How To Calm A Skin Freakout

Photograph by Winnie Au.
You know how pretty much all the drama during JoJo’s season of The Bachelorette involved Chad? Redness is the Chad of your complexion — if you’re experiencing any skin drama, you can expect redness to be there. The redness is caused by inflammation, which is essentially blood vessels being temporarily enlarged and sending fluid to an area of irritation. “When you see redness, that means there is more blood filling the blood vessels,” says Neal Schultz, MD, a dermatologist in New York City and creator of DermTV. “The issue is the cause.”

Skin redness is so widespread because there are many sources of inflammation — including injury, heat, emotion, spicy food, allergies, exercise, friction, and the immune system. “These conditions are extremely common. We see them frequently — in more than half of my patients,” says Brian Morrison, MD, a dermatologist in Miami. Seeing red in the form of flushing, rashes, bumps, scaliness, or splotches? Ahead, experts share the reasons behind your redness and how to ensure your skin stays calm, cool, and Chad-less.
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Illustrated by Paola Delucca.
What it looks like:
Skin appears blushed or flushed and might have broken capillaries visible. The areas of redness tend to appear on the cheeks and nose. In less common cases, the flush spreads to the chin and forehead. Generally speaking, rosacea looks like a sunburn that refuses to heal.

Over time, more broken blood vessels appear and the skin develops a ruddier, more persistent flush. Without treatment, the skin might develop bumps and the nose will look lumpy and enlarged from swollen tissue.

What causes it:
An emotional or physical trigger (for example, sun, heat, stress, spicy food, or alcohol) increases blood flow to the skin, dilating blood vessels. As a result, your skin appears flushed and red. The problem is that the blood vessels stay dilated, so over time they stretch and suffer damage — that’s why you eventually see the broken capillaries, Dr. Schultz explains.

“We do not really know why the blood vessels stay dilated,” says Leslie Baumann, MD, founder of Baumann Cosmetic Dermatology in Miami. “There are several hypotheses — mites on the skin, defective protein — but no one really knows.”

How to treat it:
“The most effective treatment is lasers that destroy the chronically enlarged vessels,” Dr. Schultz says. A pulsed-dye laser like the Vbeam can shrink the blood vessels to prevent flushing. For at-home products, the linoleic acid in argan oil helps soothe redness, Dr. Baumann suggests.

“I advise my patients to avoid inflammatory foods,” says Jeanine Downie, MD, founder of Image Dermatology in Montclair, New Jersey. “That means no soy or nuts — a Paleo diet can be helpful in calming rosacea.”

Sunscreen is going to be an essential, because sun damage has proven to contribute to rosacea. So those with rosacea have to be extra vigilant with the SPF to avoid flares and prevent the condition from getting worse. Elta MD UV Clear Broad-Spectrum SPF 46 sunscreen won’t leave a cast and protects sensitive skin.

Cover redness with La Roche-Posay Rosaliac CC Cream for coverage as well as SPF 30. It’s important to cool skin and get flares under control as soon as possible. A calming treatment like SkinCeuticals Phyto Corrective Masque uses anti-inflammatory botanicals and hyaluronic acid to lower the skin temperature in as little as 15 minutes.

“The longer you’re experiencing redness, the more capillaries you develop and the worse the condition will become,” says Diane Berson, MD, associate clinical professor of dermatology at Weill Cornell Medical College in New York City. “The longer you wait, the more difficult treatment will become.” Dr. Berson suggests products containing antioxidants like vitamins C, E, and B. She likes Neocutis Pêche because it combines caffeine, moisturizer, and a vasoconstrictor to target redness from multiple sources.
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Illustrated by Paola Delucca.
What it looks like:
“The prominent trait of acne rosacea is diffused redness with the tendency to have red pimples clustered at the center of the face — regular acne won’t be centralized like this,” Dr. Schultz says. You can expect to see red bumps as well as pus-filled breakouts, but blackheads aren’t usually present in acne rosacea.

What causes it:
Like vascular rosacea, the experts aren’t exactly sure what causes the condition. There appears to be a connection between an excess of demodex mites, organisms that naturally occur on the skin and usually don’t cause any trouble. Some theories suggest that having higher numbers of these mites might cause an immune system response that results in inflammation.

How to treat it:
“We do know that when you use medications to kill the mites or a laser like the Vbeam to shrink the vessels, the pimples get better, so they must be related,” Dr. Baumann says.

Since this is a form of rosacea, you can’t treat the acne as aggressively as you would otherwise — many acne-fighting ingredients can be irritating and cause flare-ups. Dr. Schultz says that acne rosacea is very sensitive to oral antibiotics, and they often help control the breakouts in less than a month.

