One of the first signs of sun damaged skin might not be what you'd expect, especially if you are of Northern European descent. That's my heritage. As a child, I had the "English Rose" complexion with milky white skin and pink cheeks. In the summer, I would get a smattering of freckles across the bridge of my nose that faded long before Halloween. My sun-tanned skin faded just as quickly, and by Christmas my face and body once again looked the underbelly of a salt-water fish.
When I was a child and young adult, the only concern about sun exposure was to avoid a sunburn because sunburns hurt, not because we knew then that each burn would aggregate the damage that many of us would start to see in our 30s. As an aside, peeling off the epidermal layers from our healing skin days after a burn was kind of fun ... if perverse.
The following
Mademoiselle ad from 1961 was a bit before I was born, but Sea & Ski was the tanning lotion my family used. (Note: we called it "tanning lotion" back then, not sunscreen.) I bet our little green bottle of Sea & Ski didn't even have an SPF of 15, but it smelled heavenly.
I have always been very active and love being outdoors, so my skin soaked up a lot of sun. I also had my share of sunburns—some so bad they blistered, yes, even on my face. Ever get a cold sore after a sun-drenched weekend? I did. Cold sores (aka fever blisters) are a virus, and having one crop up on my lower lip was my immune system telling me to
please back the eff off.
There weren't as many options for sun protection as we have today, other than Sea & Ski, Coppertone, zinc oxide (what lifeguards wore on their noses), or putting on a tee shirt. I had no idea then that spending my summer days on the lake or beach or sailing from Wentworth to Boothbay would come back to bite me.
By now we all know that prolonged exposure to sun prematurely ages the skin. When the sun's ultraviolet rays hit our skin, they prompt the cells to produce pigment, which some of us will see as a tan, but which, with chronic exposure over the years, can create brown spots that do not fade in winter the way our tans used to.
The condition of the woman's face below at left is similar to what I saw in the mirror in my late 30s, with hers maybe a bit more severe. What is truly telling is the underlying damage to the skin when seen through a black light (aka ultraviolet light, or Wood's lamp).
Here's a more extreme case of sun-damaged skin. If you lived near the ocean, you surely saw older women, just like her, who appeared on the beach,
impossibly tanned, as early as Memorial Day.
Years before I noticed any changes in pigment to my skin, I began to notice a silver-dollar sized cluster of red splotches in the middle of my chest, which on closer inspection appeared to be tiny veins. I went to a dermatologist who pronounced, "Sun damage." That's ridiculous, I thought. It looked more like a rash or broken blood vessels from an injury. He then said, preying on my vanity and with dollar signs winking in his irises, "I can permanently remove those veins ... and also get that vein near your left nostril, as well." He bought out a giant magnifying mirror and showed me a vein the width of a silk thread, which only an atomic force microscope would see, but I was young, and I was vain. I said yes.
I learned years later that I had undergone my first laser treatment, which was probably KTP or diode or Nd:YAG laser, all of which doctors used to treat single, large, visible blood vessels. The laser he used came out of a device that looked like a pen attached to an arm, which he wielded like a dentist drill, and oh, did it hurt! I can be quite stoic when it comes to painful treatments—I've even removed deeply-embedded glass from my own foot—but no advance knowledge would have stopped the stream of water that poured out the sides of my eyes, down my temples and into my ears.
The next morning, the affected skin scabbed over, but it wasn't anything that kept me home with a bag over my head. In a couple weeks, the red splotches and barely-visible veins were, indeed, gone, but because I was still an outdoors person, and because I did not believe that the visible veins were caused by the sun, they came back. And guess what. They brought some friends.
Disappointed, I assumed the dermatologist had lied to me when he said removal was permanent, and so I lived with these teensy, almost invisible veins near my nose and on my chest for another ten years. During that time, a tiny, slightly-raised red spot appear under my right eye, but I just got used to it. But back to my mid-to-late 20s, another change I noticed was that the intense flush I would get from vigorous exercise, cold winds, alcohol (especially red wine and beer), and even sex took longer to fade. I was beginning to resemble Miss Piggy (who used to be a lot more pink and fat but I guess her appearance has become impolitic).
