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The Truth Behind Skin Redness

Cynthia Price, MD July 2014 issue of Skin Inc. magazine
The Truth Behind Skin Redness

The technical explanation for the redness seen in the skin of many clients is simply a heightened intolerance to topical products or external factors. This can be driven by a number of conditions—primarily rosacea, impaired barrier function, atopic dermatitis and poor lifestyle choices. Although there are still mysteries behind the causes of some of these challenges, there are also solid treatment guidelines available to alleviate them. The many myths and misconceptions that exist around skin sensitivity and redness make successful treatment difficult. Each condition will be reviewed in this article, as well as the gold standard for its treatment, and the myths that can cause confusion and improper treatment of redness will be dispelled.

What causes skin redness?

Erythema is characterized by redness of the skin or mucous membranes, caused by hyperemia of the superficial capillaries. Erythema is typically a result of the aforementioned skin conditions, skin injury, infection or inflammation. Sensitive skin conditions often present with some degree of visible redness and inflammation, which can cause clients some discomfort. Integrating topical anti-inflammatory ingredients to help combat redness will often also improve microcapillary function by suppressing the proinflammatory mediators, vascular endothelial growth factor (VEGF) and prostaglandin E2 (PGE2), and inhibit the production of inflammatory cytokines. Persistent erythema is usually a result of one or several of the following:

  • VEGF, which encourages microcapillary hyperpermeability (leakiness);
  • PGE2, which induces microcapillary dilation (capillary enlargement); and
  • Proinflammatory cytokines, the immune-activated cells involved in the amplification of inflammatory reactions.

Ingredients with higher levels of omega-3 and omega-6 essential fatty acids act as potent anti-inflammatory agents. Specific support ingredients assist in calming and soothing the skin. These anti-inflammatory and calming ingredients include:

  • Bisabolol, which is the active component in chamomile that provides anti-inflammatory benefits;
  • Evening primrose oil as a source of omega-3 gamma-linolenic acid (GLA), which provides both redness-reducing and anti-inflammatory benefits;
  • Menthyl lactate to soothe and cool irritated skin; and
  • Willow bark extract, a natural analgesic related to aspirin that also acts as a soothing and calming agent.

Because barrier function can be greatly reduced in those suffering with a sensitive skin condition, maintaining adequate epidermal moisture is imperative. To effectively hydrate the skin, a moisturizing product must contain humectant and occlusive ingredients.

Common skin conditions exhibiting redness

The most common sensitive skin conditions that are characterized by redness are rosacea, impaired barrier function, atopic dermatitis and unhealthy skin due to smoking. Although each of these conditions has a different etiology behind the appearance of redness, the treatments can often be quite similar. (See Treatment How-to: Redness-Prone Sensitive Skin Facial for a universal redness service.)

Rosacea. This chronic condition is seen most frequently in women between the ages of 30 and 50, but it affects men much more destructively. According to the National Rosacea Society, the vascular disorder of rosacea affects more than 16 million people annually, and can only be controlled and not cured.1, 2 Those with rosacea tend to get red quite easily and that redness persists throughout long periods of time. Severe dryness is also common in rosacea-sufferers. Rosacea is seen in four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous and ocular. Clients may have multiple subtypes simultaneously, but each subtype involves varying degrees of redness.

Impaired barrier function. In addition to redness, those with impaired barrier function usually suffer from acute moisture loss, irritation and general hypersensitivity. This condition is a result of a disruption of the stratum corneum (SC), leading to a reduction in its ability to retain moisture within the skin, and reduced support of the production and maintenance of the skin’s natural moisturizing factor (NMF) and pliability. The NMF is comprised of a mixture of low-molecular-weight, water-soluble compounds formed within corneocytes, and it is critical to maintaining the moisture and flexibility of human skin. A disruption in the SC also leads to an increase in transepidermal water loss (TEWL), elevating skin dryness.

Impaired barrier function is usually caused by the overuse of aggressive topical products, use of excessive topical perfumes in products and harsh environmental factors. Redness is a key visible indicator of impaired barrier function.

Atopic dermatitis. A personal history of allergies can be a common factor in the development of atopic dermatitis. This condition is characterized by redness, hypersensitivity, irritation, pruritus (itching) and eruptions of rashlike lesions. More than 90% of atopic dermatitis cases have a bacterial presence, and it may leave those affected more prone to viral infections and superficial fungal infections.3

Lifestyle choices affecting redness. Smoking is one of the most avoidable lifestyle choices that cause skin redness, aside from unnecessary UV exposure. Smoking one cigarette constricts capillaries, and robs the skin and vital organs of needed oxygen for up to 90 minutes. If a person smokes more than one cigarette in this time period, or even one every 90 minutes, the skin becomes chronically starved of oxygen. At this point, the body begins angiogenesis, the development of additional capillaries, in an attempt to bring oxygen to the starved skin, leading to a reddened appearance with sporadic broken, visible capillaries.

