Under My Skin
Dr Veronique Simon - Vogue Magazine Article
When rosacea struck in Calgary Avansino's mid-thirties, the effects ran much deeper than she could have imagined.

I was one of those annoying girls who never had acne as a teenager, never had anything more than a few monthly spots on my chin in my twenties, and didn't even buy my first foundation until I was 30. Then, at the age of 33, my fresh-faced, foundation-free days abruptly ended.


It all began in June 2008, when a few unfamiliar red marks debuted on my right cheek. I chalked them up to stress and ignored them. As summer drew to a close though, I could no longer deny that this "breakout" was something more serious. The right side of my face was swollen and covered with blemishes, my nose was red and inflamed, and nothing I applied made any difference. Within months I went from being someone who rarely spent more than five minutes applying makeup to a person who stared obsessively in the mirror seeking ways to conceal this foreign complexion.

It didn't take long 
to be diagnosed with 
rosacea and told that "there is not much known about it and no known cure". All four of the dermatologists I visited (yes, four - I was determined to find one who would offer a glimmer of hope) explained that it was chronic inflammation where blood vessels dilate too easily. It occurs most commonly in women (check) with fair skin (check) who are prone to blushing (check). So, at an age when I assumed I was well beyond my "skin-issue" years, I was suddenly a textbook case. All the doctors told me to treat it with oral and topical antibiotics.

This was very, very bad news for a girl who will fight a cough for months to avoid conventional medicine; a girl who argues with her surgeon post-C-section over antibiotics because I didn't want my babies to get the drugs through my breast milk. (I lost that battle - reasonable, non-hormonal husband talked sense into me.) I decided to try any other option first: red-light treatments, speciality facials, vitamin concoctions and absolutely every cream marketed for rosacea.

What began as a condition I felt I could manage both practically and psychologically was quickly spiralling.

Unfortunately, nothing had any significant effect on me, and what began as a condition I felt I could manage both practically and psychologically was quickly spiralling.

Let me preface the following by saying that I am not a crier. Yes, I sobbed to my boss when I resigned after 13 years, but in general I am not prone to tears. I have never cried in the loo at work; I don't cry when I fight with my husband; I have never cried when feeling sorry for myself. Whether it's a good or bad trait (and I'm really not sure which), I'm pretty tough. So, publicly I put on a brave face (which necessitated applying a hell of a lot of foundation) and faced the world more fiercely than ever, as if nothing had changed. Except something had changed... In fact, some days it felt as if everything had changed.

Behind the façade I was most definitely crying. I vividly remember arriving home from a beach holiday (sun exposure aggravates the condition) and sobbing 
in my bathroom before work as I tried to cover up a constellation of spots that were impossible to conceal. I desperately wanted to call in sick, to hide, to escape, to run away where no one knew me. Mirrors became 
the enemy. Once I stopped in the ladies' room at Claridge's before an important meeting and, after glancing at the mirror, sat frozen in the loo for a good 10 minutes wondering how I could cancel it without being completely unprofessional. Rosacea made me scared to face the world and that is really not me; I am outgoing, strong-willed, self-confident. Where had that person gone? How could my personality evaporate because of something so superficial? In situations like that - and daily, if I'm 
honest - I began reciting a mantra: "Don't be so vain - you don't have cancer, you are blessed with two beautiful children and a loving husband, you are good at your job, you are strong, you are healthy - it's just bloody bad skin."

If I ran into people, especially those I hadn't seen in awhile, I locked eyes with them, never letting my gaze lapse, because I thought if I held their eyes, they wouldn't be able to look around my face.

I began to adopt some strange habits, which I subconsciously convinced myself would protect me from judging eyes. I grew out my fringe and began sweeping it neurotically over the side of my face; I cupped my hands over my cheeks when
I was seated at meetings (very out of character - I am a complete germaphobe and never touch my face); and when I'd enter my editor's office for a meeting, instead of sitting next to her as usual, I sat in the furthest seat, hoping that angle would obscure the worst. If I ran into people, especially those I hadn't seen in awhile, I locked eyes with them, never letting my gaze lapse, because I thought if I held their eyes, they wouldn't be able to look around my face. I probably seemed a bit psycho.

