a genetic predisposition and should be extremely careful so another episode doesn't arise. However, if it's due to an allergen, which seems likely in my face, recurrences aren't expected.
When skin returns to total normality, Dr. Wexler said patients can slowly add back in favorite products.
My suggestion? If you're dealing with a bad reaction to a product, don't diagnose yourself and go see a dermatologist as soon as you can. If you already know you have barrier impairment, consider following some of Dr. Wexler's tips or exactly what your skincare pro tells you to do.
While I'm so excited to give my anti-aging serum the limelight once again, I will definitely be taking it one tub of cream at a time
Rosacea
Rosacea facts
- Rosacea is a common, chronic, incurable, adult acne-like skin condition that is easily controllable and medically manageable.
- Rosacea commonly affects the central third of the face, especially the nose, and its intensity varies over time.
- Rosacea symptoms and signs include
- redness of the face (easy facial blushing or flushing),
- tiny red pimples and fine red vascular lines (telangiectasias) on the facial skin,
- rhinophyma (an enlarged, bulbous red nose, like W.C. Fields), and
- eye problems, such as swollen, red eyelids (blepharitis), conjunctivitis, and rosacea keratitis.
- Rosacea may be mistaken for rosy cheeks, sunburn, or quite often, acne.
- Rosacea triggers include alcohol, hot or spicy foods, emotional stress, smoking, and heat.
- Rosacea can be a very bothersome and embarrassing condition.
- Untreated rosacea tends to worsen over time.
- Prompt recognition and proper treatment permit people with rosacea to enjoy life.
Photodynamic Therapy & Rosacea
In dermatology, PDT with the photosensitizer Levulan Kerastick (20% delta-aminolevulinic acid HCl) is used for the treatment of very early, thin skin cancers called actinic keratoses (AK). The initial approval was specifically for the treatment of actinic keratosis of the face and scalp with a combination of an application of the photosensitizer followed by a timed exposure to a special blue light source. PDT is also used for acne, rosacea, skin cancer, sun damage, cosmetic skin improvement, oily skin, enlarged sebaceous glands, wrinkles, rejuvenation (anti-aging), warts, hidradenitis suppurativa, psoriasis, and many other skin conditions.
What is rosacea? Is rosacea contagious? What does rosacea look like?
Rosacea (ro-zay-sha) is a common, acne-like benign inflammatory skin disease of adults, with a worldwide distribution. Rosacea is estimated to affect at least 16 million people in the United States alone and approximately 45 million worldwide. Most people with rosacea are Caucasian and have fair skin. The main symptoms and signs of rosacea include red or pink facial skin, small dilated blood vessels, small red bumps sometimes containing pus, cysts, and pink or irritated eyes. Many people who have rosacea may just assume they have very sensitive skin that blushes or flushes easily.
Rosacea is considered an incurable auto-inflammatory skin condition which waxes and wanes. As opposed to traditional or teenage acne, most adult patients do not "outgrow" rosacea. Rosacea characteristically involves the central region of the face, mainly the forehead, cheeks, chin, and the lower half of the nose. It is most commonly seen in people with light skin and particularly in those of English, Irish, and Scottish backgrounds. Some famous people with rosacea include the former U.S. President Bill Clinton and W.C. Fields. Rosacea is not directly caused by alcohol intake, but it can be aggravated by it. Rosacea is not considered contagious or infectious.
The redness in rosacea, often aggravated by flushing, may cause small blood vessels in the face to enlarge (dilate) permanently and become more visible through the skin, appearing like tiny red lines (called telangiectasias). Continual or repeated episodes of flushing and blushing may promote inflammation, causing small red bumps, or papules, that often resemble teenage acne. Rosacea is also referred to as acne rosacea. One of the most unpleasant aspects of rosacea is the overgrowth of dermal tissues producing a "phymatous" change in the skin. This appears as a thickening and permanent swelling of the facial tissues. A bulbous nose called rhinophyma is an example of this change.
Is rosacea like acne?
Rosacea, although distinct from acne, does have some similarities. It is occasionally referred to as "adult acne." Unlike common acne, rosacea occurs most often in adults (30-50 years of age). Unlike acne vulgaris, rosacea is devoid of blackheads and characteristically does not resolve after puberty. Rosacea strikes both sexes and potentially all ages. It tends to be more frequent in women but more severe in men. It is very uncommon in children, and it is less frequent in people with dark skin.
What are causes and risk factors of rosacea?
The exact cause of rosacea is still unknown. The basic process seems to involve dilation of the small blood vessels of the face. Currently, it is believed that rosacea patients have a genetically mediated reduction in the ability to dampen facial inflammation that is incited by environmental factors such as sunburn, demodicosis (Demodex folliculorum in the hair follicles), flushing, and certain medications. Rosacea tends to affect the "blush" areas of the face and is more common in people who flush easily. Additionally, a variety of triggers are known to cause rosacea to flare. Emotional factors (stress, fear, anxiety, embarrassment, etc.) may trigger blushing and aggravate rosacea. A flare-up can be caused by changes in the weather, like strong winds, or a change in the humidity. Sun exposure and sun-damaged skin is associated with rosacea. Exercise, alcohol consumption, smoking, emotional upsets, and spicy food are other well-known triggers that may aggravate rosacea. Many patients may also notice flares around the holidays, particularly Christmas and New Year's holidays.
Rosacea risk factors include fair skin, English, Irish, or Scottish heredity, easy blushing, and having other family members with rosacea (called "positive family history"). Additional risk factors include female gender, menopause, and being 30-50 years of age.
