Kelly Thai

2/28/19
Transcribed Interview #1

KT: Before we get started, I just wanted to confirm with you again that it is okay to record this
conversation.

AF: Yes, it is thank you for confirming.

KT: Great! So let’s get started with the first question.

AF: Okay.

KT: So during your teens and 20s in the National Rosacea Society interview, you mentioned that
you struggled early on with blemishes. Did you ever suspect that it could be rosacea?

AF: At the time, no, I had no clue. I don’t think I even had heard of it- especially not in my teens.
I think maybe in my mid-twenties it started coming up a little bit, but I just thought rosacea was
you have a super red face. I didn’t realize that it included the blemishes aspect. I clearly
remember when I just moved to Portland, Oregon in my mid-twenties. I probably had a pretty
nasty flare up, but I just took it as, “Wow my face is really angry about moving here.” So, I had
no idea what was going on, and it was a problem. And so I’ve tried, oh my god, I’ve tried almost
everything under the sun. I’ve never tried Accutane or anything like that, but you know like the
stupid Proactiv stuff, a couple of different topical antibiotics. Sometimes it would work for a
little while then it would stop working, so it was very frustrating, and I feel like had I’d known
earlier on what it was and what was going on and you know had I had access to [pause]. Well I
don’t know. Maybe ten years ago treatments, I don't know if treatments have advanced. So I feel
like perhaps I could have avoided some frustration.

KT: So I guess you never assumed that rosacea would be super serious.

AF: Right, yeah, I definitely fell prey to the common myths of like “Oh rosacea only affects old
men, alcoholics, or [pause]” not me, you know? I didn’t think [pause]. I just thought it was when
you get really red in the face and it was purely the coloration like you blush too much, nothing to
do with actual blemishes or anything else, and so yeah total misconception about what it was.

KT: So when did you realize that it was getting worse and that you had to go see a dermatologist
to really diagnose yourself?
AF: So I started working [pause]. I had a salary. I was a salary person for a while. I’ve always
been self-employed, but first I needed to be salaried ‘cause life. And under this [pause]. Like
working for this company all of a sudden I had much better health insurance-- like the best health
insurance I’ve had in a long time, and perhaps since. Finally I got to go to a dermatologist; it was
purely because I had insurance. Had I had insurance ahead of this I probably would have gone
much earlier. And also the dermatologist in my area I didn’t trust very much because I had
people close to me have bad experiences with them, so I avoided them. Fast forward this. I
finally have insurance and I am finally am in a different location that I deem “who is the good
dermatologist here?” and went to see that guy. Within a seconds of seeing my face, he’s like,
“Oh you have rosacea” and I was like, “Oh okay wow.”

KT: Did your dermatologist really illuminate that you had a condition that might had been a little
more serious than you originally believed?

AF: I also ended up not liking this dermatologist either because he was very dismissive and his
bedside manner wasn’t very good. Basically was like so, “So you have rosacea and has your face
been more sensitive to like wind or hot conditions or the sun or certain foods or whatever?” And
to me, I think probably because it had been going on for so long it wasn’t like, “No, it doesn’t
seem more sensitive than it has been,” but that could have been because I’ve had it for such a
long time that I didn’t know. You know?

KT: So it sounds like he really only recommended avoiding flares like flare up triggers such as
sunlight. Did he ever tried to prescribe any treatment?

AF: Yes, and this is when the story gets fun, well I don’t know about fun, so he prescribed
minocycline.

KT: Minocycline?

AF: Yes, so he put me on like two weeks of that, no, or maybe like a just keep taking that until it
works kind of a thing. I think I got until day twelve, and even though it was working and my
face, I remember I kept touching my nose because it felt so small, and cool, and wonderful. And
I just kept touching my nose. I’m like, “I know I shouldn’t touch my nose, but oh my god, my
nose feels so amazing” and then I started breaking out in hives. And I had a nasty, nasty allergic
reaction to the stuff. And thankfully I had sensed the moment that I noticed the hives. I
immediately was able to go over to the office and he was like “Oh yeah,” again very dismissive,
“you’re just having a drug reaction. Here’s some Prednisone and don’t wear tight clothing or
exercise or anything like that. It’s probably gonna get worse before it gets better” and prescribed
me another type of antibiotic immediately. And I was like, “Okay” and the way he dismissed it
made me think okay well this is gonna set for a couple days, but I ended up in the ER. It was a
very nasty couple of days.

KT: When you were trying to pay for all of this, did your insurance cover it?

AF: Yes, the insurance covered the antibiotics. He also prescribed [pause]. I can’t remember the
name of it now, but it was a newer treatment for the Demodex mites.

KT: Oh, okay.

AF: Oh gosh, I wish I could remember what it was called, but this stuff was covered. My
insurance was amazing. It didn’t cover my ambulance ride to the ER which sucked, but it
covered everything else. Thank god, I am pretty sure.

KT: You were very lucky.