I will be forever thankful to those people who didn't shy away from it. I met a friend for lunch and her opening line was, "Lord, what is going on with your skin?" Her candour was a huge relief. The whispers hurt so much more. Once (and to this day I don't know why she did it), a colleague told me she had heard some of our mutual friends at a party talking about how bad my skin was. I laughed it off but that comment emotionally paralysed me for days.

Finally, like any sensible person, I gave in and went on as many antibiotics as a respectable doctor would prescribe. Within weeks, my face began to clear. Hallelujah! Sadly, though, the honeymoon was short-lived. Once a three-month course of antibiotics ended, I'd have a grace period of a month, and then I'd wake 
up and see spots reappearing: 
the demoralising cycle starting 
all over again. Desperate, I 
took three more rounds of
 medication (usually in the 
lead-up to the fashion shows) 
over the next two years, but 
ultimately realised I couldn't 
take antibiotics for the rest 
of my life. It goes against 
absolutely everything I believe 
- I'm a clean-living girl who 
loves green juice and vegan 
baking; how could I justify 
poisoning my body with 
toxins over and over again in
the name of vanity?

Picture credit: Patrick Demarchelier

The solution came when 
I was least expecting it. At 
a work lunch the conversation moved
 to health and I left the meeting with 
the number of a nutritionist who, I was assured, could sort my "gut" issues. It's 
not surprising that my tummy was out of whack after multiple rounds of antibiotics, but I didn't realise it went much deeper than that. I quickly booked in to see Petronella Ravenshear (I loved her by name already) and talked through my stomach problems, not even mentioning my skin, but bless 
her, at the end of our session, she said 
"and while I'm at it, why don't we have a 
go at that rosacea I see you are battling?" 
I held back tears (remember, tough girl) and reluctantly said OK, but I really 
didn't think it would work. In Petronella's experience, the primary causes of rosacea are low stomach acid, low levels of good gut bacteria, parasites, overgrowth of yeast and infection of H pylori, so we attacked them all. "We have to eradicate pathogens, improve digestive chemistry and supply the gut with the nutrients it needs to heal," she told me and, with hope, I did exactly as she instructed - diligently taking pills 
in the morning, before meals, after meals and before bed. Every morning, before eating or drinking anything else, I religiously swallowed my dose of liquid probiotics; 
I carried around mini-ziplocks full of pills wherever I went and shamelessly pulled them out to stay on schedule; and I became more dedicated than ever to my gluten- and dairy-free diet to give my gut the best chance to heal itself.

Slowly, slowly, slowly, my skin miraculously began to clear. I didn't want to believe it at first - I couldn't allow myself that excitement - but over the course of nine months, the bumps and spots (technically called pustules) first subsided, then cleared completely. The swelling and redness has also reduced considerably although not entirely, so I am now barraging that with lasers - something I couldn't do before because the spots were too sensitive.

I can't deny that the psychological scars remain. I still need to "have my face on" before I feel confident enough to face 
the world, and I still obsessively look in the mirror first thing every single morning with the fear that new spots will be staring back at me. I know it's absolutely nothing like beating cancer or overcoming a serious illness, but in my life so far it was a tough challenge that I tried (not always successfully) to face with as much grace
as I could muster. And if I can encourage even one person who is fighting acne, rosacea, eczema or psoriasis to persevere, to keep looking for answers (not always in traditional places) and, most of all, to be as kind and sympathetic to oneself as possible - then every word will have been worth writing.

These days I appreciate each moment of clear skin that I am blessed with and, in general, make it my mission to focus on the positive and find the silver linings in whatever life throws me - so for that, I thank you, rosacea.

Treatments that helped

Nutritional consultation with Petronella Ravenshear, £160, Chelseanutrition.com

Combined Laser Treatment For Rosacea at Dr Sebagh, from £450, Drsebagh.com

Intense Pulsed Light at Dr Nick Lowe, £400, Drnicklowe.com

Rejuvenator treatment with Dr Veronique Simon, £400, Simontherapie.com

The Skin Calm Facial at Content Beauty, £110, Beingcontent.com

The Liz Earle Signature Facial, £90, Lizearle.com