What are rosacea symptoms and signs?
Typical signs and symptoms of rosacea include
- facial flushing,
- blushing,
- skin redness (erythema),
- burning,
- red bumps and pustules,
- small cysts, and
- thickening of the facial tissue, especially the nose.
The symptoms and signs of rosacea tend to come and go. The skin may be clear for weeks, months, or years and then erupt again. Rosacea tends to evolve in stages and typically causes inflammation of the skin of the face, particularly the forehead, cheeks, nose, and chin.
When rosacea first develops, it may appear, then disappear, and then reappear. However, the skin may fail to return to its normal color, and the enlarged blood vessels and pimples arrive in time. Rosacea rarely resolves spontaneously.
Rosacea generally lasts for years, and if untreated, it tends to gradually worsen.
How long does facial flushing from rosacea last?
Early in the course of rosacea, facial flushing is transient, lasting for minutes to hours. Later, as the disease progresses, the flushing becomes permanent and the redness does not resolve.
Is it possible to prevent rosacea?
It is not possible to prevent rosacea, but it is possible to limit one’s exposure to triggering factors. Once the diagnosis of rosacea is made, it is wise to avoid factors like spicy foods, hot liquids, smoking, and irritating cosmetics that are known to trigger rosacea.
What tests do health care professionals use to diagnose rosacea?
Rosacea is usually diagnosed based on the typical red or blushed facial skin appearance and symptoms of easy facial blushing and flushing. Rosacea is largely underdiagnosed, and most people with rosacea do not know they have the skin condition. Many people may not associate their intermittent flushing symptoms with a medical condition. The facial redness in rosacea may be transient and come and go very quickly.
Dermatologists are physicians who are specially trained in the diagnosis of rosacea. Generally, no specific tests are required for the diagnosis of rosacea.
In unusual cases, a skin biopsy may be required to help confirm the diagnosis of rosacea. Occasionally, a noninvasive test called a skin scraping may be performed by the dermatologist in the office to help exclude a skin mite infestation by Demodex, which can look just like rosacea (and may be a triggering factor). A skin culture can help exclude other causes of facial skin bumps like staph infections or herpes infections. Blood tests are not generally required but may be used to help exclude less common causes of facial blushing and flushing, including systemic lupus, other autoimmune conditions, and dermatomyositis.
While most cases of rosacea are fairly straightforward, there are some atypical cases that are not as easy to diagnose. Other skin diseases and rosacea look-alikes include
- acne vulgaris,
- Demodex folliculitis,
- staph infection,
- systemic lupus erythematosus,
- medication reaction (for example, niacin),
- seborrheic dermatitis,
- allergic or contact dermatitis,
- eczema,
- seasonal allergies,
- allergic conjunctivitis,
- perioral dermatitis,
- carcinoid syndrome,
- dermatomyositis,
- impetigo, and
- herpes simplex.
Recently, there has been an association noted between rosacea and certain auto-inflammatory diseases, including diabetes, inflammatory bowel disease, and cardiovascular disease.
How does rosacea affect the nose and the eyes?
The nose is typically one of the first facial areas to be affected in rosacea. It can become red and bumpy and develop noticeable dilated small blood vessels. Left untreated, advanced stages of rosacea can cause a disfiguring nose condition called rhinophyma (ryno-fy-ma), literally growth of the nose, characterized by a bulbous, enlarged red nose and puffy cheeks (like the classic comedian W.C. Fields). There may also be thick bumps on the lower half of the nose and the nearby cheek areas. Rhinophyma occurs mainly in men. Severe rhinophyma can require surgical correction and repair.
Some people falsely attribute the prominent red nose to excessive alcohol intake, and this stigma can cause embarrassment to those with rosacea.
Rosacea may affect the eyes. Not everyone with rosacea has eye problems. A complication of advanced rosacea, known as ocular rosacea, affects the eyes. About half of all people with rosacea report feeling burning, dryness, and irritation of the tissue lining of the eyes (conjunctivitis). These individuals may also experience redness of the eyelids and light sensitivity. Often the eye symptoms may go completely unnoticed and not be a major concern for the individual. Many times, the physician or ophthalmologist may be the first one to notice the eye symptoms. Untreated, ocular rosacea may cause a serious complication that can damage the cornea permanently damaging vision, called rosacea keratitis. An ophthalmologist can assist in a proper eye evaluation and prescribe rosacea eyedrops. Oral antibiotics may be useful to treat skin and eye rosacea.
What about using acne medicine for rosacea?
Since there is some overlap between acne and rosacea, some of the medications may be similar. Acne and rosacea have in common several possible treatments, including (but not limited to) oral antibiotics, topical antibiotics, sulfa-based face washes, isotretinoin, and many others. It is important to seek a physician's advice before using random over-the-counteracne medications since they can actually irritate skin that is prone to rosacea. Overall, rosacea skin tends to be more sensitive and easily irritated than that of common acne.
Does rosacea get worse with age?
Yes. Although rosacea has a variable course and is not predictable in everyone, it tends to gradually worsen with age, especially if untreated. In small studies, many rosacea sufferers have reported that without treatment their condition had advanced from early to middle stage within a year. With good therapy, it is possible to prevent progression of rosacea.
What types of doctors treat rosacea?
Dermatologists are most familiar with which option might be best for each individual. Ophthalmologists treat rosacea-related eye disease.
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