Dermatologists often prescribe the topicals Finacea or Soolantra to kill microbes and control inflammation. If you have this condition, it's best to go easy on your skin and use gentle ingredients as if you had sensitive skin. Avoid breakouts with Neutrogena Oil-Free Acne Wash Redness Soothing Facial Cleanser, which calms irritation and fights breakouts.

The impulse is to target the acne with drying ingredients, but drying out the skin will aggravate rosacea. Use a gentle moisturizer like L’Occitane Shea Face Comforting Oil to comfort skin and keep it hydrated.
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Illustrated by Paola Delucca.
What it looks like:
You’ll often see defined areas of flaky, scaly skin with underlying redness on the knees, elbows, and scalp. These lesions have a tendency to crack and bleed. “The main difference between psoriasis and other conditions is that the borders are very clear,” Dr. Morrison says. “What is also unique about psoriasis is that the blood vessels are very superficial — if you look closely, you can see the red dots.” Since the vessels are so shallow, psoriasis lesions bleed very easily. The areas also create a burning or stinging sensation, rather than the intense itch those with eczema experience.

What causes it:
Psoriasis is a systemic disease caused by overactivity of the immune system, which leads to an overproduction of skin cells. Skin usually regenerates every 30 days or so. Psoriasis causes cells to turn over 10 times faster. The old cells aren’t able to shed fast enough, so they pile up on the surface creating plaques. Psoriasis is genetic and can be triggered by infections, stress, dry skin, and some medications.

How to treat it:
“First, I have to get through the scaliness of the plaques to address the blood vessels and inflammation,” Dr. Schultz says. “Salicylic and glycolic acids are able to exfoliate without irritation.” He suggests using Neutrogena T/Sal Shampoo and bringing the lather down the body. Topical tar can help slow down skin turnover. Neutrogena T/Gel contains an FDA-approved form of coal tar to treat psoriasis plaques. (Schultz warns that T/Gel isn’t for light hair because the tar can turn hair brassy.) For tough spots to treat, like elbows and knees, doctors might prescribe Sernivo spray.

To address the inflammation, dermatologists often use a cream that contains a form of vitamin D called calcipotriene. Cortisone is often prescribed as well, Dr. Schultz says. But cortisone is a steroid and can cause thinning skin — which leads to more redness and inflammation — so it’s a temporary solution.

A 20-minute soak in an oatmeal bath can take out the sting and soften skin. Make your own by grinding a cup of plain oats in a food processor or blender until you have a fine powder, and adding to warm water. You can also add a quart of whole milk for more anti-inflammatory benefits.
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Illustrated by Paola Delucca.
What it looks like:
Similar to psoriasis, eczema is a chronic rash condition. Where psoriasis often appears on areas where skin is thicker (like elbows and knees), the inflammation from eczema usually develops on the face and neck, as well as sensitive spots inside the wrists, knees, and elbows. The rash doesn’t have clear, defined borders and looks like raised, red skin that itches and often develops blisters and bleeds. (Psoriasis has a crusty, white appearance.) In some instances, the skin becomes broken from the rash and scratching, putting you at higher risk for bacterial and viral infections.

“Eczema is common in children with about 90% of them ‘outgrowing’ the condition by the age of 9,” Dr. Morrison explains. However, adults aren’t immune to eczema.

What causes it:
This is another one where the exact cause isn’t clear, but it appears to be connected to allergies, asthma, dry skin, irritants, and stress. “Eczema has a strong genetic component,” Dr. Morrison says. “A mutation in the filaggrin gene is the known cause of this condition in some people.” Filaggrin is a protein that is important in maintaining a healthy skin barrier. When the barrier is weakened, irritants and allergens are able to enter the skin and cause inflammation.

How to treat it:
“We usually treat this condition with a combination of anti-inflammatory creams such as topical steroids and/or newer calcineurin-inhibitor creams,” Dr. Morrison says. Once the rash and redness are controlled, using moisturizer will help strengthen the skin barrier to avoid future flares. Ingredients like lipids and colloidal oatmeal in Aveeno Eczema Therapy Moisturizing Cream help calm irritation and rebuild the skin barrier.

Doctors might also use UVB light to suppress the immune-system activity in the skin. Phototherapy involves exposing skin to controlled UV light in a light box for about 15 minutes three times a week. “This is one of the few occasions [when] dermatologists encourage some sun exposure,” Dr. Morrison says.

Derms also encourage patients to avoid fragrances (especially in detergents, fabric softeners, and dryer sheets), since they can cause flares of eczema. Hot water also dries out the skin, so lukewarm water is preferred for bathing. Avoid harsh lathering agents and keep the skin moisturized with a body wash like Cetaphil Eczema Calming Body Wash or Mario Badescu Cucumber Cream Soap.

