Facial Redness

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 20.1 lists those cosmeceuticals that are currently used in moisturizers designed to improve facial redness. At present, there are no good cosmeceutical vasoconstrictors that deal with the vasoactive component of facial redness; however, brimonidine (Mirvaso, Galderma) has been approved in the prescription realm. This gel delivers a vasoconstrictor to the skin surface with an effect lasting 8–12 hours. Topical brimonidine is perhaps the first prescription cosmeceutical because it has no permanent effects on the skin and is highly useful in redness reduction, leading to appearance improvement. On the other hand, some cosmetic companies have adopted the prescription concept of topical corticosteroid-induced vasoconstriction by incorporating 0.5% hydrocortisone into facial redness formulations. While topical hydrocortisone may induce some redness reduction, chronic facial exposure to corticosteroids is not recommended and the dermatologist is encouraged to examine cosmeceutical redness-reducing products carefully.

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 B ₅ , 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 20.1 . Patients can take this list to the cosmetic counter or spa and select those products that contain the ingredients listed.