Ruddy complexion (facial redness)

One of the most common findings in PV is a ruddy (red or flushed) complexion. This is caused by the high concentration of red blood cells circulating in small vessels of the skin [3]. Patients may notice that their face looks constantly flushed, even without exertion or exposure to heat.

Aquagenic pruritus (itching triggered by water)

Itching, especially after warm showers or baths, is a hallmark of PV. This can affect the face, scalp, and upper body. In a study of ~440 patients, itching was reported by more than half of PV patients, often making everyday comfort worse [4].

Rashes and mottling

• Livedo reticularis – a net-like, purplish rash that may appear on the face or body. While uncommon, this rash can sometimes be one of the first visible clues that leads to a PV diagnosis [5].
• General rashes or burning sensations – caused by changes in circulation and inflammation in the skin.

Burning, stinging, or facial pain

Some PV patients describe experiencing burning, tingling, or stinging sensations in their facial skin, especially when their blood counts are high. This is related to microvascular symptoms (changes in small blood vessels) [6].

Psychosocial impact

Visible redness and rashes on the face can affect self-esteem. Having visible symptoms on your face can be emotionally challenging and affect self-esteem. It’s common for patients to downplay these effects, but it’s important to discuss them with your doctor. Addressing the underlying PV can not only improve your physical comfort but also your emotional well-being. [7].

Facial symptoms in PV come from the exact mechanisms driving the disease overall:

• Too many red blood cells → cause flushed skin and visible small blood vessels.
• Blood flow changes → lead to mottled rashes and burning discomfort.
• Histamine release and inflammation → contribute to itching after bathing [1].

• Control the disease: Phlebotomy (blood removal), aspirin, and medications like hydroxyurea or interferon help lower blood counts, which can reduce redness and itching [6].
• Skin-directed relief: Using moisturizers, antihistamines, or prescription creams may help reduce itching and rash.
• Lifestyle tips: Cooler showers, gentle cleansers, and avoiding hot environments may minimize flare-ups.
• Symptom tracking: Reporting changes in facial symptoms can help doctors see if blood counts are stable [7].

1. Why does PV cause a red face?

PV increases the number of red blood cells, which makes blood thicker and gives the skin a flushed or ruddy look [3].

2. Can PV cause rashes on the face?

Yes. Some patients develop a net-like rash (livedo reticularis) or redness associated with small vessel changes. Itching and burning sensations may also affect the face [5].

3. Does treating PV help with facial symptoms?

Often, yes. Controlling blood counts through phlebotomy or medication can reduce redness and itching, although some patients may still require additional treatments for skin comfort [6].

1. Radia, D., & Geyer, H. L. (2015). Management of symptoms in PV and ET patients. Hematology ASH Education Program Book, 2015(1), 340–348.
2. Hoffman, R. (2002). Quality of life issues in PV and ET. Semin Oncol, 29(3), 3–9.
3. Bluefarb, S. M. (1955). Cutaneous manifestations of polycythemia vera. Quarterly Bulletin of the Northwestern University Medical School, 29(1), 8.
4. Siegel, F. P., Tauscher, J., & Petrides, P. E. (2013). Aquagenic pruritus in PV: influence on quality of life. Am J Hematol, 88(8), 665–669.
5. Filo, L., Brezová, V., Hlavčák, P., & Filová, A. (1999). Livedo reticularis as a presenting symptom of PV. Clin Exp Dermatol, 24(5), 428.
6. Geyer, H., Scherber, R., Kosiorek, H., et al. (2016). Symptomatic profiles of PV patients. J Clin Oncol, 34(2), 151–159.
7. Harrison, C. N., Ross, D. M., Fogliatto, L. M., et al. (2025). Patient and physician perceptions in PV: Landmark 2.0 survey. HemaSphere, 9(3), e70106.