AF: I was very lucky in that sense, but then of course like once I was good again and now this is
the fourth antibiotic I am allergic to, I was like, “No, I am not going to try another antibiotic and
add another one to my list. No more antibiotics. I don’t want to be a life of antibiotics.” I said,
“Just fine I have rosacea and I’m going to deal with it on my own.”

KT: That’s pretty impressive. It must’ve been a great challenge.

AF: So frustrating.

KT: Once you started to gain more knowledge of your rosacea and knowing what it
encompassed, so you described it also caused you to work from home sometimes. During that
period where rosacea and your painting conflicted, when you were making your wine stains did
it lose or gain more of a cathartic purpose?

AF: Yes, actually when I started trying to do the avoiding triggers and trying to rule out I want
gluten free for a hot minute and then I was [pause]. I don’t know I was trying the various things
that people said you should give up if you have rosacea and one of them was alcohol, so I
stopped drinking anything. And I found that I absolutely hated making the wine stains because I
couldn't drink the wine which is how it works. I have a glass of wine for me and a glass of wine
for the painting. Those two go hand in hand. And I hated it, so I actually stopped making wine
stains when I first gave up alcohol.

KT: And did it?

AF: It didn’t change anything so I was just so frustrated, so I said “If this isn’t making a
difference I will go back to how I was because I didn’t need to needlessly have this go on
anymore for me especially when the wine stains were something [pause]”

KT: Important to you?

AF: Very important to me and, you know, at that point it was becoming more and more of my
livelihood because I had switched back to being self-employed by that point.

KT: So it was really a struggle between your passion and your self care?

AF: Right. That was exactly-- at that point, what was going on. I guess maybe six months later I
ended up moving back to my hometown. This was actually within days of the National Rosacea
Society interview. I had decided and came up with this ridiculous thing that I called, “None life”
which was basically I went through every single thing I could research about every single trigger
and gave up all of them at the same time because I wanted to try to. If you rule out one thing, but
something else is happening but you don’t know what that thing is either, it’s just not scientific
and it’s not helpful-- not that I’m a scientist or know scientific stuff.

KT: Of course.

AF: I was attempting my best, so I ruled out everything and that also didn’t help.

KT: Your cold turkey sounds very difficult.

AF: It was awful.

KT: It must have put a lot stress on you.

AF: It did have some good health benefits. Because people were doing intermittent fasting and
all these other things, it was basically the strictest paleo diet you could do. I did feel better and I
have retained a lot of that in my diet now which I do think has eventually helped, but it didn’t at
the time make a remarkable difference in my rosacea.

KT: I apologize for the noise.

AFs: Oh, that’s fine.

KT: So with rosacea avoiding all these triggers and getting treatment, how did it impact your art
changing the way you paint and just looking at your art in general?

AF: So when I went totally trigger free, and around that time I had already done the #nomakeup
series because I thought it was really interesting so like “Okay, this is ironic. Here I am. I have
rosacea, but my artistic expression centers around something that is supposedly one of the top
triggers for rosacea,” so that’s when I got the idea to do the #nomakeup series and so I tried my
very best to turn this challenge into something that could be a means of connecting with other
people. If they’re going through the same sort of thing or any other kind of disfiguring-

KT: A balance between yourself or any problems you might have?

AF: Yeah, and then what does it really mean to [pause]. Your face is very important like your
face is so important.

KT: It’s really out there.

AF: It’s there, it’s your face. Like you’re human to be so attuned to faces and so the moment you
have anything that makes your face look weird, anything like, blemishes, like a port wine stain.
There’s a medical name for it I don’t remember, or like a pigmentation problems or any of those
kinds of things that make your face not look like a normal like a #normalface. It can be
incredibly alienating especially if you are somebody that should (which is always a loaded word,
you know ​should b​ e considered) to look a certain way like with women.

KT: You don’t want to be isolated but yet you feel that way.

AF: Right, so being able to turn the wine stain thing to shine light on what I was going through
all in one fell swoop felt really satisfying. To have this interview with the National Rosacea
Society and to connect with people and I exhibited that series at a college nearby and various
classes like philosophy class and other classes came in to talk about different layers of that. And
it felt good to be able to find at least one positive aspect of the whole thing, to be able to channel
it through the artwork. But generally otherwise now aside from that specific project, I just keep
my rosacea on one side of my life and the art and stuff I just do on the other side.

KT: So it feels more separate now?

AF: Yeah.

KT: So it seems like you managed to find ​your balance which is great.
AF: ​Right, definitely, definitely.

KT: ​So, we have reached fifteen minutes, and if you like to go that would be fine.

AF: ​No, I can chat for a little while longer yeah little while longer.

KT: Okay, so I have one last question for you.

AF: ​Sure.

KT: How did it affect your life professionally and socially in a broad sense? Friendships or jobs
that might be sort of conflicting with how you felt.