The overuse of aggressive topical products can often lead to acute and chronic redness, even if no known sensitivities or sensitive skin conditions exist. Additional lifestyle considerations for clients suffering from varying degrees of redness include avoiding spicy foods; hot liquids; alcohol and topical products containing alcohol; smoking; hot baths and showers; sun exposure; and high concentrations of aggressive topical ingredients, such as benzoyl peroxide and glycolic acid. Clients experiencing redness should also consider drinking plenty of water; using only half the amount of laundry detergent that is recommended by the manufacturer; avoiding products with synthetic fragrances or colors; and applying an appropriate moisturizer immediately after showering.

Ingredients that reduce redness

Regardless of which condition is responsible for causing the redness, there are a handful of tried and true ingredients that can mitigate redness, including:

  • Ascophyllum nodosum extract from brown algae, which reduces VEGF and PGE2 expression when combined with Asparagopsis armata extract; and
  • Capparis spinosa fruit extract from caper bud extract, which inhibits the production of proinflammatory cytokines.

Additionally, corticosteroids may be used to reduce inflammation and soothe the discomfort that often accompanies erythema. As with aforementioned conditions, every client should use a broad spectrum SPF of 30 or greater every day. When it comes to skin conditions involving redness, the barrier function is often impaired, allowing for a higher risk of UV-induced inflammation, which can worsen many of the sensitive skin conditions skin care professionals aim to treat. This increased inflammatory response can further weaken damaged capillaries and lead to increased vasodilation. Proper UV protection can help mitigate these negative outcomes.

There are many causes of acute and chronic skin redness. As a skin health professional, it is imperative to identify the main cause of the redness; however, there are standards of care that are effective to minimize redness, regardless of its cause.



(All accessed Apr 23, 2014)

Cynthia Price, MD, is a board-certified dermatologist, pediatrician and fellowship-trained pediatric dermatologist practicing out of Scottsdale, AZ. She is a fellow of the American Academy of Dermatology and the American Academy of Pediatrics, as well as a member of many other medical organizations. Price is an educator for PCA Skin.


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Treatment How-to: Redness-prone Sensitive Skin Facial

This protocol is designed to soothe sensitive skin conditions and to alleviate persistent redness.

Cost: $75–150

Duration: 30–40 minutes

Contraindications: Check for any allergies to ingredients in this treatment during client consultation.




Equipment and supplies needed:

Cotton pads

Warm water


Products needed:

Cleanser (lactic acid, gluconolactone and aloe vera)

Cleansing bar (resorcinol, pumpkin seed oil, honey and vitamin E)

Toner (lactic acid and pumpkin wine extracts)

Hydrating mask (oat kernel extract, Arnica montana and cucumber fruit extracts)

Hydrating serum (glycerin, sodium PCA and niacinamide)

Corrective product (red and brown algae, caper bud extract and bisabolol)

Antioxidant-based massage medium (vitamins and essential fatty acids)

Calming product (allantoin, aloe vera and mushroom extracts)

Moisturizer (jojoba seed oil, hydrolyzed silk, squalane and vitamin E)

Broad-spectrum sunscreen (siybin and caffeine)

Step 1: Cleanse the area of treatment thoroughly with cleanser. Rinse and pat dry.

Step 2: Using the cleansing bar, cleanse the skin a second time. Allow the lather to remain on the skin for approximately two minutes. Remove with cotton pads dampened with warm water.

Step 3: Using a cotton pad, prep (degrease) the skin with the toner. Allow the skin to dry. Evaluate the client’s sensitivity by asking, “On a scale from 1 to 10, 10 being extremely active, how do you rate this sensation?”

Step 4: Using gloved hands, massage the hydrating mask into the skin to address impaired conditions of all kinds. For increased moisture retention, allow the mask to remain on the skin for up to 10 minutes before removing thoroughly with dampened cotton pads.

Step 5: Apply the hydrating serum to encourage ceramides, essential fatty acid and moisture retention.

Step 6: Soothe red and irritated skin by applying the corrective product.

Step 7: Perform a circulation-enhancing massage using the massage medium.

Step 8: Enhance the treatment by applying the calming product

Step 9: Seal in moisture using the moisturizer.

Step 10: Protect delicate skin from UV rays by applying the sunscreen.

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