Resumen

Objectives: To enhance clinicians’ ability to recognize red flags in facial erythema, differentiate benign dermatologic conditions from systemic and malignant causes, and apply a phenotype based approach for accurate diagnosis and management. Introduction: "Red face" is a common clinical finding but does not represent a single disease entity. Instead, it encompasses a wide spectrum of dermatologic and systemic disorders, presenting with different shades and patterns of redness. Facial erythema may be classified as transient or persistent, depending on duration and underlying pathophysiology. While most cases are related to benign inflammatory dermatoses such as rosacea, seborrheic dermatitis, or contact dermatitis, facial erythema may also signal serious systemic diseases, posing significant diagnostic challenges for clinicians. Materials / method: A narrative review of the literature was performed focusing on the clinical classification, differential diagnosis, diagnostic approach, and management of facial erythema. Emphasis was placed on clinical morphology, distribution patterns, associated functional and systemic symptoms, and the role of patient history, diaries, laboratory investigations, histopathology, and immunohistology. Results: Facial erythema is categorized into transient and persistent forms. Transient erythema is mainly associated with episodic flushing due to vasoactive mediators or medications, whereas persistent erythema results from repeated episodes leading to telangiectasia and long-standing vascular changes. The differential diagnosis is broad and includes rosacea, acne vulgaris, seborrheic dermatitis, atopic and contact dermatitis, photodermatoses, and systemic diseases such as carcinoid syndrome, pheochromocytoma, mastocytosis, anaphylaxis, cardiac disorders, and rare malignancies. Conclusion: Facial erythema represents a multifactorial and diagnostically demanding clinical sign. A structured diagnostic strategy based on clinical evaluation, recognition of red flags, and appropriate use of complementary investigations is essential to distinguish benign inflammatory conditions from potentially life-threatening systemic diseases. Early and accurate diagnosis not only improves therapeutic outcomes but also reduces the risk of overlooking serious underlying disorders.