AF: ​Yeah, so being self employed played it doesn't conflict with that because I work from home
and so I can, if I have a bad flare up, which actually did have a couple weeks ago which kind of
surprised me. I can get away with not leaving the house, if I don't want to. Not going on public
and not showing my face. I have that ability, and I feel actually weirdly very lucky about that
because I know other people have to go into work and it's just the worst, if you like, have a
raging flare up. It's, you know, you can try to put makeup on it, but you know that you're putting
stuff on it that's making it worse like it's just, yeah, so you know, I have the ability to stay home.
Socially, it doesn't affect me much beyond dating which is interesting. It definitely affected my
confidence when I was in a position where I needed to be dating again. But fortunately, I have, I
was able to see a new dermatologist here that I like way better so much better. And since the first
guy that I saw that I hated, there's this new stuff, Finacea stuff. I don't know if you've heard of it.

KT: Yes, in passing, yeah.

AF: Yeah, so Finacea is called azelaic acid or whatever.

KT: Yeah, there are a bunch of different ones.

AF: ​And I liked it because it wasn't [pause]. It's not, it's actually kind of from a natural source.
It's still, you know, I mean with anything, it’s a chemical, it’s chemistry, right? But I liked that it
wasn't an antibiotic, and I ran into the weird roadblock of being self employed again and then I
had crap insurance again. And so the insurance that I was on at that time when I first learned
about it and was first prescribed it did not cover it and it would be $350 out of pocket which was
prohibitive to me. So I had to figure out a way around that plus I didn't want to pay $350 for
something that I wasn't sure would give me an allergic reaction again. So, I had a friend who had
gone to a dermatologist and got samples of it and had extras so they were able to gift me them
which you're not supposed to do which is real life. And so I was able to test them like on the
inside of my elbow and make sure that it wasn't going to set me off. And then I just had to wait
until I changed insurance, and then found something that covered it, and now I have a much
easier copay on it.

KT: And if this isn't too personal. Do mind telling me which insurance company that was?

AF: ​Let's see. So, in New York, I was on Fidelis, but actually I was on Medicaid for a second. It
was Medicaid that didn’t cover it. But then I'm on the marketplace. And so, it's still Fidelis, but it
was a different level. So now at this different level because I'm paying into it.

KT: So once you changed levels, itt covered it?

AF: ​Yeah, exactly. And then I almost changed out of Fidelis, but I've discovered, because of
other reasons. And, but then I discovered, other insurance companies, even though they had
better health coverage in other areas, they wouldn't cover the Finacea. Then I had to decide, do I
want better health coverage or do I want Finacea? and I ended up being like, I’ll just have the
Finacea and just cross my fingers and hoping nothing happens to me.

KT: So sounds like it was very limiting and just restricting much of your options.

AF: ​Oh yeah, oh my god, no health care coverage and insurance is so hard to navigate especially
as an individual person. Like I don't have access to the different like. I just feel like at a corporate
level if you've got insurance through whoever you're working for. That is just weirdly better.
And so if you're self employed and you're managing all of your own stuff. The options are just
not as good. So, but again, you know, everything has pros and cons and I'm able to work from
home and schedule my own day and be in charge of my own hours.

KT: Have you ever felt that staying home you overused that sort of ability to stay home when
you have bad flare ups or do you feel like it doesn't really hinder you in any way?

AF: ​That's a good question. I never thought about that. I mean the Finacea has worked really
well. And I am very much in love with it, so fortunately, I haven't had too many flare ups since it
really started working really well for about a year now. But like I said two weeks ago I had a
really bad flare up, and it did remind me like I had already forgotten what it was like to not want
to go out in public, and how, like it made me feel really like I was taking it for granted.

KT: So like you were feeling it all over again as though you hadn’t had the medication?
AF: Right. ​And I was like, “Oh my god. How did I do this for three, four, five, six, seven years?
How did I live?” because with the Finacea now there are days that I can go out make up free and
feel very comfortable doing that.

KT: So it really boosts your confidence.

AF: ​It really does. ‘Cause it's your face.

KT: Yes, it’s the first thing people see.

AF: Yeah, your face is important.

AF: ​Well, I'm hoping that this was helpful and all.

KT: This is actually very helpful, so I greatly appreciate you coming to take time out of your day
to be interviewed.

AF: Yes, of course.

KT: So, thank you.

AF: Thank you for bearing with me and being totally like, I don't know why I thought three
fifteen and not three thirty.

KT: It’s okay. Thanks.

AF: Yeah.

I conducted an interview with wine stain artist, Amelia Fais Harnas. In order to obtain this
interview, I contacted her through her website which prompted a quick response. After brief
email communications we were able to schedule a time that worked for both of us. As a bearer of
rosacea, she was able to provide her own personal experience with rosacea. This experience
includes struggles with self care, her self image, and health insurance coverage. She notes that as
a wine stain artist, a trigger of rosacea flare ups, wine, uniquely conflicted with her career. These
conflicts were seen to be detrimental to her work until she became more comfortable with her
rosacea and receiving treatment once her healthcare insurance provider covered it.
 Kelly Thai
3/26/19
Transcribed Interview #2

KT: Okay, so I guess let's dive right on in. Sure. So, in your years of experience, do you believe
rosacea has a sudden or gradual onset?

