Douglas Marshall-MacDonald


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Adult Acne? What's really going on? A guide to treating Rosacea and Inflammation...

Adult Acne? What's really going on? A guide to treating Rosacea and Inflammation...

There’s one thing I’ve done almost perfectly since the age of 15:  Take care of my skin.  As a junior in high school I was using Clearasil Clear Stick and my mom’s Prescriptives Alpha Hydroxy moisturizer.  I always had a skin-care routine, even through college.  No matter what time I got home from the bars or what condition I was in, I was washing my face before bed.  I never skipped and I never skimped. I’m still religious with my skin, night and day.  I can’t think of a day in the last 20 years that I didn’t apply moisturizer to my face.  It would be like walking out of the house naked.

High School 1994, 1995, 1996.  The Best Groomed guy in my class...

High School 1994, 1995, 1996.  The Best Groomed guy in my class...

When I lived in New York I did marketing and managed product development for a cosmeceutical skin care line created by a dermatologist.  I made friends with the chemist who formulated the products and I picked her brain about ingredients.  She also formulated for La Prairie -- so she knew her stuff.  Between working for a dermatologist and befriending a chemist, I learned everything there was to know about skin and caring for it. 

Since I’ve been so regimented about my skin, it always looked pretty good.  Until I turned 32.  I never went through that awkward teenage acne break-out phase until I was in my 30’s.  Everything I knew and believed about my skin no longer served me.  My perfect skin turned on me.  I no longer had control.

When I was 32, I developed Rosacea.  For a long time I thought it was acne because it behaved the same way.  Red, rough, inflamed skin on the nose, on the cheeks and forehead.  Not only does my skin get red and blotchy, it breaks out.  Almost like cystic acne.  I was diagnosed with Rosacea: It’s like teenage acne for adults.  Except using products that acne prone teenagers use to clear up skin actually makes Rosacea worse.  Rosacea defies all the rules for how to treat acne.  Because it’s not truly acne, it’s inflammation.  The more you fuss with it, the worse it gets.  See one little red dot and try to rub/exfoliate/pop it and the next day you have a big bright red bump that actually hurts.  When one is clearing up, another one comes in.  It’s a never-ending cycle.  The text books have a nasty term for this: A “Flare-up”. Ugh.

There are things that trigger rosacea, except we don’t really know exactly what they are and it is different for each person.  For me, the worst offenders that lead to flare-ups are heat, sun, tomatoes and chocolate.  I forbid myself to do hot yoga or get more than 1 Caprese salad a week in the summer.  I binged on sweet cherry tomatoes from my friend’s organic garden two summers ago and my skin suffered the consequences for 6 weeks.  An indulgence like that unleashed a non-stop series of red rashy inflamed skin on my cheeks.  I have to think twice before I open the sun roof in the car when it's warm out (even if I'm wearing a high SPF).  A few too many rays hitting my nose and it gets red and swollen like a clown.  I resist dark chocolate.  Every time I indulge in chocolate around the holidays, I can guarantee a big break out.

Emotionally, this has been a HUGE setback for me.  Some people might not think it’s a big deal, but for me it feels like it is.  When my skin breaks out, it really messes with my head and my self perception.  I live in fear of an imperfect complexion; I don’t know why, it’s just my thing.  I used to feel so in control of my skin, but once Rosacea hit, I have no control.  As I write this, I sound kind of vein and trite.  However, I need to remember that all the concealers, acne products and clear skin solutions wouldn’t be available if there wasn’t a market full of people who feel the same way I do.  Since I’m so open with my skin struggles and I try to share what works for me, I seem to attract people that have the same issues and confusions.  I get texts, e mails and direct messages on Instagram every time I talk about skin care asking for help. This blog post is my attempt to put it all in one place!  I’ve gotten a lot of information along the way from professionals and I want to share some of my findings with you! 

