Facial Rosacea:
Facial Flushing and its Relationship to Rosacea

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I.  Introduction

II.  Facial flushing is the first and universal symptom of rosacea

III.  Facial flushing is underestimated because it is not always visible

IV.  Why is flushing localized to the face?

V.  Rosacea sufferers and flushing

VI.  References

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I.  Introduction

Facial flushing is the classic symptom of rosacea. In all simplicity, flushing is the result of increased blood flow through dilated facial blood vessels. During a flush, a rosacea sufferer's face can turn various shades of red depending on the amount of blood flowing through the skin. A sufferer may experience a fire-red face during intense flushes, a mildly-red face during moderate flushes, or a barely noticeable pinkish-hue during mild flushes. Depending on the stage of rosacea, a facial flush can be transient (lasting only for seconds), or long-standing (lasting for days, weeks or months).

 

II.  Facial Flushing is the First and Universal Symptom of Rosacea

Medical experts indicate that frequent facial flushing is the first symptom of rosacea:

• Dr. Wollina states, "Recurrent flushing is the earliest component of rosacea to be apparent." (1)
  
  
• Dr. Marks indicates that frequent or persistent flushing is the first tell-tale sign of rosacea. (2)
  
  
• Numerous other rosacea studies and reviews suggest that facial flushing is the first symptom of rosacea. (3-10)
  
  
• Rosacea experts urge general physicians to be on the lookout for pre-rosacea flushing because it is an early warning sign of rosacea. Dozens of experts point out that pre-rosacea flushing can often be detected in children, teenagers, and young adults. (11 - 19)
  
  

III.  Facial Flushing is underestimated because it is not always visible

General physicians and rosacea sufferers often underestimate the frequency of facial flushing because it is not always visible to the naked eye. A facial flush does not always have to result in a fire-red appearance; in many cases it may only result in a pinkish-hue, or a 'healthy glow'. In fact, medical experts point out that facial skin can be completely normal-toned (pale-colored) during some flushing episodes. These physicians have found that blood vessel dilation can occur deep within the facial skin, making it hard to detect. (20)  More recently, a non-invasive clinical study has verified this phenomenon; utilizing laser doppler flowmetry and reflectance spectroscopy, Drs. Anderson and Maibach demonstrated that blood vessel dilation can occur long before the naked eye can visibly detect it. (21)

 

IV.  Why is Flushing Localized to the Face?

Vascular experts indicate that normal facial blood vessels have several important characteristics that make them much more likely to dilate (and be noticed), than most other blood vessels in the human body:

1. More blood vessels: Clinical studies demonstrate that normal facial skin is supplied by an incredibly high number of blood vessels - much greater than most other areas of the body. (6, 39, 49, 50)
   
   
2. Greater blood flow: Clinical studies indicate that resting blood flow in normal facial skin is much greater than that found in other areas of the body. (6, 51-53)  In fact, under normal conditions, facial blood flow is 10 to 20 times greater than that required to supply the skin with oxygen and nutrients! (54)
   
   
3. Greater width of blood vessels and more superficial blood vessels: In some areas of the face, blood vessels are very wide and close to the surface of the skin. (55, 56)  Both of these attributes make facial blood vessels more visible to the naked eye.
   
   
4. Specialized thermoregulatory blood vessels: The facial skin contains specialized 'thermoregulatory shunt vessels' that are unique to the face. The only purpose of these vessels is to aid the body in releasing heat. These vessels bring large volumes of blood to the superficial layers of the facial skin. (54, 57-64)
   
   
5. Facial blood vessels respond to more stimuli: Normal facial skin is generally much thinner and more penetrable than other areas of the human body, and thus facial blood vessels continually 'see' and respond to more stimuli (i.e., environmental and skincare insults).  (65, 66)

 

In addition to the above reasons why normal facial blood vessels may be more prone to visible flushing, rosacea sufferers may have other alterations that make them even more susceptible to flushing  (1, 7, 13, 23, 67, 68):

 

Normal Blood Vessels	Rosacea Blood Vessels
Normal Vascular Smooth Muscle Cells	Damaged Vascular Smooth Muscle
Normal Endothelial Cells	Damaged Endothelial Cells
Normal Healthy Blood Vessel Walls	Vessel Walls Atrophied/Defective
Innervated by Normal Nerves	Innervated by Dilator Nerves

 

 

V.  Rosacea Sufferers and Flushing

Whatever the reason for flushing, clinical studies have shown that rosacea sufferers have a much greater rate of resting blood flow than normal subjects:

• In a controlled clinical study of 25 rosacea patients, research physicians found that facial blood flow, as measured by laser-doppler flowmetry, was significantly higher than normal subjects. Blood flow was a whopping 4 times higher! (69)
  
  
• Consistent with the above findings, two additional studies found that resting facial blood flow (as indicated by increased facial heat), was greater in all rosacea subjects when compared to normal control subjects. (12), (18)

VI.  References

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