Snapshot A 30-year-old woman presents with complaints of redness in her face, especially in her cheeks. She notes that it is worse after sun exposure. She has a history of unspecified joint pains but no other symptoms. Physical exam shows some pustules and papules on her cheeks. Introduction Common facial dermatosis vascular (flushing, blushing, telangiectasias) inflammatory (papules, pustules) Cause is unknown Exacerbated by hot foods and drinks spicy foods alcohol heat sun Epidemiology most commonly in adults can occur in children, though rare Presentation Skin findings facial eruption forehead cheeks nose around the eyes erythema with telangiectasias flushing papules and pustules may appear Non-skin findings ocular symptoms (> 50% of patients) conjunctivitis with lacrimation telangiectasias of eyelid blepharitis meibomian gland dysfunction Evaluation Diagnosis is usually based on clinical exam and history Biopsy to rule out lupus if indicated Differential Acne vulgaris Pustular tinea Folliculitis Lupus erythematosus Treatment Lifestyle modifications avoid spicy foods avoid hot food/drinks avoid sun exposure and use sunscreen Pharmacologic topical metronidazole topical sulfacetamide brimonidine the best treatment for persistent flushing alpha-2 agonist, causes vasoconstriction systemic antibiotics like tetracycline for resistant or ocular symptoms isotretinoin for chronic or relapsing cases Prognosis, Prevention, and Complications Disease course varies chronic condition Complications recurrence of disease or resistant disease