Why Your Face Flushes in the Cold, and Where Rosacea Comes In
Almost everyone flushes when they come in from the cold. For some people the colour does not fade, or comes back after a glass of wine, a hot drink or an argument, and settles into a permanent redness across the cheeks and nose. That is the point at which an ordinary reflex has become a condition, and the colder months, with their swings from freezing air to heated rooms, are when it tends to show.
Almost everyone goes red in the face when they come in from the cold. For some people the colour does not fade, or comes back after a glass of wine, a hot drink or a row, and slowly turns into a permanent redness across the cheeks and nose. That is the point where an ordinary reflex has become a condition, and the colder months, with their swing from freezing air to heated rooms, are when it tends to show.
Flushing and rosacea: the essentials
The short version
Blood vessels in the skin widening to release heat, then reacting to sudden changes in temperature
The blood vessels in your skin widening to let heat out, then reacting to sudden changes in temperature.
A chronic inflammatory condition of the central face, affecting more than 14 million Americans
A long-lasting inflammatory condition of the middle of the face, affecting more than 14 million Americans.
Flushing, persistent redness, visible vessels, acne-like bumps, sensitivity, and sometimes eye symptoms
Flushing, redness that stays, tiny visible veins, pimple-like bumps, sensitive skin, and sometimes sore, gritty eyes.
Heat, cold wind, alcohol, spicy food, sun, stress and irritating skin care
Heat, cold wind, alcohol, spicy food, sun, stress and harsh skin products.
They calm the inflammation and the bumps, but cannot remove vessels that are already permanently widened
They calm the inflammation and the bumps, but they cannot remove tiny veins that have already widened for good.
A vascular laser such as VBeam, absorbed by the blood in the vessel, performed here by Dr. Gallacher
A vein laser called VBeam, which is taken up by the blood in the tiny vein. Dr. Gallacher does this herself.
What a flush actually is
What a flush really is
The skin of the face is one of the body’s main radiators. When the body needs to lose heat, the small vessels just under the surface widen, bring warm blood close to the skin and give off heat, and the face goes red. The reverse happens in the cold: the vessels narrow to conserve heat, and when you come back into warmth they widen again, often sharply. That rebound is the flush you see after a winter walk.
The skin of your face is one of the body’s main radiators. When you need to lose heat, the tiny blood vessels just under the surface widen, bring warm blood close to the skin and give off heat, and your face goes red. In the cold the opposite happens: the vessels narrow to keep heat in, and when you come back into the warm they widen again, often sharply. That rebound is the flush you get after a winter walk.
In most people the vessels widen and then settle, and nothing is left behind. The difference in rosacea is one of degree and persistence. The system that links the nerves, the vessels and the immune cells of the facial skin is over-reactive, so the vessels widen more easily and more strongly, and over years they can stay widened. The result is a flush that lasts longer each time, and eventually a redness that does not go away.
In most people the vessels widen and then settle, and nothing is left behind. In rosacea the difference is one of degree and staying power. The system that links the nerves, blood vessels and immune cells in the skin of the face is over-reactive, so the vessels widen more easily and more strongly, and over the years they can stay widened. The flush lasts longer each time, and eventually the redness does not go away.
Where rosacea comes in
Where rosacea comes in
Rosacea is a chronic inflammatory condition that mainly affects the central face. It often begins in the thirties or forties, affects all skin tones although the redness is harder to see in richer ones, and is distinct from acne even though the bumps can look similar. In the current expert classification, persistent redness across the centre of the face that is periodically intensified by triggers is enough to make the diagnosis, and other features, including flushing, bumps, visible vessels and eye symptoms, add to the picture.
Rosacea is a long-lasting inflammatory condition that mainly affects the middle of the face. It often begins in your thirties or forties, it affects every skin tone although the redness is harder to see in richer ones, and it is not the same as acne even though the bumps can look alike. In the current expert classification, redness across the centre of the face that stays and gets worse with triggers is enough for a diagnosis, and other signs, including flushing, bumps, visible veins and eye symptoms, add to the picture.
It is not caused by poor hygiene, and it is not simply a consequence of drinking. Those are common beliefs that cause real distress. Heat, sun, alcohol, spicy food and stress are triggers that make the flush worse in people who already have the tendency, which is a different thing from causing the condition.
It is not caused by poor hygiene, and it is not simply the result of drinking. Those are common beliefs that cause real upset. Heat, sun, alcohol, spicy food and stress are triggers that make the flush worse in people who already have the tendency, which is a different thing from causing the condition.