BC: Let’s put it this way. I think for a lot of people it's more of a gradual kind of onset. And I
think that people don't always appreciate that until it gets bad enough to [pause]. They may think
that it's an acute onset when in fact, in retrospect, and if you're able to look at images over a
period of time, you can appreciate that often things have started a long time before the patient
actually becomes concerned about it.

KT: So, just to interpret what you said, so you would say it's more of a lack of care, so to speak,
until it gets worse enough that they sort of have to go to see a dermatologist.

BC: Yeah, I mean I think that a lot of people will have some subtle findings for a while, and then
when it reaches a certain point when they notice it. It becomes an issue for them as from then
they’ll end up going to the dermatologist.

KT: So, how would you describe the general awareness and stigmas of rosacea once they start to
notice that's becoming an issue?

BC: Probably, I mean, people present somewhat different ways. But one of the more common
findings would be increased redness, so increased blood vessels on the face, particularly on the
mid-face and around the nose and mouth and chin and forehead. You know, places where it
becomes I think it often a quality of life issue because people see it and take notice of it.

KT: So, how would you really describe these stigmas surrounding rosacea? Do you think people
are aware that rosacea is more than just a redness or can worsen over time?

BC: I think what happens to them is [pause]. There are people who really get primarily the red
changes where there are increased vessels, but many people will get a combination of findings
which includes increased blood vessels, inflammatory acne lesions, and then sometimes
thickening of the skin that can be very dramatic over a long period of time.

KT: And, how would you describe this and children? Do you believe that it could be more so
considered in diagnosis or it's not really thought of in kids?
BC: Well there is a special subset of rosacea that is referred to by a different term. If I give you
the term you can certainly take a look at it. But the term that you'll see and again, I think that
clinically and although we don't usually biopsy it. If you were to biopsy it microscopically and
clinically it shares a lot of features with adult rosacea, and it's called a periorificial, peri means
around and orificial means around body openings, which means it's particularly around the eyes,
the nose, and the mouth. So it is referred to a periorificial dermatitis.

KT: Periorificial dermatitis. Thanks.

BC: And there's actually another adjective that is used to describe it with the periorificial
granulomatous dermatitis because there can be the same kind of inflammatory findings in
children as long as the adults.

KT: So, it's definitely a subset, and is part of rosacea. It's not separate. Is it?

BC: I, again, I think there were people that would considered it as a separate entity. And it
doesn't always have the same implications in terms of long term findings and issues because if
you leave it alone over a period of a year or two it may actually go away. Whereas the prognosis
is a bit different in children than it would be in an adult. I'm not saying it can't stay for a longer
period of time, but if you're very patient and don't care about it. It not infrequently will go away.
Whereas in adults it tends to probably be persistent for a long period of time, and it doesn't often
go away by itself.

KT: So, just to clarify, so it may or may not turn into rosacea so to speak. So does the treatment
differ for it?

BC: It is very interesting because the treatment can be very similar to the treatment that is used in
adults. There are some topical medications that can help, but if people are impatient, they often
are, particularly in children, you'll sometimes move to the oral medications. They're a little
different but are similar to those used in adults and it often clears them. And once they're cleared,
the kids are clear, they can come off the medications, and usually stay off the medications long
term.

KT: So, continuing on, so in your observations, how do you believe rosacea impacts people
emotionally?

BC: Well it looks kind of peculiar because people develop a lot of redness, not everyone, but
most people do. They develop inflammatory lesions on the skin like pustules and cysts, and that
can be uncomfortable. And because of the combination of thickening of the skin and because of
all those findings, it can be pretty disfiguring. I mean it can hurt and be uncomfortable but can
also be disfiguring even if it doesn't cause symptoms.

KT: So again, it's more, it could lead to a damaging the quality of life?

BC: Big time. Yes.

KT: Would you say that this might sort of impact mental health?

BC: Absolutely.

KT: And what about children? aside from people in general.

BC: In kids, it depends on the age of the patient. We see it in a fair amount younger children
often under eight, you know sometimes as young as six or seven years of age. It is probably
when it occurs in children that it often occurs in the prepubertal age group. So, the kids might be
bothered by it, but the parents are more bothered by it than the kids are because of the age group
affected. I think.

KT: And if I may, what age group do you work we work with?

BC: We do pediatric dermatology, so we see kids, probably, most of our patients are between
zero and twenty-one years.

KT: So again to bring up the depending on age as to how they're affected would, how you
describe a little bit of the difference between younger kids probably around like five to ten and
older kids who are in their teens and above?

BC: Oh yeah, the older kids. It can overlap with acne vulgaris. And they're clearly some older
kids who get this periorificial dermatitis. And in the younger kids. I think it's probably more
depending upon the age of the child, it's usually more than parents who are concerned, and
they're the ones who initiate the visit to the dermatologist most of the time. Because if they're
younger. The younger children until they probably get to middle school, although I don't think
this is always true I think sometimes in elementary school it does become an issue when dealing
with their friends, but in the, in the very young children, probably not as big an issue as it is the
questions about the inflammatory component of the illness.