Now, 20-something years later, I realize that the dermatologist had been partly right when he said that the redness was caused by the sun. Aside from creating hyperpigmentation, ultraviolet rays also break down the blood vessels under the skin and can cause red blotches that fade very slowly or, eventually (for some of us), do not fade at all. But there was also another underlying, chronic condition that would eventually get worse over time, which had to do with my own DNA and my lifestyle.
Do you blush? I have always been a blusher. You know how some people turn pale when they feel embarrassed or upset? Or their face doesn't change at all when they are having a good belly laugh? That's not me. I turn red. Furiously, neon, beet purple-red. My eyes water and redden, and even my ear lobes turn red. Over time, I observed that when I blushed, my skin didn't return to its normal fair state as quickly as had previously—even when it wasn't a blush brought on by more vigorous external conditions, like the above-mentioned cold, heat, or exercise. Sometimes a blush blush was just a blush, but it could last more than an hour, and my cheeks and chin and ear lobes would actually feel warm top the touch. Sometimes a flush was accompanied by a sensation of stinging or burning.
In my mid 30s, I noticed that if I pulled the skin tight around my chin, I could see a cluster of veins visible on the surface. So it wasn't just pinkness I was seeing; there were veins present that were causing the red I saw every day. The same tiny veins were also present on both apples of my cheeks, but my chin had both red and blue in it. I'd been using Prescriptives custom-blended powder to even out my skin tone for many years, but the powder/foundation was no longer concealing the redness, not past the first hour of so. That prompted my mission to
find a more effective foundation, which was moderately successful. Meanwhile, I wanted to know why my face stayed red all the time, sometimes just pinkish and other times really
really red. The catalyst was when a colleague commented on my sunburn, when I hadn't been out in the sun at all. I called my primary care physician that afternoon.
Diagnosis: Rosacea!
My doctor told me I had
Rosacea, a condition I had never heard of before, and she sent me home with some pamphlets and a prescription for Metrogel, which is a topical antibiotic that was supposed to clear up the skin and help calm the redness.
Cause: Rosacea is the result of swelling of the blood vessels just beneath the skin's surface. It is not harmful, but you might feel like harming someone when you wake up day after day with a face that looks sunburned. Even the
National Rosacea Society has not identified a single cause, probably because there isn't one.
What they do know is that you are more likely to have or develop Rosacea if you:
- are fair-skinned
- are female (not as common in men, who can develop the more severe type, such as W.C. Fields, who surely had Rosacea with rhinophyma)
- have a history of excessive alcohol use/abuse (they aren't called "gin blossoms" for nothing)
- are pregnant
- have a history of repeated sunburns
- are between the ages of 30-50 (I was 34 when diagnosed but noticed signs as early as my late 20s)
DISCLAIMER: Before you read on, please know that I am merely a well-read amateur on this issue. I have no formal medical training. If you think you might have Rosacea, see a qualified dermatologist, preferably someone who is traditionally trained with an interest in integrated medicine, because much of Rosacea can be managed by lifestyle changes (diet)—especially if you don't have permanent redness yet. The sooner you learn how to manage it, the better your skin will look.
Signs/symptoms: The primary signs of Rosacea are:
- Blushing or flushing easily, where the blush lingers longer than it does in other people or than it used to on you
- Permanent facial redness, with or without visible spider-like blood vessels, which are called telangiectasia
- Acne-like skin, called papules and pustules—or P&P, which might ooze or crust over
- Tightness, burning, or stinging sensations in the face
- Irritated, bloodshot, watery eyes (a subtype called ocular rosacea)
- A red or bulbous nose (called rhinophyma, which is rare)
Based on exhaustive research and my own experience, I believe rosacea to be both a lifestyle and vascular condition. You can't escape your heritage, so if you are fair skinned, never
ever let your skin burn in the sun. But if you're a blusher (and I can now so easily identify those adorable, blooming-cheeked children who will be at risk for developing Rosacea as adults), there isn't much to be done about it besides knowing your personal triggers and trying to avoid or minimize them.