Amp up your moisturizing game to help repair the skin barrier and prevent further irritation. Look for petrolatum, hyaluronic acid, and peptides to heal a stressed skin barrier. Erno Laszlo Phormula 3-9 Repair Balm contains glycosaminoglycans that speed cellular repair.
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Illustrated by Paola Delucca.
What it looks like:
A rash in an area exposed to an irritant or allergen. It only occurs when the skin is in contact with the allergen, and the rash is confined to just the area that the irritant has touched. Otherwise, the rash can resemble atopic dermatitis (a.k.a. eczema).

What causes it:
“An irritant like acid or an allergen like poison ivy causes the immune system to react,” Dr. Baumann says. Irritants can be things that would cause a rash for anyone, like harsh chemicals, or allergens that might not cause a reaction in some people, like nickel. The allergic rash usually develops within a couple days of the exposure.

How to treat it:
Topical steroid creams are the usual treatment, Dr. Morrison says. Antihistamines like Benadryl can help reduce the irritation. If the problem is persistent or occurs on a regular basis, you might want to see an allergist for patch-testing to identify the specific allergen causing the reaction.

For instant relief, try a spray like Curel Itch Defense Instant Soothing Moisturizing Spray. It’s unscented, cooling, and hydrating — plus, you won’t have to rub it in and risk making the urge to scratch worse.
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Illustrated by Paola Delucca.
What it looks like:
The skin develops flat spots of discoloration that look like freckles. The pigmentation can appear pink, red, brown, or purplish depending on your skin tone. The marks eventually fade, but can take weeks or months to disappear.

What causes it:
After the skin is injured or experiences inflammation, due to any wound — acne, burns, or cuts, for example — the skin sends melanin to the injured area, causing the telltale discoloration. Essentially any form of skin irritation can cause it. “The darker your skin pigmentation, the more likely you are to develop hyperpigmentation,” Dr. Berson says. “And the more inflamed the skin is and the longer the inflammation is there can make the pigmentation worse.”

How to treat it:
“Don’t pick at breakouts!” Dr. Downie says. When you pick, squeeze, or scratch, you’re causing more injury to the skin and prolonging the inflammation — and increasing your odds of developing dark spots. You also need to be hyper-vigilant about sunscreen — UV rays will cause more inflammation and increase melanin production.

“You have to be cautious with any topical treatments,” Dr. Berson says. “Some ingredients that treat hyperpigmentation can also be irritating and actually cause more pigmentation.” A combination retinoid and hydroquinone can treat the pigment at the surface while also preventing more breakouts, Dr. Berson suggests. Sometimes a steroid might be needed to target inflammation deeper in the skin.

Chemical peels can remove the pigmented surface layers as well, but these need to be administered by a professional — the risk of causing more irritation is high if not done properly. “You have to be careful with OTC peels, because using them in the wrong way will only cause more problems,” Dr. Berson warns.

For stubborn marks, the picosecond laser can break up the pigment with energy that hits the skin in trillionths of a second. (The PicoSure laser also has impressive success in treating acne scars.)

Wearing sunscreen is essential in preventing the pigment from worsening — UV rays send a signal to produce melanin. Adding an SPF-pigment-treating combo to your skin-care routine will keep you covered. Try L’Oréal Paris Revitalift Bright Reveal Brightening Moisturizer SPF 30.

Target dark spots with a serum like Kiehl’s Clearly Corrective Dark Spot Solution, which uses vitamin C and white-birch extract to treat and prevent scars.
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Illustrated by Paola Delucca.
What it looks like:
After spending time in the sun, you develop a red, bumpy rash. While sunburn may be redness on any exposed skin, a sun allergy has a rash-like texture that shows up just on the chest, legs, and arms. You’re more likely to have it after you’ve spent long periods with little sun exposure.

What causes it:
The reason some people develop a sensitivity to sunlight isn’t entirely understood, but the UV radiation stimulates immune-system activity and causes a rash. “Polymorphous Light Eruption [PMLE] is most common in young-adult women, so it may be related to hormones,” Dr. Berson says.

How to treat it:
For severe cases, Dr. Berson prescribes a steroid cream to treat inflammation, in addition to an antihistamine. But often, an OTC hydrocortisone will stop the itching and swelling. Taking non-steroidal anti-inflammatories like ibuprofen is another way to calm inflammation in a sun allergy or burn.

Dr. Berson is also a fan of a milk compress as a home remedy. “A combination of half milk, half water, and ice cubes is a great way to soothe any skin inflammation,” she says. Soak a rag in the mixture and gently apply it to any irritated area.

For immediate relief, you can’t go wrong with some basic aloe like Banana Boat Soothing Aloe After Sun Gel.

Regular misting with Avène Thermal Spring Water will also calm angry skin and offer cooling benefits.

Protecting your skin from the sun can prevent outbreaks. If you’ve suffered from a sun allergy, add sun-protective clothing (like these rash guards and hoodies) to your wardrobe in addition to sunscreen.
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