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    The brilliant dermatologist who fixed my rosacea, the Daily Mail, August 2011

    Follow the link to the Daily Mail

    Turning 40 is never great. When I hit that particular milestone four years ago, however, I could at least console myself that my years of bad skin were well and truly behind me. In my teens and twenties I’d been a victim of spots and breakouts that had caused me considerable anguish. But in my thirties, my skin miraculously cleared up. For the first time in my adult life, I could wake up next to my partner without feeling unsexy and self-conscious, go to work wearing just a slick of mascara, and adopt low-maintenance beauty on holiday.


    But as my forties advanced, to my horror, my complexion began to deteriorate again. My forehead, cheeks and chin seemed permanently covered with a rash of small white pimples, as well as deeper spots. No sooner had one cleared up than more appeared, leaving my skin permanently blotchy, bumpy and red, while my sebum glands seemed to have gone into overdrive, meaning, even wearing non-oily foundation, my T-zone was shiny by mid-morning. Uneven skin tone and dullness aged me prematurely, too. Beauticians prescribed acne facial treatments, friends diagnosed stress or age-related hormonal change and my usual beauty regime was replaced by a series of panic beauty buys, gleaned from online research on ‘adult onset acne’; but nothing I tried seemed to make the slightest difference to my skin. Stupidly, it didn’t occur to me to consult my GP; I put my spots down to bad luck, not a diagnosable condition, and kept hoping that with the right products it would clear up on its own.


    As it turned out, my problem was not adult acne or even bad luck but rosacea, a condition which affects about 10% of the population but which remains poorly understood by beauty professionals, the general public and even some doctors. The root cause of the condition, as Dr Anthony Bewley, a consultant dermatologist at Bart’s Hospital in London explained to me, is a genetic propensity to flush, which is why so many fair-skinned people are sufferers. ‘The flushing can be triggered by various factors,’ says Dr Bewley, ‘including over-indulgence in alcohol, spicy food, sunlight, vigourous exercise, saunas and steam rooms, or just working hard outside, which explains that characteristic red, ruddy face farmers so often have.’


    Frequent, excessive flushing in turn exhausts the blood vessels, so that instead of returning to normal they remain dilated, leaving the skin permanently red. After this first stage of the condition, in the second stage the vessels may begin to leak white cells, producing the characteristic papules, or white pimples (which unlike acne spots are sterile, not infectious). In the third and most serious stage, sufferers can experience a disfiguring swelling of the nose called rhinophyma. And for some people, me among them, rosacea is also characterized by excess sebum or oil production and hyper keratinisation, where the cells lining the hair follicle do not slough off as they are meant to, but instead block the follicle, causing spots. Delightfully, rosacea is also associated with a skin mite called demodex folliculorum, which lives on 60 to 90 per cent of humans, but is apparently more numerous on the skin of people with rosacea. Some European dermatologists believe demodex folliculorum is the real culprit behind the condition, but British doctors, including Dr Bewley, are sceptical.


    Looking back I wish I’d sought medical advice sooner, but I’m still shocked that not a single one of the many facialists and medispa therapists I saw over the course of 18 months even suggested it as a possibility. ‘Rosacea can be mistaken for eczema, acne, psoriasis or even an allergy to make up,’ says Dr Bewley. ‘GPs are usually able to recognise it but beauty professionals really need to inform themselves about basic skin health, especially because treatments involving steaming can exacerbate rosacea.’


    It was only by booking a consultation with a proper dermatologist, Dr Stefanie Williams at the European Dermatology Clinic in London, that I finally got a diagnosis. Having taken a look at my skin through a special magnifying glass, she was quick to conclude from my telltale white pimples that my problem was rosacea. The news that my condition was incurable, permanent and apparently typical in women my age who’d previously suffered from acne came as the most horrible shock and I went home to my boyfriend that night and wept. Reassuring as Dr Williams had been about the available treatments, at my lowest point I felt in despair about spending my forties, fifties and beyond not only lamenting the loss of youthful bloom, but being permanently disfigured by spots too.


    People who’ve always taken their good skin for granted perhaps can’t quite imagine what it’s like to wake up every day feeling flawed and not fit to face the world without a layer of disguising foundation. Psychodermatologists agree that the extent of a disease – whether acne, rosacea, vitiligo or psoriasis – is irrelevant to the impact it can have on self-esteem, self-confidence, relationships and one’s performance in the workplace. ‘Anything that involves the face,’ says Dr Bewley, ‘automatically has an effect on confidence. And if you talk to people who have arthritis, say, or a heart condition as well as a skin disorder, they will very often say that the latter causes them more unhappiness than the former.’ That’s why, he continues, ‘no good dermatologist should ever underestimate its psychological impact.’


    Other people might not even have noticed my spots, but to me, they were a source of daily, low-level misery. True, the lumpy, bumpy acne of my teenage years was mostly gone; but suffering from breakouts alongside wrinkles and all the other joys of ageing made me feel and look much worse than I had as a young woman. Yet despite all the research on the psychological effects of bad skin (acne sufferers, for example, are twice as likely to kill themselves as their peers) there were times when I was frustrated to the point of tears by medics including my GP and two further specialists who refused to take my concerns seriously. If you are one of the many women who feels they should ‘just put up with’ bad skin, read on, because a month into a (somewhat controversial) new treatment programme for my rosacea, I feel like a different woman.


