Approach to the patient with facial erythema
- Mark V Dahl, MD
Mark V Dahl, MD
- Section Editor — Acne and Rosacea
- Professor Emeritus
- Mayo Clinic College of Medicine
Facial erythema (facial redness), a clinical finding most noticeable in fair-skinned individuals, occurs as a result of cutaneous blood vessel dilation and increased blood flow to the skin. Although transient facial erythema is often observed as a normal, neurologically-mediated response to strong emotion, exercise, or heat exposure, inflammation and a variety of medical conditions can lead to longer-lasting and symptomatic or cosmetically distressing facial erythema.
Examples of disorders that may present with diffuse or localized facial erythema and the evaluation of patients with this clinical finding will be reviewed here. More detailed information on flushing and many of the other disorders associated with facial erythema is available separately. (See "Approach to flushing in adults" and 'Etiology' below.)
A variety of factors, including primary skin diseases, external insults, and systemic illness may cause facial redness. Knowledge of the distinctive characteristics of these disorders is helpful for diagnosis.
Primary inflammatory skin diseases
●Rosacea – The erythematotelangiectatic subtype of rosacea is characterized by centrofacial erythema and telangiectasias (picture 1A-B) . Affected patients also often exhibit flushing and sensitivity of facial skin. The patient history and physical findings are usually sufficient for the diagnosis of this disorder. Other rosacea subtypes may also demonstrate these clinical features. (See "Rosacea: Pathogenesis, clinical features, and diagnosis".)
●Perioral dermatitis – Perioral dermatitis (also known as periorificial dermatitis) presents with multiple, small, inflammatory papules clustered around the mouth, nose, or eyes (picture 2). Fine scale and dermatitis are also often present, but the rash is characteristically more red and bumpy than red and scaly. In patients with perioral lesions, the skin immediately adjacent to the vermillion border of the lip is classically spared. Perioral dermatitis most frequently affects young women; occasionally the disorder occurs in children. (See "Perioral (periorificial) dermatitis".)
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- Primary inflammatory skin diseases
- Disorders due to external insults
- Photosensitive disorders
- Systemic disorders
- Infectious disorders
- Localized inflammatory infiltrates
- PATIENT ASSESSMENT
- DIAGNOSTIC TESTS
- Patch testing
- Serology and other tests
- TOPICAL CORTICOSTEROID USE
- INDICATIONS FOR REFERRAL
- SUMMARY AND RECOMMENDATIONS