Holiday Parties Bring Out the Worst of My Rosacea

The first time my face became a liability, I was at an office holiday party. New to both the company and the city, I was desperate to make a good impression and shatter the spell of anxious shyness that had made my first few months at the job excruciatingly lonely.

As I stood in line at the open bar, waiting for a refill on my tumbler full of wine, a coworker motioned me to step aside. “Hey,” she asked. “Are you doing OK?” Her question threw me off; my confusion must have been obvious by my stammered reply. “You just look really red,” she explained, peering at me with evident concern. “I wanted to check in and make sure that you hadn’t had too much to drink.”

I hustled to the bathroom and leaned over the sink to examine my face. My nose was Rudolph-crimson, my eyes puffy, and a splotch of scarlet bloomed in the middle of each cheek, like on a Russian nesting doll. I had only had one glass of wine and was clear-headed, but I definitely looked like I had overdone it on the holiday cheer. I was mortified.

I have rosacea, a skin condition that affects more than 14 million people in the U.S. and over 400 million worldwide. For me, the primary sign of rosacea is a flushed, reddened face, though symptoms of the disease can also include white-head-like pimples, rough bumps, cheeks criss-crossed with red filigrees of broken capillaries, and in severe cases, a thickening of the skin.

To many people, these don’t look like the symptoms of a skin disorder. It looks like you drink too much, that you’re upset or angry, or that you’ve been crying. Simply put, it looks like you’ve got other problems.

Rosacea is a chronic condition, but it’s not a constant companion. I can go weeks or even months without a major flare-up. And then, often at the times when I most want to appear polished, impeccable, and totally in control, my rosacea-red face floats up, betraying me as flustered, emotional, and supremely un-chill.

Some people experience more flare-ups in the summer, triggered by the sun and heat. For me, it’s this time of year—the stretch of winter when my mayonnaise-hued skin fades to the translucent white of Elmer’s glue—that amps up my symptoms. There’s something about holiday parties in particular that brings out the worst of it. Using the magic of the color-wheel to cancel out my red face and replace it with a confident, unflappable replica, I prep my skin with sensitive cleanser, sensitive toner, sensitive moisturizer, and spackle on a layer of green-hued primer beneath full-coverage foundation. Then I just hope for the best. But despite my precautions, I often feel the hot sting of rosacea smoldering through my makeup like burning embers, setting my face aglow.

The ultimate cause of rosacea is still unknown, and there is no cure. There appears to be a genetic component: the condition is more common among people of northern and eastern European descent, and more frequently diagnosed in women than in men. What’s clear is that the cause does not lie entirely on the skin’s surface. Rosacea is also a disorder of nerves and blood, a malfunction of internal systems that sets off a cascade of inflammatory reactions.

“There are nerve cells in your body that control blood vessels’ opening and closing,” explains Rajani Katta, M.D., a Houston-area dermatologist and former professor at the Baylor College of Medicine. Normally, your blood vessels dilate to increase blood flow in response to changing conditions, like fluctuations in temperature or physical exertion. In people with rosacea, these reflexes seem to be hair-trigger-sensitive and prolonged. So anything that causes blood vessels to dilate can trigger a flare-up. This includes exercise. Cold temperatures. But also warmth: an overheated office, or sitting snugly by the fireplace.

Katta, who specializes in the relationship between diet and skin health, tells me that some of the most common rosacea triggers are foods and beverages, which contain naturally occurring chemicals that affect circulation. Alcohol is a major one—this is why wine, liquor, and beer can all cause facial flushing. Spicy foods are another. Foods containing cinnamaldehyde, a compound that (as you might guess) is found in cinnamon, but also in a wide range of foods, including tomatoes, citrus fruits, and (alas!) chocolate. Winter’s warming drinks—hot coffee, hot cocoa, mulled cider, peppermint tea—are also potential triggers.

What’s more, the inflammatory aspects of rosacea can be aggravated by disruptions of the skin barrier, says Katta, “which happens more often in wintertime because of extremes of temperature.”

And then there’s stress. Anxiety exacerbates rosacea symptoms. This creates a wicked kind of feedback loop, where the fear of turning red summons the redness, which in turn causes more anxiety, and on and on—until you’re just, like, Enough already, I’m staying home and watching Netflix here on my couch where no one can see me.

There’s growing evidence that rosacea may take a toll on mental health. In a survey of 1,675 patients conducted by the National Rosacea Society, 90 percent said the disorder had diminished their self-confidence and self-esteem, with more than half admitting that they had purposely avoided face-to-face social contact because of the condition. Researchers at Wake Forest University recently reviewed the published scientific literature on rosacea and mental health and found numerous studies indicating significant correlations between rosacea and increased incidences of depression.

It’s been about 10 years since rosacea landed in my life, and the pattern of redness on my face has evolved and changed. It no longer resembles painted doll-cheeks; now it’s more like a ruddy moth perched on my nose, its crimson wings spreading out beneath the ridges of my cheekbones.

There are several topical creams and treatments, such as low-dose antibiotics, that give some patients relief from their symptoms, though none have ever worked that well for me. Dermatologists can also recommend laser-based therapies that may reduce the visibility of broken capillaries—though these tend to be costly, upwards of $500 a session, and are rarely covered by insurance.

In the absence of a cure, self-care is often recommended as the first line of defense. We’re told to be gentle to our skin, and take precautions to minimize sun damage. And avoid known triggers, including foods and other situations that can bring on a flare-up.

Following this to the letter, of course, would require giving up some of winter’s chief consolations and delights: A hot mocha on a cold morning. That celebratory New Year’s Eve flute of champagne. Sitting by the fire on a chilly evening.

For years, I’ve been ashamed of the way rosacea makes me look. Not so much because I worried that people would form the wrong impression of me, but because it seemed to expose the real me to the world: emotionally messy, prone to over-reacting and sometimes to overindulging, in every way the opposite of chill. All the things that I’d worked so hard to cover up and tamp down, glowing through.

This holiday season, I’m taking a different approach. Instead of masking my scarlet face and hiding the stigma of my immoderate complexion, I’m making my peace with it.

I’m not red. I’m blazing. I’m shining bright.