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Sunday, August 16, 2015

Rosacea And The Wine Lover: When Passion Threatens Appearance

Joey Casco, The Wine Stalker
I've always been of fair complexion, thanks to the Irish and German in me, but the southern Italian genes that gave me my last name allow me to tan pretty effectively. I just don't because I'm not an outdoorsy person. I taught myself how to program when I was 13 in the early 1990's and that was it. I've been a computer shut-in, night-owl, and pasty white ever since. I want that complexion back, actually.

Last winter something very different for me started to happen: my face started to get red from alcohol. And I'm not just talking about actually consuming it; I'd turn red even when spitting it out for tastings. I had never had that happen to me before. I was never one to get what those outside of the know refer to as "red-face".

Then in the spring it became constant. My cheeks were pink 24/7. They'd turn red and my forehead would join in when I got hot or got really active. I stopped drinking and tasting for a few weeks, as I could afford to because reviews for the blog were written and scheduled way ahead of time and my job was taking a break from having sales people come around with new things to taste. It stayed the same however and people told me it was probably the massive amount of pollen that was around. Finally after a month I went and saw the doctor. What was it? Rosacea. 

Rosacea is a chronic skin condition that commonly gives you rosey cheeks like Santa Claus and flare-ups that will turn your entire face red. But that's just subtype 1 of rosacea and it's called erythematotelangiectatic rosacea, also known as ETR.

WC Fields
Subtype 2 is papulopustular rosacea and it mimics acne. Subtype 3 is phymatous rosacea and it enlarges the nose. WC Fields had it. Bill Clinton's got it. Subtype 4 is ocular rosacea and it makes the eyes dry and irritated.  If you have any of the other subtypes you're bound to get red, dry eyes and teary during flare-ups, but subtype 4 is a completely different animal.

I'm lucky enough to only have subtype 1. For now, at least.

You can literally wake up one day and have rosacea for the rest of your life, which is kinda what happened to me. But it seems to be hereditary, especially among those with Celtic or Scandinavian lineage. It was once called The Celtic Curse. Your body has been sitting on the code waiting for it to be released, which for most is mid-30's... like I am right now. There's no cure. Only treatment.

And it doesn't matter what you do to prevent it. Rosacea is NOT something you acquire from alcohol abuse or organ damage. My liver and kidney's are a perfect example of healthy ones. You could never have a drink in your life and be as healthy as an ox but if rosacea is in your DNA you're gonna get it, goddamnit!

HOWEVER, Rosacea flare-ups are triggered by something and every person has different ones. So what specifically does this have to do with wine? Why would this be the topic of a wine blog post? Because there's one trigger that seems to be almost universal... consumption of red wine. Alcohol dilates blood vessels, which is what's happening to people with rosacea anyways, so it just makes it worse. Especially red wine, causing 76% of us to flare up, the most of any trigger.

Red wine
In the few months I've been dealing with this thing I've found that my triggers are alcohol (distilled spirits give me the biggest flare-ups of any alcohol, even red wine), dust, sweat and heat. Pretty basic, actually. As far as I know I have no complicated triggers such as avocados, which is entirely a possibility for some. Mondays are the worst because that's the day I'm running around the most and moving massive quantities of dusty cases of liquor and wine. My hands get black from the dust and my face gets itchy and red.

But so far I've got it easy. Check out this quote I found by "Joan M of California" on the Rosacea Research Foundation's website ( would be great if I could be like everyone else go out for pizza, drink a glass of wine with dinner, or eat chocolate if I get depressed. If I get off the narrow rope and indulge, Ill pay for it the next day with a swollen face, red itchy skin, and numerous pustules and papules that will stay on my face for weeks at a time.

All I can think of is Marlon Brando saying "THE HORROR! " Because really, if you can't go out and do something fun with your family and have some delicious food because people will look at you weird for the next two weeks then you're living in a nightmare. Joan deserves a pizza, a huge box of chocolate, and a whole friggin' case of wine. This is a real struggle that 16 million diagnosed Americans face every day. The keyword there is "diagnosed" because it's been estimated that MOST people that have the condition don't even get it looked at to be officially diagnosed. They just happen to come in "blushed" now.

Listen, I'm not gonna lie: It's embarrassing. A pink head with pale extremities and torso will affect your self-esteem and self-awareness. It sucks ass. Good thing I'm cute.

