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Blushing

Introduction

Blushing, sometimes known as 'flushing’, is where areas of the body suddenly become red in colour.

This is due to an excess amount of blood flowing into the small blood vessels that are located just below the surface of the skin.

Areas where blushing commonly occurs include:

  • the face
  • ears
  • neck
  • upper chest

As well as causing redness, blushing can sometimes make the affected area feel hot.

Blood vessels

The skin contains a network of small blood vessels which have tiny muscles in their walls.  Usually, these muscles are partly squeezed or contracted. However, if the muscles contract more than normal,the blood vessels to close down so that less blood passes through them.

If the blood flow is restricted, the skin becomes pale and white. When the muscles are completely relaxed, the blood vessels widen (dilate). This allows more blood to pass through the skin, making it appear red.

Who is affected by blushing?

Blushing affects both men and women, and is a normal response in anyone who is feeling a strong emotion, such as anger, embarrassment or excitement.

Blushing can sometimes be caused by a number of medical conditions. See Blushing - causes for more information.

Hyperhidrosis

Some people who get facial blushing, may also have excessive sweating, particularly of the face or hands. This condition is known as hyperhidrosis.

A surgical procedure called endoscopic thoracic sympathectomy (ETS) is often used to treat hyperhidrosis when it occurs with blushing. However, ETS is usually recommended only if more conventional treatments, such as psychological therapies, have not worked. 

See the topic about Hyperhidrosis for more information about the condition.

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Symptoms

The main symptom of blushing is redness of the skin, which occurs as a result of the blood vessels constricting (tightening) and then dilating (widening). The face, ears, neck and upper chest are the main areas of the body affected by blushing.

The medical term for severe cases of blushing is idiopathic cranio-facial erytherma. It can be treated using a surgical procedure known as endoscopic transthoracic sympathectomy (ETS). See Blushing - treatment for more information about ETS.

When to see your GP

Visit your GP if your blushing is so frequent and severe that it is having an impact on your personal and professional life. Your GP can establish what is causing your condition and recommend the most appropriate treatment for you.

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Causes

The autonomic nervous system

The small muscles in the blood vessels are controlled by the autonomic nervous system. The autonomic nervous system is the network of nerves in the body that produce automatic reactions. You do not have any control over it . 

Sometimes, blushing is due to the autonomic nervous system working too hard. It can be affected by factors such as heat, illness, and emotions. If you are the type of person who tends to blush easily, or regularly, it may be because you feel embarrassed, guilty, excited or angry.

Some people blush more easily than others. For example, after eating hot, spicy food, the face of one person may become slightly flushed, whereas someone else, who eats the same food, can become very red.

Medication

Certain medications can cause blushing. These include:

  • tamoxifen which is often used to treat breast cancer
  • raloxifene which is often used to treat osteoporosis (a condition that causes the bones to become weak and brittle)
  • calcium-channel blockers which are used to treat high blood pressure (hypertension) and angina (a condition that causes chest pain due to a restriction in the supply of oxygen-rich blood to the heart)
  • calcitonin which is sometimes used to treat bone disorders such as osteoporosis
  • glyceryl trinitrate and isosorbide dinitrate which are sometimes used to treat  angina

Certain medications that are sometimes used to treat prostate tumours in men can also cause blushing. These include:

  • buserelin
  • triptorelin
  • goserelin
  • leuprorelin

Medical conditions

Sometimes, blushing can be associated with other medical conditions, such as:

  • rosacea
  • carcinoid syndrome
  • erythrophobia (a fear of blushing)
  • menopause
  • mastocytosis

These conditions and their symptoms are briefly described below.

Rosacea

Rosacea is a common skin condition that affects the face. It can cause symptoms such as:

  • flushing
  • persistent redness
  • spots, papules (round, red bumps) and pustules (pus-filled swellings)
  • visible blood vessels
  • thickened skin (in severe cases)

The cause of rosacea is unknown, but it is believed that a number of factors may be responsible, such as abnormalities with the facial blood vessels, the H. pylori bacteria (bacteria that is found in the digestive system) and genetics.

See the topic about Rosacea for more information about the symptoms of this skin condition.

Carcinoid syndrome

Carcinoid syndrome is a term that is used to describe a number of symptoms that can occur alongside a type of cancer that is known as carcinoid. Carcinoid is a cancer of the neuroendocrine system (the system that produces hormones).

Carcinoid syndrome affects around 1 in 10 people with carcinoid cancer, and is caused when hormones are released into the blood by carcinoid tumours. This leads to symptoms such as:

  • flushing of the skin
  • diarrhoea
  • wheezing
  • abdominal (tummy) pain

Carcinoid syndrome is usually treated with a number of different medications.

Erythrophobia

Some people have a fear, or phobia, about blushing. The medical name for this is erythrophobia and it is linked to social phobia. Social phobia is a type of phobia (anxiety disorder) where someone has a fear of being embarrassed or humiliated in public.

People with erythrophobia are unable to control their blushing and become more nervous or anxious by the fact that others are likely to notice their blushing. This can result in them blushing even more.

A number of different treatments are available for social phobia. See Blushing - treatment for more information about the available treatment options.

Menopause

Flushing of the face can also occur as a symptom of the menopause. The menopause marks the end of menstruation (a woman’s monthly fertility cycle) and usually occurs at around 50 years of age). Flushing of the face happens as a result of a decrease in the female hormone called oestrogen.

See the topic about Menopause for more information. 

