26 October, 2014

Rosacea and pregnancy hormones (autoimmune disease and microchimerism)

Rosacea and pregnancy hormones

-How does pregnancy affect rosacea?
-Can pregnancy trigger onset of rosacea?
-Fetal microchimerism
-Patient testimonials on pregnancy and rosacea
-How to treat rosacea during pregnancy

I've long pondered on this topic. Many years, close to a decade in fact. I have till this day not found a clear definite answer on these questions, but I did find a lot of clues and information. I'll try to put it in this post. Note, I received a comment from a friendly lady who wrote that you shouldn't worry too much about things like pregnancy making rosacea worse, because of the stress it could evoke, and that a lot of things can possibly worsen it, and you should go for it and not let them scare you or hold you back. That it isn't clear how rosacea will respond to pregnancy, so why write about it here? She is right. Rosacea shouldn't come in the way of such important, life changing things as having children. I don't try to scare people, the aim is more to find information that is out there on this topic, to gather it. Patients testimonials both positive and negative, taken from public online forums and websites, although I will point out later here as well that those sailing through pregnancy might not be inclined to post about it as much. So you never get a completely realistic representative idea of the risks, by simply looking at online posts. I try to find explanations why the women who write on public forums that their rosacea worsened, or even have it started during or after pregnancy. Not to say; don't have babies when you have rosacea. My own history in this is complex and multifaceted and not really of a lot of importance in this post, in the sense that in my own choices, it hasn't simply come down to not wanting a redder face. It has been a very long journey in that respect for me, with years in hospitals and all sorts of underlying health problems, but I have tried to keep most of that out of this post and focus on the above topics :) 

How does pregnancy affect rosacea?

Rosacea can be affected by pregnancy. Many patients have reported that their rosacea started during or after childbirth. Those at risk for this to happen, might have had a predisposition for rosacea; the genetic make up for it or the risk factors to develop rosacea, like pale (or lighter) skin tone, sensitive skin and being able to blush or get some redness from alcohol, change in temperature for instance. But there are also many testimonials on rosacea forums and in heaslth groups of women who saw their rosacea calm down during pregnancy. How pregnancy can affect preexisting rosacea is a difficult estimation. It has been hard to find clear numbers of research on this topic, but the general consensus is that rosacea can do exactly everything under the sun during pregnancy: either flare, stay stable, or actually be positively influenced by the hormones of pregnancy. It's tough to predict what will happen to you if you fall pregnant and already have rosacea. My own dermatologist said to me at the time, when I asked and asked and asked about the topic, dying for some doctor to tell me with some certainty "Yes you will be fine, go for it!", that he sees more than half of his female patients doing well, either stable or improving during pregnancy, and less than half of them getting worse. He said when I asked for advice, that he wouldn't advice his patients to refrain from pregnancy, as the rosacea outcome could go either way. And that he felt most of his patients were able to bring rosacea back under control as soon as they could go back on medication after birth or breast feeding. Pregnancy can make rosacea temporarily better he said, possibly because of the rise in estrogen (aka estradiol) hormones, produced by the body. He found estrogen to be, all in all, a positive hormone in terms of suppressing inflammation and flares. On the other hand, the progesterone levels go up too and this can cause a flare up. Not everybody is affected the same by these hormones and for some they have no effect on rosacea. But progesterone has been compared to the 'male' hormone, and can also play a part in acne for instance. After reading up for this blog post, I found some clues that it might not just be progesterone that causes rosacea flares, but that estrogens have a similar potential in fact. This is a little image of the levels of both hormones during pregnancy:

More on these hormones and pregnancy: 

In pregnancy and birth, hormones are there to help regulate the many changes taking place to enable your baby to be born safely. Some of the most significant hormones are:


During early pregnancy, the female hormones (which include estrogen and progesterone) have helped release an egg from your ovary and implant it in the lining of your uterus. There are higher levels of both of these hormones during pregnancy as they help to create the necessary increase in blood supply, especially to the uterus and breasts. Progesterone and another hormone, relaxin, also enable the muscles of the uterus to relax to make room for the growing baby. The change may affect other muscles in the body, which can sometimes make your joints and your back ache and affect your pelvic floor. During pregnancy blood vessels will dilate. This can be seen from as early as the 5th week of pregnancy. This vasodilatation can can be induced by neural, hormonal or neurohormonal triggers. Both estrogen and progesterone increase nitric oxide levels in the body, which is a blood vessel dilator (link). Also, the increased volume of blood during pregnancy puts your blood vessels under pressure. Even people with healthy skin can develop spider veins because of this, and for those with an already weakened blood vessels system in the face (which has blood vessels lie closest to the surface, most visible and which has the thinnest skin of your body), the extra blood volume (due to progesterone) can make us looked more flushed and red and hot. The skin will also retain more moisture during pregnancy, which makes it look more smooth and fills up fine lines, giving many a smooth look. Or, if you are unlucky, the puffed up face look from excess water retention and edema :)  Many women find that their skin can become more sensitive during the pregnancy. Common skin conditions during pregnancy. 

There are also other changes brought on by pregnancy which can influence rosacea;  in a normal pregnancy, plasma volume, cardiac output and sodium load increase, and systemic vascular resistance falls with a resultant drop in blood pressure of 10 mmHg. To allow tolerance of the fetus, pregnancy produces an environment of immune suppression with depressed immune function of natural killer cells, phagocytic cells and cell mediated cytotoxicity. Malar erythema (see pics), a red rash on the face, is a more common thing to happen during pregnancy and might make it hard to distinguish from a rosacea flare. 

The role of estrogen

Estrogen, produced by the ovaries and later by the placenta, helps the uterus grow, maintains the uterine lining, steps up blood circulation, and activates and regulates the production of other key hormones. Estrogen increases blood flow to mucous membranes and causes them to swell and soften, giving mom-to-be an endlessly stuffy nose, plus sinus congestion, headaches, and postnasal drip. The flushed pregnant "glow" or skin rashes stem from the same extra blood flow to the skin. Estrogen, along with progesterone and melanocyte-stimulating hormone, can cause skin discolorations (hyperpigmentation), like the darkening of the nipples, areola, and white line that runs down the abdomen. The skin on the forehead, nose, and cheeks may start to look tanned, creating the chloasma, or "mask of pregnancy." Estrogen changes during pregnancy can also cause dilation of the blood vessels, instability and congestion of blood vessels. Also, like progesterone, estrogen affects nitric oxide levels and causes some vasodilatation (source). It is estradiol that stimulation of endothelial nitric oxide synthase. After binding to specific ‘non-genomic’ membrane-bound estrogen receptors, 17╬▓-estradiol has also been found to trigger a nitric oxide-independent vasodilator response, probably mediated by activation of large conductance calcium-dependent potassium channels (source). In the skin, estrogens affect skin thickness, wrinkle formation and skin moisture. Estrogens can increase glycosaminoglycans (GAGs), such as Hyaluronic Acid, to maintain fluid balance and structural integrity. It provides the skin with its ability to resist stretching and keeps the skin firm and moist, giving it the smooth, soft feel we so often associate with the skin of a woman. Androgens, on the other hand, stimulate collagen production resulting in the stronger, coarser skin of a man. Estrogens can also increase collagen production in the skin, where they maintain epidermal thickness and allow skin to remain plump, hydrated and wrinkle-free.  

Summarized, estrogens:
-Increases blood flow.
-Affects nitric oxide levels and blood vessel dilation.
-Increases the rate of cell turnover in the basal layer of the epidermis.
-Reduces the size and activity of the sebaceous glands.
-Keeps sebaceous secretion thin and less fatty.
-Slows the rate of hair growth.
-Increases the action of the enzyme hyaluronidase, which produces hyaluronic acid.
-Keeps the skin metabolically active.
-Its regulatory effect on the size and action of the sebaceous gland means that compared with men, women generally have finer pored and drier skins.

Estrogen is not purely a female hormone. It is primarily made in the ovaries and is abundant in females, but it is also found in males and made in different tissues outside of the ovaries. The word estrogen actually encompasses a group of chemically similar hormones, so it is not a single substance. Estrogens include estradiol, the most abundant form in adult females, estriol, the primary estrogen during pregnancy and estrone, which is produced during menopause. In females, estrogens are made by converting the male hormones, known as androgens, into estrogens. And these androgens are initially derived from cholesterol, the primary steroid that gives rise to many steroid hormone families. The conversions from cholesterol to androgens, or from androgens to estrogens, is all made via the actions of certain key enzymes. Without these enzymes, conversion would not be possible. The skin, among its myriad of functions, also has the necessary components to produce both cholesterol – and derive sex steroids from it – within the skin.

The Role Progesterone Plays in Pregnancy and the skin

Progesterone is produced first by the ovaries and then by the placenta starting around the second trimester. Progesterone keeps the placenta functioning properly and the uterine lining healthy and thick, and it stimulates the growth of breast tissue. It smooths muscles and softens cartilage, loosening joints and ligaments, contributing to late-pregnancy aches in the hips and pubic bone. Even your teeth and gums take a beating; gums swell and bleed under the influence of progesterone, which also bathes bad mouth bacteria in a nourishing brew, contributing to "pregnancy gingivitis." Progesterone increases secretions from the sweat glands and can cause acne, or heat rash and pruritic urticarial papules. Progesterone is antiatherogenic, it prevents vasoconstriction by increasing levels of nitric oxide (NO), which causes vasodilation, it inhibits platelet aggregation, it prevents inflammation by inhibiting the Th1 cytokine response and natural killer cell activity, both of which lead to inflammation. Progesterone causes acute endothelium-independent vasodilatationprobably through the cyclic AMP pathway, in 1st and 2nd order human umbilical arteries and veins and in human omental arteries. In rat tests, administrating progesterone long term caused their cardiac output to be raised and the peripheral vascular resistance to be reduced, resulting in dilated blood vessels. The underlying mechanism of this progesterone-related effect is unclear. (source; here you can read more on other pregnancy hormones playing a role in vasodilatation). 

The skin contains receptors for progesterone but its action on the skin is unknown. However, it has been shown that progesterone can interfere with the action of estrogen receptors in the skin. 
Of course, with puberty, menstruation and menopause, progesterone is also a key player. However, the research is still scant in this area. Future research will hopefully shed some light on the interactions between estrogens and progesterone.

In this interesting article on rosacea skin and aging and inflammation, there is a chapter about hormones:

The relatively high incidence of rosacea among women (some studies indicate that it may be 3 times as common in women as in men) isn't likely to be the result of greater sun exposure, so it's reasonable to look for hormonal causes. 
In old age, it's well recognized that men's estrogen level rises. But the estrogen industry has convinced women that their estrogen declines as they get older. It's common knowledge that aging rodents often go into "persistent estrus," and that their estrogen levels generally increase with age (Parkening, et al., 1978; Anisimov and Okulov, 1981). Several studies in women have shown that serum estrogen levels rise from the teens into the 40s (Musey, et al., 1987; Wilshire, et al., 1995; Santoro, et al., 1996). Other studies show that serum and tissue estrogen concentrations are not concordant, and that some tissues may contain several times as much estrogen as the serum (Jefcoate, et al., 2001). Local irritation increases tissue estrogen content. The antiestrogens, especially progesterone, begin declining in the 30s, so that the rising estrogen has more effect on the tissues during those years. These are the years in which the incidence of rosacea rises suddenly. Rosacea develops later on average in men, whose estrogen levels rise significantly at later ages.

Estrogen's most immediate effect on cells is to alter their oxidative metabolism. It promotes the formation of lactic acid. In the long run, it increases the nutritional requirements for the B vitamins, as well as for other vitamins. It also increases the formation of aminolevulinic acid, a precursor of porphyrin, and increases the risk of excess porphyrin increasing light sensitivity. Both aminolevulinic acid and excess porphyrins are toxic to mitochondria, apart from their photosensitizing actions. Nitric oxide, glutamate, and cortisol all tend to be increased by estrogen. Veins and capillaries are highly sensitive to estrogen, and women are more likely than men to have varicose veins, spider veins, leaky capillaries, and other vascular problems besides rosacea. Estrogen can promote angioneogenesis (new blood vessel formation) by a variety of mechanisms, including nitric oxide (Johnson, et al., 2006). "Estrogens potentiate corticosteroid effects on the skin such as striae, telangiectasiae, and rosacea dermatitis" (Zaun, 1981). Early forms of oral contraceptives, high in estrogen, were found to increase acne rosacea more than three-fold (Prenen & Ledoux-Corbusier, 1971).

