Couperose: What is it and how does it develop?

Red veins in the face, also called couperose, is a common skin phenomenon. Although it is harmless, many people experience couperose as disturbing. But how does it actually develop? In this blog, as a skin therapist, I explain what science says about the causes and risk factors of couperose.

What is couperose?

Couperose is a condition in which the small blood vessels in the face are permanently dilated, causing red or purple lines to become visible on the skin. This mainly occurs on the cheeks, nose and chin. Although couperose is not a medical condition in itself, it can be accompanied by sensitive skin and sometimes burning or tingling.

How does couperose develop?

The exact cause of rosacea is complex and is influenced by several factors:

• Blood vessel changes: The blood vessels in the skin temporarily expand with temperature fluctuations or blushing. With couperose they no longer contract, which means they remain permanently visible.
• Genetic predisposition: People with fair skin (skin type I and II) and a family history of couperose or rosacea have a greater chance of developing visible blood vessels.
• Sun exposure (UV radiation): Sun damage weakens the blood vessel walls and can lead to an accelerated breakdown of collagen and elastin in the skin. This causes the blood vessels to lose their strength, making them more likely to dilate.
• Temperature fluctuations: Cold and heat (e.g. from saunas, hot drinks or spicy food) can cause an overactive reaction of the blood vessels, which can contribute to rosacea in the long term.
• Hormonal influences: Pregnancy, menopause and hormonal fluctuations can play a role in the development of rosacea.
• Age: As the skin ages, the elasticity of the blood vessels and the firmness of the skin decrease, increasing the chance of visible veins.

Is couperose the same as rosacea?

Couperose is often associated with rosacea, but they are not exactly the same. Couperose refers purely to the visible blood vessels, while rosacea is a chronic skin condition that can also cause inflammation, redness and pimples. However, many people with rosacea also suffer from couperose.

Histopathology: What happens in the skin with couperose?

Under the microscope, couperose shows that especially the small veins (venules) in the superficial skin remain dilated. The blood vessels are located close to the skin and are therefore clearly visible. With prolonged exposure to UV radiation and other provoking factors, these vessels can lose their firmness, partly due to the breakdown of collagen and elastin in the surrounding tissue.

What can you do about couperose?

Although couperose does not disappear on its own, there are options to reduce the visible blood vessels or protect the skin from getting worse:

• IPL and Laser Therapy – An effective method to target and reduce blood vessels.
• Good sun protection – Wearing an SPF 30 or higher daily will help prevent further vascular changes and sun damage.
• Avoiding triggers – Hot drinks, alcohol, extreme temperatures and spicy spices can aggravate rosacea.
• Soothing skin care – Use gentle, non-irritating products to control redness.

Conclusion

Couperose is a common skin condition that is caused by a combination of genetic predisposition, external factors such as sun damage and temperature changes, and decreased vascular elasticity. Although it is harmless, it can be cosmetically disturbing. Fortunately, there are effective treatments available to reduce couperose and prevent further aggravation.

Sources

• Abram, K., Silm, H., Maaroos, HI, & Oona, M. (2010). Risk factors associated with rosacea. Journal of the European Academy of Dermatology and Venereology, 24 (5), 565–571.
• Helfrich, Y.R., Maier, L.E., Cui, Y., Fisher, G.J., Chubb, H., Fligiel, S., … & Voorhees, J.J. (2015). Clinical, histologic, and molecular analysis of differences between erythematotelangiectatic rosacea and telangiectatic photoaging. JAMA Dermatology, 151 (8), 825–836.
• Kim, M., Lee, H. J., & Hwang, Y. J. (2021). Angiogenesis in chronic inflammatory skin disorders. International Journal of Molecular Sciences, 22 (21), 12035.
• Lee, WJ, Jung, JM, Lee, YJ, Won, CH, Chang, SE, Choi, JH, … & Lee, MW (2016). Histopathological analysis of 226 patients with rosacea according to rosacea subtype and severity. The American Journal of Dermatopathology, 38 (5), 347–352.
• Rainer, B. M., Kang, S., & Chien, A. L. (2017). Rosacea: Epidemiology, pathogenesis, and treatment. Dermato-Endocrinology, 9 (1), e1361574.
• Walker, J. G., Stirling, J., Beroukas, D., Dharmapatni, K., Haynes, D. R., Smith, M. D., … & Roberts-Thomson, P. J. (2005). Histopathological and ultrastructural features of dermal telangiectasias in systemic sclerosis. Pathology, 37 (3), 220–225.