Dear Daniela: What Can I Do About My Red, Blotchy Skin?

Dear Daniela,
My skin never looks as even as I’d like. I don't think I have rosacea but my cheeks, ​nose, ​chin and forehead always look quite ruddy. I am Irish, and I notice other Irish people get high colour in their face and neck too, though I do find when I’m eating and sleeping well and exercising it’s less pronounced. It’s just generally blotchy and uneven and it’s a pain – what can I do?
Ali, 28
Redness is an especially evasive beast. As anyone with sensitive skin knows, half of the things you’re told are "totally safe to use" seem to be exactly the opposite. Plus, the more you touch your skin or load it up with products, the worse it gets, because if there’s one thing redness-prone skin doesn’t like, it’s being bothered. That said, perennial redness in the skin can be caused by a lot of things, so I decided to get some specialist advice right off the bat. I called Dr. Justine Kluk, a dermatologist and skincare expert, to hear her thoughts: "It’s very common in Celtic people and other people with very fair skin to complain about redness," she explained. "Quite simply, when the skin is that much thinner, to the point of being almost translucent, any flushing or dilated blood vessels are just so much more visible – hence the redness."
What Dr. Kluk and I both thought interesting was your comment about rosacea. It’s very possible that you don’t have it, but as Dr Kluk told me: "Rosacea is very misunderstood as a condition, and it’s very common. If you google it, you’re going to get quite graphic photos of people with extreme redness, rough and broken skin, that sort of thing, but that is a very advanced kind of rosacea. There are much subtler, less pervasive forms of rosacea, and just because you have a less aggressive kind of rosacea now, it doesn’t mean it will become more like that at all. It’s possible to have rosacea without any textural changes to the skin." Rosacea can affect any part of the face but often the central part is most noticeably hit; you can get it around your eyes as well, which you mentioned in your longer letter. Crucially, it’s a relapsing condition, which might explain why you can go through periods of not being bothered by it, before it strikes again. "One answer is it could be a post-inflammatory response to something, and every time you experience it, the residual redness lasts a little longer or fades a little less completely, meaning there’s a growing baseline of redness," added Dr. Kluk.
I won't hammer on too much about it, but I want to mention something about rosacea and stress. You said that your skin gets better when you’re well rested and generally feeling healthy, which Dr. Kluk had some insight about: "Stress can make any condition worse, from eczema to acne. It lowers your skin’s barrier function and means it’s more easily irritated." Here’s the thing: stress to your skin is not necessarily to do with things going on at work, or even interpersonally. It can simply be a lack of sleep or keeping irregular hours: "Your body perceives these things as stress, so even if things are pretty okay with work for example, you could still physiologically be experiencing stress," added Dr. Kluk.
Anyway: solutions. Dr. Kluk suggested a gentle, non-foaming cleanser to help replenish your skin’s barrier function, and said that an SPF every day was non-negotiable for someone as fair as you. "A good creamy cleanser like Avène Extremely Gentle would be ideal, as well as some lovely soft cotton wool to rinse it off," added Dr. Kluk. As for SPF, try Avène Mineral Fluid or NeoStrata Sheer Physical Protection – mineral might be kinder on your skin than chemical. I’d also really recommend SkinCeuticals Phyto Corrective Serum (the mask is great too) for everyday use, which Dr. Kluk echoed: "It’s really effective at calming and regulating redness."
It might be worth looking at your routine and diet to see if you can identify any specific triggers: caffeine, spicy food, alcohol or late nights, for example. Obviously you can’t avoid these things all the time and it may be hard to identify an exact cause if you have a heavy week or two, but knowledge truly is power. You could also try some cryotherapy-style treatments for a quick fix – cold makes your blood vessels constrict, which helps with redness and puffiness. Try Anne Semonin Express Radiance Ice Cubes for a pick-me-up. Dr. Kluk also suggested a gentle day cream like La Roche-Posay Toleriane to help protect your skin from daily aggressors.
Reading your letter reminded me of a conversation I had with the facialist Kate Kerr a few months ago. She told me she felt people had lost sight of what real skin looks like, and had been given unrealistic expectations. Take a random patch of skin from your arm or stomach or leg – it’s probably not uniform in tone, and has some dilated pores maybe, or blemishes, or other irregularities. Well, of course – it’s skin, and the milieu of follicles, sebaceous glands, dead skin, hair, pores, lines, scars, all of it, means it will never look FaceTune smooth. The rise of no-makeup makeup has made it ever more popular for brands and celebrities to push images they claim are unretouched, or have 'minimal' makeup. It’s got to the point where we expect our complexions to have a level of uniformity that’s simply not natural. Likewise for our obsession with 'glow' – we all want to be radiant without highlighter, and we’re told that if we can’t 'glow' from our diets, the pills and powders we pop in the name of beauty, rigorous boutique exercise classes and eight-hour, 1,000-thread-count sleep, we’re at fault. Skin is skin is skin. It’s not perfect, and that’s okay. Of course, I understand your frustration, but I hope this can set you free somewhat.
Good luck!
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