Kelli wrote on the rosacea forum about using progesterone supplements during her pregnancy:

"When I was pregnant, I was put on progesterone suppositories - twice a day. Man I hated those things, but they more than likely saved my baby's life. So, while I was glad that my baby was viable and healthy (this was after a miscarriage), I was also noticing that the longe I used the progesterone, the worse my face got. I used it for my first trimester, and I looked horrid. I have P&P rosacea, so I broke out horribly! I don't know if it makes a difference that mine were suppositories, and you're speaking of creams, or if it was something all together different. I jsut know that I was on extremely high doses of the stuff, as well as what my body was trying to produce naturally." Link and link with more information on hormones and your skin. And in this article increased blood flow and vasodilatation in pregnancy is explained.

My German dermatologist was a lot less optimistic about pregnancy prospects for women with rosacea :( 

He said that he does see the two different effects, but that there are some clues to predict your own outcome in this. For instance; how bad do the fluctuating hormones in your normal menstrual cycle affect your rosacea? I think many female rosaceans have found that fluctuating hormone levels can reflect in their faces. Many say that the week prior to menstruation can be the toughest, with most flares and outbreaks. That is the same for me. In this last week, estrogen levels are low and progesterone goes up. Here the menstrual cycle and these 2 hormone levels during it are put in a little diagram:

Here a doctor explains the menstrual cycle and changing hormone levels. Some quotes from her site: "Two ovarian hormones are responsible for your menstrual cycles; estrogen and progesterone. [..] Levels of estrogen begin to exponentially rise about a week before ovulation and peak just a day before. This estrogen peak then sensitizes the pituitary and it responds with a surge of LH (luteinizing hormone). LH then causes the follicle to release an egg (ovulation). The “shell” of the follicle now becomes a corpus luteum which now concentrates on producing increasing amounts of progesterone.  Circulating progesterone can rise 10 fold during the week following ovulation. Estrogen production also rises about 6 or 7 days after ovulation. Both these hormones cause the glands in the lining of the uterus to become thick and lush so, if an embryo were to be deposited, it could implant, be nourished and grow. If there is no pregnancy to keep the corpus luteum going it succumbs and there is a decline (so sad) of both estrogen and progesterone. These fallen levels can no longer support the lining of the uterus….it sloughs and hence bleeding occurs. The now low level of estrogen stimulates the pituitary to begin to produce FSH and the entire process begins once more.

How do the rise and fall of these hormones affect our skin?

The skin is the largest organ we “own”…. There are hormone receptors in the skin and the blood vessels that supply it. Most of what we know regarding to the effects of estrogen on the skin come form studies of what happens to the skin in the absence of estrogen (during menopause).

Here is the estrogen good stuff:
It increases skin thickness, decreases collagen breakdown, increases collagen production, increases water binding capacity, increases the ability of blood vessels to dilate, increases elasticity and improves wound healing. This hormone helps prevent sebum (lipid) production, which feeds bacteria and increases the development of pimples. Estrogen also effects fat accumulation under the skin (subcutaneous). Here’s an interesting stat: The thickness of subcutaneous fat has been measured during the menstrual cycle, using ultrasound and MRI. The maximum thickness of subcutaneous fat over the thighs and abdomen has been found to increase during the menstrual cycle (as much as 7.3% in the abdominal region and 4.1% in the thighs). This certainly appears to validate your frequently voiced concerns that you are “get fatter” during your period. Whether this is due to an increase in water retention or changes in the fat cells is not clear. There is also estrogen bad stuff that can occur in the skin. It increases pigmentation. It also has been associated with decreases cellular-immune response.

Here is what has been noted during the luteal (progesterone) phase of the menstrual cycle:
There is more sebum production and an increase in skin microbial count….these 2 factors can make you more prone to acne a week before and during your period. The skin is also more sensitive to UVB rays between days 20 and 28 which mean an increase in sun sensitivity.

Effects on the immune system   
This is complicated…. estrogens suppress immune response in the cells as well as what we call natural killer activity. (There is a war going on between our bodies and the antigens to which we are exposed). Estrogen also increases certain immune proteins in the blood. Because of this increase in antibodies, estrogen may be the significant factor in our high ratio compared to men (20:1) of developing the autoimmune disorder systemic lupus erythematosis (SLE). And if you remember that T cells help us fight infection….well progesterone seems to suppress their formation. (Note T cell numbers remain depressed throughout pregnancy when there is a huge amount of progesterone produced by the placenta….a possible reason for infection severity in pregnant women.)

The doctor refers to the higher incidence of auto immune diseases in women compared to men. There are a few theories for this, and one is the mentioned different hormone levels in women, but another one is microchimerism (more about that soon). 

My German derm. told me a different thing from my London derm; he didn't think pregnancy would treat my rosacea too well. A few of his arguments were; I have flares in the last week of my cycle. I have had an IVF treatment and the pregnancy hormones they administered me caused a pretty bad rosacea flare. I have positive ANA blood levels and a couple of diagnosed auto immune diseases, plus the blood values for lupus. He believes that pregnancy can be a trigger for more lurking auto immune diseases for me, like full blown lupus and arthritis and he thinks it could be the trigger for rosacea going into fourth gear for me. This might be related to a phenomenon called Microchimerism (I will explain this one in a bit).

Also, the fact that I had 3 early miscarriages and not one pregnancy made the 6+ week mark is an indication to him that my body is too hostile in a way for it; the immune issues might be too strong to allow a foreign body like a fetus to successfully implant, unless I want to use steroids and other medications to calm the immune system down and help keep the pregnancy. Immunologist says the same thing. Steroids are out of the question for me as they all make my rosacea explode and given all the trouble we had it start with, and the severe impact my rosacea still has on my every day life, we decided against more IVF's at the time (I also have low ovarian reserve). I wrote about it before here, it has been a hard thing to come to terms with and I have a lot less heart ache over it now than 4 years ago when this was at play, but it will probably never be something I'm entirely happy about. If my rosacea was a bit less aggressive and I could just fall pregnant easily and naturally, it would have been easier. 

This brings me to the second topic; can pregnancy act as the trigger for the onset to rosacea?

Either because of the hormonal changes, or because of the effects of pregnancy on the immune system? Therefore I would have to rate rosacea as an auto immune disease. This is an assumption, as it is still not clear that rosacea is in fact auto immune in origin, but there are indications that it might be in at least a section of patients. And in my own case an immunologist, internist and rheumatologist have diagnosed other auto immune diseases plus elevated ANA and inflammatory levels, so there is a chance that for me, they are all connected somehow, being all inflammatory diseases affecting the own bodies tissues. And as I wrote before, I do believe that immune related problems, for instance coming the bowel, can be the fire underneath our rosacea. 

Especially the stories out there of rosacea improving during and after pregnancy make me wonder why that can happen. I read about it on forums and I know 2 girls with rosacea who both had a reduction of rosacea symptoms during pregnancy and all through their breastfeeding year. Both had been very worried of the effects of pregnancy beforehand, as both have the more severe flushing issues, need ventilators, have cold packs at hand. Why does rosacea get worse according to many and better for some? Perhaps it has to do with the immune system, I wonder. Your immune system response is lowered during pregnancy. The body naturally lowers it down, to prevent the body from rejecting the (of partly foreign dna made) fetus. This means that pregnant women can catch a cold sooner than non pregnant women, but it also accounts for the improvement of some auto immune illnesses during pregnancies (and worsening of others). My friend has severe asthma and had a complete remission during both her pregnancies. Arthritis also tends to improve during pregnancy. I will get deeper into this in the next topic. 

Can pregnancy trigger the onset of auto-immune diseases?  

It has long been debated, why so many more women develop autoimmune disease than men. In the United States for instance, 75% of the auto immune patients (23,5 million approximately) is female. There are a few autoimmune diseases which men develop equally, or more often than women, for instance type 1 diabetes, Crohn's disease and psoriasis. But the ratio for multiple sclerosis is for instance 3:1 in favor of females, and for systematic lupus erythematosus it is even 9:1. For autoimmune thyroid disease the ratio is 8:1. The reason for this disproportionate division is still not entirely clear, but has been researched a lot. Something that is different in men and women, is that women have higher numbers of CD4 cells than men (CD4 are white blood cells connected to T helper cells; they send signals to other types of immune cells, the CD8 or killer cells for instance, which then destroy the infection or invading threat), and an increased CD4/CD8 ratio, plus higher levels of IgM (a type of antibody that is produced by B cells and which is one of the first antibodies which attacks an antigen) and Th1 cytokine production (cytokines are hormonal messengers who play a big role in the immune system, immunity and allergic responses; some are pro-inflammatory and some are anti-inflammatory but promoting allergic responses). So all these ones are linked to immune function and attacking invading threats in the body. You can imagine that having too high numbers of them could make the immune system more likely go in overdrive. 

It is thought that triggering the immune system can lead to the onset of autoimmune diseases (although genetic predisposition is also at play). These triggers can be hormonal changes, explaining why many female patients find that their symptoms and inflammatory outbreaks follow waves of intensity during their menstrual cycle and pregnancy or when they use the pill. "In a number of experimental disease models estrogens exacerbated disease, and androgens can inhibit disease activity. However, human studies have failed to demonstrate a clear-cut influence of hormonal environment on disease susceptibility to lupus or other autoimmune disorders." More on that can be read here. Also, there are autoimmune diseases which start in childhood, when these hormonal differences are not really as much at play yet, for instance juvenile rheumatoid arthritis, and even then more girls than boys develop it. The different sex hormones are however not thought to be the holy grail in explaining this phenomenon of women having higher onset of autoimmune disease (AID). Many AID occur after reproductive years and giving people extra sex steroids isn't usually having disease altering effects. 

Another theory for this phenomenon is X chromosome inactivation, where one of the two X chromosomes which women carry is inactivated in favor of the other, leading to potential susceptibility to autoimmune disease. It is still a theory and quite complex matter for me to understand as a non doctor, but it is linked to reduced T cell (or B cell) tolerance. Lowered T cell tolerance is critical in all forms of autoimmune disease. It makes that the body no longer tolerates the own cells and self-antigens. Self antigens are any of your bodies own antigens (for instance mitochondria, muscle, parietal cells) which set up the production of autoantibodies, needed to defend the body from infection and harm. We need them to be fine tuned; only attack the invading bacteria and viruses, not our own body cells. But this goes wrong in autoimmune disease and we find our immune system attacking the own organs for instance, thinking it is an invader. However, it was also long clear that pregnancy is linked to autoimmune disease onset. It causes an increased risk to develop them. 

Recently a deeper explanation for the higher autoimmune rate in females has been found. It is called fetal microchimerism (also called "post-pregnancy chimerism")

It refers to the presence of low concentrations of two genetically different cell populations in one person's body. It can take place after blood transfusion, organ transplant, from being twins in the uterus and sharing the same placenta, but also from pregnancy itself. Fetal microchimerism refers to the presence of low levels of fetal cells who persist in maternal tissues during and after pregnancy; so cells from a fetus or baby that has been growing in the mothers body can somehow, through the placenta, nestle itself in the body of mum. And because the babies cells are only for 50% made out of the mothers DNA, and for the other 50% from the fathers DNA, this 50% strange DNA can sometimes cause immune problems in the mother, as our own immune system does not like foreign cells in the body. I'll go further into this. The connection between fetal microchimerism and human disease was first made by J.L. Nelson, who thought that it could explain the higher incidence of autoimmune disease in women. When a woman is pregnant, the child is fed through the placenta. Cells pass from the mother to the child and vice versa. Scientists discovered that there are also little cells from the fetus/baby going back into the blood stream and body of the mother who stay there. During pregnancy, this happens in a symbiotic way, and the lowered immune response in the mother due to the pregnancy hormones makes this all possible. However, these fetal cells are not only in the mothers system during pregnancy alone. The discovered already back in 1979 the presence of calls with Y chromosomes in a woman's body. Since women have only 2 X chromosomes (and men X + Y chromosome), scientists concluded that these cells must come from the son she had. Since it has been discovered that all pregnant women carry such fetal cells in their body, up to 6 percent of the free floating DNA in her blood consists of cells from the child. This percentage goes down after birth, but now it has become clear that a smaller percentage of cells stays in the mothers body, for up to 30 years. They are stored in organs, bone, skin for instance. The theory is that this is an evolutionary helper; when a mother has a second baby from the same partner, her body and immune system will detect the same DNA combination as what is already stored in her body, and the chances of miscarriage will go down. 

