Ep #28 Facial Redness 101: What’s Really Causing your Red Skin?

SKIN TO IT Podcast

Dr. Sandy Skotnicki and Marlo Sutton dive into the complexities of facial redness, specifically distinguishing between rosacea and sun damag

Key takeaways

• Rosacea is often driven by genetic vascular instability and inflammatory responses in the skin.
• Sun damage typically presents as redness on the forehead, neck, and chin, whereas rosacea is more concentrated in the center of the face.

Main topics

• Differentiating rosacea from sun damage
• Biological causes of facial redness

Notable quotes

You can't remove a physical entity with a cream.

Conclusion

A practical guide for managing facial redness through informed skincar

Transcript preview

Speaker 1 (0:01) Every Thursday, let's get skin to it with dermatologist Dr. Sandy Skotnicki and personal stylist and beauty enthusiast Marlo Sutton for a new episode of Skin to It, where we guide you through the maze of skincare and cut through that noise to help you achieve your healthiest skin. Speaker 1 (0:23) Welcome back to Season 3 of Skin To It. We're very excited to bring you a whole new series of episodes. Yeah, it's so exciting. I can't believe it's Season 3. Yeah, Speaker 2 (0:32) I know. Can't wait to get into it. We have really fascinating topics and talking to some great people. We Speaker 1 (0:39) have less guests this season, but I think it's because the feedback was everyone likes the banter between you and I, which I think is great, and we can kind of get it. done in like a 30-minute episode, which I think people appreciate. Speaker 2 (0:51) Yeah, yeah. I think we're just going to give you good information that you will have fun listening to. It'll be, you know, light and interesting, informative. And like I said, yeah, the banter is always good. It's always good. I always have questions for Dr. Sandy here. And Speaker 1 (1:07) we tried to do a little bit of mix of, you know, cosmetic and then some, we did a few bit more medical and drug. drug-related ones this season, so I hope you all enjoy that. I think we just have to talk to a little bit what we've Speaker 2 (1:19) been up to since we recorded last season. Well, we went to Uruguay. Yes, that was incredible. To visit our friend, Speaker 1 (1:31) Carmen, who is the Speaker 2 (1:32) ambassador at Uruguay. Yes, we've traveled. I mean, you've done a ton of Speaker 1 (1:37) travel, so have I, and most recently. Rome. So I went to Rome for a month, yeah, to write. So I got, I'm writing the second edition of my book, Beyond Soap. So I wrote it in the revisions in Rome for the month of February, which was awesome. Speaker 2 (1:51) Yeah. Speaker 1 (1:52) And you're traveling soon as well. Yeah. Well, and we Speaker 2 (1:57) have in June, we are going to be in hiking the Scottish Highlands. Exactly. I'm looking forward to that, to do that with you. Yeah. Speaker 1 (2:06) Very, very excited. Maybe we'll get a few episodes out of it. Oh, definitely. Episode ideas. Yeah. Yeah, yeah, definitely. I love it. Anyway, we are so excited about this episode and now we're going to dive into today's topic. Thank you so much. Speaker 1 (2:24) Welcome back to Skin To It. I'm Dr. Sandy Scott-Nickey, board-certified dermatologist. And I'm Marlo Speaker 2 (2:30) Sutton, fashion stylist and skincare enthusiast. Funny that I have to read that. Today, we're tackling something so many people deal with, facial redness. It's huge. It is. It's Speaker 1 (2:42) huge. Speaker 2 (2:44) Obviously, it's not just one thing. It's what we're going to learn about today, many different causes. And I think a lot of people are going to be excited to learn what they can do Speaker 1 (2:54) for their patients. Speaker 2 (2:54) This is going to be a well-listened-to episode. Speaker 1 (2:56) For Speaker 2 (2:56) sure, for sure. Speaker 1 (2:57) So before we jump in, I want to acknowledge our sponsor. This episode of Skin To It is brought to you by Bioderma, a dermatology-driven skincare company known for its science-based approach to supporting the skin's natural barrier. Bioderma develops products based on the principle of eco-biology, designed to work with the skin's natural biology to help maintain healthy, balanced skin. Marla and I also want to give a shout out to Bioderma for sponsoring our first two seasons, really getting us going on this journey. And so we're forever thankful for them for that. Thank you very much. Yep. Speaker 2 (3:31) Okay, we want to get right into it. And, you know, I love your stories. Speaker 2 (3:36) I'm sure you have so many people who've come into your office with facial