North Vancouver nurse shares decades-long struggle with rosacea When North Vancouver nurse Cathy Grehan (50) started developing pimples around her nose and chin a couple of years ago, she thought: “What’s going on here? I shouldn’t have acne at my age…” Like many Canadians, she had no idea the cause of her skin problems was rosacea. “I just wanted it to go away,” recalls Cathy. “The acne-like spots came and went. It got me down. You look at everyone else and think why is this happening to me?” In fact, this episode turned out to be just one of many in Cathy’s decades-long journey with rosacea, a common, chronic inflammatory skin condition causing redness on the face, and for some, small red bumps and pimples. Early signs of rosacea seen in her teen years One of the earliest sign of rosacea – facial redness that comes and goes – began showing up when Cathy was a teen. “While my friends were putting on blush, I didn’t need it. I already had redness in my face. My skin was so different from everybody else in my family. My mum joked she did not know what she ate when she was pregnant with me.” During her teenage years, she also experienced another of the most common early symptoms of rosacea: easy and frequent flushing and blushing. “I definitely blushed much more than other people but thought that was just how it was for me.” Years of coping with facial redness In her 20’s and 30’s, Cathy used makeup to hide her facial redness which had now become more persistent in nature. “My face has always been red. If you look at my skin, it will have a reddish tinge to it. The counter lady at the cosmetics store was always trying to get rid of the redness in my face.” “It was emotionally hard always having to cover up the redness and it flared up in times of stress, typically family holidays.” “I shouldn’t have acne at my age…” But it was the appearance of acne-like pimples on her nose and chin in her late 40’s that was the final straw for Cathy and led her to seek medical help. “When it became pimples on top of the redness, I started thinking something is going on here. I was embarrassed and self-conscious and had had enough,” she says. Her diagnosis was a surprise. She did not have adult acne. Cathy had rosacea. And the condition had evolved over the years from a type characterized by frequent flushing and persistent facial redness, usually on the cheeks, nose, chin or forehead, to a form that now included small red bumps and pimples. Most Canadians unable to recognize rosacea Cathy, like most Canadians, had been unable to recognize she had rosacea, a skin condition affecting around 3 million people here. According to a survey by the Acne and Rosacea Society, some 7 in 10
Canadians shown an image of a person with persistent redness in the central face – the #1 sign of rosacea – were not aware this was due to rosacea. Added to this, it is very common for people to mistake the type of rosacea with red bumps and pimples for adult acne. Her best advice: Get a correct diagnosis With a positive diagnosis of rosacea, Cathy was able to take the first steps to getting the condition under control. In fact, she says her best piece of advice for those who suspect they may have rosacea or adult acne is to get a correct diagnosis from a qualified medical professional. “Sometimes it’s the not knowing that is frustrating. You think you know what it is and start treating it improperly yourself. When you get a correct diagnosis, you receive good advice with that and can make decisions based on your own circumstances. The costs of treatment can be a factor for people but at least you can find out what is available and determine what will be a good fit for you”. No cure for rosacea but various treatments available To date there is no cure for rosacea. However, there are various medical treatments to reduce facial redness, red bumps and pimples, visible blood vessels, irritated eyes and other signs of rosacea. It is usual to undergo a combination of treatments. Cathy’s treatments included a topical (applied to the skin), oral antibiotics and 3 laser sessions. While she was pleased with the results – much clearer skin – rosacea is a chronic condition that comes and goes over the years so while there is much improvement at times, the battle is never completely over. “Rosacea is a chronic nag...” “Rosacea is a chronic nag… it just doesn’t go away. Sometimes it’s better and you think, oh wow, look at my face! Then other times it’s so frustrating when it comes back,” says Cathy. She adds there is an emotional toll associated with the condition and explains why. “It’s on your face, in my case on my nose and sometimes my chin, and you just can’t hide it. It’s not like a rash on your elbow that you can put on a sweater and nobody sees. It’s front and centre for everybody that sees you. “Right now I’m having a bad breakout