They now suspect that these fetal cells, which consist for 50% of the mothers own genes and for 50% of the dad's, making it a partly foreign body, can also kick the immune system into defense mode. Likely only for those women with a comprised immune system and a predisposition for autoimmune 
disease, but even that isn't fully understood yet. The mechanism would then be that the body wants to detect and eradicate these 'invading' foreign cells, but since they are safely and long term stored in the mothers body tissues, they cannot be killed and in term the immune system can run wild with forming inflammatory substances to attack, aiming it instead on a certain organ for instance. Which is what effectively happens when you have an autoimmune disease. And scientists found recently fetal cells from decades earlier in tissues and organs of women with autoimmune diseases. They also link this microchimerism to risk of cancer (reduced risk of breast cancer), rheumatoid arthritis and other autoimmune diseases (both increased risk), and since the fetal cells stay decades after giving birth in the mothers body, so is the increased risk of developing these autoimmune diseases. However, the link has not been proven without a doubt yet, it is a research in the process. But information is very diverse on this topic and in this big scale scientific research I read: 

"It is accepted that even short-term microchimerism can lead to autoimmune disease and the higher amount of trafficking at caesarean section might increase the exposure of these mothers and facilitate the development of autoimmune disease." 

It would seem a better explanation in a way than X chromosome inactivation, because the onset of autoimmune disease in men and women tends to follow a similar path and similar numbers, right up to the reproductive years of women; after approximately age 20, women get a massive rise in autoimmune disease, while the statistics for men stay on roughly the same level. Only after menopause do these percentages get back on the same line. 

How soon in the pregnancy does microchimerism take place?

To develop microchimerism, it is not necessary to go through the full pregnancy and to deliver a baby. It starts to take place very early on in the pregnancy, from 6 weeks gestation. Also, scientists found that the highest levels of fetal cells ( up to 500,000 nucleated fetal cells) were found back in the mothers circulation after an abortion had taken place. Possibly because there is a cutting off the placenta then and more fetal cells can enter the uterus and mothers body therefore freely. Fetal microchimerism is measured by using a technique called polymerase chain reaction (PCR), where Y chromosome DNA is identified. Microchimerism takes place regardless of the babies sex, but since mother and daughter both carry two X chromosomes, it is much easier to detect microchimerism through the one Y chromosome of a son. Here is an image of the research outcome, where they tested if types of pregnancy outcome influenced the onset of autoimmune disease:

Their final conclusion was: 
"In this study we report the risk of autoimmune disease during and after pregnancy. Overall the risk of autoimmune disease (AID) in women was significantly higher in the first year following vaginal delivery or caesarean section, but was lower in the first year following abortion. While the risk of AID was reduced between the 3rd and 10th year following vaginal delivery, there was no evidence of a change in the risk of AID beyond the first year following CS or abortion. However, women who were pregnant had a higher incidence of AID than those who had no pregnancy records. Pregnancy has both short and long term effects on the woman's immune system. Fetal microchimerism, or low levels of fetal cells persisting in the mother, is implicated in the pathogenesis of autoimmune diseases, which have a predilection for women after childbearing. While basic molecular studies have implicated persisting fetal cells in the mother in some AID, supportive epidemiological evidence is limited. To our knowledge, this is the first epidemiological study on the risk of AID following pregnancy. The main strength of the paper is the large cohort used and the fact that it is population based, which avoids the problem of selection bias.

So to summarize, levels of microchimerism were measured in women having abortions compared to deliveries 
of their babies, both natural births and caesarean sections. They were connected to how many of these women developed 
autoimmune disease (AID). Women who had a vaginal delivery or caesarean had the highest risk of developing AID (caesarean the highest risk of the two). Scientists think it has to do with the amount of fetal cells that getting in contact with the mother during these incidents. These researchers found however that women who had an early abortion, had less risk of developing AID, and they think that the fetal cells that are interchanged then are very primitive fetal cells, which might somehow have a protective effect against AID on the mother receiving them. But overall, women who had been pregnant had a statistically higher risk of getting auto-immune diseases than women who had never been pregnant. 

In this scientific rapport scientists researched and compared the levels of fetal microchimerism (FM) resulting from miscarriage or abortion. They found that FM levels were higher after an abortion than after a spontaneous miscarriage. Abortions that were done surgically also resulted in higher FM cell count in the mother compared to medically induced abortions (with abortion inducing drugs). FM is also later detectable when it is the result of miscarriage/abortion, than when it stems from a full term pregnancy; years later in fact. And fetal cells (from the baby) that are stored in the mothers body for years or decades after the pregnancy, can be linked in some cases to auto-immune diseases. Some cases of rosacea are also thought to be auto-immune related.  "We found that fetal cell transfer was common in both miscarriage and abortion. [..] Additionally, aneuploid or otherwise genetically abnormal fetal cells are overrepresented in miscarriage and pregnancy termination compared with uncomplicated term deliveries, and the implications of acquiring genetically abnormal cells are unknown."

(30 min)
(2 weeks)
Fetal microchimerism detection, n (%)4/75 (5%)18/75 (24%)2/5 (40%)
Fetal microchimerism concentration,*
median (range), mean
0 (0.0–0.7), 0.10 (0.0–36.0), 10.60 (0.0–0.7), 0.2
Table 1. Fetal microchimerism detection and concentration after miscarriage and pregnancy termination

The researchers state that because there are so many missed miscarriages (close to half of all pregnancies), and because of the risks FM pose on health onset, this could pose a problem for general womens health. "Women who have given birth to a child with Down Syndrome for instance, have a higher risk of developing Alzheimer dementia (a common risk in individuals with Down Syndrome themselves). Whether this could be related to microchimerism from the child with Down Syndrome is unknown, but it is notable that both murine and human studies have demonstrated localization of microchimeric cells in the brain of the mother." It is clear that pregnancy loss (miscarriage or pregnancy termination) can result in acquisition of cellular fetal microchimerism that can persist long-term. Further investigation of the relationship between pregnancy outcomes and both immediate transfer and long-term persistence of fetal microchimerism is needed in order to better understand reproductive influences on disease. Fetal microchimerism has been associated with both beneficial and detrimental effects. Furthering our understanding of the physiology of maternal-fetal cell transfer and the ways in which obstetric management can influence the process may allow us to shift this balance toward benefit. 

This is a very easy to read and interesting article on fetal microchimerism and the positive and negative health effects it can have for the mother. And this and this easy to follow article does the same. FM can help protect against the onset of breast cancer, multiple sclerosis and rheumatoid arthritis (These conditions improve during pregnancy and for some time afterward — suggesting that the mother’s immune system is more focused on attacking the “other,” not herself), but increase the risk of developing other autoimmune diseases like lupus. "While fetal cells may stimulate the mother’s immune system to be more vigilant, this dynamic can tip into something like violence. A mother’s body may attack the fetal cells within, and in the crossfire her healthy cells get bombarded. The fetal cells themselves may also attack us, the little traitors. What sets off these battles is unknown, but in the fallout, we may suffer autoimmune diseases like scleroderma and lupus". Fetal cells can also act as cancer stem cells in the mothers body. It is unclear if FM can have any effect on rosacea. Rosacea isn't even classed as a strict autoimmune diseases yet, although it seems clear that at least a portion of rosasea sufferers have underlying autoimmune diseases and quite possibly have rosacea acting like an autoimmune diseases, with the body promoting inflammation in the skin and bloodvessels. 

And on a different note, there are also cells of the mother circulating in the body of the baby, both while it is in the uterus and once it is born. Nearly 1 in every 100 cells in a fetus comes from her mom. The population plummets to something like 1 in 100,000 after birth, but they still are present then and breast feeding will make more cells enter the babies body again. "Maternal cells are busybodies. Some researchers think they train and shape the baby’s immune system and even decrease the risk of allergies. They’re healers too; there’s evidence that maternal stem cells can morph into, for instance, insulin-producing cells that proliferate and repair damaged tissue in kids with juvenile diabetes. And, like fetal cells in mothers, maternal cells in children may cause autoimmune problems. How many people have left their DNA in us? Any baby we’ve ever conceived, even ones we’ve miscarried unknowingly. Sons leave their Y chromosome genes in their mothers. The fetal cells from each pregnancy, flowing in a mother’s bloodstream, can be passed on to her successive kids. If we have an older sibling, that older sibling’s cells may be in us. The baby in a large family may harbor the genes of many brothers and sisters. My mother’s cells are in my body, and so are my daughter’s cells, and half my daughter’s DNA comes from her dad. Some of those cells may be in my brain. This is squirm-worthy. But there’s something beautiful about this too. Long post postpartum, we mothers continue to carry our children, at least in a sense. Our babies become part of us, just as we are a part of them. The barriers have broken down; the lines are no longer fixed. Moms must be many in one."

It is interesting that during testing, one firth of women without a son were tested positive for FM. This can be explained by (missed) miscarriages of a male embryo, a vanished male twin, or even male cell transfer from an older sibling through the maternal circulation to a later pregnancy. There has even been done a suggestion that intercourse could lead the way to male DNA entering and staying in the body, but this has not been researched yet. 

So, it sounds like there’s some mixed effect going on here. Fetal cells can sometimes cause auto-immune disorders (like scleroderma and lupus), but they might also be protective in some cases (like rheumatoid arthritis and multiple sclerosis), depending on factors we don’t understand very well yet. See this research article for more in depth info on this. My risk investigation towards rosacea is that its closest linked to LUPUS, one of the 4 autoimmune diseases mentioned in these articles to worsen due to fetal microchimerism, and therefore pregnancy can in theory exacerbate rosacea along the same pathways, possibly. Apart from the hormonal imbalance and the increase of hormones like estrogens and progesterone, aiding in rosacea-like symptoms, perhaps microchimerism can be another piece of the puzzle in trying to find out why exactly pregnancy can sometimes make rosacea worse for (some) patients.  

Some public comments from readers of the articles I linked to here on this topic:

Lacey D said: "I agree… but… I have lupus and have never been pregnant- no, not even with a fetus that miscarried without me knowing it- I’m a lesbian. I would believe that in this case it is the cells working the other way- my mother’s cells, some of which may have been her mother’s cells, or those of her older sister, both of whom have/had lupus. This is all so fascinating."

chgoliz said: "Absolutely.  Auto-immune disorders run on one side of my family.  We’ve all had kids, and pregnancy definitely exacerbated our medical situations, but the family genes were already there, ready to be turned on.  Some of the new research on MS (one of the diseases that runs in the family) suggests that it’s a common virus that sets the genes off.  Pregnancy is a huge stressor, but there are plenty of others….genes are the real cornerstone."

agthorn1981 said“One theory is that this “otherness” stimulates the mother’s immune system just enough to help keep malignant cells in check. The more fetal cells there are in a woman’s body, the less active are autoimmune conditions such as rheumatoid arthritis and multiple sclerosis. These conditions improve during pregnancy and for some time afterward — suggesting that the mother’s immune system is more focused on attacking the “other,” not herself.” I wasn’t taught this in my cancer biology and immunology classes in grad school; rather, it was that pregnancy acts as a mild immunosuppressive to dial down the mother’s immune responses and protect  the “foreign” fetus (one supporting piece of research at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1782465/ and many more available with searching). It would also explain the improvement in the autoimmune diseases. This is why women who have previously had melanomas have higher rates of recurrence or metastasis during or immediately after pregnancy – because her immune system had previously held the cancer cells in check, but the immunosuppressive state of her pregnancy allowed the cells to proliferate and spread. Unfortunately it’s a lot less warm and fuzzy of a theory."

Antinous / Moderator said"Researchers looking at centuries of records in Britain determined that the fewer the children (including none), the longer the woman will live. And the older the woman when she has her first child, the longer she’ll live. Despite the breast cancer risk, having children still shortens your lifespan."

CAKTwo said: "I was about to reply with this fact as well! It is NOT that the mother’s body is attacking the “other” better and ignoring the mother, it is that the mother’s body has lowered her ability to attack anything (sperm, fetus, the mother, common infections, etc). I have multiple sclerosis which I was diagnosed with years before my pregnancy (and which I most likely suffered from for the decade prior to diagnosis). Pregnancy was one of the best times of my life as my MS was in full remission. It remained so until about 4 months after pregnancy where my body flared up with one of the worst exacerbation I’ve ever had. Right now they are researching how to administer this immunosuppressive in a pill form to help decrease the effect of autoimmune diseases on the body."