KT: So what contributes to the irritants of, sort of, leading to more increased flare ups and such
like that?
BC: Well, that's the interesting thing is that I don't think for, I don't think most of us in rosacea
[pause]. I think that genetics plays a big role. In adults eating spicy foods, unprotected sun
exposure, trauma to the skin from other things, to the face, particularly smoking, alcohol. Those
are all things that probably contribute to rosacea. In younger children most of those things are
not an issue.

KT: So how would you describe the frequency of flare ups in kids?

BC: Well again in kids, I think it tends to be a bit more unpredictable because it often doesn't run
in families. And when they get rosacea, often if we bring them in and treat them we can get it to
clear. I want to say always, but usually it doesn't recur. In older kids and adults, it's a more of a
chronic problem which requires more persistent treatment.

KT: So how would I describe, how would I word this? So, how would you describe like the
difference between kids, and the adults as to why adults have a more chronic sort of dealing with
rosacea rather than kids who usually after some time or treatment, it goes away for a period of
time or permanently?

BC: Oh yeah, I think in kids we really don't understand what the triggers are. And most of the
time I don't think that, at least as far as data we know, family history plays a role, so adults who
have rosacea doesn't predict that their kids will have rosacea and children who get this variant of
rosacea don't necessarily get rosacea adults. Older kids and adults who get persistent rosacea are
more likely to have, I think, a family history of more chronic rosacea and treatment tends to be
more prolonged as well.

KT: Again, to be a little more specific, what do you believe are the emotional consequences of
leaving rosacea untreated? Would the severity, sort of, correlate with emotional health?

BC: I think that the severity of the skin findings definitely correlate. In most patients it's going to
correlate with how uncomfortable they are with it, how it impacts impacts the quality of life. So,
if you have a little bit of redness [pause]. I mean many people won’t really pay attention to it. If
you have increasing redness, and you have inflammatory lesions then it becomes a bigger issue
and they're more likely to seek help. And if not only other inflammatory redness, if they develop
thickening of the skin, it can become deforming. And I think in that setting, it becomes an
incredibly high quality of life issue. And not all, but most people would probably seek help to
manage it when it gets to that point.
KT: So, what would serve as a barrier to receiving treatment a little later or earlier? Is it usually a
concerned parent that brings a kid in or is it usually a kid sort of persistent, “Oh I need to go.
This is bad for me,” well not, this isn't bad for me, but “I'm feeling bad.”

BC: I think in the children's life it is the parents who are more likely to be concerned about it and
bring the kids in. In the adults, again, I think it's a super major quality of life issue. I mean maybe
more than just that. It may be uncomfortable and maybe painful too, but I think, more so it’s a
quality of life issue because [pause] especially when they get the more severe vascular changes
and the inflammatory lesions and the thickening of the skin. It becomes a super major issue. I
mean it's not the kind of thing that people in their surroundings won't notice at work, at school;
becomes a big deal.

KT: And for your experience when treating adults or kids, do you see a direct impact on their
quality of life improving after receiving treatment that betters their appearance?

BC: I think that's true. It's not unusual, especially in the pediatric age group and in a subset of
the adults, it's not unusual see a dramatic improvement sometimes in periods in a period of just a
few weeks. But certainly within a period of a month or two, you may see a very dramatic
improvement and improvement in the skin translates into improvement in the quality of life
particularly for adults.

KT: How would you describe the sort of confusion, whether or not this is a serious condition that
some people might notice redness but sort of brush it off as something that's not too serious?

BC: Well since most patients are not sick from it, I mean, they don't have fever, they are not
medically ill. It may be something that people don't pay attention to, how they how they appear
to others. It may not be as big an issue. For those who pay attention to that, it's a big deal. And
then there are some patients who have itching and burning and discomfort from the inflammatory
lesions and I think those patients also tend to come for help pretty quickly.

KT: Great. So actually, that's all I have for you today.

BC: Oh my god, that was easy.

KT: Yeah, pretty quick. Thank you for answering all my questions very in depth.

BC: Sure, no no no and like I said, it might be interesting if you haven't heard about this
periorificial granulomatous dermatitis. Just pop it in Google you'll see some images and get a
sense of what those kids who often respond, if they don't respond the topical medications like
some adults do, they often respond very quickly to oral medications. So they get on and off fairly
quickly and they stay good for quite a while afterwards.

KT: Yeah, I'm definitely going to check that out. It's very interesting that I wasn't able to find it
earlier. So, thank you for all your time. I appreciate you answering my questions.

BC: Let me know if I can help you anymore.

KT: Okay, great. Thank you.

BC: Bye.

KT: Bye.