Test: Diagnosis is not difficult. It simply requires an office visit where the doctor will examine your face and ask you questions about your medical history. After my initial diagnosis, I later self diagnosed myself with subtype 1, as my skin was similar to the woman's skin below, and I never developed P&Ps or skin thickening.
Triggers: It is impossible to avoid all triggers (like walking into an overheated building from a cold parking lot), and I am sure few of us would want to swear off sex forever, so we do our best. Triggers can also vary from person to person, but you can minimize some of them and help prevent or reduce flare-ups.
- Avoid direct sun exposure; even strong sunlight through a closed window (like while driving) can cause a flare-up in some people, even in winter.
- Use sunscreen every day, though keep in mind that we do need to absorb some sun for it's vitamin D—speak with your healthcare practitioner about managing your risk.
- Protect your face in cold, strong winds with a scarf, although also know that hot breath trapped under the fabric can cause your face to overheat and flush.
- Don't take super-hot showers and baths; make the water more tepid.
- Avoid saunas and hot tubs.
- Read the ingredients in the products you use and watch for trends in your skin's reaction; then avoid buying products that contain those ingredients (for me it's chemical sunscreen, alcohol and witch hazel).
- Avoid vigorous activity in hot weather and try to exercise in the early morning or evening, or work out indoors where you can use a fan or air conditioner, preferably blowing on your face.
- Try to reduce stress. If you don't do yoga or meditate, now might be a good time to start, but know that bending forward, with your head parallel to or below your knees, can trigger a flush in some people, so start a yoga practice with upright positions. (Bending over to tie shoes or put on stockings can also bring on a flush—keep your head over your heart.)
- Limit hot spices, alcohol (especially red wine), and hot beverages.
As you pay attention to what your triggers might be, here are some other things you might consider:
- Keep a food diary and write down what you eat, so you can more easily spot trends before a flare-up. Some of the most common food triggers are dairy—especially yogurt and sour cream (yogurt does me in every time), vinegar, certain fruits, like pineapple and avocado, certain vegetables, like spinach, and any food to which you have an IgE/IgG response, where wheat, milk, corn, soy, fish, and eggs are the most common.
- Experiment with controlling your carbohydrate intake and eliminate or limit sugar and flour. This is the single best dietary change I do to keep my skin calm, especially if I keep carb level around 100 grams.
- Carry a mini portable fan with you, maybe even one that disperses a fine mist of water, which you can aim at your face to cool it down and also annoy people on the subway.
- Drink ice water. You can even hold an ice cube in your mouth during a flare-up and pull it out to rub the cube against your skin.
Treatment: There is no known cure for rosacea, only treatment, but your dermatologist can help you identify triggers and might prescribe something to ease any discomfort or deal with P&P:
- Oral antibiotics (such as the 'cyclines) or topical (such as metronidazole) might help control acne-like skin problems. Note that Rosacea is not acne, so it won't respond to over-the-counter acne treatments, like benzoyl peroxide or AHAs/BHAs—these treatments could make your symptoms look or feel worse.
- Other vitamin A-type medications (such as Accutane or isoretinol) are stronger alternatives to antibiotics. We older ladies will have to see if our skin can handle tretinoin.
- Laser surgery, which collapses those surface veins and swollen nose tissue.
Is it really
that important to quickly get a flare-up under control? Yes, because it is the chronic blushing that ultimately leads to permanent redness (telengectasia) as the blood vessels become aggravated, much the same way sitting with your legs crossed can lead to varicose veins.
What I did
After a month on Metrogel, I passed on additional antibiotic treatment, partly because it did nothing but make my skin feel tight and itchy, but also because I did not want to compromise my immune system by using antibiotics long term.
