Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Approach to the patient with facial erythema

INTRODUCTION

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.)

ETIOLOGY

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) [1]. 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 is often present. 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".)

              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2014. | This topic last updated: May 9, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. 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.
  2. Naldi L, Rebora A. Clinical practice. Seborrheic dermatitis. N Engl J Med 2009; 360:387.
  3. Leung DY, Bieber T. Atopic dermatitis. Lancet 2003; 361:151.
  4. Nosbaum A, Vocanson M, Rozieres A, et al. Allergic and irritant contact dermatitis. Eur J Dermatol 2009; 19:325.
  5. Hönigsmann H. Polymorphous light eruption. Photodermatol Photoimmunol Photomed 2008; 24:155.
  6. Millard TP, Hawk JL. Photosensitivity disorders: cause, effect and management. Am J Clin Dermatol 2002; 3:239.
  7. González E, González S. Drug photosensitivity, idiopathic photodermatoses, and sunscreens. J Am Acad Dermatol 1996; 35:871.
  8. Walling HW, Sontheimer RD. Cutaneous lupus erythematosus: issues in diagnosis and treatment. Am J Clin Dermatol 2009; 10:365.
  9. Costner MI, Grau RH. Update on connective tissue diseases in dermatology. Semin Cutan Med Surg 2006; 25:207.
  10. Vafaie J, Schwartz RA. Erythema infectiosum. J Cutan Med Surg 2005; 9:159.
  11. Bonnetblanc JM, Bédane C. Erysipelas: recognition and management. Am J Clin Dermatol 2003; 4:157.
  12. Choonhakarn C, Poonsriaram A, Chaivoramukul J. Lupus erythematosus tumidus. Int J Dermatol 2004; 43:815.
  13. Obermoser G, Sontheimer RD, Zelger B. Overview of common, rare and atypical manifestations of cutaneous lupus erythematosus and histopathological correlates. Lupus 2010; 19:1050.
  14. Poenitz N, Dippel E, Klemke CD, et al. Jessner's lymphocytic infiltration of the skin: a CD8+ polyclonal reactive skin condition. Dermatology 2003; 207:276.
  15. Rémy-Leroux V, Léonard F, Lambert D, et al. Comparison of histopathologic-clinical characteristics of Jessner's lymphocytic infiltration of the skin and lupus erythematosus tumidus: Multicenter study of 46 cases. J Am Acad Dermatol 2008; 58:217.
  16. Thiyanaratnam J, Doherty SD, Krishnan B, Hsu S. Granuloma faciale: Case report and review. Dermatol Online J 2009; 15:3.
  17. Colli C, Leinweber B, Müllegger R, et al. Borrelia burgdorferi-associated lymphocytoma cutis: clinicopathologic, immunophenotypic, and molecular study of 106 cases. J Cutan Pathol 2004; 31:232.
  18. Mullegger RR. Dermatological manifestations of Lyme borreliosis. Eur J Dermatol 2004; 14:296.
  19. Marqueling AL, Gilliam AE, Prendiville J, et al. Keratosis pilaris rubra: a common but underrecognized condition. Arch Dermatol 2006; 142:1611.
  20. Rapaport MJ, Rapaport V. Eyelid dermatitis to red face syndrome to cure: clinical experience in 100 cases. J Am Acad Dermatol 1999; 41:435.
  21. Rapaport MJ, Lebwohl M. Corticosteroid addiction and withdrawal in the atopic: the red burning skin syndrome. Clin Dermatol 2003; 21:201.