Eye involvement is easy to miss. Dryness, a gritty feeling, redness of the eyelid margins or recurrent styes can be part of rosacea, and they deserve an assessment of their own and not only treatment of the skin.
Eye problems are easy to miss. Dry, gritty eyes, red eyelid edges or styes that keep coming back can be part of rosacea, and they need looking at in their own right, not only treating the skin.
Why the colder months and the holidays are harder
Why the colder months and the holidays are harder
Autumn and winter combine several triggers at once. Cold wind and low humidity dry and irritate the cheeks, indoor heating and hot showers push the vessels the other way, and the holiday season adds alcohol, rich and spiced food, hot drinks, late nights and stress. None of these is dramatic alone. Together, and in quick succession, they give a sensitive face no time to settle.
Autumn and winter bring several triggers at once. Cold wind and dry air irritate the cheeks, indoor heating and hot showers push the vessels the other way, and the holiday season adds alcohol, rich and spicy food, hot drinks, late nights and stress. None of these is dramatic on its own. Together, and one after another, they give a sensitive face no time to settle.
Practical changes help more than most people expect. Many find a scarf over the cheeks in wind, lukewarm rather than hot water, cooling down gradually when coming indoors, and a gentle, fragrance-free cleanser and moisturiser make a visible difference. A daily broad-spectrum sunscreen matters all year, because sun is among the commonest triggers. Scrubs, strong acids and over-exfoliation tend to make a reactive face worse, a pattern also described in The Twenty-Micron Wall That Keeps You Alive.
Practical changes help more than most people expect. Many find that a scarf over the cheeks in wind, lukewarm rather than hot water, cooling down gradually when you come indoors, and a gentle, unperfumed cleanser and moisturiser make a visible difference. A daily broad-spectrum sunscreen matters all year, because sun is among the commonest triggers. Scrubs, strong acids and over-exfoliating tend to make a reactive face worse, a pattern also described in The Twenty-Micron Wall That Keeps You Alive.
It is useful to notice your own pattern rather than follow a generic list. Some people flush with red wine and not with spirits, some with heat and not with spice, and a short diary over a few weeks often shows which triggers are yours.
It helps to notice your own pattern rather than follow a general list. Some people flush with red wine and not with spirits, some with heat and not with spice, and a short diary over a few weeks often shows which triggers are yours.
What helps, and what cannot
What helps, and what cannot
Treatment targets the specific features present, because inflammation, redness, vessels and eye disease each need something different. Prescription creams and, when needed, tablets treat the bumps and the inflammation, and gentle skin care and trigger control reduce the load. What they cannot do is remove a blood vessel that has become permanently widened, and they do not clear the fixed background redness those vessels create. This is the point at which many people conclude their treatment has failed, when it has in fact done its job.
Treatment is aimed at the particular signs you have, because inflammation, redness, tiny veins and eye problems each need something different. Prescription creams and, when needed, tablets treat the bumps and the inflammation, and gentle skin care and avoiding triggers lighten the load. What they cannot do is remove a tiny blood vessel that has widened for good, and they do not clear the fixed background redness that those vessels cause. This is where many people decide their treatment has failed, when it has actually done its job.
For persistent redness and visible vessels the tool is a vascular laser. VBeam is a 595 nm pulsed dye laser whose light is absorbed by the haemoglobin inside the vessel and much less by the skin around it, so the vessel is heated and closed and the body clears it, as set out in What a Laser Actually Does to a Blood Vessel. Diffuse redness can be treated across the cheeks and nose, and individual vessels can be traced one at a time in the same visit. Improvement builds over the weeks after a session, and the number of sessions is set for the individual.
For redness that stays and tiny veins you can see, the tool is a vein laser. VBeam is a pulsed dye laser whose light is taken up by the blood inside the vessel and much less by the skin around it, so the vessel is heated and closed and your body clears it away, as explained in What a Laser Actually Does to a Blood Vessel. Spread-out redness can be treated across the cheeks and nose, and individual veins can be traced one at a time in the same visit. The improvement builds over the weeks after a visit, and how many visits you need is worked out for you.
Redness and swelling after treatment generally last a day or two. Skin tone matters, because pigment competes with haemoglobin for the light. VBeam works very well on fair skin and moderately well on olive skin, while in richer skin tones more of the light is absorbed by pigment, which reduces the effect and raises the risk of a pigment change, so suitability is assessed first and a different approach may be advised. Laser treatment improves the vessels and the fixed redness. It does not switch off the tendency to flush, so trigger control and skin care continue alongside it.