A. Ambrosini said“In the first trimester, one out of every fifty thousand cells in her body are from her baby-to-be (this is how some noninvasive prenatal tests check for genetic disorders). In the second and third trimesters, the count is up to one out of every thousand maternal cells.” Your numbers are for the fraction of fetal cells in the BLOOD, which constitute a very small fraction of the total number of cells in the mother’s BODY."

Cassie Murdoch: "As an immunologist, I've know this for years. It's called "post-pregnancy chimerism," and previously, studies looked at women who had sons for detection of Y chromosomes. While the number of cells that are from fetal tissue are quite low, they can still be found in women up to 27 years after birth! Woman who also have these detectable fetal cells have higher levels of autoimmune issues like systemic sclerosis. (If you're more curious, look up Bianchi, 2004, "Fetomaternal cell traffic, pregnancy-associated progenitor cells, and autoimmune disease" in Best Practice & Research Clinical Obstetrics & Gynaecology) [..] I really have a strong distrust about most immunological "media" declarations because they often don't understand the science behind the immune system. Things that enter are body that are foreign (antigens) will generative both adaptive and innate immune responses. Woman have a 3 times higher likelihood of autoimmune disease than men. Could it be involved with pregnancy? Hormones? Being fucking awesome? I don't know, but I have an autoimmune disease that effects woman to men 9:1. Another great researcher on the topic is David Haig ([www.oeb.harvard.edu]) I really recommend people read about the topic rather than trust the media...because we all know how it can be distorted. But I'm happy to see be more interested in this really fascinating phenomenon."

Cassie Murdoch: "There was a Radiolab? This American Life? Something where they interviewed another researcher who had done a TON of research on this. Some interesting points: *It doesn't matter whether the pregnancy ended in a live birth, miscarriage or abortion; baby cells still lurk around until the woman is in old age. *Instances where a woman who had multiple pregnancies contracted hepatitis - she was given months to live but, as it turns out, all of her little fetal cells had essentially regenerated her liver. *On the flip side, women who have had multiple pregnancies have higher rates of auto-immune disorders, so those foreign cells floating around in a woman's body can have negative impact too. Overall, it's mind-blowing, isn't it?"

badmutha said: "It is insane! But it kind of makes sense now about my husbands mother. She was preggers 5 times, had two live births. Developed horrible RA after the last one was born."

Fluffernutter: "Crazy, I started having some MS like issues right after my daughter was born, had a few flares since then. MS is an autoimmune of the brain and spine. I wonder if there is a connection."

I have tried to make an inventory of online public comments from rosacea patients who posted about the effects their pregnancies had on their rosacea. As always, I assume that patients who have unhappy experiences might be more likely to post about it than women who are sailing through pregnancy without much bother for their skin. So it will not be a representative reflection of reality, but more a global impression of what women have written about their experiences. I also read many positive testimonials from women with rosacea about their pregnancy positively affecting their rosacea, but they are made in private social media health groups, so I cannot link to them or quote them here. Below are some testimonials from public online places.

Snowwhite 33 wrote on April 27th 2017: "Rosacea has worsened after pregnancy. 
Hello everyone. So before getting pregnant (2 years ago) I have had success for controlling mu rosacea symptoms by applying rozex and erythromycin gel twice daily. My face has been cleared for 3 years, until I got pregnant and up till now, 2 years post partum my face is very bad with a lot of flare ups and never went back to its state prepregnancy. Does anyone has an explanation for this? Putting in mind that I didn't breastfeed my baby. And I had my hormones checked and they were normal. Only thing is that I have lactose intolerance and digestion problems and I used to eat unhealthy during pregnancy and had stomach pains. Does anyone come across any articles that have linked pregnancy with bacterial imbalance or bad bacteria overgrowth?  Plz help its devastating"

Snowwhite 33 wrote on May 20th 2014: "Hi all, Firstly I'd like to ask you all to forgive me. What your about to read may upset you and you might think that I am a selfish ungrateful and crazy woman. Here goes... After 5 years of trying for a baby my husband and I had to have ivf, it worked and God blessed us with a little girl who is now 8 months old. Whilst preg I supposedly developed rosacea, it's not been confirmed that it is yet??? One says its dermatitis the other another thing??? Crazy!!! Whilst I was preg I should have been happy but I wasn't I was just thinking about my skin and didn't enjoy my preg at all after baby was born I was breast feeding and the condition went away but after a few months it came back. So it's made me not enjoy my maternity leave. Or enjoy my baby, I'm too busy looking in the mirror and she will b crying for me. I'm a bad mum and shouldn't have been given my little girl. [..]  Now when I wake some days I look in the mirror and depending on how my skin is reflects my mood. Some days I could just end it all, but then who would love my baby girl the way I do? My face meant the world to me (shallow I know) but I was a model for a few years and that's all I had. So my husband tells me "you don't have much of a personality" I feel my life is over, this condition has brought on OCD's and I'm afraid little one will pick up on it.Please don't think I'll of me I'm just a 27 year old woman with issues, big issues I think. Has anyone ever fell like this? Am I the only one? Is there hope with this hideous condition because I can't take no more. Every morning I wake up afraid, what will I look like today?  I'm sorry for letting it all out but this is the first time I have ever said all these things."

Fauxmccoy replied on May 20th 2014: I can certainly relate to not enjoying a pregnancy. With both babies, I had morning sickness all day, every day until actual delivery. I lost an average of 25 pounds each time. The worst part was a feeling that i was already a failure. The second pregnancy had just begun when my best friend suicided. it was pretty hard to get in touch with the joy I was supposed to be feeling. I was fortunate to not experience post partum depression and both babies and mom were well. It sounds as if you do not have a definitive diagnosis. Was this made by a GP or a derm? At any rate, you need a solid diagnosis before you can start to heal. I would also strongly encourage you to get some psychological help. The situation you are describing sounds like classic depression (post partum or otherwise) and your life is too important to ignore such signs. Marriage counseling does not sound like a bad idea either. Also -- you are at a time in your life where your hormones are fluctuating. I never felt as if i 'glowed' during my pregnancies, unless it was a neon green glow of nausea. A lot of people who are newly diagnosed focus on their face in a manner that just adds to the problem, some continue for much longer. Please, for your sake and your baby's, get some help. as for your former career -- are you aware of how many celebrities who are absolutely gorgeous also have rosacea? Princess diana, her sons, cameron diaz, renee zellweger, mariah carey, rosie o'donnell, bill clinton ... the list goes on. What is important to know is that the condition did not hold them back and it does not have to hold you back either. 
best wishes to you, cheryl"

RubyPheonix wrote on May 22nd 2014: "Hello! I just wanted to make a quick post to introduce myself. I have had rosacea since my early 20's, maybe even my teens if what I always considered severe blushing when embarrassed was flushing. When I went to the derm about 4 years and received my official rosacea diagnosis, she set up a regimen and I told her it wouldn't work for me because my husband and I were trying to get pregnant. She wanted me to just take the drugs until I got pregnant, and then we'd figure something else out. I never went back. The low-dose antibiotic she prescribed turned babies' teeth gray if they were exposed in utero! Thanks a lot doc. I never took it, and we were pregnant within the month. So I've basically just let my rosacea run rampant these past 4 years believing that as long as I was pregnant or breastfeeding there wasn't much to be done. It has gotten really bad, and I can't ignore it any longer. I believe I have some part of all 4 of the subtypes at this point. A few pustules on my nose are the most recent addition. Any time one of my kids touches my nose it hurts. My skin was feeling chapped or raw all the time too. This past week I've started supplementing with vit. c & b complex, as well as probiotics. I am also washing my face with CA baby shampoo using a minky wash cloth. At night, I apply straight coconut oil with a drop of lavender eo worked into and sleep with that on my face. I wake up very pale. I still have one severe red patch (the area that precipitated my trip to the derm in the first place), but all of the other newer red patches go away. My redness does creep back in over the course of the day though. I guess I'm just curious if there are any other young mother's out there dealing with this with any success."

Redinseattle wrote on October 10th 2010: "Help! Horrible rosacea flare after pregnancy. I have had rosacea for years, but had been managing my symptoms with my usual regimen for some time prior to my pregnancy with decent results (taking oracea, washing with just cool water, moisterizing during the day, avoiding triggers) While pregnant, I could not continue my oracea use, but this was OK because for whatever reason during pregnancy my symptoms stayed stable. I gave birth 7 weeks ago, and now am horribly red, swollen, scaly and with waaayyy more P&Ps than I usually get. I saw my derm, who says nothing can be done until I stop breastfeeding. I hate to stop breastfeeding to control my rosacea, but am concerned about this horrible redness becoming my new baseline. I have tried a few new things in hopes of dimming the redness (eucerrin night cream, topical turmeric paste) to no avail. Anyone have any advice??"

Auburn replied on October 10th 2010: 
"Hi Red,Well, if he won't prescribe anything, then you could try cleansing with raw honey and applying honey masks, every other day for a while. For instructions click the link in my signature (it's a seb derm treatment but many forum members with rosacea find it calming)."

wkz replied on October 13th 2010: 
Hi, So sorry to hear that. Hormones can really mess up the equilibrium, and I very much understand your frustration. Your hormones will be adjusting for a while, there is no quick fix, but ask your derm about creams that you can use while breastfeeding. Not all creams, lotions, potions are safe, but some are. I am currently trying a variety of herbal teas. Olive leaf tea had antibiotic properties, and a few other seem to be good for skin (Marigold, Linden, Green). 

Good luck WKZ"

Supramom2000 replied on October 13th 2010: "Red, A few tips that you can try while nursing: Give up all cow's dairy. Switch to goat's milk and/or coconut milk products. [..] Definitely do the honey/oil mask treatment and cleanse with raw honey. Go lower carb - only complex carbs, but maybe try gluten free for a while as well. And for sure cut out all "crap". No white sugar, no processed foods, no fast food. For redness try a milk compress on your face or cheeks with any milk - cow, goat, coconut, etc. You can also try yogurt spread on for 10 minutes or so. But try to use a plain, unsweetened yogurt. I use goat's milk yogurt. Also try a mixture of epsom salts and tepid water (distilled if you can buy some) and splash that on your face for a couple of minutes, then do the mask. Drink 1/2 your body weight in ounces of distilled water (if you can buy this) daily. Try to walk for 40 minutes a day (very tough with a baby, I know!) But my daughter always fell asleep on the walks, so they were a wonderful time of quiet and peace. [..] I wish you the best of luck!"

LuckoftheIrish replied on October 14th 2010: 
My rosacea was triggered by my second pregnancy so I know exactly where you are coming from. The hormones just go haywire and, as a result, so do your symptoms. It's horrible because you know you shouldn't be worrying about something as 'trivial' as your skin when you've just had a baby, but it can really knock your confidence. For me, it just felt like something else to worry about - and with a toddler of 15 months and a newborn, I just didn't need it! As far as symptoms go, I guess I am 'lucky' in that I just have the flushing and burning and, after nearly two years of trying out different things, I have found some relief with vitamin d3 supplements of 4400 iu per day, as well as coconut oil taken orally and used topically at bedtime. Neither of those will affect your ability to breastfeed. As an aside, I also developed very bad perioral dermatitis immediately after the birth (and I'm talking days here) and I treated it incredibly successfully with topical apple cider vinegar."

Chryssie6 wrote on March 3rd 2014: "Need help - pics attached. Hello, I was diagnosed with rosacea a little over a year ago. I was having moderate success keeping it in check with Finacea. Then I got pregnant and my face exploded! See attached pics. Now Finacea seems to be making things worse. I basically have to live with it until the baby is born. But for after the baby is born, does anyone else have rosacea like this? If so, what worked to calm the inflammation? Chryssie6"

Kash replied on March 4th 2014: "
I had a worsening of rosacea symptoms when I got pregnant too. I now have a 5 month old. I couldn't use any medical treatments but I used a product called Psoria Gold to help with inflammation. It seemed to really control the bumps and is safe during pregnancy. It is curcumin based. It's a bit pricey though. Another thing you could try is manuka honey. These things worked for me but can't say for sure if they'd work for you. Still using while breastfeeding too. It's hard not being able to treat anything but you're little one will make it all worth it! Congrats on your pregnancy!"

Anathema replied on March 11th 2014: "I think it has to do with Hormonal changes, Increase in Estrogen and progesterone. Could some one give me a link if clinical trials have been done on Hormones and Rosacea thanks."

