Anyone with persistent facial redness—we’re not talking about a healthy post-workout flush—knows how difficult it can be to pin down the culprit of the issue. As Spokane, WA dermatologist Wm. Philip Werschler, MD explains, redness indicates an increase of blood flow to the area, but the list of causes for facial redness is virtually endless. The good new? Most cases can be linked to a handful of triggers. 

Common Causes

If unintended, Dr. Werschler explains that redness may stem from inflammation—think: sunburn, rosacea, seborrhea, atopic dermatitis/eczema, Lupus, etc.—irritation (use of Retin-A, overly aggressive washing/exfoliation or product irritation), allergies, increased vascularity, which may be from a type of rosacea termed erythemato-telangiectetic, aka spider veins, emotion—such as blushing or flushing—or infection, “and the list goes on and on,” says Dr. Werschler. The American Academy of Dermatology contends that reactions to medications, shingles or rare cancers may also cause redness.

However, Dr. Werschler notes the most common causes of facial redness are from rosacea, irritation from product use, and emotion. “If there is scaly or dry skin involved, then it’s likely seborrhea.”

Masking Matters

In the age of COVID-19, face coverings and masks have taken a toll on our skin, and dermatologists are seeing their fair share of “maskne,” but Dr. Werschler also contends they are seeing a lot of “maskitis,” aka mask dermatitis from the chronic wearing of so many face coverings. The reason? Increased heat and humidity to the lower facial skin’s environment can lead to rosacea-type breakouts, some masks cause friction-type irritation which can cause redness along mask lines, and others may contain mild allergens as components of their manufacture, adds Dr. Werschler.

Diagnosing the Issue

If skin redness is a persistent problem, seeing a board certified dermatologist should be the first step of your treatment plan. While it may seem daunting, the consultation primarily consists of your dermatologist asking a series of questions to help get to the root of the problem. 

“One of the first things we ask is if the redness is episodic or chronic, how long it lasts, and when and why does it appear. Is it after eating spicy foods or consuming alcohol, in the heat or cold, with exercise, etc. Is it 5 to 10 minutes after a hot shower or several hours afterwards?”

Once those baseline questions are answered, your dermatologist will ask about any symptoms of itching, burning, stinging, hives or welts, and if the redness occurs anywhere else, such as the scalp, ears, chest, etc. Your provider will also ask how long you have experienced the redness and what you find alleviates the problem. 

“These questions help us to determine patterns which then help fit into diagnostic categories,” says Dr. Werschler. “As an example, if someone’s skin is sensitive to hot showers or spicy foods, that’s likely rosacea. If their facial skin burns when exposed to brief periods of sunshine, including through window glass, we think about Lupus.”

Treating the Problem

Treatment depends on the cause of redness, but if your dermatologist determines it is rosacea, topical and oral medications, laser treatments, lifestyle and dietary choices, and skin-care regimens can help alleviate the problem. “If it’s from product use or sensitivity, switching skin-care routines, usually towards less irritating or drying products, will help,” says Dr. Werschler. “If it is from a skin disease such as eczema or seborrhea, treatment of the underlying condition [is the best course of action].”

The Bottom Line

If you have persistent redness of your face without explanation, see a board certified dermatologist sooner rather than later. “If your redness is lasting more than a week or two, if it’s getting worse, if you’re developing scabs, sores, blisters or deeper painful swelling or firmness in your skin, you need to see a dermatologist right away,” Dr. Werschler says.

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