Redness and swelling after treatment usually last a day or two. Skin tone matters, because colour in the skin competes with blood for the light. VBeam works very well on fair skin and moderately well on olive skin, while in richer skin tones more of the light is taken up by the skin’s own colour, which weakens the effect and raises the risk of colour change, so suitability is checked first and a different approach may be advised. Laser treatment improves the veins and the fixed redness. It does not switch off the tendency to flush, so avoiding triggers and gentle skin care carry on alongside it.
When redness is not rosacea
When redness is not rosacea
Facial redness has several other explanations. Seborrhoeic dermatitis, contact dermatitis, acne, a reaction to a medicine and, less commonly, a lupus-type rash can all resemble it, and menopause can cause flushing that has nothing to do with the skin condition. The distinction matters because the treatments differ and some, such as a steroid cream used on the face, can make rosacea considerably worse.
Facial redness has several other explanations. Flaky dermatitis around the nose and brows, a reaction to something you have put on your face, acne, a reaction to a medicine and, less often, a lupus-type rash can all look similar, and the menopause can cause flushing that has nothing to do with the skin condition. It matters because the treatments differ, and some, such as a steroid cream on the face, can make rosacea a good deal worse.
Flushing that comes with other symptoms, such as wheezing, diarrhoea, fever or unexplained weight loss, should be assessed medically and not assumed to be rosacea. A dermatologist examines the pattern, the triggers and the eyes, and rosacea is usually diagnosed from that alone, without tests.
Flushing that comes with other symptoms, such as wheezing, diarrhoea, fever or weight loss you cannot explain, should be checked by a doctor and not assumed to be rosacea. A dermatologist looks at the pattern, the triggers and the eyes, and rosacea is usually diagnosed from that alone, without tests.
Questions patients ask
Does alcohol cause rosacea?
Does drinking cause rosacea?
No. Alcohol is a common trigger of flushing in people who already have rosacea, but it is not the cause, and many people with rosacea drink little or nothing. Noticing whether it is one of your own triggers is more useful than assuming it is.
No. Alcohol often sets off flushing in people who already have rosacea, but it is not the cause, and many people with rosacea drink little or nothing. It is more useful to notice whether it is one of your own triggers than to assume it is.
Can rosacea be cured?
Can rosacea be cured?
It can be controlled, often very well, but it commonly relapses, so a cure cannot be promised. Treatment aims to keep the inflammation quiet, clear the vessels and redness that can be cleared, and reduce the trigger load, with maintenance when it is needed.
It can be kept under control, often very well, but it commonly comes back, so a cure cannot be promised. Treatment aims to keep the inflammation quiet, clear the veins and redness that can be cleared, and reduce your triggers, with upkeep when it is needed.
Will a laser stop my flushing?
Will a laser stop my flushing?
A laser treats the vessels and the fixed redness they create, and that often makes a flush less visible. It does not remove the underlying tendency to flush, which is why skin care and trigger control continue after laser treatment.
A laser treats the tiny veins and the fixed redness they cause, and that often makes a flush less noticeable. It does not remove the underlying tendency to flush, which is why skin care and avoiding triggers carry on after laser treatment.
Is VBeam suitable for darker skin?
Is VBeam suitable for darker skin?
It can be, but less straightforwardly. In richer skin tones more of the light is absorbed by pigment rather than by the vessel, which reduces the effect and raises the risk of a pigment change. Suitability is assessed individually, and a different approach may be recommended.
It can be, but less simply. In richer skin tones more of the light is taken up by the skin’s own colour instead of the vein, which weakens the effect and raises the risk of colour change. Whether it suits you is decided individually, and a different approach may be advised.
Can I put hydrocortisone on red cheeks?
Can I put hydrocortisone on red cheeks?
It is better not to, without a diagnosis. Steroid creams on the face can thin the skin and trigger or worsen a rosacea-like rash, and they can hide a condition that needs a different treatment. Persistent facial redness is worth having examined first.
It is better not to, unless a doctor has diagnosed the problem. Steroid creams on the face can thin the skin and set off or worsen a rosacea-like rash, and they can hide a condition that needs a different treatment. Redness on your face that will not go away is worth having examined first.
- Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148-155. Source
- Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220(4596):524-527. Source
Talk it through with a physician first.
Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.
This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.