Chryssie6 updated on March 14th 2014: "So, as an update, 
I am now almost 23 weeks pregnant. My p&p's have not subsided a ton and I find that I am flushing much more due to temperature changes and anxiety. (I think that is at least partly hormonal!) I have changed my skincare routine since I had the horrible rashy burning outbreak when using Financea about 2 months ago. I am now using Eucerin redness relief night cream, mixed with a 5% dilution of tea tree oil twice per day. I wash with 2% zinc soap in the morning and Cetaphil foaming face wash at night. (I did clear this with my OB and he indicated it was okay) I have seen slight improvement, but those who have been successful with tea tree oil indicate that it can take up to 8 weeks to see sustained improvement, as you will go through break cycles at weeks 2-3 and weeks 5-6. (I am currently on week 5) I will update again as my treatment and pregnancy progresses. I also have plans to do vbeam when on maternity leave. Chryssie6"

And she then updated on September 21st 2014: "Update....Sorry that I forgot to update more frequently as my pregnancy progressed. It turned out that the tea tree oil didn't really help much with the P&p's. I abandoned it after about 10 weeks. I ended up only washing with CeraVe cleanser and using Eucerin Anti-Redness Night Cream for a moisturizer for the remainder of my pregnancy. 
At about 32 weeks, my face cleared up beautifully and you could hardly tell that I had rosacea until about 3 days after the baby was born. Then p&p's and inflammation came roaring back. (Of course ) So, I went to the derm and got a prescription for Oracea. Additionally, I started mixing my Finacea with the Eucerin cream and applying once a day only at night. Things are looking a little better, but the general rule of thumb is that it can take up to 3 months to see results from these methods. I am only on about week 5, so I will need to wait and see. I will update again as more time passes. No magic solution for me as of yet."

Artist wrote (quote taken from here): "A lot of people have commented that their rosacea got a lot better or even disappeared temporarily while they were pregnant. I'd say that, for me, it was a little more difficult to treat while pregnant because of the hormone swings and having to go off of medications. It wasn't bad, though. I started using Red Light Therapy, topical licorice cream, and went to some extra IPL sessions to make up for not being on medications. I'd say my skin did well for most of my pregnancy. I would do great for maybe ten or twelve days, then maybe have a mild breakout for a few days, then I'd be great for a few weeks, then a mild and brief breakout, etc.." 

Red Rose wrote on June 4th 2009: "
Hey, don't be too afraid of pregnancy if you have rosacea. When i was pregnant with my daughter, it was like a miracle. One month into the pregnancy my skin cleared up, and it was so beautiful! The pregnancy hormones somehow made my rosacea recede for the entire 9 months, and even after i gave birth, during the time i was nursing my girl, my skin was just perfect and glowing, no acne, no breakouts no dryness, it was unreal. Then when i stopped nursing, my rosacea started coming back, slowly but surely, my skin dried and has fine lines, that's how the doc got a hint that maybe i had a hormonal imbalance also being a trigger for my outbreaks. And yes, my skin tinlges and itches when i put that Finacea on, and i did get the same little pimples on my entire face...ugh!...they're tiny whiteheads...lol...the dermatologist told me that was normal and that i should allow at least one month to see a bigger improvement. The flaking has almost stopped completely and the redness has gone down a lot, and i mean a lot! when my outbreaks get better they always shrink to tiny red blotches the size smaller than a dime, one on each of my cheeks next to the nose and one in the middle of my forhead almost between the eye brows...but those never disappear completely...  (speechless) ah, rosacea S-U-C-K-S-!"

Anonymous wrote on April 6th 2012: "
Up until pregnancy I have had a mild case of Rosacea that comes and goes and generally responded to prescription metrogel when needed. Well not the pregnancy hormones have kicked in (9 weeks) and my face is a mess. I wake up with my cheeks fully inflamed and little postules all over my cheeks. everything is irritating to my skin. I already have given up caffiene, alcohol, spicy foods (all common triggers). I don't want to use metrogel as from everyting I have read its not necessarily proven to be safe during pregnancy esepcially for extended use. I can't get in to see my dermatologist for another 6 weeks. I can only imagine what my face will look like by then! Anyone have any other suggested meds or home remedies that have helped them? I can't even use soap on my face right now its so irritated."

Another anonymous replied: "I'm guessing the extra estrogen in your body is what is triggering the more severe case of rosacea. I use just the tiniest bit of Nutrogena anti-red face wash. It does have a small amount of anti-acne med in it that is debatable for pregnancy but I use just a very, very small dab and I dilute it on a wash cloth with a lot of water. It works for me. I would try to get into see a derm earlier. Explain to the front desk it's a bit of an emergency , you're pregnant, etc. I bet they'll squeeze you in." [..] The perfect solution for you is red light therapy. Not only is it helpful for rosacea, it's the only treatment that is safe during pregnancy (from what I know, but of couese check with your doctor first!)..This is an article about it, hope it helps: http://www.light-therapy-reviews.net/red-light-therapy/
[..] My dr. told me he would never, ever do light therapy during pregnancy. I have uneven pigmentation and very oily skin, and he basically told me I just need to suck it up until after pregnancy. Our hormones are a mess right now and our skin can act badly to light therapy, microderm etc. My derm does have me on finacea gel, which he says is safe during pregnancy. I think people also use this for rosacea - something you may want to check into. It's helped keep my skin under control.

hrh1977 wrote on 19 January 2012: "I was diagnosed nearly 3yrs ago shortly after the birth of my daughter, but had been suffering in silence for about 5yrs. Due 2 breast feeding I was limited in treatment available. After weaning complete( 9months of trying creams, pills, none worked.) My doctor referred my 2 the dermatologist. I was put on isotretinoin 30 mg everyday. Within a couple of months my face had cleared up , redness was much better & I thought 'wow' .. unfortunately as soon as they lowered my dose my symptoms started 2 return. 18months since I started with dermatologist & I'm almost back 2 square 1. As I have quite a severe case of rosacea ,face, neck, ears & chest, I'm wondering what alternative therapies may help , if anyone has any experience or knowledge I would be grateful 2 hear from u, I am desperate 4 help & can't really afford 2 go private."

Essy wrote on March 15th 2012: "I had rosacea for about a year prior to getting pregnant. Now I'm 10 weeks pregnant and it has gotten worse. I was using Prosacea (sulfur gel) and/or sibu sea buckthorn seed oil, but I stopped after consulting a nurse. I think the problem is that each topical remedy is homeopathic and has not undergone much testing to make sure it is safe. Just wondering if anybody else has dealt with rosacea during pregnancy and if you have any tips--or especially if you used either of the remedies I mentioned during pregnancy and things turned out fine with the baby. Thanks!"

Cardio Carrie wrote on August 3rd 2013: "I have had quite bad rosacea for over 10 years now. [..] My rosacea gets affected a lot by hormones so is far worse in pregnancy. I want to have one more baby so will probably leave IPL until after that." 

Long time and highly respected, beautiful Rosacea Forum member Jen wrote a long beautiful post with a lot of pictures of her rosacea history and mentioned her pregnancies in it (thanks Jen for letting me share this!). 

"Ahhh...well...I've been thinking that I haven't really shown what my face used to look like. I've posted one good photo (when I started down the natural healing path), one flushing photo with hardly a scrap of p&p (somewhere down the track of natural healing) and my avatar is a glam shot taken at the end of 2004 with a heap of makeup on (done by a professional makeup artist) to hide what was underneath. Anyway, I thought I would throw up some mug shots of the things I've had to deal with since having Rosacea. I'm kinda past the vanity thing but just for good measure, I'm throwing in a 'normal' pic of me...yup...wedding day in 1997 but this is what I miss. I mean, looking normal. Blah! These are not really in any order but here goes:

1. Wedding day 1997 (makeup on big time but underneath was pretty normal back then). Some zits to cover but you wouldn't even know.

2. Just after giving birth March 2004. I remember that my face was calm then. I think the redness had more to do with giving birth than Rosacea. It was still there though...obviously!

3. Not cropped. You can see the Rosacea creeping back in here.

4. Yup, my son taking the pic again...still in my jammies! Don't remember when. Flash on...and still big time red!

5. No idea even what year this one was. Might have been after a course of antibiotics.
6. Think the flash would have been on for this one.

7. Flash again. Urgh, good look Jen! NOT! LOL
8. I remember my face felt good in this photo but sure doesn't look it, huh!
9. This one's a doozy! Look at the swelling around the eyes! Soooo ouch!!!

10. P&P...gotta love them!   
11. Same day, can't remember which day, other side of face.
12. Loads of spots. Leave me alone you horrid Rosacea beast!!!

13. Please...someone save me from this beast! Inside shot, flash on. But still red and those horrid p&ps!
14. A little calmer, maybe?
15. Not sore here.

16. Flushing...ouch!
17. Feeling and I think not looking too bad.

I was thinking also that these photos might help newbies to recognize if they have Rosacea or not. I know these pics are ugly but heck, that's how it is. Hey, you might notice that quite often the p&p's come up in the same spots. Just when you think you've got rid of them...BAM...back they come! Jen"

And Jen updated on August 4th 2006: "I think that after my first pregnancy in 2001 Rosacea kicked in for me. Maybe it was a bit before but really noticeable after the birth of my first child. [..] I must say that the improvement from diet took hold quickly and I was really surprised at just how sudden it was. I had only been using my red LED array for over a week at that point in time (the last photo) but it sure helped to calm things down a lot. I still go up and down and am in a bit of a rut at the moment. *Sigh* It'll pass though and I need to look at the long term, bigger picture. [..] Yeah, took me a bit of courage to post all of those uglies! I guess I have managed to get past the vanity side of it and look at Rosacea more as a medical condition. Stepping outside and looking back in, evaluating and being clinical about what I see in the pics has helped a lot. It's still upsetting to go out in public wearing my health issues on my face but I have worked out ways to deal with it now. If people make comment, I discuss my face in terms of a medical condition and it doesn't take long for folks to get bored with that. So the subject is changed fairly quickly and they no longer stare with sideways glances, trying not to catch my eye! LOL You've just got to laugh or else you will want to cry! Laughter is the best medicine. In fact, I think the best line I have is "Yeah, well I so wish my health issues presented themselves on my behind, rather than my face!" That usually gets a laugh and the conversation moves on. [..] On the Irish side of my family, other family members definitely have Rosacea. My uncle has a bulbous nose but for various reasons, has neglected to undertake any major treatment. My Rosacea (besides my uncles) seems to be the most obvious in my family though...or more severe than other family members. Perhaps that has something to do with genetics or how I have treated my body over the years? My two sisters don't appear to have Rosacea so that would lead me to believe that it may well be pot luck with a recessive Rosacea gene. How much is due to that or lifestyle, I don't know. I am thinking that I may also need to look at hormones (thanks to those who have suggested this on and off the Forum)."

Hopeful wrote on October 20th 2008: "Hi guys, or rather gals, 
I'm assuming this topic is more likely to be read by the female population. I have been having trouble with rosacea for over 1.5 years. This had put a tremendous burden on my life. But I don't want to give up! My husband and I have plans to start a family, we're both in our early 30's and I'm concerned that a change of hormones may worsen rosacea symptoms. There're different ideas going around that rosacea may be related to the immune system, or hormone change, or stress, either way- noone knows and it may be different triggers for different individuals. Has any of you ladies experienced changes in rosacea symptoms during pregnancy and if so, how did you deal with it. Or have you noticed an improvement of symptoms or maybe no change at all. I'm currently taking doxycycline, 100mg a day. I know I will have to discontinue this, but I'm a bit concerned of a possible flare up during pregnancy and not being able to take antibiotics to get it back under control. Thank you so much, I'd appreciate any input at all! Hopeful"

JMAngel replied on October 20th 2008: "Oooh, excellent thread - I really want to know too as we're supposed to try for a baby beginning of next year but the main thing I'm scared about is out of control skin - I too take doxycyline for both acne and rosacea and am also on dianette for acne - coming off both of these in December makes me hyperventilate - please ladies, any experiences of pregnancy and rosacea much appreciated xx

Rachzon replied on October 23rd: "I was actually diagnosed with Rosacea when I was pregnant. I had been having symptoms for a while but thought that they were just pimples and blushing. When I was pregnant I went to see the Derm for a check up and he noticed the spots on my skin. I have to say that to this point it was annoying but did not impede on my life in any way. When I was about 4 months pregnant my skin went mad. Red, peeling and lumps every where. I used Dr Hauschka Sensitive conditioning ampules at the time and my skin was great again after about 2 months. My skin was fine again until I was pregnant with my second and the same thing happened. It settled again after about 2 months, I didn't get a dramatic effect with the Dr Hauschka as I did the first time. Towards the end of both pregnancies my skin was really good. My skin has been off again and on again until about July this year and then it did take a turn for the worse. Looks good again after lots of hard work. It is my understanding that the hormones can have an effect on Rosacea. It certainly did for me. But compared to the love of a child it is a small price to pay. My skin was actually really good whilst I was breast feeding. All the best with the babies girls!"