To obtain a better understanding of the impact of rosacea on quality of life and awareness, I
conducted an interview with Dr. Bernard Cohen, a pediatric dermatologist. Through various
emails, a time and date was arranged in which the interview could be held. He described his
perspective of rosacea’s effects in his experience as dermatologist. Emphasizing the impact on
the quality of life, he explains that this may vary depending on a variety of factors including age
and severity. Within his experience, he noticed that treatment tended to improve both the
appearance of skin as well as self image. This was a common trend that was prominent in each of
his answers.
Kelly Thai
Howard High School
13 May 2019

Methods

Materials
For the purpose of analyzing documents, it is necessary to have connection to the internet
and a functional computer or phone. This will ensure that the analysis may be completed in a
timely manner. These will be free of cost and there will not be a barrier in writing online as there
are offline saving options.

Procedure
Through the use of document analysis chart, various first hand accounts of people with
rosacea were individually analyzed for comparison. A dedicated amount of time will be given to
each document until there is an in-depth breakdown of the information. This will build the basis
of the support for the research hypothesis answer.

Primary Document List

1. Jacoby, S. (2018, May 14). 11 people describe what it's really like to have rosacea. Self.
Retrieved from https://www.self.com/story/what-its-really-like-to-have-rosacea
2. Rosacea can't curb career of actress Cynthia Nixon. (2012). ​Rosacea Review.​ Retrieved
from
https://www.rosacea.org/rosacea-review/2012/summer/rosacea-cant-curb-career-of-actres
s-cynthia-nixon
3. Jenn. (2017, July 17). Success story: my life with Rosie. ​Rosacea Review.​ Retrieved from
https://www.rosacea.org/blog/2017/july/success-story-my-life-with-rosie
4. Tennant, L. (n.d.). Why the misery of 'adult acne' could be caused by blushing. ​Daily
Mail.​ Retrieved from
https://www.dailymail.co.uk/health/article-2023760/Rosacea-Why-misery-adult-acne-cau
sed-blushing.html

Description of Documents

1. This document provides eleven direct testimonials of people with rosacea. Each
testimonial details each personal experience encompassing a variety of topics:
relationships, appearance, and daily routines. These lifestyle effects calls for more
awareness of rosacea and its specific detriments to physical and emotional health. The
recent publication of the source suggests that awareness continues to be a persistent issue
surrounding the condition.
2. This document is an anecdote about overcoming the challenges of rosacea. It addresses
the dangers of unawareness that may not appear concerning upon first glance. The
account urges those who suspect they have the skin condition to see a dermatologist to be
 formally diagnosed. As a result, this provides the opportunity to adjust a lifestyle to fit
one’s needs.
3. This document is an unique account in which the author deals with rosacea. By naming
the condition as “Rosie,” it is personified creating an image readers may better relate to.
While acknowledging that rosacea has caused many struggles, it is appreciated as it has
added character and understanding to the author. The account focuses on developing a
positive approach to managing rosacea.
4. This document is a first person account of rosacea addressing cost of treatment and the
impact on self confidence. Beginning, she notes that there is a lack of awareness and
understanding of the condition. She then cites the current research of her time to explain
the causes, triggers, and appearance of rosacea. Highlighted is her treatment process
where she describes in-depth how each medication worked. Despite the various treatment
options, there continues to remain barriers to these options.
 Primary Document Analysis Chart

Document #: 1 Date Analyzed: 5/15/19

Type of Magazine article (Web)

1. Document
(Format)

Date(s) of 2018
2. Document

3. Source Self Magazine

Author/Creator Sarah Jacoby (Senior Editor with focus on Health and Beauty)
4. (Position)

Audience, if General public (focus on women)

5. specified

6. Document A. Self Image ● Denial of permanency

Information and Mental ● Worry of flare-ups
Health ● Difficulty feeling normal (vain,
silly)
● Less self esteem and confidence
● Added stress and frustration
● Desire to look like themselves
rather than generically beautiful

B. Daily Life ● Required makeup and/or skincare

routines
● Difficulty managing the condition
as it tends to be unpredictable
● Avoidance of triggers (adjusting
lifestyle to accommodate)

C. Social Impact ● Embarrassing in cases of dating

and professional work
● Constant advice from peers on
how to fix skin
● Nicknames based off facial
redness

D. Discovering ● Needing to be diagnosed by a

Rosacea dermatologist
● Belief rosacea would disappear on
its own
 E. Undergoing ● Must manage stress
Treatment ● Prescription medication may be
more effective
● Lack of insurance coverage
leading to unexpected costs
● Difficulty discovering which
treatment method works best for
them

F. Awareness ● Not knowing what was wrong

without dermatologist diagnosing
the issue
● Doctors at hospitals unsure of how
to deal with rosacea or identify it
● Notice symptoms long before
diagnosis; however, it would be
dismissed as unimportant
● Confusion with acne

7. Possible Bias ● Interviews intend to spread awareness and understanding

(up to 3 points) of rosacea

8. Lack of ● Each interview is very brief, lacking depth when

Information addressing insurance coverage and history with rosacea
(up to 3 points)
 Document #: 2 Date Analyzed: 5/18/19

Type of Newsletter (Web)

1. Document (Format)

Date(s) of 2012
2. Document

3. Source Rosacea Review Newsletter

Author/Creator Cynthia Nixon (Actress and rosacea patient)

