Erythematotelangiectatic Rosacea: When Facial Redness Isn't Just Sensitive Skin

What it looks like

ETR mainly affects the central part of the face, particularly the cheeks and nose. The redness can be constant or come and go, but over time it often becomes more permanent. Some of the most common features include:

• Redness that doesn’t fully go away
• Episodes of flushing that can be triggered by heat, sun, spicy foods, alcohol, or stress
• Fine, visible blood vessels on the skin (telangiectasias)
• A burning or stinging sensation
• Dry or overly sensitive skin

These symptoms may start off subtle but can gradually intensify without treatment.

What causes it

The exact cause of ETR is still being studied, but several contributing factors have been identified. People with ETR tend to have facial blood vessels that overreact to common stimuli. These vessels dilate too easily and remain open longer than they should, leading to visible redness.

There is also often an inflammatory component, involving proteins in the skin like cathelicidins, which trigger redness and irritation. Other potential contributors include:

• Sun exposure
• Wind and temperature extremes
• Genetic predisposition
• An increased number of Demodex mites, which are microscopic organisms that live on the skin

How it differs from other types of rosacea

Rosacea can present in several forms. ETR is primarily about redness and visible blood vessels without breakouts. Other common types include:

• Papulopustular rosacea, which looks more like traditional acne with bumps and pustules
• Phymatous rosacea, which causes thickened skin, usually around the nose
• Ocular rosacea, which affects the eyes with redness, irritation, and a gritty feeling

Many people have overlapping features, but if redness is your main concern without breakouts, ETR may be the dominant type.

What else could it be?

Several other conditions can cause facial redness and need to be ruled out before diagnosing ETR. These include:

• Lupus
• Seborrheic dermatitis
• Allergic or irritant contact dermatitis
• Photosensitivity reactions
• Menopausal hot flashes
• Reactions to certain medications or internal conditions

A thorough evaluation by a dermatologist can help make sure the diagnosis is accurate.

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How we treat it

While there’s no cure for ETR, treatment can significantly reduce symptoms and prevent progression. A combined approach is usually best.

Skincare and lifestyle
Avoiding known triggers like hot beverages, sun exposure, spicy food, and alcohol can prevent flares. Using a gentle, non-irritating skincare routine is essential. Daily use of a broad-spectrum sunscreen and a basic moisturizer helps support the skin barrier. For rosacea-prone skin, less is more. Avoid harsh products, exfoliants, and strong actives unless recommended.

Topical medications
Topical brimonidine or oxymetazoline can reduce redness by constricting the superficial blood vessels. These are often used daily or before important events. Some patients may experience a rebound effect where redness returns or worsens temporarily once the product wears off.

Laser and light treatments
Pulsed dye laser (PDL) and intense pulsed light (IPL) therapy are highly effective in reducing visible vessels and overall redness. These treatments target the blood vessels directly and usually involve a series of sessions. Results are not permanent, but regular maintenance treatments can keep symptoms under control. Patients also often report better skin texture and comfort after laser therapy.

Oral medications
For more severe flushing that doesn’t respond to topical or laser treatments, oral medications like beta blockers, clonidine, or gabapentin may be considered. These are not FDA-approved specifically for rosacea but can be helpful in select cases.

When to see a dermatologist

If redness or flushing is affecting your quality of life, it’s worth getting checked out. ETR is a chronic inflammatory skin condition, and the earlier it's treated, the better the results tend to be.

At Pure Dermatology, we offer a personalized, evidence-based approach to treating all types of rosacea, including ETR. Whether you’re dealing with persistent redness for the first time or have tried treatments without success, or are simply looking for a skincare regimen for your sensitive skin, the board-certified dermatologist at Pure Dermatology can help.