Facial Redness: From Rosacea To Rare Causes - A Dermatologist Explains.

In this episode, Dr Stefanie Williams breaks down ten reasons for facial redness, from common culprits like rosacea, seborrhoeic dermatitis, and eczema to less common autoimmune and malignant causes. Clear patterns, telltale clues, and treatment pitfalls help you move from guesswork to informed action.

• Rosacea signs including vessels, papules and ocular clues
• Perioral dermatitis patterns and steroid pitfalls
• Seborrhoeic dermatitis driven by Malassezia and oiliness
• Atopic eczema versus seborrhoeic features and triggers
• Contact dermatitis split into irritant and allergic mechanisms
• Everyday product culprits including retinoids, acids and fragrance
• Chronic sun damage as an amplifier of persistent redness
• Autoimmune causes including lupus and psoriasis
• Rare but serious Sézary syndrome and when to escalate
• Practical reasons to seek diagnosis before treatment

Transcript

Setting The Mission: Decode Redness

SPEAKER_00 0:01

Dermatologist debriefs. Join no-nonsense dermatologist Dr. Stephanie Williams as she debunks myths and shares her professional insights. Separating facts from fiction in just a few minutes.

Rosacea: Vessels, Bumps, And Triggers

Perioral Dermatitis: Patterns And Pitfalls

Seborrhoeic Dermatitis: Yeast And Inflammation

Atopic Eczema Versus Seborrhoeic Dermatitis

Contact Dermatitis: Irritant Or Allergic

Chronic Sun Damage And Broken Vessels

Autoimmunity: Lupus And Psoriasis

Serious But Rare: Sézary Syndrome

Other Flush Triggers And Final Takeaway

SPEAKER_01 0:16

Hello, this is Dr. Stephanie. Today we are going to talk about 10 reasons your face may be red. So let's get started. Reason number one is rosacea. This is a chronic inflammatory as well as vascular disorder, and one of the most common reasons patients come to see Mediudello with facial redness. Patients very often feel that their skin is dry, however, most of the time this is not real dryness but a sign of microinflammation in the skin. Furthermore, there may be broken vessels, so-called teleangiactasias, on the cheek and around the nose. And in addition to those vascular symptoms, there may be inflamed lesions like little red bumps called papules, which sometimes can have a pus-filled head, in which case they're called pustules. And these can look very similar to acne lesions. However, although it can look like it, rosacea is not adult acne, it is a completely different condition altogether. Rosacea can sometimes even affect the eyes, causing a feeling of dryness or burning or kind of grittiness, and sometimes it can cause a thickening of the skin on the nose, which are all additional keys what we may be dealing with, i.e. rosacea, as a cause of your facial redness. And it goes without saying for all of the 10 reasons we are discussing today for facial redness, if you suffer with any of these, make sure to see a dermatologist who can diagnose properly what is going on and can treat it as well. Going on to reason number two for facial redness, which is perioral dermatitis, also called Pod. That can be another reason your skin looks red, and this condition can somewhat look similar to rosacea in that your skin may be a little bumpy. However, in Pod, in addition to those red bumps, there may also be flaking and tiny blister-like lesions. And this rash typically appears around the mouth area, sometimes also around the eyes or nose, and that's why there's actually a newer name for perioral dermatitis, which is called periorificial dermatitis. The skin often feels tight to patients, but there are no prominent vascular symptoms like in rosacea. Also, unlike rosacea, it typically spares the skin right around the lips. So there's like a free margin around the lips before the rash starts. POD can be caused by overly rich skin care or by prolonged use of topical corticosteroids on the face. So it's very important that this is diagnosed properly because otherwise your doctor may prescribe steroids and that will just mask it, but ultimately will make it worse. Moving on, reason number three for why your face may be looking red is saboric dermatitis, which we also call sepderm. And this is particularly common in men. The skin may be red all over, although there is often a kind of yellowish tint of red. And the skin is usually on the oily side. So that might manifest itself in itchiness or dandruff-like flaking. And these are all clues that we are maybe dealing with cybaroic dermatitis. Sepderm is driven by a yeast called malassesia, formerly known as puterosporum, and inflammation. So we all actually have this fungus on our skin, it's part of our normal skin flora, but in cibaroc dermatitis patients, there is an overgrowth of it. Plus, there is also an abnormal inflammatory response by your immune system to the yeast and its metabolic byproducts. So while we all have the fungus on our skin, patients with cybaric dermatitis don't deal with it in the same way, and the immune system is overreacting to it, and that's what's causing the inflammation in the skin. Reason number