Red cheeks are a very common concern for patients coming to a Medical Laser practice particularly if your background is Caucasian. Redness of the cheeks can be the result of various factors such as inflammation in the skin, increased blood flow to the skin or increased numbers of superficial blood vessels in the surface layer of the skin (epidermis).
One of the commonest causes of red cheeks is Rosacea. This is a chronic skin condition that effects about 10% of adults in Western populations and most commonly is characterised by facial flushing and redness on the central face and/or the presence of acne (when it is called Acne Rosacea). It effects women more than men and one recent study found it is underdiagnosed and is much more common in under 30 year olds than previously thought.
Flushing refers to when blood vessels in the skin open up (dilate). Many things can cause Flushing apart from Rosacea, ranging from simple blushing and anxiety through to alcohol, food additives, certain medications and a variety of tumours. In some women the time around menopause can be a time of increased susceptibility to flushing and these are often referred to as hot flushes. If Flushing is related to an increased activity of the nerves supplying the blood vessels it is typically associated with increased sweating as well.
Cheek redness from inflammation can occur with Dermatitis but unlike Rosacea there is usually scaling and flaking of skin with itchiness. Sun damage can cause redness due to increased numbers of small capillary blood vessels (often called Broken Capillaries) but there will often be other signs of sun damage such as uneven pigmentation, sunspots and solar keratosis. The use of certain medications such as steroids can also cause increased blood vessels on the face and hence facial redness.
Some more serious medical conditions can be associated with cheek redness and flushing such as Auto immune diseases (eg Lupus, Sarcoidosis and Scleroderma) and some cancers (Thyroid, Pancreatic, Renal and Carcinoid).
Whenever a patient comes in complaining of cheek redness it is important to take a full medical history including a family history and a history of medication and supplement use. It is important to exclude more serious causes and it is also important to realise that more than one condition can occur at the same time such as Rosacea and Sun Damage.
Whatever the cause of facial redness and flushing it is important to understand that the condition will be aggravated by certain triggers. These exact triggers can vary between different individuals but generally things that cause skin inflammation such as sun, wind and cold will make facial redness worse. Anything that raises the body temperature will cause blood vessels to open up and aggravate the condition for example heavy exercise, alcohol, hot baths, spicy foods and hot drinks.
Patients with facial redness often describe a concern that people think they drink excessive amounts of alcohol. The stigma of facial redness and the incorrect cultural association with alcoholism can adversely affect quality of life and is a common reason patients might seek treatment for facial redness. Whilst alcohol consumption can raise body temperature and result in an opening up of blood vessels and as such be a trigger factor to make facial redness more apparent, the primary cause of the facial redness is not excessive alcohol intake.
The treatment of facial redness very much depends on first identifying the cause. Treatment then typically involves a multifaceted approach of minimising aggravating factors (in particular the need to use a sunblock), recognising triggers and reducing these, advice on skincare, topical medications if appropriate and then the use of medical grade Vascular Lasers to reduce and control the redness.
The most popular Vascular Laser we currently use for treating facial redness is the EXCEL V. This laser has the option of 2 wavelengths of laser light to target both small and large unwanted blood vessels and for the majority of patients this is the laser of choice when treating facial redness. However, other lasers such as the VBEAM, the 532 VARILITE and broadband light sources such as the BBL, are also used in certain situations. A recent trend is the combination vascular treatment where both a laser and broadband light source are used in the same treatment session to get faster results.