“Why Is My Face So Red?”: Two Common Skin Problems

Is your face red all the time? Especially on your nose and cheeks?

UVA dermatologist Barbara Wilson, MD, contributed this post.

As a dermatologist, I see patients every day upset because the most obvious part of their body, their face, is red, sometimes scaly, sometimes with pustules that look like acne. Fortunately, we can treat these conditions.

Causes of Red Face: Rosacea, Rosacea-Like Demodicosis

Many conditions can cause your face to be red, but let’s look at two of the biggest: Rosacea and its great mimicker, rosacea-like demodicosis.

Most rosacea sufferers have very sensitive facial skin and flushing triggered by stimuli such as alcohol (especially red wine), heat, embarrassment, spicy foods and hot drinks. They may have redness and obvious blood vessels on their nose and cheeks and papules and pustules that resemble acne.

Less commonly, rosacea sufferers, particularly men, may develop an overgrowth of the skin on the nose called rhinophyma. Finally, some suffer from eye involvement called ocular rosacea blepharitis, which manifests as redness and a gritty feeling in the eyes.

Rosacea-like Demodicosis

Another less-known condition, rosacea-like demodicosis, is actually caused by a mite: Demodex folliculorum. This tiny mite lives in follicles and usually doesn’t cause rashes, but if you have it in large numbers, its symptoms are sometimes indistinguishable from rosacea with a red face. Besides the eye involvement and papules or pustules, you may have burning, stinging, scaly facial skin with a sandpapery texture.

We don’t know why some patients face turn red and develop rashes from this mite, but immunosuppression or using strong steroid creams on your face may increase the risk.

We can tell the difference between the two conditions because patients with rosacea-like demodicosis usually don’t respond to rosacea treatments.

Treating Rosacea and Rosacea-like Demodicosis

These conditions can be stubborn, but they usually respond well to appropriate treatment. Rosacea treatments include:

• Topical medications like an antibiotic cream or gel called metronidazole
• Azaleic acid gel
• Oral antibiotics such as doxycycline

Rosacea-like demodicosis responds to sulfur-containing creams and oral Ivermectin, which have antiparasitic properties that target the demodex mites.

In both of the conditions, the redness can be treated with lasers.

So if you suffer from a red face, don’t despair. Once we determine the cause, there are many easy treatment options available.