Facial Redness

Published on 15/03/2015 by admin

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Last modified 22/04/2025

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Chapter 23 Facial Redness

Zoe Diana Draelos

Facial redness can be due to a variety of dermatologic causes including rosacea, physiologic flushing, telangiectasias, eczema, seborrheic dermatitis, psoriasis, irritant contact dermatitis, etc. All of these conditions have in common activation of the inflammatory cascade, which results in vasodilation and the recruitment of white blood cells. Facial redness is minimized by cosmeceuticals functioning as anti-inflammatories and barrier enhancers. Table 23.1 lists those cosmeceuticals that are currently used in moisturizers designed to improve facial redness. At present, there are no good cosmeceutical vasoconstrictors to deal with the vasoactive component of facial redness.

Table 23.1 Cosmeceuticals to minimize facial redness

Cosmeceutical	Effects on skin physiology	Patient selection comments
Prickly pear	Mucilage rich in mucopolysaccharides forms protective film	Extract used in moisturizers, usually does not provide mucilage properties
Aloe vera	Mucilage containing 99.5% water and a mixture of mucopolysaccharides and choline salicylate	Salicylate component functions as topical anti-inflammatory, since mucilage properties lost in most moisturizer formulations
Bisabolol	Chamomile extract prepared by distillation	Potent anti-inflammatory in moisturizers
Allantoin	Comfrey root or synthetic manufacture from uric acid	Used commonly in sensitive skin formulations
Panthenol	Barrier enhancing humectant	Used to hydrate the skin and prevent barrier damage
Tea tree oil	Polyphenols	May cause allergic contact dermatitis
Evening primrose oil	Polyphenols	Purported to be of benefit in atopic dermatitis
Ginkgo biloba	Polyphenol fraction	Ginkgolides, bilobalides are active anti-inflammatories
Green tea	Polyphenols	Epigallocatechin, epigallocatechin-3-gallate are active anti-inflammatories
Saw palmetto	Polyphenols	High concentration needed for efficacy
St John’s wort	Polyphenols	High concentration needed for efficacy

Notice that the facial redness cosmeceuticals fall into several categories. There are those, such as aloe vera and prickly pear, that can function as a mucilage to put a protective coating over the skin, minimizing the effects of barrier damage. Aloe vera further is rich in choline salicylate, a well-known anti-inflammatory present in aspirin. This is the second category of cosmeceuticals for facial redness, the naturally occurring anti-inflammatories. Bisabolol and allantoin also fall into this category as the most commonly used natural anti-inflammatory agents. The third category involves those substances that decrease facial redness by improving the skin barrier. Panthenol, also known as vitamin B₅, is an example of a humectant that decreases skin dehydration and improves barrier function. A better functioning barrier will also aid in facial redness reduction. Finally, the last category is the anti-inflammatory polyphenols, which are quite numerous. The best studied of these polyphenols is green tea, which is the most potent. Many cosmeceuticals for facial redness combine a variety of polyphenols to obtain the final formulation.

Designing a facial cosmeceutical treatment regimen for patients with facial redness can be a challenge. The major problem is that products are introduced to and withdrawn from the marketplace with great rapidity. For this reason, rather than discussing specific product names, I have presented a facial skin care maintenance routine demonstrating which product type should contain which cosmeceutical active to be most effective. These recommendations are listed in Box 23.1. Patients can take this list to the cosmetic counter or spa and select those products that contain the ingredients listed.

Box 23.1 Skin care ingredient recommendations for facial redness

1. CLEANSER SELECTION

• Product description:

Synthetic detergent mild liquid cleanser with excellent rinsability. Removal of any soap residue is critical to preventing irritation. Recommend a product labeled as a sensitive skin foaming face wash.

• Cosmeceutical ingredient:

None in particular, since the short contact time during cleansing would do little for facial redness.

• Rationale:

Mild cleanser to clean skin while minimizing barrier damage.

2. TONER OR ASTRINGENT SELECTION

These are liquid products designed to remove any unwashed soap residue, increase sebum removal, or provide a mild skin moisturizer. These products evaporate quickly from the skin surface and may provide a sensory stimulus that results in flushing and redness. All sensory stimuli should be avoided in patients with facial redness, and toners or astringents are not recommended.

3. MOISTURIZER SELECTION

• Product description:

Cream rather than lotion with minimal water or other vehicle to evaporate from face. Avoid propylene glycol, glycolic acid, salicylic acid, strong fragrances, and products with extensive botanical cocktails. These may evoke facial stinging.

• Cosmeceutical ingredients:

Allantoin, bisabolol, and panthenol.

• Rationale:

Allantoin and bisabolol form the basis for many of the sensitive skin claims in moisturizers, time tested effective ingredients for reducing inflammation. Panthenol is a nonsticky humectant to enhance stratum corneum hydration and prevent or minimize barrier damage.

4. SUNSCREEN SELECTION

• Product description:

Thicker lotion or cream sunscreen labeled for sensitive skin with SPF 15. Avoid gels, water-resistant products, and sticky high SPF products.

• Cosmeceutical ingredient:

Zinc oxide or titanium dioxide.

• Rationale:

Chemical sunscreens absorb UV radiation and transform it to heat, which may invoke facial flushing and vasodilation. Physical sunscreens mainly reflect UV radiation preventing photoaging without a sensory component.

5. TREATMENT MOISTURIZER SELECTION

• Product description:

Cream moisturizer with petrolatum, dimethicone, low levels of glycerin to prevent transepidermal water loss and increase skin hydration, thus enhancing the skin barrier.

• Cosmeceutical ingredient:

• Rationale:

Of all the polyphenols, green tea is the most potent anti-inflammatory and demonstrates the highest efficacy.

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Procedures in Cosmetic Dermatology Series Cosmeceuticals 2e