Why Is My Face Always Red?Rosacea Explained

Your cheeks go hot and pink the second you walk into a warm restaurant. One glass of wine and they’re scarlet. A friend says, “Are you sunburned?” You haven’t been outside in a week.

What it looks like

The American Academy of Dermatology (AAD)² says rosacea mainly affects the face and can show up as flushing, lasting color that’s red, violet or brown, acne-like breakouts, or visible blood vessels. Some people get irritated eyes or thickening skin. The AAD also notes that people with darker skin may never see a red face, which is one reason it gets missed.

The NHS³ describes early signs as redness across the nose, cheeks, forehead, chin, neck and chest that comes and goes, with a burning feeling when you use skin care products. Later, the redness can stay, small bumps can appear, and the skin on the nose can thicken.

It’s nothing you did. The NHS³ says rosacea isn’t caused by poor hygiene and isn’t contagious.

Who gets it

NIAMS¹ says it’s more common in middle-aged and older adults, and that women get it more often than men, though men tend to have more severe cases. Fair skin raises the risk, and darker-skinned people may be underdiagnosed. The NHS³ agrees that it mainly affects women and people with lighter skin.

The exact cause isn’t known. NIAMS¹ says inflammation plays a role, scientists don’t fully understand why it happens, and both genes and the environment likely contribute.

The condition runs in cycles. NIAMS¹ says rosacea often moves between flare-ups and periods of remission.

The triggers

The AAD’s⁴ list is a tour of ordinary life: sunlight, stress, heat, alcohol, especially red wine, spicy foods, some skin and hair care products, some makeup, wind and cold, some medicines, and exercise. The NHS³ adds hot drinks and extremes of temperature.

Everyone’s list differs, which is why the AAD⁴ suggests finding yours. It recommends a diary: write down what you eat and drink, the products you use, and what you’re exposed to, like cold and heat, and note when you flush. Its form asks for at least 2 weeks of daily entries. If your cheeks feel warm to the touch, you may be flushing.

The play

Try this: keep a two-week flush diary

Each day, write down what you ate and drank, which products you used, and where you were: cold, hot, windy, stressed.

Mark when your face flushed.

Look for repeats, then bring the page to a dermatologist.

Is it rosacea or a hot flash?

If you’re in your late 40s or 50s, both can flush your face. The National Institute on Aging⁵ says a hot flash is a sudden feeling of heat, most often in the upper body and face, and that the face and neck may become flushed.

Hot flashes are sudden waves of heat, while rosacea can leave lasting color, bumps or visible blood vessels, according to the AAD². The AAD also says no medical test can tell if you have rosacea, so a dermatologist is the one to sort it out and build a plan. If your breakouts look like adult acne, our article on adult acne covers that side.

What helps

Rosacea can’t be cured, the NHS³ says, but treatment can help control symptoms. NIAMS¹ says the same, and the AAD⁶ says treatment can prevent rosacea from getting worse.

The NHS³ self-help list is short. Wear SPF 30 or higher sunscreen every day. Avoid your known triggers. Use gentle skin care. Manage stress. Protect your skin from extreme temperatures. It lists alcohol, spicy foods, hot drinks and intense aerobic exercise among the things to avoid. Exercise is a personal call. The AAD⁴ lists it as a trigger for some people, and exercise matters for your health, so ask your dermatologist how to handle it.

Medical treatment depends on your signs. The AAD⁶ mentions prescription creams, oral medicines and laser or light therapy, which is unlikely to be your only treatment. The NHS³ says a GP usually prescribes creams or antibiotics for 6 to 16 weeks, with a referral to a dermatologist if those don’t work.

When to get checked

Don’t wait if

1. Urgent

   Go to urgent care right away if you have eye pain, blurred vision, sensitivity to light, or eye redness or grittiness that’s getting worse. The NHS³ lists these as possible signs of keratitis, an eye problem that needs urgent care.

The AAD⁶ says a dermatologist can diagnose rosacea and create a treatment plan that brings relief. Eyes need special attention. NIAMS¹ says eye symptoms deserve medical attention, because untreated ocular rosacea can lead to vision loss.

Book an appointment if any of these fit:

• Your face stays red, or flushes easily and often
• You have bumps that look like acne but don’t behave like it
• Skin care products burn or sting
• The skin on your nose is thickening
• Your eyes feel irritated, gritty or dry
• You aren’t sure if it’s rosacea or hot flashes

Next time someone asks if you’re sunburned, you’ll have a better answer than “it’s the wine.”