I lived with the redness as long as I could, using makeup to mask it, until I finally accepted the red was shining through anything I put on top, the same way Rudolph's red nose burst through the clay cover meant to hide the glow. I finally decided I'd had enough and made a consultation with a dermatologist who performed laser treatment, recommended by my own dermatologist. Was it necessary? No. Did I do it based on vanity? Yes. Did I feel better after? Yes. Would I do it again? Hell, yes.
I didn't just jump in, though. I had already spent several years reading about Rosacea and trying to manage my symptoms naturally. If you think laser treatment might be for you, educate yourself and be aware of the risks before you go through with any procedure. Even non-invasive procedures that don't require surgery have risks. Make sure you get a referral from someone you trust or research the doctor you are thinking of seeing.
During my consultation, this new doctor and I discussed the different types of of treatment available, what each procedure targeted (for example, the difference between laser or intense pulsed light therapy), and what the risks factors were. She set my expectations from the start that it would require several sessions for me to achieve satisfactory results. She also mentioned that touch-up sessions are often needed every 4-12 months, depending on how well the treatment addressed the underlying condition and whether I maintained a lifestyle that minimized my triggers.
She recommended that I use a combination of Vbeam and IPL.
Vbeam
The Vbeam pulsed dye laser, which is highly specialized for treating Rosacea, produces an intense, single wavelength (burst) of light, which selectively destroys the targeted blood vessels without damaging the surrounding skin and tissue. Vbeam is used to treat vascular skin conditions, such as rosacea, facial and leg veins, psoriasis, scars, red birthmarks (hemangiomas and port wine stains), cherry angiomas, uneven coloring of the neck and chest, red stretchmarks, and warts. It can also be moderately skin rejuvenating and smooth over fine lines, but I didn't have redness in areas where fine lines form, so I cannot comment on those claims.
Though atypical, Vbeam can cause some bruising, but this depends on if you bruise easily and if the machine is initially set too high. An experienced practitioner will quickly correct the setting, but she will start at the highest setting she thinks you can handle (based on her experience with other patients) so you get your money's worth. You can expect extreme redness immediately after the treatment (which calms down dramatically over a couple hours), and possibly some swelling, which can last a couple days, but it isn't anything that would keep you inside under the covers.
Intense Pulsed Light
Unlike Vbeam, which targets specific blood vessels, IPL (also called also called Photoderm, Fotoderm, and Photofacial) is not a laser. It produces a broad spectrum of light that works best on diffuse redness and brown discolorations and goes deeper than Vbeam, which handles only the surface veins.
I agreed on the doctor's recommended course of treatment, starting with Vbeam to first get rid of surface redness and then attack the deeper, more diffuse red (help stop blushing in its tracks) and also fade the brown pigmentation.
Before your first treatment
Here are some tips based on my research and my experience:
- If possible, plan your first treatment when your skin will be at its most pale. The paler the skin, the more easily the laser can target the red (or brown, in the case of IPL).
- Consider making your appointment on a Friday, so you have the weekend to "recover." It shouldn't take more than a few hours, unless you bruise easily, like I do, and then the bruises will take a few days to fade.
- Starting two weeks before your appointment, avoid direct sun exposure. Always wear sunscreen, and if you need to be outside, wear a hat.
- Clean up your diet. Avoiding junk food like sugar and white flour can help minimize any potential swelling.
- Do not drink alcohol or take aspirin before your laser treatment.
- Bring a wide-brimmed hat to the appointment. Your skin will be extremely sensitive after and you don't want any sun to get on it.
- You can bring your own sunscreen, but the dermatologist will probably offer you some.
- Wear absolutely no makeup to your appointment, not even sunscreen.
- Wear a shirt you don't love.
- Ask about taking an oral antifungal, starting the day before your appointment, especially if you have ever had a cold sore before. The doctor will need to write you a prescription, and some may do this as a matter of course.
- If you bruise easily, consider taking arnica (an OTC supplement) 10 days before treatment, on up to the day of the appointment, and afterward until any bruising heals completely. You can buy arnica at any pharmacy.
