The most likely diagnosis of a chronically red face is rosacea. It is usually bilaterally symmetrical and most common in females of Celtic origin. There are two peaks in age of onset - 20's to 30's and the 40's to 50's.
Rosacea starts with episodic flushing which gradually gives way to a fixed erythema.
Persistent telangiectasia develops in the affected area and acute inflammatory episodes may occur with the formation of non tender papules and pustules. The role of the Demadex follicularum mite in the pathogenesis of rosacea is still unclear but a local delayed hypersensitivity response to Demadex antigens may be partly responsible for the inflammatory component. Precipitants Precipitating stimuli for rosacea include heat, UV light, spicy foods, stress, exercise, alcohol and hot tea or coffee. Management Management involves identifying and avoiding any precipitating factors. All sources of heat, such as excessively hot baths or showers, saunas, direct radiant heat and hot beverages should be avoided.