How Molly Got The Upper Hand on Rosacea

Molly Row got a brutal wake-up call one day in 2004. “I woke up one morning covered in acne — small bumps and large swellings,” the 53-year-old real estate agent from Sonoma County, Calif., recalled. “It was so pronounced, I was convinced it was an allergic reaction to something."

It turned out it wasn’t though. It was rosacea, a skin disorder that affects some 16 million Americans. Rosacea is a chronic skin condition that causes redness; acne-like pimples; red, spidery facial veins; and sometimes thickening of the skin on the nose. In some people, including Row, it causes dryness and redness in the eyes. Without treatment, rosacea can get worse.

Living with rosacea hasn’t been easy for Row. “I have an acute form, extreme redness and constant burning," she said. "Being covered in acne at my age is horrible. Horrible at any age, [but] you don’t expect to revisit it later in life. My skin gets red if I bend over to tie my shoe.”

Susan Stuart, MD, founder and medical director of La Jolla Dermatology in San Diego, said "dermatologists often use various topical products to manage rosacea." The topical antibiotic metronidazole and another medication called azelaic acid are usually effective treatments. “Both of these work to control the redness and bumps commonly seen with rosacea,” she said.

Neither medication worked for Row, however — nor did many others. After a year of unsuccessful treatment, she was put on isotretinoin, commonly known as Accutane. “I was on it for five months — the drug works wonders but is wicked,” Row recalled. The isotretinoin caused Row’s joints to ache, and side effects got worse as her dose increased. “It became painful to lift a carton of milk," she said. "The last couple of weeks, my spine hurt.”

Isotretinoin is a controversial drug because of a long list of possible side effects, including severe birth defects, depression, and other medical problems. It's usually used as a last resort in people with the most severe type of acne that hasn't been helped by conventional treatment. Dr. Stuart confirmed that it's not a primary treatment for rosacea.

Once Row stopped the isotretinoin, the side effects disappeared, but her rosacea came back. She started oral antibiotics and a topical ointment that contained sulfur. Row believes that the isotretinoin made her skin responsive to the medications, meaning that finally, after two years, her complexion cleared.

Living With Rosacea: Lessons Learned

Row is vigilant about keeping the upper hand on her rosacea. “I have the acne well-controlled, but it takes only a couple of days for a full-blown flare to take over and months to recover.”

She doesn’t rely on medication alone. “Once I was off the [isotretinoin], I found the ointment helped control the acne, but I was unable to find makeup that did not exacerbate the condition," she said. Even some cosmetics labeled "hypoallergenic" or "sensitive" gave her problems. After some detective work on the Internet, Row learned about dozens of specific ingredients that tend to irritate acne and rosacea-prone skin. Now she buys only makeup without the potential offenders.

National Rosacea Society guidelines advise people with rosacea to choose fragrance-free products. Other common ingredients that can be irritating include alcohol, witch hazel, menthol, peppermint, and eucalyptus oil. Talk with your doctor about which specific ingredients you may want to avoid.

Rosacea Care Tips from a Patient

Row advises people with rosacea to do their homework and find out what specific cosmetic ingredients may irritate their skin. “Don’t be swayed just because something is labeled for sensitive use — check the ingredients,” she said. Also, ask for free samples before you buy. “This is not about spending lots of money, it is about understanding what you are using,” she said.

In a survey conducted by the National Rosacea Society, most people reported that sun exposure triggers a flare of rosacea. Row is no different, but she takes precautions. “I wear sunscreen daily and always a wide-brimmed hat when gardening or doing other outdoor activities," she said. "I wear a heavier block when on vacation at the beach so I can swim in the ocean for an extended period of time."

Row has found a way to peacefully coexist with her skin condition. “I no longer worry about not being able to control how I look,” she said.

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