"Mild" Rosacea
But I'm also in the wine retail business so technically the thing that pays my bills is a trigger! I've gotta taste what I sell so I can sell it, right? I've gotta taste other stuff to see if I want to sell it, right? Being physically active is also a trigger and working at a busy liquor store during tourist season is far more physical than you may think it is. I'm averaging over 6 miles a day just during my work hours, and that doesn't take the amount of lifting activity into consideration. Then I ride my stationary bike for an hour at night bringing me into double digits. In short, I sweat from my head a lot.

Am I supposed to find another career because rosacea wants to be a dick and rear its ugly head just when I'm finally starting to do well financially for the first time in my life? Should I give up on this blog and make it about being unemployed on the shitty-paying and highly-seasonal Cape Cod? Most importantly, do I quit on a passion because of something that is entirely visual and not threatening to my health? Ah, hell no. Nature may always find a way but humans love a challenge.


There are medications you can take and apply to keep your flare-ups down. There are other things in preparation that you can do to prevent a flare-up and to sooth it during one. You don't have to just live with it. You can fight it.

Metronaidazole gel for rosacea
When you're first diagnosed you'll be given a daily medication to apply. I was prescribed  a clear metronaidazole gel that I smother on my face at night, and after a few weeks it was clearly working. On the nights that I forget to apply the stuff it's pretty obvious the next day. So it works.

You're also going to be put on a few weeks worth of antibiotics for several reasons. One of them is small intestinal bacterial overgrowth (SIBO), because cleaning that crap up will bring down the redness if you have SIBO. Also, for some reason people with rosacea have high levels of antimicrobial peptide cathelicidin, which help defend against bacteria. So what could antibiotics possibly do for you because you have a lot of something that's already kind of a natural antibiotic? Damnit Jim, I'm a wine blogger not a doctor!

There are other topical and oral things you can use. Laser treatment is an option if you're into that kind of thing. There's also something called red light therapy. It's literally a red LED light that looks like the shrink ray from Despicable Me, and you totally point it at your face and hope you don't get shrunk. You know what? It's just best to listen to the following person when it comes to red light therapy...

Julie Campbell, who writes the Treat Rosacea Options blog, was awesome enough to tell me of her experience with rosacea, the struggle with also being a wine lover, and what she does for treatment and flare-up prevention. She's a big supporter of red light therapy.

Julie B Campbell - Rosacea treatment that works
I received a diagnosis about 15 years ago, when I was in my early 20s. Before that, I’d thought it was acne and had been using acne treatments to try to improve it (bad move!). I made the discovery that it was rosacea through a self-diagnosis based on research I’d done on the internet out of frustration with my lack of success with acne products. I asked my doctor about it, and he confirmed it. Prescription medications didn’t work for me, so I had to look for lifestyle changes and alternative solutions to keep the symptoms under control, which is what I use now.

I was also in my very early 20s when I first started to enjoy red wine. Before that, I’d liked only white wine. It was at that time in my life that I discovered a love of food, as a whole, and I opened myself up to new flavors and culinary experiences. Suddenly, the entire concept of drinking red wine and discovering outstanding pairings for it made sense to me. It was a beautiful, multi-sensory experience. Before that, I’d called it a pointless activity that only snooty people would do to show off (there is something about being that age that makes you think that you’ve figured everything/everyone out, despite the fact that you’ve barely experienced the world).

By the time I was in my late 20s, my rosacea symptoms had progressed from looking as though I blushed easily, and having the occasionally “pink cheeked” look, to appearing as though I had a permanent sunburn. I started to become very aware of it, particularly because none of the treatments prescribed by my doctor were working. It didn’t take long for me to notice that red wine would bring on a flare-up very quickly. In fact, some wines would cause my skin to redden in a matter of one sip! The apples of my cheeks would turn a deep purple-red, as though they were competing with the color of the wine.

I started to cut back on the amount of red wine that I was drinking; saving it for only special occasions. That allowed me to enjoy it as a treat, and because it was a special occasion, the odds were that I was wearing makeup that would cover the redness. Finally, though, by my early thirties, I had stopped drinking it altogether. The reaction from my skin – and the time it needed to heal – just wasn’t worth it. I did miss it, though.

Vector - Despicable Me
I have only very recently returned to drinking red wine. The reason is because I started using red light therapy (an LED product called “Peak 630” – I’m not selling that product, btw, it’s just what I happen to use) as a part of my overall rosacea-busting lifestyle that includes avoiding many triggers, protecting my skin from the sun, using the right skincare, etc. Though red light therapy doesn’t stop my cheeks from flushing from drinking red wine, the reaction is muss less dramatic, and it’s far more temporary.  By the next morning, my skin has returned to normal. So while red wine is still a trigger, I have found a way to control the reaction so that I can still enjoy red wine.

