Research Article| Volume 35, ISSUE 2, P201-206, March 2017

The “red face”: Not always rosacea


      Facial erythema (the “red face”) is a straightforward clinical finding, and it is evident even to the untrained eye; however, a red face does not represent a single cutaneous entity. It may be due to a plethora of distinct underlying conditions of varying severity, including rosacea, demodicosis, dermatomyositis, lupus erythematosus, allergic contact dermatitis, drug-induced erythema, and emotional blushing. In clinical practice, dermatologists do not encounter only one type of facial erythema but rather a number of different shades of red. This review presents the clinical spectrum of facial erythemas and addresses the question of what lies beneath a red face by discussing the key clinical and histopathologic characteristics.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinics in Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ikizoglu G.
        Red face revisited: Flushing.
        Clin Dermatol. 2014; 32: 800-808
        • Wilkin J.
        • Dahl M.
        • Detmar M.
        • et al.
        Standard classification of rosacea: Report of the National Rosacea Society expert committee on the classification and staging of rosacea.
        J Am Acad Dermatol. 2002; 46: 584-587
        • Draelos Z.D.
        Cosmetics in rosacea.
        in: Zouboulis C.C. Katsambas A.D. Kligman A.M. Pathogenesis and Treatment of Acne and Rosacea. Springer, New York, NY2014: 717-727
        • Tanghetti E.A.
        • Jackson J.M.
        • Belasco K.T.
        • et al.
        Optimizing the use of topical brimonidine in rosacea management: Panel recommendations.
        J Drugs Dermatol. 2015; 14: 33-40
        • Powell F.C.
        Understanding rosacea.
        Br J Dermtaol. 2015; 173: 635-636
        • Steinhoff M.
        • Schmelz M.
        • Schauber J.
        Facial erythema of rosacea: Aetiology, different pathophysiologies and treatment options.
        Acta Derm Venereol. 2016; 96: 579-586
        • Powell F.C.
        N Engl J Med. 2005; 352: 793-803
        • Lazaridou E.
        • Fotiadou C.
        • Ziakas N.G.
        • et al.
        Clinical and laboratory study of ocular rosacea in northern Greece.
        J Eur Acad Dermatol. 2011; 25: 1428-1431
        • Vieira A.C.
        • Mannis M.J.
        Ocular rosacea: Common and commonly missed.
        J Am Acad Dermatol. 2013; 69: s36-s41
        • Webster G.
        • Schaller M.
        Ocular rosacea: A dermatologic perspective.
        J Am Acad Dermatol. 2013; 69: s42-s43
        • Brown T.T.
        • Choi E.Y.
        • Thomas D.G.
        • et al.
        Comparative analysis of rosacea and cutaneous lupus erythematosus: Histopathologic features, T-cells subsets, and plasmacytoid dendritic cells.
        J Am Acad Dermatol. 2014; 71: 100-107
        • Cribier B.
        Rosacea under the microscope: Characteristic histological findings.
        J Eur Acad Dermatol. 2013; 27: 1336-1343
        • Draelos Z.D.
        Facial skin care products and cosmetics.
        Clin Dermatol. 2014; 32: 809-812
        • Olazagasti J.
        • Lynch P.
        • Fazel N.
        The great mimickers of rosacea.
        Cutis. 2014; 94: 39-45
        • Chen W.
        • Plewig G.
        Human demodicosis: Revisit and a proposed classification.
        Br J Dermatol. 2014; 178: 1219-1225
        • Brutti C.S.
        • Artus G.
        • Luzzatto L.
        • et al.
        Crusted rosacea-like demodicidosis in an HIV-positive female.
        J Am Acad Dermatol. 2011; 65: e131-e132
        • Hsu C.K.
        • Hsu M.M.L.
        • Lee J.Y.Y.
        Demodicosis: A clinicopathological study.
        J Am Acad Dermatol. 2009; 60: 453-462
        • Forton F.M.N.
        Papulopustular rosacea, skin immunity and Demodex: Pityriasis folliculorum as a missing link.
        J Eur Acad Dermatol Venereol. 2012; 26: 19-28
        • Dessinioti C.
        • Antoniou C.
        • Katsambas A.
        Acneiform eruptions.
        Clin Dermatol. 2014; 32: 24-34
        • Welsh O.
        • Vera-Cabrera L.
        Red face and fungi infection.
        Clin Dermatol. 2014; 32: 734-738
        • Dessinioti C.
        • Katsambas A.
        Seborrheic dermatitis: Etiology, risk factors and treatments: Facts and controversies.
        Clin Dermatol. 2013; 31: 343-351
        • Morton C.M.
        • Bhate C.
        • Janniger C.K.
        • et al.
        Ulerythema ophryogenes: Updates and insights.
        Cutis. 2014; 93: 83-87
        • Black A.A.
        • McCauliffe D.P.
        • Sontheimer R.D.
        Prevalence of acne rosacea in a rheumatic skin disease subspecialty clinic.
        Lupus. 1992; 1: 229-237
        • Roihu T.
        • Kariniemi A.L.
        Demodex mites in acne rosacea.
        J Cutan Pathol. 1998; 25: 550-552
        • Tan E.M.
        • Cohen A.S.
        • Fries J.F.
        • et al.
        The 1982 revised criteria for the classification of systemic lupus erythematosus.
        Arthritis Rheum. 1982; 25: 1271-1277
        • Petri M.
        • Orbai A.M.
        • Alarcon G.S.
        • et al.
        Derivation and validation of systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus.
        Arthritis Rheum. 2012; 64: 2677-2686
        • Van Zuuren E.J.
        • Fedorowicz Z.
        Interventions for rosacea: Abridged updated Cochrane systematic review including GRADE assessments.
        Br J Dermatol. 2015; 173: 651-662
        • Ilkovitch D.
        • Pomerantz R.G.
        Brimonidine effective but may lead to significant rebound erythema.
        J Am Acad Dermatol. 2014; 70: e109-e110
        • Routt E.T.
        • Levitt J.O.
        Rebound erythema and burning sensation from a new topical brimonidine tartrate gel 0.33%.
        J Am Acad Dermatol. 2014; 70: e37-e38
        • Swanson L.A.
        • Warshaw E.M.
        Allergic contact dermatitis to topical brimonidine tartrate gel 0.33% for treatment of rosacea.
        J Am Acad Dermatol. 2014; 71: 832-833
        • Galderma Ltd.
        Mirvaso (brimonidine) 0.33% topical gel. Summary of product characteristics.
        (Available at:) (Accessed May 7, 2016)