4. (Position)

Audience, if People with rosacea and general public

5. specified

6. Document A. Self Image and ● Constantly at the forefront of

Information Mental Health her mind

B. Daily Life ● Forced to wear more makeup

despite having sensitive skin
● Development of a skin care
routine

C. Social Impact ● Having to avoid triggers that

were originally integral parts
of her life

D. Discovering ● Difficult to understand as she

Rosacea did not know why her skin
was prominently red

E. Undergoing ● Tested various skin products

Treatment since the appearance of
symptoms
● Harmed skin using products
not intended for rosacea

F. Awareness ● Did not know what rosacea

was until a dermatologist
diagnosed her
● Created public service
announcements to spread
awareness on rosacea

7. Possible Bias ● Has created public service announcements in order to

(up to 3 points) support those with rosacea and spread awareness of the
 condition
● Written by an actress whose career also focuses on
appearance

8. Lack of Information ● Does not address cost of treatment

(up to 3 points)
 Document #: 3 Date Analyzed: 5/18/19

Type of Newsletter (Web)

1. Document
(Format)

Date(s) of July 17, 2017

2. Document

3. Source Rosacea Review Newsletter

Author/Creator Jenn Adele K. (Rosacea patient)

4. (Position)

Audience, if People with rosacea

5. specified

6. Document A. Self Image and ● Nervous and tense with condition

Information Mental Health ● Relieved, sad, and scared of what
is to come now that she knows she
has rosacea
● Attempt to accept rosacea rather
than pursue aggressive attempts to
be rid of it

B. Daily Life ● Has to deal with the

unpredictability of rosacea
● Uses unpredictability of rosacea to
make healthier choices, so it may
help alleviate some of its
symptoms

C. Social Impact ● Has become more empathetic and

less rude to others
● Has developed more social
intuition

D. Discovering ● Original symptoms were sensitive

Rosacea skin and a tendency to blush
● Diagnosed with multiple other
skin conditions and allergies
● Diagnosed with rosacea in 2017

E. Undergoing ● Prescribed various treatments

Treatment since she was twenty and had not
discovered one that worked long
 term until 2017

F. Awareness ● Unrecognized for 20 years

● Health professionals would guess
her condition

7. Possible Bias ● Published in a rosacea support newsletter

(up to 3 points)

8. Lack of ● Does not address cost of treatment

Information ● Does not clarify whether she has multiple skin conditions or has
(up to 3 points) been incorrectly diagnosed each time
 Document #: 4 Date Analyzed: 5/18/19

Type of Newspaper (Web)

1. Document
(Format)

Date(s) of 2011 (updated)

2. Document

3. Source Daily Mail

Author/Creat Laura Tennant (Rosacea patient)

4. or
(Position)

Audience, if People with rosacea and general public

5. specified

6. Document A. Self Image and ● Discouraged

Information Mental Health ● Less confident
● Frustrated
● Difficulty living a fulfilling life

B. Daily Life ● Usual skin care routine morphed into a

frenzy of purchases to stop her skin
from worsening
● Cut down on triggers: sunlight, coffee,
spicy foods, etc.

C. Social Impact ● More focused on self appearance

● Relied on friends for support

D. Discovering ● Received diagnosis in European

Rosacea dermatology clinic
● Tested two treatment methods before
learning Roaccutane was most
effective

E. Undergoing ● Originally prescribed acne treatment

Treatment ● Advised to avoid triggers
● Given antibiotics and topical
medication to stop the symptoms of
rosacea
● Extremely high costs due to nature of
the prescribed drug

F. Awareness ● Believed to be acne, stress, or

 age-related
● Various doctors she met with over a
year and half did not mention rosacea
● Wished she was actively aware of her
problems sooner
● Doctors failed to consider condition
seriously

7. Possible ● Travelled to European clinic and is European; the European

Bias dermatology community on rosacea differs slightly from that of
(up to 3 the American one
points)

8. Lack of ● Does not address social impact in-depth

Information
(up to 3
points)
 Results: Primary Document Analysis Chart Howard High School, 2019

Document: #1 #2 #3 #4

1. Type of Document Magazine article Newsletter (Web) Newsletter (Web) News article
(Web) (Web)

Date(s) of 2018 2012 2017 2011 (updated)

2. Document

3. Source Self Magazine Rosacea Review Rosacea Review Daily Mail

Newsletter Newsletter Newspaper

Author/Creator Sarah Jacoby (Senior Cynthia Nixon Jenn Adele K. Laura Tennant
4. (Position) Editor with focus on (Actress and (Rosacea patient) (Rosacea
Health and Beauty) rosacea patient) patient)

Audience, if General public (focus General public People with People with
5. specified on women) (focus on those rosacea rosacea and
with rosacea) general public

