What Causes My Red Face?

Author: Bart Nieuwenhuijsen

There are many things that can cause a face to become red temporarily, such as consumption of alcohol or spicy food, being embarrassed in social situations or having a sensitivity to niacin or mono-sodium glutamate (MSG). However, there are many conditions that can be the cause of more chronic facial redness. This article describes a few of them.

1. Cushing's Syndrome
   Cushing's syndrome is a hormone disorder that is caused by the exposure of the body to too much cortisol (a stress hormone). Cushing's syndrome is relatively rare, and in addition to redness of the face, includes the following symptoms: high blood pressure, high blood glucose levels, fatigue, irritability, depression and anxiety. Women with Cushing's syndrome often show signs of increased hair growth on the face, neck, abdomen, chest and thighs.
2. Lupus (SLE, Systemic Lupus Erythematosus)
   Lupus is an autoimmune disease affecting multiple organs and tissues, including the skin, heart, kidneys, liver, lungs, joints, brain and blood. The facial redness that is sometimes associated with lupus is a rash across the cheeks and nose. The facial redness with lupus exists in a butterfly pattern (butterfly rash) and does not involve the forehead. Lupus patients can also have skin rashes on other parts of their body, which often develop or get worse after sun exposure. Lupus is frequently diagnosed by antibody testing.
3. Rosacea
   The facial redness of rosacea involves the cheeks, nose and the forehead and develops gradually. It starts out as a redness of the face that resembles facial flushing that does not to go away and in many cases looks like sunburn. However, while the initial facial redness may vary from day to day, rosacea symptoms progressively get worse: in addition to the initial facial redness, small papules and pustules appear on the face, which may burst and ooze. The face often feels itchy and painful. In progressive rosacea, capillaries become permanently widened (telangiectasias). These telangiectasias do not respond well to topical treatments and cause the face to have a "residual" redness. Telangiectasias can be effectively treated with intense pulsed light.
4. Scarlet fever
   Scarlet fever is caused by an exotoxin from the bacterium Streptococcus pyogenes. Clinical signs include a high fever and a sore throat followed by a rough (sandpaper-like) rash over the body lasting for 3-4 days. The skin will start to peel after the rash is gone. Other classic signs of scarlet fever are a bright red tongue with a strawberry appearance and a facial redness on the cheeks (the nose and areas surrounding the mouth are usually not red).
5. Rubella
   Rubella (also called German measles) is a disease caused by the rubella virus. It has an incubation period of 2-3 weeks and symptoms are a rash that first develops on the face, which spreads to the trunk, arms and legs. Complications due to rubella are rare, but rubella can cause complications during pregnancy if the infection occurs within the first 20 weeks of pregnancy.