Persistent facial redness — also known as rosacea — is an annoying and potentially disfiguring skin condition that can lower self-confidence and self-esteem. Learn more about rosacea, what you can do at home to reduce and conceal flare-ups, and medical strategies to get the red out.
Facial redness can result from many things: over-exfoliating or scrubbing your skin; excessive sun exposure; and medical conditions such as allergic contact dermatitis, lupus, and demodicosis, a rash caused by the demodex mite. But the most common cause of facial redness is rosacea, a chronic, inflammatory skin condition that often worsens over time.
An estimated 14 million Americans have rosacea, which usually affects people of northwestern European descent and is three times more common in women than in men. Famous people with rosacea include Mariah Carey, Rosie O’Donnell, and Bill Clinton. You’re more likely to develop rosacea if you have fair skin, are between ages 30 and 60, and have a tendency to blush.
Rosacea is seldom a medical problem unless it affects tissue around the eyes. But it can be a major cosmetic concern because flare-ups can last for weeks or months, causing facial redness that looks like a permanent sunburn, visible blood vessels, and bumps and pimples that may sting and burn. In addition to the nose, cheeks, and forehead, rosacea can affect the neck, chest, ears, and scalp.
Subtypes of Rosacea
No one knows what causes rosacea, a highly variable skin condition with signs and symptoms ranging from mild to severe. There are four subtypes of rosacea:
• Erythematotelangiectatic rosacea, which is associated with persistent facial redness, visible blood vessels, burning and itching sensations, and a tendency to blush or flush easily.
• Papulopustular rosacea, which is associated with persistent facial redness and bumps or pimples that are often mistaken for acne.
• Phymatous rosacea, which is associated with thickened and enlarged skin, especially on the nose, resulting in a condition called rhinophyma. This is the skin condition that gave Bill Clinton his famously bulbous nose.
• Ocular rosacea, which is associated with dry eye, tearing and burning, and swollen eyelids. In severe cases, it can damage the cornea and cause vision loss.
When You Should Seek Medical Attention
Because rosacea tends to worsen over time, persistent facial redness should be evaluated by a doctor or dermatologist. Your facial redness may be caused by rosacea, but it may also be caused by acne or seborrheic dermatitis, a chronic, inflammatory skin condition that affects the skin’s oil glands. Many times, rosacea is accompanied by unrelated skin conditions such as seborrheic dermatitis.
If you have mild rosacea, your doctor may only advise a skin-care regimen and keeping a “rosacea diary” to help identify and avoid the things that cause flare-ups. But if you have a more severe form of rosacea, you may require treatment with oral antibiotics such as tetracycline, doxycycline, or minocycline, and/or topical therapy with a cream containing an antibiotic, tretinoin, benzoyl peroxide, or azelaic acid to quickly control facial redness, bumps, and pimples. After remission, you may need to continue topical therapy indefinitely.
Other medical treatments for rosacea include:
• Isotretinoin (Accutane), a powerful oral medication usually prescribed for cystic acne. Because this drug is associated with serious side effects, close monitoring is essential.
• Single-wavelength laser or intense pulsed light therapy. Both of these treatments target and eliminate visible blood vessels.
• Carbon-dioxide laser. This treatment can vaporize excess tissue caused by phymatous rosacea.
Home Care for Rosacea
Many factors can trigger rosacea flare-ups. These include various foods and beverages, especially spicy foods and alcoholic beverages such as red wine, beer, bourbon, vodka, and champagne; and the use of cosmetics, hair sprays, and cleansers that contain irritants such as alcohol, witch hazel, eucalyptus, menthol, peppermint, and fragrances. Patients commonly report that flare-ups are associated with excessive sun exposure, emotional stress, and hot weather.
If you can identify your triggers and minimize your exposure to them, you may be able to prevent episodes of facial redness.
One of the most important home strategies is appropriate and consistent skin care. Start with gentle twice-a-day cleansing. For most skin types, a good choice is a cleanser containing less than 10 percent soap and a neutral pH. If you have oily skin, use a mild soap such as Dove or Oil of Olay. Dermatologists also recommend regular use of moisturizers — some of which contain sheer, green-tinted neutralizers to reduce facial redness — and sunscreens with an SPF of at least 15.
Cosmetics used to conceal rosacea include multifunction products such as green-tinted primers that also contain sunscreen, and oil-free foundations and concealers. Choose a foundation that closely matches your skin tone and a concealer that’s one shade lighter.
There’s no doubt that rosacea can affect your appearance and outlook. But with proper medical treatment and home care, you can minimize facial redness, bumps, and pimples, and restore your natural, rosy glow.