I first noticed a rash-like spot on my upper right cheek in March, 2011. There were a few bumps as well, and I thought it was just a sign that I needed to trade out my makeup. I’d had small areas like that before, and changing the concealer usually helped.
So I did that, but this time it didn’t seem to help. I noticed more bumps, but because it happened so slowly I didn’t pay much attention. Every time I noticed them, I just thought, “I must be breaking out.” Maybe I was sleeping on that side? Using my cell phone too much between cleaning the screen?
It took a while for the spot to grow, too. I got married in August 2011, and luckily, any redness and bumps could be easily covered up with concealer and tinted moisturizer.
Let me back up a bit. Ever since I was 14, and read about the importance of sunscreen, I used moisturizers that contained SPF of at least 15. When outside for longer than a half hour or so (i.e., playing soccer, swimming, etc.) I smeared on a stronger, waterproof sunscreen (Bullfrog or Neutrogena). I also always washed my face twice daily with a gentle face wash, exfoliated when I remembered to, and always, always moisturized twice a day. If I had any breakouts, I’d use an acne treatment, and sometimes a toner if I felt like it.
About a year or so before I noticed the strange rash, I stopped doing those things with any consistency. I had begun to hear about the dangers of sunscreen (does sunscreen itself cause skin cancer?!), and about the importance of using natural beauty products.
But the problem with most natural and organic beauty products is that they very often contain a huge list of ingredients with multiple essential oils, which ended up being incredibly irritating to my skin. I believe that the sudden change in my skin care habits really helped to set the stage for my skin to get very much out of whack.
A few more months went by after the wedding before I really thought, OK I need to check this out. The rash slowly grew, and my skin was super dry yet oilier in patches than it had ever been. It was still confined to my right cheek.
Even though I consciously tried to modify my sleeping and talking on the phone positions, I thought I must have still been using the right side in some instances.
Finally, in March 2012, I realized I needed to figure out what was going on. A little Googling helped me decide to start by getting some antibiotic ointment from the drugstore, which only made it angrier. (Word of advice – don’t Google an issue until you know what it is you’ve got. Google does not take the place of a professional diagnosis.)
After using the antibiotic ointment, my cheek became so red that I couldn’t ignore it. Everyone I saw kept asking me if I’d gotten sunburnt on one side of my face.
I went first to Dr. #1 in La Jolla, sometime in April/ May 2012. He was very nice, but his methods ended up causing me more damage. He first got me on a steroid ointment for a couple of weeks, but that didn’t help, and probably made things worse once I finally went off of it.
Then, a retinol cream and an antibiotic. I stopped the antibiotic cream because it seemed to anger my skin, and while the retinol didn’t seem to do much damage on its own, Dr. #1 forgot to stress sunscreen to me, and my moisturizer had none.
At the time I lived in San Diego, so the sun was a daily accessory. The rash spread, and became even angrier. But because it spread so slowly I almost got used to it, and didn’t work on the issue as fast as I should have.
During the time that I was seeing Dr. #1, I never altered my regimen any further than adding his prescribed treatments. I still used the same cleanser and moisturizer, and sometimes even went without moisturizer or washed my face with harsh body wash from the gym. I dabbed lavender oil on the bumps. I still was not wearing sunscreen.
After we realized those weren’t working, by maybe August or September, the Doc said he thought what I had was keratosis pilaris, which are the little red bumps usually seen on upper arms. They can also occur on the cheeks. He even suggested I get tested for lupus, to rule it out as a possibility.
In January 2013, I decided to try a new doctor. Dr. #2 heard me out, took a look at my face, and scraped a sample of my right cheek cells and disappeared for a couple of minutes. When she came back into the room, she announced “You have more demodex than anyone I’ve ever seen. Your cheek is crawling with them.”
What are demodex? They’re tiny skin mites, and most people have them. They live in the hair follicles of our skin and feed on sebum (oil). From what I can gather, researchers are still learning about demodex and what they do, but for the most part, their presence doesn’t cause any harm or irritation.
Sometimes though, when the ecology of our skin is altered (in my case by using the wrong products for my skin, not protecting it, etc.), or when our immune-response is compromised, they can breed out of control.
Dr. #2 told me to use Permethrin cream twice a day for a month to kill off the buggers. And she stressed sunscreen, sunscreen, sunscreen. When I went to fill the prescription, the pharmacist did a double take and asked me if I knew why I was using it, but the doc had prepared me for this -- Permethrin is typically used for scabies, which explained the pharmacist’s worried look.
I assured her that I didn’t have scabies, and that it was being used off-label to treat a less scary infection. Using the scabies cream, coupled with a gentler cleanser and slathering my face with sunscreen helped, and the diagnosis seemed right to me. I’d always felt like I had some infection that was causing the rash; none of the other possible diagnoses seemed right.
The correct diagnosis had been made, but the rest of the journey was just beginning, because after the demodex overgrowth was gone, I had to figure out a regimen to heal my skin and keep it overgrowth-free.
I started experimenting nonstop with various moisturizing sunscreens, since I now had strict orders to keep my face protected. I also stopped wearing much makeup at all, because it just seemed wrong to cover my skin with makeup while it was trying to heal.
I’ve always had pretty sensitive skin, a fact I had ignored when I started using cleansers and moisturizers that, while natural and organic, were full of things like lavender oil, tea tree oil, etc. When I stopped using sunscreen, my skin was open to even further damage.
Honestly, to write about all the products I have tried in the last two years would take another blog post, or two. I tried anti-redness, antioxidant, light, heavy, gentle, and gel moisturizers. I tried using cream cleansers, glycerin bars, gel cleansers and cleansers with sulfur. I tried medicated creams, gels and anti-inflammatory botanical gel. I tried cheap, expensive and everything in between. Most of the time, I could tell within one application if I was going to like it.
My skin had become so sensitive that many anti-redness, anti-aging, antioxidant, and even some lotions labeled as gentle would cause it to physically hurt or burn. Dr. #2 had stressed physical sunscreen blockers instead of chemical ones, and definitely no oxybenzone, but I had a hard time finding physical blockers that wouldn’t leave a white residue. And since my skin was so dry, that white residue would settle into the cracks and be even more noticeable.
Over time though, my skin has healed, and returned to a balance. The last time I visited Dr. #2 was in spring of 2014, over a year after our first meeting. I went in to get a mole removed, but when she saw me she said she was amazed at how much my skin had healed. People no longer ask me if I got sunburned on one cheek.
My skin is still sensitive with a tendency toward redness, which is more noticeable now that I am always covered in sunscreen and rarely tan, but I can handle that with tinted moisturizer. I’ve learned as I’ve gotten older that a mostly healthy diet coupled with lots of exercise, sleep and limiting caffeine, sugar and alcohol has a profound improvement on my skin.
At this point, I am actually using skin care products that many would deem “natural” -- cleanser and moisturizer from The Body Shop and tinted sunscreen from Bare Minerals. But through lots of trial and error I found the ones that have the fewest ingredients possible, pretty much no essential oils, and are super creamy and soothing.
There’s still a little red streak on my right cheek, and though I could get laser treatments on it, for now I’m content to just cover it up. Mostly, all is calm, and the demodex are living their lives wherever they are without upsetting my face.