Mastocytosis

Flushing of the face can also be a symptom of mastocytosis, a disorder which is caused by having too many mast cells in the body (cells that release chemicals into the body to help fight disease). Mastocytosis is a treatable condition. As well as flushing, other symptoms of mastocytosis can include:

Mast cells can be found in the following areas of the body:

  • the skin
  • the lymph nodes (a series of vessels and glands that make up part of your immune system called the lymphatic system)
  • internal organs (such as the liver and spleen)
  • lining of the lungs, intestine and stomach

Other triggers

Other possible triggers of blushing include:

  • drinking alcohol
  • eating hot, or spicy, foods
  • drinking hot drinks
  • a high temperature, or fever of 38C (100.4F), or above
  • sudden hot, or cold, temperatures
  • exercise that causes an increase in body temperature
  • monosodium glutamate, which is a chemical that is sometimes added to food to improve flavour.
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Treatment

Underlying conditions

Treatment for blushing will depend on the cause. If blushing is due to another underlying condition, such as a social phopia, the menopause, or a skin condition this condition will need to be treated appropriately.

For example, if your blushing is linked to a social phobia (a fear of being embarrassed in social situations), psychological therapy (see below) and medication, such as serotonin reuptake inhibitors (SSRIs) may be recommended to lower your anxiety.

See the topic about Phobias - treatment for more information.

If blushing is being caused by rosacea (a chronic skin condition that causes facial flushing), avoiding common triggers, such as stress, prolonged exposure to sunlight and spicy foods may be recommended. Using camouflage make-up and having laser treatment to shrink visible blood vessels are other treatment options for rosacea.

See the topic about Rosacea - treatment for more information.

Sometimes, the menopause (when a woman's monthly periods stop at around 50 years of age) can cause hot flushes. If you have hot flushes as a result of the menopause, hormone replacement therapy (HRT) or a medication called clonidine may be recommended.

See the topic about Menopause - treatment for more information.

Psychological therapy

If your blushing is caused by nervousness, or social phobia, your GP may suggest that you try a psychological treatment. Psychological treatments that may be recommended include:

  • Cognitive behavioural therapy (CBT) - a form of therapy that helps you to identify and eliminate unwanted thoughts, and can help you to change your  behaviour in response to those thoughts.
  • Breathing techniques - to help relieve anxiety and rapid breathing.
  • Changing thoughts - a technique to change and redirect your thoughts so blushing episodes are reduced.
  • Clinical hypnotherapy - a technique that may help you to reduce your fear of blushing (erythrophobia).

See the topic about Cognitive behavioural therapy (CBT) for more information.

Surgery

Surgery may be considered in some cases of severe facial blushing which are accompanied by excessive sweating (hyperhidrosis).

Endoscopic thoracic sympathectomy (ETS)

An endoscopic thoracic sympathectomy (ETS) is a surgical procedure where some of the nerves that cause your facial blood vessels to dilate (widen) are cut. Surgery is performed under a general anaesthetic, which means that you lose consciousness completely, and will not feel any pain or discomfort during the procedure.

During the procedure, a small incision (cut) beneath your armpit will made and the sympathetic nerves that make you sweat will be cut. The sympathetic nerve controls the sweat glands of the hands and armpits. It is located inside the rib cage, near the top of the chest.

As well as reducing your sweating, ETS will also reduce facial blushing because the sympathetic nerves control the extra blood supply to the skin.

There are a few risks associated with the ETS procedure. These include:

  • a small risk of injury to the chest
  • a droopy eyelid, known as Horner’s syndrome (see Blushing - complications), which occurs in about 1 in 100 cases after surgery

Despite the small risks associated with ETS, a study that followed patients over a 15-year period reported a 93% cure rate for sweating.

ETS has proven to be very effective in reducing blushing, with a success rate of 80-90% in people who have had the procedure

Make-up

Blushing can be camouflaged using a green colour-corrective moisturiser. This type of moisturiser is also useful for covering up broken veins.

Some colour-corrective moisturisers can be used under a foundation. Others can be particularly useful for men with blushing problems. Hypo-allergenic brands are suitable for sensitive skin, and can be bought over-the-counter (OTC) from your local pharmacist. 

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Complications

Complications of surgery for blushing 

A number of possible complications can happen as a result of having an endoscopic thoracic sympathectomy (ETS). For example, you may experience:

  • haemothorax
  • Horner’s syndrome
  • compensatory excessive sweating

These complications are discussed below.

Haemothorax

Studies have shown that an endoscopic thoracic sympathectomy (ETS) can lead to complications, such as excessive sweating and haemothorax. A haemothorax is when blood gathers in the space between your lungs and the walls of your chest (pleural cavity).

If this occurs, a drainage tube will need to be inserted to drain away any excess fluid. However, this operation is rare.

Although ETS has proved to be an effective treatment for facial blushing, it is important to carefully consider all of the potential complications before deciding to have surgery.

Horner's syndrome

Some people have experienced adverse effects after having surgery for blushing, such as Horner's syndrome, which affects the nerves and muscles of the eye and eyelid.

Horner's syndrome causes your eyelid to droop and your eye to appear sunken into your face. The pupil of your eye gets smaller and there is also a reduction of sweating in the affected part of your face.

People with Horner’s syndrome usually make a full recovery over time. However, a full recovery does not happen in all cases. 

Compensatory excessive sweating

Another common side effect following surgery for severe blushing is compensatory excessive sweating. This is where you sweat in other areas of your body in contrast to your original problem areas. The compensatory sweating usually happens on the chest or on the back.

Sweating is the natural way for your body to regulate your temperature. As surgery involves cutting some of the nerves in your face, which stops sweating in that area, your body may compensate causing sweating to occur in other areas.

Around 1 in 100 people will have severe compensatory sweating that can become a major problem.

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