Hopeful replied on October 23rd 2008: "Rachzon, Thank you so much for your reply and kinda encouraging news. I have noticed that pregnant women have usually either very bad complexion or perfect baby-skin, one of the extremes! I guess it depends on which trimester they are in ;-) My sister, who does not have rosacea, had always had good complexion, but after having her baby, it's gotten even better, her pores have gotten smaller and skin looks very smooth and silky. That's what I'm shooting for :) I went to talk to my primary doctor, and because my rosacea gradually developed after stopping birth control pills, he suggested to go back on them. But I really don't want to do it again before we have a baby (if we become brave enough), maybe afterwards. was your rosacea bad/moderate/light before pregnancy? Thank you again, Ally

Rachzone replied on October 23rd 2008: "Ally, I have to say that my Rosacea was pretty light before pregnancy. I have always had a reddish tinge to my complexion but nothing that made me feel too self conscious. Before I got married I noticed that I was getting lots of "pimples" but they didn't have any heads. It wasn't until I went to my Derm for a mole check up in my 3rd month of pregnancy that I mentioned them and he suggested Rosacea. It was then that all hell broke loose and my face became a mass of papules, flushing, peeling and was extremely painful. I couldn't try any routine meds because of my pregnancy. I stumbled on Dr Hauschka by chance and gave their ampules a go. It cleared it up immediately, I was also using Rosehip oil. I have to mention though that neither has worked for me since. The only thing that has cleared my Rosacea and papules completely has been the topical Ivermectin and Invisible Zinc sunscreen. I am in a trial for the Ivermectin and they make me do a pregnancy test every time I go before I can get the next course of cream. I have finished my family, two beautiful (mostly) boys is it for me. If you were at a point in your lives where you want a family I would do it and have them as soon as possible. It takes time after oral contraceptives for your body to get back to normal and any preconception book will tell you that you should be off them for some time before you conceive. I was concerned about how my face would react the second time around (same again) but it eventually settled. Now the family is done I can do what ever it takes to keep my face "normal" with only consequences to me. All the best being a Mum is such an emotional rollercoaster but it is the best thing that could ever happen to a very lucky Mum and Dad."

Gizzy wrote on October 15th 2013: "Ladies, pregnancy & Rosacea? Me and my partner want to try and conceive but I'm just really worried of the hormones making my face go nuts  I had a miscarriage last year but was at 8 weeks, I didn't notice my face deteriorate during this time. Has anyone been ok with their rosacea during pregnancy? As I'm aware you can't treat it with meds so it could escalate. I know some people would say you don't sound ready to be a mother if you have to question it, it's just a battle with the rosacea and the last thing I want is to be all stressed and it harm the baby. I wish my life was normal I hate rosacea it seems it wants to take every last thing away from me. :'(

Alyfpet replied on October 16th 2013: "Hi, Gizzy. First, let me say that I am sorry to hear about your miscarriage. That must have been an awful experience, and just heartbreaking. I wish you much luck in your efforts to get pregnant again. 
I'm sorry to say, but pregnancy definitely did worsen my rosacea. However, this is not the case with everyone. AND, even though I am at times quite miserable with this condition (like now), I wouldn't take it back for anything. My daughter is the most wonderful thing in my life, and if I died tomorrow, it would be all worth it having had her. I truly mean that!

For me, my rosacea worsened for the first couple of months of pregnancy, and then settled down to better than before I was pregnant for the rest of my pregnancy. Then, about 3 months after I had my daughter, it hit me hard. I also have ocular rosacea, and I think that this part of my conditioned was worsened the most by being pregnant. If I didn't have the ocular condition, I think I could handle everything much better. As I understand it, during pregnancy, your blood vessels dilate significantly to accommodate the extra blood flow; however, then your body tones down your immune system. The dampened immune system is why pregnant women often have fewer symptoms than before. Then, once you give birth and your immune system ramps back up, rosacea is often worse due to the changes to your vasculature that have taken place. The good new is that it sounds as if your condition did not worsen during the 8 weeks that you were previously pregnant. This might be a good sign for you, as mine definitely did get worse during that time. For me, I made the decision to become pregnant knowing that I would be having only one child (I'm on the older side) and that I could have the rest of my life to treat my rosacea however I needed to. So I sucked it up and got through it. And after I had my daughter, Oracea did get me to a place where I was living comfortably for a while. Now, however, I did a 3 day trial of the new Mirvaso and have been in a terrible place for about 3 weeks, but that is another story. I am back at square one, worse than ever, and need to figure out where to go from here. but once I get there, my daughter will be there too. :-) Good luck. I hope this helps a bit."

Alyfpet wrote more about her post pregnancy rosacea struggles here.

Newtorosacea wrote on February 17th 2010: "Anyone else get rosacea while pregnant? I first noticed my skin changing when I was pregnant two years ago. After I had my daughter, it was still there, but not horrible. Mostly a lil red and flaky on one cheek. After I stopped breastfeeding a year ago it got worse. So I have had it for a year. I went to a dermatologist who gave me doxycycline and a bar of benzoyl peroxide. Along with the rosacea I got lots of styes in my eyes. The doxycyclin seemed to help the styes, but not the rosacea. I have another dermatologist appt. this week because the last dr. I went to didn't do much for me and he wasn't the most personable dr. I have decided to go to another derm b/c it has gotten worse lately...and I have to get it under control before I go insane. I never had any skin issues until I got pregnant and I am hoping that I can get rid of it completely or subside it! Any one with same issues..please let me know I am not in the same boat and if you do, did it go away over time?

Law Holmes replied on February 17th 2010: "
My rosacea first became noticeable after I stopped breastfeeding my second child. I definitely think that hormonal changes have an impact as my skin is always worst just before / during my periods. Having said that, I think that rosacea has a tendency to emerge at the same sort of age at which women are choosing to have children these days, so it is possible that it feels like pregnancy has been a trigger when it is just an unfortunate coincidence. I wish I could give you a lovely positive story about how my rosacea has now disappeared, but unfortunately I am still struggling with it. I have recently moved from lymecycline onto erythromycin as we are contemplating having another baby (well, I am contemplating it, my husband is... undecided!) and I am half hoping that getting pregnant again could put my rosacea into remission. Though this from a woman who has spent four hours with honey caked on her face this evening and who has just spent a fat wedge of money on an LED light therapy unit.. I will pretty much try anything now!! Laura x"

Debbie replied on February 20th 2010: "You are not alone. I was just diagnosed 2.5 wks ago at pcp and confirmed at derm a few days ago. I first noticed mine either when I was pg with my first or when I was breast feeding (don't remember exactly) and I just caulked it up to those wacky hormones. Finally after baby #2 and I stopped bfing at almost a year ago I figured it may be something else.  So yeah I have rosacea. I am still at the beginning too. I was on doxy and now I'm using metrogel instead. I don't have any advice just wanted to say I know EXACTLY what you are going through. Sorry and good luck."

Aboveda wrote on March 19th 2011: "I was diagnosed with rosacea around 25. Usually not much of a problem until I pursued a PhD at age 34. The stress gave me flareups and that's when I started using Bare Essentials makeup. It doesn't irritate the skin and you control the coverage. However I am now 17 weeks pregnant and my rosacea has exploded. I was going to try something new (ZenMed) which I've heard its fantastic for clearing up rosacea, but then I got pregnant. Rosacea has no cure, it is a lifelong condition that we can only control when we know our triggers (mine are stress, red wine, full body beer, spicy foods and computer screens). I guess I'll just have to grin and bear it for the rest of the pregnancy until the skin goes back to normal."

MyScaryFace wrote on March 20th 2011: "That's so odd that pregnancy has triggered the rosacea for so many of us! I was just asking my mom tonight.. "Do you remember me having any redness/acne skin problems when I was dating my ex or right after we got married???" And she said "NO, not at all". About 6 months after I got married.. I got pregnant and then a 2nd pregnancy started about 10months after the birth of my 1st. My face/skin went DOWNHILL bad! I breastfed both of my kids as well. Then soon after the birth of my second....I had HIGH stress levels and my ex and I had issues and separated 2 months after my 2nd son was born. I've been BATTLING with my facial skin ever since. It just seems to keep gettin worse. The only meds I've tried so far are Clindamycin and Aczone. Neither worked for my skin. I have the rashy type red cheeks..and my pores clog SO easily. I also get hives on my face.. just one big one at a time.. or the mystery red bump that doesnt hurt or itch or have a head. UGH.. My chin breakouts seem the WORST. I just cant clear it up for the life of me! Little white bumps..cystic.. reg. white heads.. Frustrating. I need to get back to the Derm. and see what my other options are!"

Judworth wrote on March 20th 2011: "Looking back, I am sure that getting pregnant aged 43 sparked my rosacea (sadly miscarried) but since then my rosacea has certainly been hormonally-driven. I am now perimenopausal, & although I have had my rosacea pretty much under control. I cannot control the increased flushes brought on by the ups & downs of hormone 
levels! I also get hives on my arms, legs & torso when my hormone levels go crazy! Off to see Prof Tony Chu in May............need assistance from an expert now after years of battling alone! J"

Mcinnis wrote on March 20th 2011: "Hi there. just wanted to let you know that my roscea was great during preg and was good up until recently when i stopped breastfeeding. i did however have 7 IPL treatments before I got preg so i am sure that helped. try not to worry about it.. this is such an exicting time for you!

Mercergirl wrote on June 10th 2007: "I had my first son 9 months ago... and during my pregnancy, my skin glowed. My rosacea was milder than it had ever been... now it's back to where it was unfortunately- but not any worse... personally, pregnancy was great for my skin."

Munch Ausen replied on June 10th 2007: "I am male but I've had this thought. The chances of your children having the same rosacea problems as yourself are quite high. Have you ever considered not having children so that you don't pass on this red beast? I have."

Skywolf replied on June 10th 2007: "Munch, My Father passed this on to me, not one of my brothers got it, I did, luck of the draw. I hate having this, but I would rather be here and deal with it then to never be here. Don't ever let rosacea keep you from having children. Laura"

Claudia replied on June 11th 2007: "During both pregnancies my rosacea went into remission...very little redness and few breakouts --- YEAH!!! This continued while I was actively nursing but as soon as the nursing was less and everything was back to "normal" then back came the flare-ups (arrgghhh...). And both times it took me by surprise because back then I was still hoping I would magically outgrow this affliction. I agree with above...don't ever let rosacea stop you from having children! My daughter doesn't have it but I think my son does. I've apologized to him for giving him such an awful disease but he just shrugs it off and hugs me. Treatments are soooo much better now and he's got it under control at a young age whereas I suffered for years. CV"

Unisushi wrote on March 31st 2008: "Rosacea remission with pregnancy? Since my problems seem to have escalated once I was no longer pregnant or breastfeeding, several doctors and family member have suggested that a second pregnancy would cure my skin woes. Anyone have this experience or know someone who was able to improve their skin during pregnancy? I'm curious, because it seems like it could easily go either way. Thanks! - Sari

LaurenKitz replied on March 31st 2008: "A lady i work with told me that a friend of her's rosacea completely cleared up when she was pregnant. not sure if it was just during pregnany, or if it remained clear after birth. but yes, i have heard this before."

Lookout replied on March 31st 2008: "I didn't have full blown rosacea when I was pregnant (just mild redness on apple of cheeks and dry skin that was acne prone) anyway, my skin looked awesome during my 3 pregnancies! I believe it is due to the estrogen...as it is like 3 or 4 times the normal level and progesterone does increase also but not nearly like estrogen does....and after delivery our estrogen plummets and other hormones surge...prolactin for breastfeeding and so on. I think this drasitic suddenly drop of estrogen can cause a flare up for women that are prone to it."

