Skin with Redness and Visible Vessels

Redness or small visible vessels are skin symptoms caused by an abnormality in the face’s venous system and a sign that it is not working normally. Redness, with or without heating, can be temporary or longer lasting.

Certain factors aggravate the condition:

  • Experiencing drastic temperature variations (hot-cold);
  • Consuming hot and spicy food, alcohol, etc.

Rosacea and couperosis, which is a form of rosacea, most often cause redness and visible vessels to appear on the face, however these aren’t the only causes. Certain dermatological diseases that cause dilated blood vessels stimulate couperosis and flushing can correspond to underlying diseases that must be explored. In addition, certain medications can cause vascular dilations to appear on the face or increase those already present. A dermatological consultation is therefore warranted if there are doubts.

Couperosis is a dilation of small superficial skin vessels in the papillary dermis. The papillary dermis refer to the uppermost layer of the dermis and is highly vascular, feeding nutrition to select layers of the epidermis. The medical term corresponding to vascular dilation is telangiectasias.

The network of superficial vessels forms a "capillary system" made of reddish linear lines on the face. Some of this network’s parameters may vary, depending on the person and his/her skin type, the age of the process, and the internal, external or changes in temperature. The vessels are more or less wide and their colour ranges from bright red to purple or even bluish.

The topography varies but is usually relatively symmetrical on the face. Sometimes only the nostrils are affected, but can more commonly be seen across the cheekbones or the cheeks. In severe cases however, telangiectasias may present across the entire face.
When the tree branches in telangiectasias are difficult to see with the naked eye and redness dominates; this is called erythrosis.

Woman looking at her skin in the mirror

The general term describing the condition mid-way between the two variants is erythro-couperosis.
A spider angioma may be observed with couperosis. This is a star-shaped vascular tree containing a more or less raised central red spot.

In most cases, couperosis is not related to any underlying disease; it appears slowly and progressively over time. Couperosis is a form of rosacea and flushes may occur before it appears. 

The other signs of rosacea are erythrosis and possibly red papules (small spots) or pustules. 

Woman with hair in the wind
  • In most cases couperosis is hereditary however some exterior factors, such as variations in weather conditions and exposure to intense sun and cold, can cause it to appear.
  • Contrary to popular belief, alcohol does not directly cause couperosis or rosacea however those with this condition may find that alcohol consumption can aggravate symptoms.

This is due to its effect on englarging the body's blood vessels allowing more blood to flow into the papillary dermis.

Who is affected by couperosis?

Coupersis can affect any skin type although people with fair, thin skin are more often affected. 


What are the symptoms of rosacea?

Rosacea is a common dermatological condition that only affects the face, particularly the nose, cheeks, forehead and chin. In rarer cases, the eyes may also be affected and this is referred to as ocular rosacea. This visible skin condition is often psychologically challenging because it causes disfiguration and is frequently mistaken for a sign of chronic alcoholism.


Three different forms, three symptom types

Step 1

1/ The vascular form: erythrosis and couperosis

It appears as redness on the face, with or without couperosis (small dilated blood vessels on the cheeks and nose, called telangiectasias). This redness may sporadically be accompanied by vasomotor flushes, i.e. sensations of hot flushes on the face that quickly dissipates.

Step 2

2/ The papulo-pustular form

Erythrosis is combined with flare-ups of pimples that resemble acne (red spots and small pustules, but no comedones), still found exclusively on the face. This may also be referred to as acne rosacea. While the small pimples may resemble acne, they are not caused by an imbalance of bacteria and excess sebum production causing comodones. For this reason, the term "acne rosacea" is inaccurate and is being phased out.

Step 3

3/ The hypertrophic form

This form is mostly characterised by a large, bumpy nose and is much rarer. Medically termed rhinophyma is an advanced type of rosacea that almost exclusively affects men. Unlike what many people think, this is not related to alcohol consumption. 

What causes rosacea?

While the main underlying cause of rosacea is still unclear, a variety of factors have been observed to play a large role in its progression.

Genetic factors women with fair skin are particularly affected;
External environmental factors exposure to UV rays, temperature changes
Stimulant use Such as alcohol, spices are dominant in the onset of rosacea
Body areas
Abnormal facial vein function seems to be the main cause of flushing
A small parasite Demodex folliculorum, typically found in the skin, can also play a significant role if prevalent. Here it causes an inflammatory reaction.

Who is affected by rosacea?

Rosacea is three times more common in women than in men, and people with fair skin are the most affected.
Symptoms often appear around the age of 30, but it has a peak age of around 50.
A frequent characteristic of rosacea is that it occurs in sensitive skin.

Visit your dermatologist so he/she can confirm the diagnosis and indicate whether you suffer from couperosis, rosacea or another condition.

Doctor with a patient in a medical office

Preventive treatment includes limiting triggering factors, such as temperature changes, UV exposure, hot drinks, spicy dishes, coffee and alcohol. Alcohol does not cause this condition, but consuming it may exacerbate symptoms.
If flushing occurs, doctors recommend letting an ice cube melt in your mouth during the first few minutes of flushing.

Bioderma - Woman protecting from the sun

Certain medicated treatments may be prescribed by the doctor:

  • Locally, metronidazole as a gel, cream or compound.
  • Orally, antibiotics (tetracycline), generally over a three-month period, in cases of papulo-pustules or ocular rosacea.

That said, rosacea is not cured by these treatments due to its progression from flare-ups and local treatments need to be maintained continuously.
Redness is difficult to treat; however, laser treatments are particularly beneficial, especially pulse dye lasers, Nd Yag and KTP. The various types of vascular lasers are described below.

Woman taking medication

The preferred treatment for couperosis is laser treatment. This technique has significantly changed the management of this problem. There are several types of laser treatments for vascular lesions, i.e. laser treatments that specifically target the vessels and the haemoglobin found in red blood cells: KTP laser which particularly acts on the tree branches of couperosis, Nd:YAG laser, and pulse dye lasers which also act on erythrosis and spider angiomas.

Woman having skin therapy

Dermo-cosmetic treatments are useful for all cutaneous forms of rosacea and couperosis; they should be moisturising, soothing, non-occlusive and intended for sensitive skin. It is  important to use appropriate cleansing products and ideal if they have vasculoprotective properties. Depending on where you live, limiting contact with tap water may also be recommended.

'Hard water' contains higher levels of calcium and magnesium which can leave the skin feeling feeling dry and cause changes in its pH balance. The daily use of sunscreen is also recommended.

Bioderma - woman applying cream on the face