Do You Have Flushing and Redness? You May Have This Type of Rosacea
If you have flushing and redness on your face, you could have erythematotelangiectatic rosacea. Here's what skin experts want you to know.
Why is my face so red?
Perhaps it started out slowly: You might have noticed that occasionally you had rosy cheeks for no apparent reason. Later, you may have had a sudden feeling of warmth and redness rushing to your cheeks, perhaps after a glass of wine or a spicy food dish. If this sounds familiar, you could have the skin condition rosacea, especially one that is a real mouthful to say: Erythematotelangiectatic rosacea, the type that afflicts nearly half of the 16 million Americans with rosacea.
What is erythematotelangiectatic rosacea?
This is one of the four subtypes of rosacea, and it’s also known as vascular rosacea. Erythematotelangiectatic rosacea (ETR) is characterized by flushing and redness; the unwieldy name is a combination of erythema (a tendency to redness) and telangiectasia, which refers to widened blood vessels just below the skin. “Signs are an increase in background redness that may wax and wane—flushing and blushing—or may be persistent, and permanently dilated blood vessels,” says Hilary Baldwin, MD, a dermatologist and associate professor of dermatology at Rutgers Robert Wood Johnson Medical School in New Jersey. “Either or both may be present. There may [also] be symptoms of irritation including itch, sting, burn, or tightness.”
Doctors point out that ETR often occurs alongside other rosacea components, including acne-like pimples on the face, eye irritation, and, less commonly, skin thickening, particularly on the nose. But in a survey of patients by the National Rosacea Society (NRS), the flushing and redness were often the first signs of rosacea to appear.
This redness can pop up at inopportune moments, sometimes leading to embarrassment and affecting quality of life. In another NRS survey, 90 percent of rosacea patients polled said rosacea’s effect on their personal appearance affected their self-esteem and self-confidence. The good news is that there are very effective treatments for ETR. (First, check out some other conditions that can explain why your face is red.)
What causes ETR and who gets it
The underlying reasons why ETR—and rosacea in general—develop aren’t well understood. “There is no single answer to this question and there are likely many reasons,” Dr. Baldwin says. “First is the inflammatory process of rosacea that floods the affected [skin] with inflammatory cells and inflammatory cytokines.” Cytokines are molecules that tell the immune system to act.
“Second is the release of nitric oxide, which causes the blood vessels to dilate,” she says. This protein helps the blood vessels open up.
The third is miscommunication between the nervous system and blood vessels, says Dr. Baldwin: “Basically the nerves are telling the vessels to dilate erroneously.” The effect of these overactive, dilated blood vessels is more blood in your face, causing redness. Tiny blood vessels themselves may be visible through the skin as well. “Patients often call them ‘broken blood vessels,’ but there is nothing broken about them,” Dr. Baldwin says.
Women between the ages of 30 and 60, especially those with fair skin, are more likely to experience ETR and rosacea in general; although again, it’s not clear why. (Find out more about rosacea’s symptoms and treatments.)
The immediate cause of an ETR flare-up is often something in the environment that triggers it. “Some, but not all patients report that specific situations, and food or drink, makes them turn red,” Dr. Baldwin says. “Common triggers include spicy foods, hard cheeses, red wine, other alcohols, hot coffee or tea, exercise, hot weather or cold weather, sun exposure, excitement, or anger.” Stress may also bring it on, which is why you might flush before a big meeting at work. (These foods can trigger rosacea flare-ups.)
There are two FDA-approved topical rosacea treatment options for ETR. “Background redness is best treated with two prescription medications: Rhofade (oxymetazoline) and Mirvaso (brimonidine),” Dr. Baldwin says. “They are applied in the morning, work rapidly, and generally keep people ‘unred’ for most of the day.”
These medications work by shrinking the blood vessels back to normal. “They are essentially like Visine for the face, wherein they actually constrict the blood vessels transiently, just like you would put Visine your eyes to constrict the blood vessels, so it’s less red and you flush less,” says Mona Gohara, MD, a dermatologist in Connecticut and an associate clinical professor at Yale School of Medicine, department of dermatology. “This is essentially the same concept but it’s not the same ingredients as Visine. But the problem is that it’s not permanent, so when you stop [applying the medication], it’ll just come back.”
Lasers are a more permanent solution to flushing and redness. “Laser treatments utilize lasers that specifically target blood vessels and over a series of treatments, can greatly reduce both background redness and visible telangiectasias [blood vessels],” says Channa Ovits, MD, a dermatologist at Westmed Medical Group in Westchester, New York.