Kristina B. replied on April 1st 2008: "Hi Sari, As you say, it could go either way. When I was pregnant, 6 years ago, although I looked very healthy, my skin became much more red and flushy than it had ever been, and that continued afterwards. I didn't recognize it as rosacea at the time, and it's only in the last few months that my rosacea has progressed beyond having a "rosy" complexion; but in retrospect I think it was a factor. I was pregnant with twins, though, and went to full term, so there was a lot of blood circulating! Best wishes, Kristina"
SophiaT replied on April 2nd 2008: "My face was great when I was pregnant. I had seb derm and while I was pregnant it had gone completely. Also, my face was not red or oily at all!!!! But around 6 months after I gave birth to my daughter everything changed. Now my face is redder than before and oily. I believe that my seb derm is back but the good thing is that it's not flaky anymore and the quality of my skin is a lot better. Probably because I quit smoking as soon as I found out I was pregnant. Overall I would say that the quality of my skin is better after my pregnancy. The downside however is that it's redder than before." 

Miaa wrote on August 6th 2015: "Hello everyone....this is mainly to all mums. Hello im a new mum, just gave birth 3 months ago to a beautiful baby girl, i have been suffering from rosacea for several years now, and i had great sucess putting it into remission for 3 years on topical treatment and avoiding triggers, all was good till 5 months pregnancy when it went out of control and still now 3 months postpartum its out of control and not near to what it was before pregnancy, im still on the same medications, my assumption is still i have hormonal imbalance which is still causing my rosacea to be so bad....i have stopped breast feeding from 36 days, so im not sure why its still bad....i still have many pigmentations ( axillary, linea negra the dark vertical line down on ur tummy, alot of brown spots)... My questions are :
1.still having all these pigmentations means that i still have hormonal imbalance and im not back to my prepregnancy levels?
2. Having a child and rosacea is very difficult, i adore my daughter its the best thing that has happened to me but i feel bad because my brain is always preoccupied with rosacea, whenever i look at her, talk to her or even smile, my face aches very sore ithy red bumpy and flaky and i look awful so i keep thinking abt it, while i have to be over the moon cuz i gave birth to a healthy beautiful girl bas still rosacea ruining my life. I need any postive stories, anyone expierenced the same during pregnancy and after delivery. Any ideas how to cope with rosacea and motherhood, how to forget abt it and start enjoy all the good things around us....im so grateful but this thing is standing as a Ghost infront of me haunting me everywhere.... Plz i need ur help.....motives are needed urgentlyy. Have a great day everyone" 

How to treat rosacea during pregnancy

Treating your rosacea during pregnancy must be a very tough thing to juggle. It depends on your "subtype" what treatment options could be worth trying for you. Subtype 2, with skin outbreaks, pimples and redness, is easier to treat for most people and also offers some treatment options during pregnancy. Here are some options, but always make sure to ask your doctor(s) first about their safety during pregnancy use. Many products have been tested, but not properly as it is unethical to test potentially dangerous drugs on pregnant women. However, some topical products are deemed safe based on animal testing results.. Also, cream being used only on the face, means it covers a small area of human skin, and despite some particles ending up in the blood stream, the overall load may be very little and therefore not a risk for your pregnancy.

Finacea gel/cream

used for rosacea subtype 2, with skin outbreaks and pimples and redness. Most doctors are OK with you using it on your face (not entire body) during pregnancy. Read more on Finacea hereEach gram of Finacea contains 0.15g (15%) micronized azelaic acid in a gel base. It also contains 0.1% benzoic acidpropylene glycol, polysorbate 80, lecithin, polyacrylic acid, triglycerides (medium chain), sodium hydroxide, disodium edetate and purified water.

The Ordinary  

This cream has 10% azelaic acid, just like the prescription cream Finacea does. Azelaic acid is an anti inflammatory and especially can help skin outbreaks and pimples. If you mainly flush and burn just like me, this cream may be too strong for your skin, but best do a test patch on a spot on your face and be safe rather than sorry. You can read reviews on this product on makeupalley here.

Aqua (Water), Isodecyl Neopentanoate, Dimethicone, Azelaic Acid, Dimethicone/Bis-Isobutyl PPG-20 Crosspolymer, Dimethyl Isosorbide, Hydroxyethyl Acrylate/Sodium Acryloyldimethyl Taurate Copolymer, Polysilicone-11, Isohexadecane, Tocopherol, Trisodium Ethylenediamine Disuccinate, Isoceteth-20, Polysorbate 60, Triethanolamine, Ethoxydiglycol, Phenoxyethanol, Chlorphenesin.

Antibiotic creams
metronidazole cream, rosex cream: used for rosacea subtype 2, with skin outbreaks and pimples and redness. Many dermatologists and ob/gyns have been OK in the past with patients using these creams locally on some areas of the skin, in a very thin layer. 
Metrogel Ingredients: metronidazole gel 1% is an aqueous gel; each gram contains 10 mg of metronidazole in a base of betadex, edetate disodium, hydroxyethyl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycolpropylparaben and purified water.

Soolantra/ivermectin cream
used for rosacea subtype 2, with skin outbreaks and pimples and redness. Check with your doctor about using it during pregnancy. Many doctors are OK with it, as long as you use a pea sized amount on your face only (and not entire body). Read more about them in this blog post.

Other creams, like sulphur cream, sulphur soap, zinc cream or ZZ-cream
used for rosacea subtype 2 with skin outbreaks and pimples.

read more on this here.

Natural anti inflammatory herbs and supplements Read more on this here.

Low level red light therapy

Diet changes reducing the amount of inflammatory foods you eat (sugars and simple carbohydrates especially), and/or testing if you have food allergies or -sensitivities. Read more on food triggers for rosacea here

Treatment of subtype 1 rosacea with flushing and redness 
is more tricky during pregnancy. All anti flushing medication are of the C-risk category and therefore not straight forward. I know women with severe flushing subtype 1 who were allowed certain blood pressure lowering medications to help bear the brunt of the suffering. Other potential options, although in my own experience Mirvaso and Rhofade are not a safe option.. 

Mirvaso / Rhofade cream 
used for rosacea subtype 1 with flushing, redness and burning of the skin. Both have pretty bad reviews however and can cause rebound flaring of the skin. They constrict the blood vessels in the face temporary, but after that rebound worsening can happen. I would not advise you to use either of these two. 

Certain prescription medications might be prescribed by your doctor if the flushing and redness are too serious
including antibiotics to reduce inflammation of the skin, certain blood pressure lowering medications, certain antidepressants to blunt flushing response (although many are risky during pregnancy!) and certain anti-anxiety pills.

Side note: I found that my own rosacea reacted not at all, or worsened from all the natural treatment options I tried the first 6 years. Between its onset in 1999 and me starting medication in 2005, I tried homeopathy, acupuncture, anti inflammatory herbs, Chinese medicine, even 'healing crystals' (a present from my mother who hoped it would help) and multivitamins. And all the creams you can think of. Nothing helped me and as I said, most made matters worse. I realize that for a lot of rosaceans however, one or all of these things mentioned can be very beneficial. I am just not the best person to advice on them :) I made a little inventory of what rosacea patients online name as treatment options of their rosacea during pregnancy. My own bet would be to stay as cool and calm as possible, use a fan if that helps you to keep the flushing and flares under control. To stay well and clearly away from sugars, preservatives, chocolate, yoghurt, alcohol, any foods that cause flares and to eat very healthy, fruits, vegetables, drink lots of water. I would be gentle with my skin care and void endlessly long hot showers (yeh my own weak spot). 

What to do about skin changes during pregnancy?

Stick to the Pregnancy Diet. It contains the right balance of nutrients to keep your skin looking as good as it can — under the trying circumstances. Get those eight glasses of water a day. Drinking lots of water will keep your skin hydrated and healthy. If pimples are your problem, wash your face twice a day with a thorough but gentle cleanser (harsh ones will only leave skin more open to irritation). Exfoliate gently, too (don't get too aggressive), and finish off with an oil-free moisturizer. You can also use a zinc-based cream. Overly stripped skin is more prone to breakouts. Look for the words "noncomedogenic" and "unscented" when you're buying makeup and skin-care products. "Oil free" will be less likely to add excess oils and clog up pores — good if your skin is on the oilier side to begin with. But if your skin is dry, you'll do best to choose moisturizing products. A supplement of B6 might help a tough case of acne. Talk to your practitioner about it. If you see a dermatologist, always tell him or her that you're expecting. Some drugs commonly used to treat acne, like Accutane and Retin-A, should not be used while you're pregnant, as they are linked to fetal deformities. Taking too many baths can strip your skin of its moisture. Stick to short showers (good training for actual motherhood :P) in warm (not hot) water, and use a mild soapless cleanser. For very dry skin, try a moisturizer or put a warm-mist humidifier in your room. For redness on the palms of your hands, sit tight. This condition disappears after you give birth. Skin tags usually appear during pregnancy and disappear after delivery. If they don't, a dermatologist can remove them in a flash. For heat rash, staying cool can help. Sprinkle on a bit of cornstarch after a shower and avoid tight or overly warm clothing. Dress in layers so you peel down if you get too warm.

Msmyth wrote on March 31st 2006 :"Rosacea treatment during pregnancy. I would like to have a baby soon and my dermatologist has me on finacea and aknemycin twice a day. He says these meds are safe for pregnancy. Has anyone else on the board taken meds throughout their entire pregnancy? Can anyone please comment on what medicines they used and whether it had any ill effects on their fetus? Also, please comment on other meds you have heard are safe during pregnancy. I wish I could go off of them, but if I skip for even a few days I flare up. I"d be afraid I would do irreversible damage to my skin being off the meds for nine months. Someone please give me some advice on this matter and how you dealt with your rosacea during pregnancy. thanks"

Jen replied on April 4th 2006: "Hi msmyth, I took nothing to control Rosacea during my two pregnancies. My face was actually pretty good for it too. Maybe it was the healthy eating and excitement of having a baby in my 'tummy'! Truly though, be very careful about anything you take whilst trying to get pregnant, during or whilst breast feeding your baby. Maybe I am a tad over the top but I took every warning on board when I was pregnant, even if it had a tiny percentage of possibility for damage to my baby. Not to sound 'oh woe is me' but I didn't realize I was pregnant with my second child and had started taking a new course of antibiotics. It was very early days and 'touch wood' everything is fine with my now 2 year old. I mean, I wouldn't eat any processed meats (like ham in a sandwich) when pregnant, so to have started out with a few days of antibiotics, I was...well...a tad distraught! If this is your first child (and I am assuming it will be), then give yourself a break and just forget about Rosacea. My Rosacea was soooo under control when I was pregnant, so hopefully that might be the same for you? I hope so! Go a la natural girl and enjoy your pregnancy when it happens! Plenty of 'practice' is required to make one!  Jen"

Anonymous wrote on April 6th 2012: "My OB and my derm okayed Finacea and Metrogel."

Candymycandy wrote on June 30th 2014: "Hi all, not sure if anyone has any experience of this but I'd be grateful for any help/opinions. I suffer from rosacea. When I got pregnant I stopped using the gel I have (azelaic acid) but my dermatologist said there was no contraindications with pregnancy. I've since used it about 3 times in desperation as my skin as got a lot worse, sparingly and only in very small areas as I was not 100% i believed the dermo. I've now done some further googling and while a lot of sites say it's considered safe, a few say not to use it in pregnancy. Now I am totally panicking that I've done some harm and feel awful. Does anyone have any insight on this that might put my mind at rest? I've of course now stopped using it. Thanks in advance x"

Artist wrote on June 14th 2009: "I personally do NOT think a little metrocream/gel on the face would have affected your pregnancy. Maybe if you had spread a whole tube of it all over, but not the tiny amounts we use on our cheeks/faces. I think this is how my doctor explained it, and it makes sense to me. I wasn't using topicals at the time anyway, but I did have to wean off oral meds and find alternatives. Be careful since even teas and "natural supplements" are not recommended for pregnancy. That's why I tried red light therapy. You don't apply it or ingest it, and people overwhelmingly do well with it. I'd say at least 95% of feedback is very good. I bought a single head red/infrared combo lamp from acnelamp.com and started using it every night for fifteen minutes. I also bought the goggles to protect my eyes while using it. After about eight weeks I noticed overall improvement from it and I still use it two years later! I now use it every other night to maintain the results. You might want to read more about red light therapy and search some of the sites that sell them. 
Being pregnant forced me to find other ways to control my rosacea. So, now that I am done being pregnant, I have even more options than I did before :) Prepare yourself for a possible rebound flare from going off the metro anywhere from one to four months or so after stopping, but remember you do have a very good chance of improving while pregnant anyway..Also, I suggest relaxation techniques to de-stress while pregnant. An excellent, up-to-date read about stress and how it affects the body is "Why Zebras Don't get ulcers". It's fascinating! I take the trigger of "stress" for rosacea much more seriously now, and actively do things to de-stress, be calm, etc.. I have noticed an improvement in my skin since adopting a stress-free outlook :)
Cheers! Artist"

DreamsInDigital wrote on December 27th 2008: "My OB told me she thinks I have rosacea, and prescribed clindamycin gel twice daily. Everything I've read simply says "Tell your doctor if you're pregnant" but I can't find any info about its safety in pregnancy. I'm 33 weeks. I'm hesitant to start using it because I'm concerned about its safety but at the same time, my skin is so incredibly painful and nothing is helping that I am willing to try it if it is indeed okay for me to use."