Basically, I’ve spent the last 8 years researching Rosacea, seeking out professional guidance and trying out different things (some worked, most didn’t) in order to get my skin under control.  I’ve seen various dermatologists, tried different lasers and used literally every prescription medication and OTC remedy there is on the market for Rosacea.   While I haven’t cured myself, I now see getting my Rosacea under control as a form of “remission”.  I accept that my skin will never be perfect at all times, but I do my best to create the best environment for my skin to thrive.  I know for certain a few things I’m doing are really working to keep my skin clear and even toned.  And when all else fails, I have found great concealers!

The SH*T List:

After my Rosacea began in 2009, I researched product ingredients that could be triggers.  What I found was interesting--a lot of the oil free products out there that are meant for acne prone skin have hidden chemicals or emulsifiers in them that are actually more irritating to the skin.  I made a list of the top 30 most irritating ingredients in skin care products that clog pores or cause break outs.  I wrote it out on a tiny piece of paper, folded it up and carried it in my wallet.  I would be in Sephora with my list out, comparing it against ingredients on a box.  If I saw Myristyl Myristate, a highly comedogenic vegetable derived emulsifier, I knew I couldn’t get it.  A lot of oil free products that say they don’t cause breakouts, are actually worse, because they have so much genetically modified emulsifiers that are more irritating for the skin.  When you have Rosacea, the smallest thing that causes irritation could lead to a flare-up.  Know what’s in the products you use on your skin.  I like this website for reference.  If you have Rosacea, I recommend becoming a label reader.  The power starts with knowing what’s in the products you put on your face.


Get a Dermatologist and an Esthetician that you trust: 

Since 2009, there were 2 things I stopped doing because I didn’t want to irritate my skin.  I stopped exfoliating and I stopped getting facials.  Which I’d argue now, exfoliating and getting facials are the two most important things to KEEP doing as part of a treatment regimen.  The distinction is going to the right aesthetician who knows how to treat Rosacea and knowing the proper way to exfoliate at home for your skin type.  While I’ve seen many dermatologists, who have been very helpful, they don’t always have the time to walk me through a complete skin care regimen that’s perfectly suited to me (especially if they are part of a health care system and not a medi-spa).  If their primary focus is not cosmetic dermatology, they probably won't recommend a facialist or have time to do exfoliation demos for you.  I lacked true professional information so I avoided facials and exfoliation for about 8 years.  I was constantly taking matters into my own hands and making things worse.  Don’t do that.  My first piece of advice: get a good dermatologist and a good esthetician.  You need both!

My journey with Rosacea led me on a path to the right skin care specialist beyond my general dermatologist.  It took 8 years to find her:

Sarah Kurn is a Master Esthetician at The Dermatory, or as I call her, the Rosacea whisperer.  I was referred to her by 2 friends.  She's 30 minutes outside the Twin Cities in Mahtomedia, Minnesota (yes, it's worth the trip). She's a very sought after aesthetician because whatever she does is pure magic.  The average wait time to get an appointment with her is about 3 months and it's worth the wait.  I saw her in September of 2017 and got her signature Infusion Machine Renewal Facial and she got me started on streamlined regimen.  I recently had my 2nd facial with her and my skin has done a 180º turn around since she came into my life.

Sarah Kurn, a face saver.  Call 651.200.7162 for consults.

Sarah Kurn, a face saver.  Call 651.200.7162 for consults.

Before seeing her, I was trying all sorts of products and was so misguided that I was doing more harm than good.  I had too much information and while I had a good dermatologist, they don’t have time to give you a product regimen beyond prescribed medications.  The last 3 years of my life I’ve been in and out of Rosacea flare ups; some last upwards of 6 months.  By the time I met Sarah, I was desperate and disgusted.  Since then, everything has changed.  She taught me a few simple things and introduced me to a few simple products.  I’ve been getting a surprising number of compliments on my skin.  I feel more confident and informed about how to address my skin care concerns.  Naturally people want to know what I’m doing – so this is what I’m doing:

My skin in February 2018, 5 months after working with Sarah.  No filter, no concealer, no make up.

My skin in February 2018, 5 months after working with Sarah.  No filter, no concealer, no make up.