four for facial redness is atopic dermatitis or atopic eczema. So this is the kind of typical childhood eczema which can appear in adulthood too, though. And it's very important not to mix the atopic dermatitis up with cyberoic dermatitis. So although they both have the term dermatitis in their name, which just simply means inflammation of the skin, they are very different conditions. So atopic dermatitis is itchy and the skin is very dry, really never oily, unlike in septum. And in babies, atopic dermatitis commonly affects the cheeks, while in adults this is less common, but it can be triggered by things like pollens or dust mites. And another common site for atopic dermatitis on the face is the eyelid area. Reason number five, and something that can look identical to endogenous atopic dermatitis, is contact dermatitis. So this is another reason your face may be looking red. And although strictly speaking, this actually covers two different conditions. Number one, irritant contact dermatitis, and number two, allergic contact dermatitis, depending on whether it's caused by an allergy or by irritation of the skin. But generally they can look very similar. But it really bugs me when people or even journalists call skin allergies irritation. It's a completely different mechanism of action. One involves a person specific, so an individual immune response caused by T cells. This is the allergic contact dermatitis, and the other one being a concentration-dependent reaction that occurs independent of your immune system's T cells, which is the irritant contact dermatitis. Anyway, contact dermatitis, whether irritant or allergic, is a relatively common reason for facial redness, and it can be caused by everyday skincare products. Common culprits for irritant contact dermatitis include retinoids and AHHES, and for allergic contact dermatitis, often fragrances or sometimes preservatives can also cause allergic contact dermatitis and various other ingredients in skincare. Moving on, reason number seven for why your face may be looking red is chronic sun damage. So this is not quite so well known, I think, but sun damage can be a major amplifier of facial redness and broken vessels because UV radiation can damage small blood vessels and breaks down collagen too, leading to long-term redness and visible teleungactasia, so broken vessels, especially on the cheeks and on the nose. And this is why some people with fair skin complexions develop a permanently ruddy skin tone after years of sun exposure, even without obvious sunburns. So it's a kind of cumulative sun damage. Reason number eight, so we are counting down to the last three now, and just to say these are in no particular order, but reason number eight is a less common one, and that's lupus erythematosus LE. This sometimes can be mixed up with rhosacea because there is a redness in the central area of the face, the central cheeks and the nose, but it's a very different thing. So LE is an autoimmune condition that can, amongst other things, cause a so-called butterfly rash with a very distinct redness on the cheeks and across the nose. It's kind of in the shape of a butterfly, I guess. And what happens is that in lupus, your immune system attacks your own tissues. So a topical steroid to suppress that overreaction is one of the common treatments we might be using. However, that is strictly contraindicated in rosacea, which is another reason that is really important to get the diagnosis right. And there is another autoimmune condition, and reason number nine for facial retinas, and that's psoriasis. So here you may also see scaly red plaques on the face, including around the hairline, which is quite common. So again, these thick plugs with a silvery scale, which often appear on the elbows and knees, as well as scaly patches on the scalp and certain nail changes. And although this is another autoimmune condition, it is much more common than lupus and less serious for your overall health compared to systemic lupus. So that brings me to the last point on our quick list number 10. This is thankfully rare, but a serious condition, which is a containous T cell lymphoma called Caesare syndrome. This is a type of immune cell cancer that begins with white blood cells in the skin, or begins in red blood cells in the skin, and can cause a widespread redness and scaling, including on the face. So another very serious condition, and another reason why a correct diagnosis is extremely important. So there you have it. Um after only minor UV exposure. In Asian populations, there is also a genetic variant that can cause facial flushing with even very small amounts of alcohol due to acetaldehyde buildup and others, many others. So the main message today really is that facial redness is a symptom that can be a sign of various skin or even systemic diseases, and it's not always easy to distinguish them. So make sure to see a dermatologist if you suffer with facial redness, not only to get that crucial diagnosis, but also to start treatment. I hope this makes sense and I will speak to you again soon. Bye bye.