    If you go to your GP with what you think may be rosacea, the first thing he or she will do, says Dr Bewley, is address the lifestyle issues that trigger it. Rosacea skin is extremely reactive to sunlight and should be protected with a non-oily, very high factor sun screen; other preventative measures will differ according to your vulnerabilities, but may mean cutting down on coffee, alcohol and hot food. Initial drug intervention will usually consist of a course of antibiotics, often doxycycline, because at a low dose this drug has an anti-inflammatory, rather than anti-bacterial, effect on the blood vessels and papules. Tablets can be combined with topical antibiotic treatments containing metronidazol and azelaic acid, which also reduce inflammation. However, as I discovered, while these antibiotics suppress the rosacea, it can return when the course is finished. Fortunately, another treatment option is available; a low dose of Roaccutane, or isotretinoin, which achieves near miraculous results and is commonly prescribed in Europe for rosacea.


    Not so here. My first port of call was my GP, who advised me, wrongly as it turned out, that remaining permanently on antibiotics was an acceptable way of treating my skin. She warned me that most dermatologists would be very unwilling to prescribe Roaccutane in a non-severe case like mine and told me that saying my bad skin made me feel depressed could be counterproductive because of the drug’s association with depression (more on this later). She also told me that I could always consider using a specially formulated medical foundation to disguise my spots.


    This, to put it mildly, did not seem to me to be an adequate solution, and I asked to be referred to a dermotologist at St Thomas’s in London. The first medic I saw there, Dr Cardosa, advised me that it was bad for my general health to remain on antibiotics long-term, and that I should finish the course and come back to see him when my skin had deteriorated again. Feeling like crying, I agreed, but when I returned, determined to secure the drug treatment I felt I not only needed but also jolly well deserved, I was treated by a consultant dermatologist, Dr Ian White, who seemed to me to epitomise a certain style of patronising, white, male, middle-class physician. After five minutes in my company, he evidently felt he knew more about my skin than I did, despite the fact I’d lived inside it for 44 years, and, obviously unimpressed by the diagnosis of my private dermatologist, told me that ‘You may have had rosacea six months ago, but you don’t have it now.’ He consented, however, ‘since your spots obviously bother you’ to prescribe me another course of antibiotics, plus a topical treatment containing zinc, Dalacin T. Little did I know that he’s sent me away with the very same antibiotics that Dr Williams has first prescribed me – except that this time, they were at a higher dose, and therefore would be less well tolerated long term. (True to form, when I emailed him asking ‘Can I have a brief chat on the phone to you so I can get a quote from you about your objections to the use of isotretinoin in cases like mine?’ I got a fabulously rude two sentence response: ‘Sorry. Unable to provide a ‘quote’ for your article. You will need to go through the hospital’s ‘communication department’.’)


    Two months on from Dr White’s ministrations, which, once again, had left me furious and close to tears, my skin was no better, and I felt concerned that by agreeing to the course of antibiotics he had prescribed, I was running all the risks of long-term antibiotic use without reaping any benefits. The cost of seeking private treatment was a factor I had to consider, but life, I decided, was simply too short to go on suffering for a minute longer.


    I returned to Dr Williams, who agreed that I was a suitable candidate for a course of low-dose isotretinoin. The 10mg per day she prescribed has had a three-fold effect, preventing hyper keratinisation, slowing down sebum production and also serving as an anti-inflammatory and anti-bacterial. A six-month course may build up to a maximum of 30mg per day, and the effects last for many years and are in some cases permanent. While the drug itself cost under £25 for a month’s supply, patients must also commit to monthly consultations to undergo a blood test (to check liver function) and a urine test (for pregnancy, since roaccutane is strongly contraindicated for pregnancy). The total cost of my treatment is likely to be about £1500.


    The change in me and in my skin has been immediate and very noticeable to all around me. After only a month of treatment I’m fresh-faced, flawless, younger-looking and ready to face the world (and answer the door to the postman) without a layer of foundation. I’ve been alert to changes of mood because Roaccutane has been associated with depression and even suicide – although the available research on teenagers with acne has found it difficult to distinguish between the effects of the drug, and the effects of the acne. But rosacea responds well to such a low dose of the drug that its rare side effects become even less likely and I haven’t so far experienced any negative side effects, apart from lips that need regular Vaseline.


    Enlightened dermatologists like Dr Bewley are willing to prescribe roaccutane quite freely because they recognise the mental distress even mild acne and rosacea can cause and therefore feel roaccutane’s benefts outweigh any potential risks. And the jury is very much out on those risks: a study conducted at the Royal United Hospital in Bath in December 2010 concluded that ‘treatment of acne improves quality of life, particularly in those with more depressive symptoms at the outset,’ and could not find evidence of ‘mood deterioration’ in patients prescribed isotretinoin.


    I suspect that Roaccutane prescription is something of a lottery in the UK not just because of the problem of allocating resources within the NHS, but also because many doctors, like Dr White, mentally reserve if for severe cases only. But it goes without saying that I am a convert. My confidence has soared and when I wake up bare-faced next to the man I love, I feel unapologetic, and, yes, sexy. As a taxpayer, however, I still feel angry that an affordable drug which has dramatically improved my quality of life should not have been made available to me on the NHS.


    To contact Dr Stefanie Williams about rosacea treatment and facials suitable for rosacea sufferers, go to

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