During the appointment
Depending on what procedure you choose, your appointment might be different from what I experienced, but here are some things you might expect from a typical Rosacea treatment:
- The person performing the treatment might ask if she can take your "before" picture. I never saw my before-and-afters, but if it goes into the portfolio and helps a prospective customer make a decision, that's fine with me.
- She might hand you a warm, wet washcloth and ask you to cleanse your face, even if you went to your appointment barefaced.
- You'll put a paper cap over your hair and then lie down on an examining table.
- The operator will cover your eyes with sticky eye patches (don't bother curling your eyelashes that day) and spread thick, cold goo on your face. Expect that some of the goo will transfer to your hair along the hairline.
- During treatment, each pulse will feel like a rubber band snapping against your skin. It is not pleasant, but it is not teeth-clenching pain, either. On a pain scale of 0-10, I'd give it a 3, but I have a pretty high pain tolerance.
- A typical treatment lasts anywhere from 10-30 minutes.
- At the end, the operator scrapes the goo off your face, and I learned by my third appointment to wear a shirt I don't care about because we had an accidental goosplosion. (It came out in the wash.)
- You'll get a washcloth (to get the rest of the goop of your face) and probably some sunscreen.
- I also received a small, frozen blue-ice thingy (technical term) that I gently pressed on my skin during the drive home. At another appointment, I got a tea bag in a cup of ice, and I pressed the teabag on my skin, but know that the tea water will dribble down your chest while you're driving home.
After the treatment
Don't be alarmed if your skin looks like your worst sunburn,
ever, afterward. My face looked positively scalded after Vbeam (just really red, no blisters) and less red after my IPL treatments.
Recovery is quick, much faster than laser resurfacing or a chemical peel (neither of which I have ever had). By the time I got home 45 minutes later, my skin had mostly gone back to normal after Vbeam, and I could have put on a little foundation and gone straight to work after an IPL treatment.
As I mentioned above, I bruise easily, and my skin did bruise during both Vbeam treatments, but much less the second time. The doctor immediately saw what was happening and adjusted the machine to be less intense. I had a little bruising on one cheek and a couple bruise dots on my chin that my concealer mostly covered but which reminded me of chicken pox.
The evening of my first Vbeam treatment (and ignoring the wee bruises) I thought my skin looked great. Much of the redness had gone completely, and my skin was calm and fair again. There were still a few veins that didn't get zapped away, but some of them disappeared on their own over the next week. For the ones that didn't I scheduled a second appointment a month after the first one.
A month after my second Vbeam treatment, I started IPL. I saw no immediate change after the first IPL treatment, and improvements happened over time, where I noticed a lessening in the brown pigmentation that used to be freckles. But here's the thing: If you go outside without sunscreen, the brown pigmentation
will come back. So I'd say to go for IPL only if you can commit to a rigid sunscreen practice and/or are willing to go back for followup treatments.
My doctor called after every treatment to see how I was feeling. ♥
What does it cost?
It's not cheap, and it's not covered by insurance. Cost will vary by region and by practitioner. My first Vbeam treatment cost $750 (she knocked $100 off the total after she bruised me), the second one cost $500, and each IPL treatment was $350.
I still love the outdoors, although the six months I went through these treatments, my gardens suffered. But I won't hide under a hat full time, so I have given up on IPL. But when my redness comes back (and it
will because I am a furious blusher), I'll go back for one or two Vbeam treatments, which was more aggressive and slightly more painful but which gave me the fastest, longest-lasting results.
As for sunscreen, I wear Jane Iredale PurePressed foundation on a daily basis, which contains physical sunscreen with an SPF of 20, and if I am going to be outside for a while, I use Jane Iredale Powder Me SPF 30 Dry Sunscreen. (If I go to the beach, out on a boat, or up a mountain over the treeline, I'll bring a hat.)
There's a ton of information on the web about both treatments (including YouTube videos if you are inclined), but I hope you found this article helpful.
Bottom line: I'd do it again, but I feel my money was best spend on Vbeam.
