Rebecca Daley, a 39-year-old creative arts support worker from Chorley, Lancashire, has battled rosacea for 14 years, a condition that has profoundly impacted her life. The visible symptoms, including bright red, irritated, and painful skin, and on occasion, her nose swelling to three times its size and appearing to 'glow' with redness, led to immense embarrassment and social anxiety. She recalls being taunted with phrases like 'Come guide my sleigh!' near Christmas, prompting her to avoid leaving the house.

Rebecca had no prior skin issues until the traumatic birth of her son, Elliot, in 2011. The difficult delivery, where her baby was breech and stopped breathing, resulted in Elliot spending two-and-a-half weeks in intensive care. Rebecca believes the immense stress from this experience triggered physical changes in her body, as weeks later, she noticed a strange red rash with pustules and cysts on her face. Initially dismissing it due to her focus on her new son and recovery, the persistent, itchy, and burning rash prompted her to seek solutions.

Imagining a simple remedy, Rebecca first tried various over-the-counter creams, acne treatments, and spot gels, but none offered relief. It was only when Elliot turned one that her GP diagnosed her with rosacea, a condition she was dismayed to learn was common and often dismissed with advice to 'just put up with it.' Official estimates suggest approximately 2.9 million adults in the UK suffer from rosacea.

Dr. Vani Agarwal, a consultant dermatologist and spokesperson for the British Skin Foundation, explains that rosacea typically causes facial flushing, which can manifest as persistently dilated blood vessels, along with small bumps and pus-filled spots resembling acne. It can also lead to rhinophyma, an overgrowth of oil-secreting glands on the nose, causing significant swelling. In severe cases of giant rhinophyma, it can even obstruct nasal airways, leading to breathing difficulties. Additionally, rosacea can irritate the surface of the eyes and eyelids, causing dryness, itching, and redness.

The condition usually develops between the ages of 30 and 50 and is more prevalent in women and individuals with fairer skin tones. While its exact cause remains unknown, it is thought to stem from a combination of genetic and environmental factors. Common triggers include stress, alcohol, exercise, extreme temperatures, spicy foods, and hot drinks. Dr. Derrick Phillips, a consultant dermatologist at OneWelbeck private clinic in London, elaborates that stress prompts the body to release hormones like cortisol, which heighten inflammation and blood vessel reactivity, contributing to the flushing and sensitivity characteristic of rosacea.

Similarly, pregnancy hormones, with their changes in oestrogen and progesterone, can alter blood flow, increase skin sensitivity, and destabilize the skin's barrier. Dr. Phillips explains that for individuals with an underlying predisposition to rosacea, the emotional stress and hormonal fluctuations surrounding pregnancy or childbirth can either initiate symptoms or exacerbate existing ones. He also notes that blushing easily, not just from embarrassment but also as a sustained reaction to certain foods, can indicate a tendency towards rosacea, as chemical messengers cause blood vessel walls to relax, leading to dilation and increased blood flow to the skin.

Rebecca endured six years of struggle, with prescribed antibiotics and creams proving ineffective. The anxiety stemming from her appearance, particularly at work in a legal firm where she felt her make-up never concealed the redness, only worsened her symptoms. The repeated comparisons to 'Rudolph the Red-Nosed Reindeer' severely impacted her self-esteem, causing her to dread social gatherings. This emotional stress is a significant trigger, as a US study by the National Rosacea Society found 62 percent of 544 rosacea patients reported stress-induced flare-ups at least monthly, with 11 percent experiencing them daily.

At 33, Rebecca sought a second opinion from a different GP, who referred her to a dermatologist. She was prescribed Roaccutane for acne, but this resulted in severe dryness of her lips and face without improving the redness, leading her to discontinue it. She attempted to eliminate other potential triggers like spicy foods and alcohol but found it impossible to control her stress levels.

In a moment of despair in 2019, Rebecca posted a picture of herself on Instagram and was overwhelmed by the supportive responses from dozens of women who resonated with her experience. This pivotal moment led her to decide there was "no point hiding any more." She started a personal page, openly discussing her rosacea, and was inundated with followers sharing similar stories of being dismissed by medical professionals.

Her online presence led to collaborations with companies specializing in rosacea products. Through trial and error, she discovered a serum called Kalme, made with caper extract, which she found would 'instantly calm and soothe' her skin during flare-ups. She also incorporated a physical sunblock containing zinc into her routine. However, it's crucial to note that not all treatments work for everyone, as Dr. Agarwal emphasizes that treatment must be tailored to the specific type of rosacea.

Dr. Agarwal outlines common topical agents such as azelaic acid and ivermectin 1 percent cream, often used alongside anti-inflammatory oral antibiotics like doxycycline, lymecycline, and erythromycin. These antibiotics are effective against papules and pustules but offer little help for redness. For visible redness and dilated blood vessels, Dr. Phillips suggests laser treatments, including resurfacing lasers like CO2 or Er:YAG for rhinophyma to shrink vessels and thin thickened skin, and lasers like DermaV (available in NHS dermatology and plastic surgery departments) specifically for facial redness.

Increasingly, dermatologists are adopting a more holistic approach, addressing not only the skin but also the gut microbiome – the community of microbes linked to various health conditions. Dr. Justine Hextall, a consultant dermatologist at the private Tarrant Street Clinic, explains that an imbalance in the microbiome can fuel inflammation, damaging the skin's outermost layer and increasing its sensitivity to rosacea triggers like sunlight. This approach may include probiotics and a diet rich in prebiotic foods such such as leeks, broccoli, apples, and bananas, which nourish beneficial microbes that produce fatty acids to reduce inflammation and support a healthy skin barrier.

Another critical recommendation is year-round sunscreen use. Research indicates that up to 85 percent of rosacea patients experience sun sensitivity. Dr. Agarwal strongly advises daily application of a broad-spectrum SPF30 or SPF50, even during winter, to help reduce the frequency of flare-ups and protect the skin. Rebecca has since regained her self-confidence, with her condition mostly under control, despite occasional flare-ups. Her nose has returned to a normal size, and she now courageously competes in body-building contests – an activity she 'never would have dreamed of doing a few years ago.' Though there is no cure, Rebecca now embraces her condition, learning to live with it, 'Rudolph or not,' and offers advice and help to others.