She says that her triggers include stress and anxiety, extreme heat or cold, direct exposure to the sun, physical activies, alcohol (especially wine, beer and whiskey), spicy food, lobster, seasonal allergies, cosmetic products and lack of sleep. I’ve found that eating carefully, staying cool, staying hydrated, and red light therapy is helpful for all of those things except for and stress/anxiety and a lack of sleep. I haven’t figured out how to stop the impact of those.

A huge THANK YOU goes out to Julie for that. You guys really should check out her blog, Treat Rosacea Options, especially her latest post on testing out red wine with red light therapy:

Stephanie Rodriguez Orengo follows me on tumblr. She has rosacea and I asked her a few questions through email:

Are there any special preparations you make prior to a drinking session to avoid a flare-up? Truthfully, no. The moment I buy a bottle I have in mind a mental picture of what my face is going to look like but then I think on how great this bottle of merlot is going to taste. My friends do notice when my face flairs up while drinking wine and point it out but by the time that happens we're all giddy and serving ourselves another glass. 

Have you found anything that works for you to calm a flare-up in progress? Something that calms my face down would be adding cold coconut oil to my face and a cream I wear once in a while called betamethasone valerate. That cream calms down both the flaring redness and itchy skin.

So what do I do to keep the flare-ups down when I write a friggin wine blog?

Well, first thing is first: the best piece of advice I've gotten so far was from a dear old friend (and just an overall beautiful, loving person) named Samantha Jan Ruscoe. She told me that to make my pink complexion less obvious, start wearing a lot of bright blue and green. And to stay away from red. That sucks because red always looked good on me. I took her advice and it really does work, and that's why you'll almost always see me wearing bright colors, especially blue or green, on my YouTube channel.

Spiderman on hangovers
When writing a wine review I try to keep as cool as possible. It's a good idea to drink the same amount of water as wine anyways just to stay hydrated and keep brain inflammation down but now I make sure I've got a big ol' thing of ice water to keep me cool. I'll even keep a face cloth handy that's damp with cold water. I'll wipe my face every now and then with it and let it hang out on my neck for a bit.

Air circulation. That's also important. An AC or fan moving around some air does wonders. When I'm sitting in place and the air is still and stagnant I can feel my face heating up. You know what I've also found works? Bare feet. Your feet are a major part of your core temperature. That's why when you're hot in bed all you have to do is stick a foot out from under the covers and your whole body will cool down.

So my strategies for flare-up prevention when dealing with a trigger like alcohol is entirely based around not getting yourself heated up too much. Gotta keep those blood vessels happy and less reason to dilate. I'm not so desperate to start using cosmetics yet. ;)

But here's the thing: just like everybody having different triggers, everybody has different things that work for them. This leaves many people feeling alone in their struggle because there's no definitive answers. There's no text-book treatment. So please comment with the treatments that work for you and the different ways that you fight flare-ups. The more information and ideas that are out there the better.

If you stumbled across this looking for education and options then I hope this blog post helped. If you want to read more about the condition then Treat Rosacea Options ( is an excellent blog, and The National Rosacea Society ( is an outstanding resource with a hell of a lot of information.

- Joey Casco CSW/CSS

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  1. I was diagnosed with rosacea when I was about 20. I treated it for about 2 months and I'm a lucky one- I no longer have flareups. Mine was really triggered by spicy foods.

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  8. I wanted to share my experience in the hope that others may benefit, About two years ago I developed small red patches and tiny spots on my face. My nose and eyes were unaffected. I suspected that it may be Papulopustular rosacea but with Covid restrictions I put off going to the Doctor. The symptoms contined for over a year and I tried avoiding red wine and alcohol as I thought that might be a trigger but concluded that it made little difference.
    In February '22 I had a phone consulation with my Doctor and sent him an image of my condition. The Doctor thought that rosecea might be a possible cause and he said he would treat me as he would with acne. He prescribed three months of antibiotic tablets and Soolantra 10mg/g cream.
    I didnt want to take the antibiotics unless absolutely necessary so I just applied the cream for a few weeks. The condition started to improve and after 2months is no longer visible. I never used the antibiotics and my face is now back to normal, Im still drinking red wine.
    The active ingredient in Soolantra is Ivermectin which kills Demodex folliculorum. The other triggers that one reads about had no effect on my rosecea.

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