Lasers are the “treatment of choice” to reduce facial redness and capillaries, says Jason A. Clark, MD, a dermatologist and adjunct assistant professor of dermatology at Emory University in Atlanta. These lasers often use yellow or green light to target hemoglobin, the protein in your blood that gives it its red color. This light turns into heat energy, which removes the offending blood vessel.
In the past these lasers could be too strong, resulting in bruises that lasted for weeks, Dr. Clark says. “More recently, we learned to set lasers to parameters that deliver energy more slowly, to just below the bruising threshold,” he says. “Patients have better outcomes with less downtime.” According to the American Academy of Dermatology, most patients see a 50 to 75 percent reduction in visible blood vessels after one to three treatments, and results last for up to five years until new blood vessels form. But, your insurance may not cover laser/light treatments.
Over-the-counter medications or herbal remedies aren’t typically helpful for ETR. “There are very few effective non-prescription products that help to reduce redness,” Dr. Baldwin says. “I do not have any specific recommendations because I find them to be of little value.”
If you feel a flush coming on, “some people say that chewing on ice cubes is helpful,” Dr. Baldwin says. (Find out other home remedies for rosacea that doctors recommend.)
“For the flushing, eliminating the trigger is very important,” Dr. Gohara says. Some are more easily avoidable than others. You can avoid spicy food or alcohol, for example; but Dr. Baldwin points out that avoiding something you really like may decrease your quality of life. Triggers such as strong emotions or temperature changes may be harder to truly avoid, but you can dress in layers or use some calming techniques to see if they’re effective.
Also, “avoiding irritating products can help improve the redness characteristic of ETR,” says Lisa Anthony, MD, a dermatologist at Westmed Medical Group in Westchester, New York. Don’t use harsh chemicals, strong soaps, or exfoliating products on your skin, Dr. Baldwin says. Instead, “use gentle soaps, no washcloths or sonic brushes, quality dermatologic-grade moisturizers, and sunscreens,” she advises. (Try these rosacea makeup tricks.)
Misconceptions about ETR
Many people with ETR have experienced some negative stereotyping, specifically about associations between redness and drinking too much. “Not everyone who has rosacea has an alcohol problem!” says Julie C. Harper, MD, a dermatologist and president/owner of the Dermatology and Skin Care Center of Birmingham, Alabama. “Yes, alcohol consumption can be a trigger in some individuals, but it is not in everyone. Unfortunately, that perception is part of the stigma that rosacea patients are burdened with, and leaves rosacea patients feeling judged and embarrassed.”
No one should feel this way about a medical condition, although you could take the opportunity to educate people about rosacea. Luckily, though, today’s treatments are also very effective, and can greatly reduce the redness that’s affecting your quality of life.
Next, learn more rosacea facts and find out whether you have it or not.
- National Rosacea Society: "What Is Rosacea?"
- American Academy of Dermatology: "Rosacea: Signs and Symptoms"
- Hilary Baldwin, MD, dermatologist, associate professor of dermatology, Rutgers Robert Wood Johnson Medical School
- Journal of the American Academy of Dermatology: "Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee"
- National Rosacea Society: "All About Rosacea"
- National Rosacea Society: "Rosacea Awareness Month To Emphasize Benefits Of Achieving Clear Skin"
- National Institute of Arthritis and Musculosketal and Skin Diseases: "Rosacea"
- American Academy of Dermatology: "Triggers Could Be Causing Your Rosacea Flare-Ups"
- Mona Gohara, MD, dermatologist, associate clinical professor at Yale School of Medicine, Department of Dermatology
- The Journal of Clinical and Aesthetic Dermatology: "Improving Treatment of Erythematotelangiectatic Rosacea with Laser and/or Topical Therapy Through Enhanced Discrimination of its Clinical Features"
- Channa Ovits, MD, dermatologist, Westmed Medical Group
- Jason A. Clark, MD, dermatologist, adjunct assistant professor of dermatology at Emory University
- American Academy of Dermatology: "Lasers and Lights: How Well Do They Treat Rosacea?"
- Lisa Anthony, MD, dermatologist, Westmed Medical Group
- American Academy of Dermatology: "6 Rosacea Skin Care Tips Dermatologists Give Their Patients"
- Julie C. Harper, MD, a dermatologist and president/owner of the Dermatology and Skin Care Center of Birmingham