6. Document A. Self Image ● Denial of ● Constantly at ● Nervous and ● Discouraged

Information and Mental permanency the forefront of tense with ● Less
● Worry of her mind condition confident
Health flare-ups ● Relieved, sad, ● Frustrated
● Difficulty feeling and scared of ● Difficulty
normal (vain, what is to come living a
silly) now that she fulfilling life
● Less self esteem knows she has
and confidence rosacea
● Added stress and ● Attempt to
frustration accept rosacea
● Desire to look rather than
like themselves pursue
rather than aggressive
generically attempts to be
beautiful rid of it

B. Daily Life ● Required makeup ● Forced to wear ● Has to deal with ● Usual skin
and/or skincare more makeup the care routine
routines despite having unpredictability morphed into
● Difficulty sensitive skin of rosacea a frenzy of
managing the ● Development ● Uses purchases to
condition as it of a skin care unpredictability stop her skin
tends to be routine of rosacea to from
unpredictable make healthier worsening
● Avoidance of choices, so it ● Cut down on
triggers (adjusting may help triggers:
lifestyle to alleviate some sunlight,
accommodate) of its symptoms coffee, spicy
foods, etc.
C. Social Impact ● Embarrassing in ● Having to ● Has become ● More
cases of dating avoid triggers more focused on
and professional that were empathetic and self
work originally less rude to appearance
● Constant advice integral parts others ● Relied on
from peers on of her life ● Has developed friends for
how to fix skin more social support
● Nicknames based intuition
off facial redness

D. Discovering ● Needing to be ● Difficult to ● Original ● Received

Rosacea diagnosed by a understand as symptoms were diagnosis in
dermatologist she did not sensitive skin European
● Belief rosacea know why her and a tendency dermatology
would disappear skin was to blush clinic
on its own prominently ● Diagnosed with ● Tested two
red multiple other treatment
skin conditions methods
and allergies before
● Diagnosed with learning
rosacea in 2017 Roaccutane
was most
effective

E. Undergoing ● Must manage ● Tested various ● Prescribed ● Originally

Treatment stress skin products various prescribed
● Prescription since the treatments since acne
medication may appearance of she was twenty treatment
be more effective symptoms and had not ● Advised to
● Lack of insurance ● Harmed skin discovered one avoid
coverage leading using products that worked triggers
to unexpected not intended long term until ● Given
costs for rosacea 2017 antibiotics
● Difficulty and topical
discovering medication
which treatment to stop the
method works symptoms of
best for them rosacea
● Extremely
high costs
due to nature
of the
prescribed
drug

F. Awareness ● Not knowing ● Did not know ● Unrecognized ● Believed to

what was wrong what rosacea for 20 years be acne,
without was until a ● Health stress, or
dermatologist dermatologist professionals age-related
diagnosing the diagnosed her would guess her ● Various
issue ● Created public condition doctors she
● Doctors at service met with
hospitals unsure announcement over a year
 of how to deal s to spread and half did
with rosacea or awareness on not mention
identify it rosacea rosacea
● Notice symptoms ● Wished she
long before was actively
diagnosis; aware of her
however, it would problems
be dismissed as sooner
unimportant ● Doctors
● Confusion with failed to
acne consider
condition
seriously

7. Possible Bias ● Interviews intend ● Has created ● Published in a ● Travelled to

(up to 3 points) to spread public service rosacea support European
awareness and announcement newsletter clinic and is
understanding of s in order to European;
the condition support those the European
● Written by a with rosacea dermatology
beauty editor and spread community
awareness of on rosacea
the condition differs
● Written by an slightly from
actress whose that of the
career also American
focuses on one
appearance
● Published in a
rosacea
support
newsletter

8. Lack of Information (3) ● Each interview is ● Does not ● Does not ● Does not
very brief, address cost of address cost of address
lacking depth treatment treatment social impact
when addressing ● Does not clarify in-depth
insurance whether she has
coverage and multiple skin
history with conditions or
rosacea has been
incorrectly
diagnosed each
time
Discussion

Within all the documents analyzed, each reveal that there is a damaging effect of rosacea
on mental health. As a result, those with rosacea often pursue medical treatment in hopes of
clearing the appearance of the rosacea caused symptoms. Because there is also a common
difficulty in obtaining the correct prescription or receiving affordable care, untreated symptoms
and the pursuance of treatment appear to create a great deal of added stress upon the patients.
Awareness becomes of increased importance when diagnosing rosacea and its social impact.
Notably, the patients became more socially intuitive and receptive to comments about their
appearance which tended to be verbal advice or visible impressions.

Despite the variety in the accounts, a pattern can be derived from them as a whole as
there was little remarkable differences in the data: dismissal of early symptoms, realizing
significant social and personal impact of the progressed symptoms, pursuance of treatment, and
adjusting lifestyle to accommodate. While there were some biases, these were to be expected as
the sources all originated from news type sources. Loaded language was not present and instead
the authors highlighted the struggles rather than the lack thereof; however, this does not greatly
decrease the reliability of the sources as the struggles illustrated were genuine. Overall, the
aforementioned pattern may be combated with better access to treatment and a promotion of
awareness. Rosacea gained substantial hold over lives as the condition advanced while treatment
became costly.