Chinese doctors presenting at the 7th World congress of Mountain and Wilderness Medicine in Telluride last month showed us a familiar photo. They called it Plateau Facial Persistence Erythema and we commonly see it here in Summit County. This rash occurs in women and children under conditions present at the plateau region at high altitude with cold and windy winter temperatures. It’s characteristics are erythemaor redness, of the cheek prominences that is darkest in the center and can even look purple in color. The redness can spread in a spider-like pattern from the center with a gradual transition to normal-appearing skin. It is painless and often symmetrical. The cause of this rash is unclear but is thought to be related to changes at high altitudes affecting vasomotor nerve function, decreased capillary elasticity with persistent expansion, and increased blood viscosity secondary to increased hemoglobin. Children have delicate skin that may not adapt as easily to this extreme environment, causing the rash. Treatment primarily involves prevention by avoiding cold temperatures, windy areas, and UV radiation. In other countries these rosy red cheeks are not considered a disease, but rather a beautiful variant of normal!