First of all, people with Rosacea can exfoliate.  Every time I grabbed for a granular scrub in the shower, within 3 days my skin would be broken out and inflamed.  So in my mind, exfoliation was a trigger.  I hadn’t actively exfoliated in years, literally.  Sarah turned me on to a Beta Hydroxy Acid toner and gauze sponges (not cotton balls).  The gauze sponges have cross hatched pattern (made with string) on the outside with cotton on the inside.  That cross hatch actually pulls off and traps dead skin.  It’s genius.  You don’t scrub, but you apply pressure.  Beta Hydroxy Acid is essentially salicylic acid – which if you have Rosacea or very sensitive skin, this acid is great at exfoliating because it’s very gentle. 

Rhonda Allison  Beta Green Tree Cleanser  and  Beta Green Tea Lotion  with Cotton Filled Gauze Sponges.  Read below.

Rhonda Allison Beta Green Tree Cleanser and Beta Green Tea Lotion with Cotton Filled Gauze Sponges.  Read below.

The next thing she told me is to avoid Alpha Hydroxy Acids.  Basically, AHA’s are fruit acids and will appear on labels as glycolic acid and lactic acid.  They are amazing for some – but for people with Rosacea, they cause irritation and inflammation.

Sarah turned me on to Rhonda Allison products.  I didn’t know much about this skincare line.  It’s only sold by licensed Aestheticians, so they can prescribe what’s right for you.  So far, I’ve used the Beta Hydroxy Acid and Green Tea wash (this precedes the exfoliation by loosening the dead skin).  After the shower, I use the Beta Hydroxy and Green Tea lotion (aka toner) with the gauze sponges to finish pulling away dead skin.  What this has done is reveal a more even and bright complexion.  Just those two Rhonda Allison products have yielded a youthful glow. I follow that up with 2 products I’m trying: Epionce Renewal Lite Lotion (it’s great for hydration but not so emollient that it suffocates the skin) and Rhonda Allison eZinc Protection Cream that has a slight peach tint and a natural spf of 20 (due to zinc). See picture below.  For people with Rosacea, there’s a tendency to skip heavy anti-aging products for fear of triggering a flare up.  With the help of Sarah, we’ve found products that work for my skin to keep it clear AND hydrated.  It doesn’t have to be heavy, thick or greasy to do a good job.

Trying these facial moisturizers:  Epionce  Renewal Lite Facial Lotion and  Rhonda Allison  eZINC Protection Cream.

Trying these facial moisturizers: Epionce Renewal Lite Facial Lotion and Rhonda Allison eZINC Protection Cream.

Now, let’s talk about medications (topical and ingested) to help treat and prevent Rosacea. They are readily available and in my opinion, sometimes necessary.  I’ll admit, I’ve been on topical prescribed medications for years.  Very far from “all natural” and I sometimes feel guilty that I use meds to manage this.  I’ve used Metrogel (doesn’t work for me), Finacea (no idea if it works) and topical Clindamycin Phosphate gel (this works really really well) – basically I’ve used antibiotics and anti microbials on my face for years.  I also have been on and off doxycycline pills for years.  I was scared to tell all of this to Sarah as if I was cheating the system. I was waiting for her to veto Western Medicine.  When I told her about all the medications she responded in a very positive and loving way.  She believes that you have to do what you have to do.  She gets the fact that I can’t stand a break out to the point that I’d take meds to clear it up.  There was no judgement.  Even if it’s using topical antibiotics or taking a low dose of antibiotics to reduce inflammation from the inside in order to clear skin, she says it’s ok.  It’s really a matter of choice.  In the past 6 months, with the help of Sarah, I’ve been able to taper off antibiotics. 

Also, I had already been using Retin-A for anti aging. I wasn’t doing it regularly and I was afraid to over do it and upset my skin.  She said Retin-A is Rosacea friendly.  She recommended I use the Retin-A religiously.  I don’t do it every night, but definitely 5 nights a week.  That along with the Rhonda Allison exfoliation process has given me a glow back that I haven’t had in years. 

The Holy Trinity of skincare: Retin-A, Clindamycin Gel and my favorite: A mixture of the two!  Need a prescripiton for these!

The Holy Trinity of skincare: Retin-A, Clindamycin Gel and my favorite: A mixture of the two!  Need a prescripiton for these!