on the right side of my nose and face…I try to cover up with makeup but it is challenging. I went for a walk with a good friend and made sure he walked on my left side so as not to see my redness and spots on the right side of my face.” Research reveals emotional toll of rosacea The emotional impact of rosacea has been well documented. Rosacea sufferers have a 5 times greater risk for developing depression than the general population. Some 75% of rosacea patients report low self-esteem. Studies show people with rosacea have higher rates of embarrassment and social anxiety compared to others who don’t have this condition. A feeling of being stigmatized, branded or shamed by others for having a red face makes this situation worse. “Oh, she drinks too much”
Myths about rosacea add to the problem Cathy has found. “People look at you and you get associated with ‘oh, she drinks too much’ or it’s a sign of something else like ‘she’s really stressed’. No one is going to come out and ask you – ‘What’s going on with your face? Your nose is red and you have acne…’ but you know that’s what they’re thinking.” Tell your close friends “I think it’s better just to tell people who are close to you so I’ve told my friends I have rosacea. I walk with a girlfriend several times a week and half the time I won’t wear makeup. If my nose is a mess, I just say – well look at my rosacea today… I just feel I need to say something and then we can move on.” Helping others as a spokesperson A big part of Cathy’s decision to become a spokesperson for the Acne and Rosacea Society of Canada stemmed from her own life experiences with rosacea. “I have lived with it and just knowing how hard it is, hopefully I can help others.” Highlighting risk factors for rosacea The fact that Cathy is a very typical rosacea patient – in her risk factors and symptoms - helps to strike a cord with others. That starts with simply being a woman since rosacea affects many more women than men. About 2 in 3 people diagnosed are women. Cathy also fits into the age group most often affected by rosacea which is those aged 30 to 50. Another risk factor for rosacea involves ethnic origin. Those with fair-skin, particularly people of Celtic or Northern European descent, are at greater risk for developing this. Cathy’s roots are Russian Ukrainian on her mother’s side and French Ukrainian on her father’s side. Rosacea is also more common in those with blond hair and light-coloured eyes – blue, grey or green. (A note: People with darker skin types get rosacea too. The incidence is thought to be more common than is presently estimated. This area is currently being investigated.) 30% of rosacea patients have a family member with it Having a family history of rosacea is another risk factor. About 30% of rosacea patients have a close family member with the condition. Cathy’s father has the condition. “It has become more prevalent as he had aged and now affects his eyes,” she explains. A little-known fact about rosacea is that about half of all those affected by the condition have eye involvement – ocular rosacea. This can vary from mild to serious. Symptoms include red, watery eyes, frequent styes and an irritated, dry or gritty sensation. Having highly sensitive skin is common Another common thread among those with rosacea is having highly sensitive skin, something Cathy has too and has found ways to deal with. “I have to keep it very simple and mild with my skincare products… No perfume for sure. And I don’t have facials or anything like that because that would trigger my rosacea.”
While many people with rosacea have to watch lifestyle triggers such as spicy food, hot drinks, alcohol and exercise, Cathy says stress is her major trigger. Classic symptoms of rosacea Cathy’s symptoms of rosacea - from her early facial redness and tendency to frequently flushing and blushing as a teen, to the development of persistent areas of redness on the cheeks and nose in her 20’s and 30’s and finally the development of pimples and red bumps, also follow a common path for those with the condition. Moving ahead with rosacea With a busy life raising her two daughters and working as a nurse, Cathy limits the time she dwells on the ups and downs of rosacea. “I think it’s important to move on with your life and do the things you want to do despite having this condition. “My husband is very supportive and that is great. I aim to stay positive. My rosacea is not going to go away completely but I’ve learnt how to cope with it, get it under control when it’s bad, and not let it interfere. And that’s the best you can do.” For more information about rosacea, visit www.rosaceahelp.ca, a bilingual website of the Acne and Rosacea Society of Canada, a national not for profit organization dedicated to raising awareness and educating Canadians about this common skin condition.