redness. So maybe let's kind of jump right in. And so someone comes to your office and they're complaining about this. And what's the first thing that you're going to do? Speaker 1 (3:51) One of the things that's really important is, and my kids often make fun of me, like, Mom, you're not really a doctor, you're a dermatologist. And yes, I am a doctor. I went to medical school. I did four years of dermatology. Speaker 2 (4:01) Yeah, exactly. Speaker 1 (4:02) So we have to, when I see somebody with a red face, we take a history. We have an exam. History is very important because there are some weird causes of facial flushing. I mean, the most common cause, which is what we're Speaker 2 (4:15) going Speaker 1 (4:15) to talk a lot about, but there are other things that you have to not take for granted. So I talk about about their skincare regime. I talk about, are they using retinoids? What are their over-the-counter products they're using? And medications. Some medications, do you know that vitamin B3, which is niacin, can cause flushing? Speaker 2 (4:32) So I've had Speaker 1 (4:33) some people that it doesn't, and it doesn't always happen right away, can happen an hour or two later. And it's a real significant burn, right? And so you have to, if you, if there's listeners out there that like... and you have that, you've got to take a slow release. Speaker 2 (4:47) Okay. Speaker 1 (4:48) There's also some very rare internal systemic diseases that cause flushing and blushing, something called pheochromocytoma, some gut disorders. Say that three times fast. Yeah, you have to, so you do take a history. And then I think we were talking about earlier about we're doing a dermatology detective episode in a few. This is my Speaker 2 (5:08) favorite thing. I'm so excited about that. So Speaker 1 (5:09) I had this one patient come in and she was challenging because she'd seen a lot of derms. She had this persistent red face and burning. And we tried a whole bunch of things. I said, okay, listen, try my product elimination diet where you're going to remove all your products because I'm really not sure what's going on here. And she was a real natural lover. She liked to use things that weren't synthetic, et cetera. We're not going to go down that rabbit hole. But she came back a few weeks later and she was so happy. And she said, you know what? I was doing great. And I reintroduced my frankincense oil. She was using... straight up frankincense essential oil on her face. And within a few hours, she started to get this huge burn. And it actually can be a bit photo accentuated, I think. So it was also that when she went outside. So it was the frankincense oil. So these things, you know, won't come up unless you actually take a good history. Speaker 2 (6:00) Interesting. So obviously, you've kind of answered my next question that diagnosing this is not totally straightforward. It's not straightforward. Speaker 1 (6:09) It can be a Speaker 2 (6:09) little bit tricky. Speaker 1 (6:09) But I mean, the majority are. Some sort of rosacea or sun damage. Speaker 2 (6:14) Right. So, yeah, I guess what I didn't realize, too, is that, I mean, obviously I know rosacea is the redness in the skin, but it can also burn. Speaker 1 (6:22) Burn, yeah, yeah. So there's basically, so as we just said, one of the most common causes of facial redness is a disease called rosacea. It can also be acne rosacea. It affects about 1 to 20. It was funny, I was reviewing the literature, 1 to 20%. It's Speaker 2 (6:37) a Speaker 1 (6:37) big... That's a big range, yeah. But Speaker 2 (6:39) it Speaker 1 (6:39) depends on countries. It depends on, you know, because it's very ethnic-driven, like Celtic background, sort of fair-eyed, fair-skinned people are more common. So you're going to have different percentages in different populations around the world, right? So, yeah. So what does it actually look like? Well, if we want to get a little technical, there's four subtypes. So the type that— Let's get Speaker 2 (6:59) technical, Sandy. Let's get technical. Speaker 1 (7:01) Can you say Speaker 2 (7:02) erythrotelangiectatic? Speaker 1 (7:05) Erythrotelangiectatic. Very good. So erythema in Latin means red. Telangiectatic means little blood vessels that you can see. Telangiectasia is a little blood vessel. Some people just have redness. They Speaker 2 (7:17) don't Speaker 1 (7:17) have the other parts. So there's kind of four parts to rosacea. You can get pimples. You can get pustules. You can have flushing. You can just be red. And some people get ocular rosacea. So it can affect. There's a big oil gland on the top of