It's what's on the inside that counts (too)

I’m also reading books on gut health and how to eat in a way the feeds your body prebiotics and probiotics, which will balance health from within, which will lead to clearer skin.  I’ve learned over the years that when I eat junk food, my skin responds with a break out.  It’s like my radar.  I will write a whole other blog post on this, because I’m still in the learning and testing phase!  Basically, eating foods that fight and reduce inflammation (in addition to taking probiotics) and avoiding foods that lead to inflammation will heal your skin.  In short, lay off white starchy carbs (bread), sugar and dairy.  I’m trying that at the moment.  It’s not easy, but binging on pizza and nachos kind of don’t seem worth it if it results in puffy eyes, red skin and pimples.  I see that now.  When I reached for a bag of candy, in the moment, I wasn’t always thinking, “Maybe I should lay off this in favor of my clear skin.”  I’m thinking that way now.  So I’m testing this and I’ll give you an update in March!

The Facial Play by Play:

Beyond the skin care regimen, Sarah Kurn’s Infusion Machine Renewal Facial rebuilt my dermis.  Sarah did this facial based on my skin type and needs which are anti-aging, combination skin (oily and dry) and Rosacea.  According to Sarah, machines and active ingredients, when used together, yield optimal results.  And they do!

1.     We started by cleaning, lifting and toning the skin with ultrasonic cleansing and ionic detoxification.

2.     A double enzyme peel was used to lift dead cells and uneven pigmentation.

3.     Oxygen therapy infused with stem cells and growth factors to increase skin health with essential vitamins, minerals and stem cells was used.

4.     A 3D Hyaluronic Acid and Stem Cell Sheet Mask was applied and smoothed on by 9 degree cool therapy paddles.  These cool paddles helped deliver the active ingredients.

5.     Then comes my favorite part: Electric Micro-Current for sculpting, toning and wrinkle reduction.  A professional NuFace device delivered electric micro current to my face to stimulate the muscles.  Sarah calls this the Hollywood Facial because a lot of the big stars do it before red carpets and award shows.  It provides IMMEDIATE and LASTING facial sculpting by stimulating and activating facial muscles.  After my 1st treatment I had very pronounced cheekbones and a great brow lift.  I swear, I looked more angular and lifted for days.  You can get a NuFace at home device to do this and when used as prescribed (5 minutes a day, at least 5 days a week, for 60 days) you can build the muscles in your face to provide more contour and to hold things up where they belong.  I’m thinking of trying it…more to come on that!

The  NuFace  Trinity! So next level!

The NuFace Trinity! So next level!

The goal of the facial treatments above are to rejuvenate and reset skin tone and stimulate it enough to produce its own healing response.  Various techniques reduced inflammation that leads to redness and removed bacteria that leads to acne.  I emerged clean, clear and even.

On an emotional level, how did this facial affect me?? Speechless.  After the first facial, but even more so a few months later on the new regimen after my 2nd facial, I felt like I was seeing my skin again for the first time.  Feeling like I turned the clock back to before I was 32 and my skin fell apart.  I feel like I have good direction and some control over my skin.  I am empowered: I know exactly how to take care of my skin, based on my individual needs.  If I have a question, I just ask Sarah.  I no longer have to go it alone.  When people ask me what's working for me, I know exactly what is working.  The guessing game is over.

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Sarah Kurn

The Rosacea Whisperer

Cleaning up and clearing up my skin has been a process and I’m still in the middle of it. I will be seeing Sarah every few months to keep this going.  I’m going to try more of the elimination diet route and I’m going to be consistent.  I’m going to stick to expert advice, rather than making things up as I go along.  I’m on a path now, and I feel good about it.  I’m hoping that something I wrote in here helps someone!  Also, I will be writing follow ups to this blog post--ones on lasers, light therapy, masks and concealers.  There are so many topics I can cover, but this was a great place for me to start: Finding experts and getting on a regiment that works for you. 

What do you want to hear more about?  I’d love to hear your story or your skin issues, recommendations or even questions.  Email me:!

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