Courtenay_e replied on December 27th 2008: "
Have you looked into roseacea? I have it. Mine got HORRIBLE with my second pregnancy, but there are non medical things you can do to better control it. Don't use very hot water to bathe. Don't use scented soap (we use cetaphil non-antibacterial bar soap). DO NOT consume caffeine (this is a huge trigger for many people with roseacea). Take an EFA like flax or cod liver oilUse a high quality moisturizer on the affected areas immediately after bathing, and after just patting the area dry, not rubbing. And the main risk factor/cause, you have no control over...most people with the condition are of Irish or Scottish descent. That said, I did use the ointment for a while, but found that using the above methods (especially cutting out even trace amounts of caffeine) worked profoundly, and the ointment only worked a little. I called my pharmacist, who said that so little is absorbed by the skin into the blood that it has an extremely low probability of affecting a pregnancy. But I'd check with your pharmacist, as well...or look in Medications in Mother's Milk (my go to source!). I would check it for you, but I broke my foot and sprained my ankle the other day, and crutches are a pain in the rear (or the foot in my case). Good luck!"

Liseux replied on December 28th 2008: "I feel for you! 
I had rosacea unbelievably bad in my 3rd pregnancy & after. I did use clinda in pregnancy & found that it worked very well & truly, the amount that gets into your bloodstream from your skin is very very tiny. It is safe. But..Courtenay e has some excellent tips too. For natural remedies, I highly recommend Dr. Haushka products, I used them alone after clinda stopped working for me & my skin was smoother in one day. Dr. Haushka is not cheap, but you can use it sparingly & it is wonderfully made, with great ethics & no parabens or anything unnatural in there. I also found great success with the new sulfur creams, that's also a pretty natural product, but it is not recomended during pregnancy. I did use it in the beginning of my current pregnancy though--a lot of people are allergic to sulfa though. Good luck, there are good options now for rosacea!"

CincyDeb wrote on march 2nd 2014: "I developed Rosacea when I was pregnant with my first child (at age 39). I never had skin issues before, even as a teenager I finally went to the doctor and was diagnosed with Papulopustular Rosacea (acne plus redness). My doctor prescribed Monodox and it has worked WONDERS! Within a week, almost all the pimples/ bumps were gone. GONE! I only hope that once I finish up the medication (60 days), it won't all come back. The downside is the cost."

N├ągonsin wrote on July 28th 2013: "
My rosacea was getting worse and worse (partly hormonal I think, pregnancies especially made it flare up), but it's been a million times better in the last year. I went minimalist with skin care: no soaps and cleansers, I just wash my face with a petrol- and paraben-free moisturiser now. Paw paw cream, rosehip oil or a tea tree lotion for moisturizing, and mineral make-up. Stuff that was previously an obvious trigger doesn't cause a flare-up anymore and I don't have perpetually flushed, burning cheeks. To get rid of all the redness though, I suspect PP is right, laser is probably the only thing that works."

Minnie-enger wrote on a pregnancy forum, on October 10th 2010: "Hi, My cheeks starting getting red with bumps last week and has now spread down my face, over my nose, and around my eyes. The red bumps are itchy and sometimes burning. I have an appointment with a dermo tomorrow but I am curious if anyone else have developed these symptoms during early pregnancy? I think it maybe Rosacea but I am not sure since it has spread beyond my cheeks. Usually my skin is in good shape and I get occasional breakouts. This is definitely frustrating. Thanks for your inputs!"

Teresa304 replied on October 19th 2010: "I got the same thing today. I noticed it after my shower. I have always had a reddish complexion, but this is different. There are little bumps and it is itchy and burns a little. I am assuming it is rosacea, which my mom also has so I'm not surprised that I'm getting it with this pregnancy. Although I didn't get it last pregnancy. I think things that will help it include not taking hot showers, and generally trying to stay cool. rinsing your face off with cool water may help. Some say to avoid spicy foods. I was always afraid of developing rosacea when i got in my 30's because that is when my  mom's really flared up. I guess this baby to be is bringing it on. Hopefully it gets better during the 2nd trimester. Did your dermo give you any idea on over the counter creams?"

Lotussooz replied on September 11th 2010: "I woke up to RED cheeks this morning... Not to mention I am burning up at night, even my eyes feel hot.. I thought maybe I was just getting sick, many of my friends are currently sick, but i think it's just hot flashes.. i took my temp and it's normal so I don't think it's any cause for concern.. My skin which is usually very clear is really blotchy and breaking out a lot these days. I hate it. I'm not real sure what to use to help with that either though.. Frown. I'm 12 weeks today... Due date is May 24th, 2011."

Fightingfrog replied on September 11th 2010: "Sorry ladies, I developed this during my last pregnancy and there is no cure. Things that help me.
1) Make sure you wash your face at least twice a day. I notice that mine is worse when I forget to wash it...like on the weekends when my routine is disturbed
2) Eucerin redness relief product line - help alleviate some of the redness
3) Drinking a lot of water  - Rosacea causes a lot of dryness which makes the redness worse
4) Mineral Powder foundation - Do not ask me why I have NO IDEA.  I usually NEVER wear makeup. but for some reason I have noticed on the days that I wear just a little of the mineral powder foundation it actually improves my skin...maybe  some sort of protector from the elements
5) Finacea - stopped using this when we started to try to convince, but the moment I give birth I will go back to using it. I love it and it works fantastic  - you need to get the script from your Dermotologist."

Rosacean wrote on February 21st 2011: "Hi, I am suffering from rosacea for quite some time....from last and this current pregnancy.  my doc gave me a cream (mixing two different ones) but that was no help. I am trying some home remedies which work....and if someone has rosacea for the first time or initial stage then this might help you more.

1. for redness: 1/2 tsp or 1 as needed mashed tomato and same amount of honey.  mix and apply to the affected area.  leave for 1/2 hr or so....and rinse with cool water.
2. rosacea also causes swelling of the face:  1 tsp yogurt and a big pinch of turmeric powder plus finely crushed (almost like a powder) oatmeal- 1 tsp.  mix them well- apply on your face.  Let it all dry and then scrub off the dried mask and rinse with cool water.
3.  my skin gets very very dry and scaly - I put some table cream on the affected area and it acts like a moisturizer.  Some people say organic milk or goat milk is good too...but i have not tried that!
Please only try if you feel comfortable.....I use these as doc do not give me anything during pregnancy for rosacea and plus we eat all the above mentioned ingredients.  therefore causes no harm. I would like to ask minnie-enger what cream your dermo gave you and what moisturizer you use. fightingfrog- If you don't mind what brand make are you using- as I feel really awful when i have to go somewhere and I can't hide my redness and bumps etc. thanks ans i hope these remedies will help."

Danny66 replied on January10th 2014: "The easiest way to treat Rosacea during pregnancy is to drink lots of water to flush out toxins and cleanse the body. A balanced diet can also help during pregnancy; fresh fruits and vegetables with cereals and whole-grain breads, food high in protein, milk and milk products should also be included in your daily diet. Spicy food, alcohol or hot stuff should be avoided at all cost. Stress can aggravate Rosacea hence keep a happy disposition and stay away from factors that lead to stress. Wash your face regularly with cold water and a face-wash or medicated soap at least 3 to 4 times a day. :)"

Anonymous wrote on March 2nd 2013: "Rosacea worse during pregnancy? Mine's gotten awful. Nothing seems to be making it better, and I'm terrified it's going to stay like this every after I give birth. Has anyone else with rosacea had the same experience?"

Anonymous replied on March 2nd 2013: "I have rosacea and i had the opposite experience. but then, after pregnancy, my skin went back to "normal." so often we have issues during pregnancy that then reverse themselves after giving birth when our hormones return back to normal. wouldn't be surprised if that happened for you! what has your OB/midwife said?"

Anonymous replied  on march 2nd 2013: "I'm in the same boat. Hoping it gets better after delivery when I can take my medicine again!!"

Anonymous replied  on march 2nd 2013: "I had the same issue. Worst ever during first TRI. Switched from metrogel to finacea and that only helped a little. Gave up hot beverages for a while and that helped. It was improving by 6 months though. 

[..] Try coconut oil. Seriously. Organic, unrefined (unpressed) coconut oil. Give it a week. I've tried everything and it works for me. When I stop using it daily, rosacea returns. I put the coconut oil all over my face, basically used as a moisturizer. If you do some research, there is pretty profound incidental use of coconut oil for both acne and rosacea. My skin is so much better, glowing. Let me know if it works for you!! Good Luck!
[..] Mine disappeared during pregnancy and breastfeeding. Now that I have almost completely weaned my son, it is back in a big way. [..] The only thing I've tried is Prosacea topical gel which honestly don't make a huge difference, although I don't use it as regularly as I should. [..] I had the same issue. Worst ever during first TRI. Switched from metrogel to finacea and that only helped a little. Gave up hot beverages for a while and that helped. It was improving by 6 months though.

Rosacea Mom wrote on March 3rd 2010: Hi everyone, I was diagnosed with rosacea before I got pregnant- I had acne rosacea on my chin, irritation around my eyes, and burning skin. I went on prescription medications which cleared it up pretty well, but I was really worried that the rosacea would come back after I went off the meds (the meds I was on aren't safe for pregnancy). I did a lot of research and found some things that worked and have kept me rosacea-free for several years! I hope other people can benefit from this. I slowly weaned myself off the prescriptions when I decided it was time to have a baby. I started skipping a day, then two days, etc. In the meantime, I started using some natural remedies I had researched. I mixed several drops of Green Tea Extract (health food stores and online) with my moisturizer twice a day or whenever my face felt "burning". The two moisturizers that I found worked great were (and I tried a lot!) Clinique Dramatically Different Moisturizing Lotion and also Clinique's new Redness Solutions. (Clinique counters will sometimes give out samples if you ask. Clinique is found at Sephora and some department stores- you can find out at clinique.com). The other great moisturizer is Burt's Bees Radiance Day Cream (I got mine at CVS.) All of these really cooled my skin and didn't irritate. Expensive, but absolutely worth it. I also took Green Tea extract capsules daily (but drank decaf green tea instead while pregnant), and 800mg of vitamin D3. I found that alcohol, especially wine, made flare-ups worse. When my skin was not irritated, I used Tea Tree oil for the acne- but I couldn't use it during bad flare-ups because it burned. It will kill bacteria that can cause acne. I also found great make-up. Bare Escentuals (online or at Sephora, got mine from an infomercial!) didn't irritate my skin, looks natural, and covers the acne and plaques caused by rosacea. Liquid makup made things look worse, but this is powder makeup is swirled into the skin and really covers and looks good. Also expensive but worth it. Good luck, everyone!"

Extra links:

Here is a post about red light therapy during pregnancy.

Here is a post from a rosacean worrying whether metrogel use could have caused a miscarriage.
Here is a post about rosacea and pregnancy.
Here is a forum post about metrogel use during pregnancy. 
Here is a forum post about rosacea treatment during pregnancy. 
Here a forum member asks if rosacea will fade again after pregnancy.
Here is a forum post about clonidine and pregnancy.
Here is a forum post about plaquenil and pregnancy.
Here is a post from someone developing first time rosacea during pregnancy and Zoloft use. 
This is a post about rosacea and pregnancy experiences.
Here is a post about handling flare ups during pregnancy. 
Here is a forum post from someone who's rosacea starting during pregnancy and who is struggling.
Here is a post titled; I am pregnant, what to expect with my rosacea?
Here is a forum post from a rosacean who is pregnant and who's skin does well.

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