Acne 101 | Eczema 101 | The Red Face | Sun Protection

Red Face

One of the most common yet often over diagnosed facial rashes is rosacea, a chronic, relapsing and potentially life-disruptive disorder of the facial skin that affects an estimated 14 million Americans. Many patients come to the clinic with redness on the cheeks, nose, chin or forehead that may come and go. The disease is more frequently diagnosed in women, but more severe symptoms tend to be seen in men.

Facial burning, stinging and itching are commonly reported by many rosacea patients. Certain rosacea sufferers may also experience some swelling (edema) in the face that may become noticeable as early as the initial stage of the disease. It is also believed that in some patients this swelling process may contribute to the development of excess tissue on the nose (rhinophyma), the condition that gave the late comedian W.C. Fields his trademark nose.

It is often thought that fair-skinned patients who tend to flush or blush easily are believed to be at greatest risk, while in fact facial redness from rosacea is simply more obvious in lighter skin. A normal blush or sunburn may appear the same, as can flushing from medications such as niacin or some antihypertension drugs. Flushing occurs when a large amount of blood flows through vessels quickly and the vessels expand under the skin to handle the flow. However, people with extensive sun damage, certain skin types and even treated rosacea patients can still have a red face or blood vessel streaks, which is often misdiagnosed as active rosacea. This is because visible blood vessels (telangiectasia) not only develop with rosacea (or were likely always there), but there may be some residual persistence of redness from the dilation of blood vessels during active disease. Unfortunately these patients continue their medications unnecessarily while more appropriate treatments include camouflage makeup, sunscreens, a vascular laser, or intense pulsed light source.

Unlike some conditions, there are no histological, serological or other diagnostic tests for rosacea. A thorough examination of signs (appearance of bumps or pimples) and symptoms (redness, flushing, and swelling, burning, itching or stinging) as well as a medical history of potential triggers lead to the diagnosis. The National Rosacea Society suggests that the most common triggers of rosacea were sun exposure, emotional stress, hot or cold weather, wind, alcohol, spicy foods, heavy exercise, hot baths, heated beverages and certain skin-care products. In other words, almost anything that is potentially stimulating is bad news for rosacea. Unfortunately for some, certain conditions such as lupus, seborrheic dermatitis, drug eruptions, and even rare forms of lymphoma can look just like rosacea and are often missed by the untrained eye or worse when the patients are diagnosing themselves.