Flushing of Face means an episodic attack of redness of the face and the feeling of warmth of facial skin. It is also known as blushing. All of us have experienced the flushing of warmth and redness of face many times in our lifetime. Blushing is triggered by emotional conditions like embarrassment, anger, excitement, or stress is a normal physiological condition. This does not require any treatment and resolves spontaneously once the emotional/outburst is over. The physiology in flushing of the face is triggered by emotions is due to the dilatation of blood vessels in the face as a result of the parasympathetic response to emotions. Dilatation of blood vessels results in increased flow of the blood (mainly in the superficial capillaries of the face) causing redness and warmth of the face.
Causes of flushing of the face
Medical condition like
- Carcinoid syndrome
- Panic disorder
- Other causes: alcohol consumption, intake of hot and spicy food, strenuous physical exercise, exposure to sudden hot or cold temperature, severe coughing, sexual intercourse, orgasm, sneezing, caffeine consumption, emotions(stress, anger, excitement, etc.)
Flushing in menopause-common cause
Menopause is the time when the woman’s menstrual cycle is stopped permanently. Flushing of the face is common in menopause due to the decreased level of estrogens. Hot flushes present with intense heat and sweating of the face increased heart rate, etc. and last for about 2 minutes. It can begin several years before menopause in some women. It may occur at every few minutes or 2 to3 times in a week.
More than 90% of people suffering from carcinoid syndrome presents with flushing of the face. These occur unexpectedly and unpredictably. Increased serotonin levels in carcinoid are believed to cause flushing which is absolutely wrong. It is due to the secretion of kallikrein which is converted into potent vasodilators bradykinin. Bradykinin dilates blood vessels causing increased flow of blood, which in turn results in flushing of the face.
Alcohol flush/Asian flush
Some people experience flushing of face after consumption of alcohol. This is due to deficiency of the enzyme alcohol dehydrogenase. This has increased the risk of esophageal carcinoma. It has strong associations with Asian ancestry hence called Asian flush.
Anaphylaxis is a type of type I hypersensitivity reaction, is a serious and life-threatening allergic reaction caused due to ingestion of food allergy to the particular person, insect bites, drug allergies and latex allergies.
An anaphylactic reaction is rare and is reversible. Symptoms of anaphylaxis are hot flushes, angioedema, hypotension, vomiting, lightheadedness etc. It occurs due to release of cytokines in response to an allergen.
Symptoms of flushing of face
Symptoms associated with hot flushes are the additional symptoms of the underlying disorder causing flushing of the face. It may be associated with the symptoms related to other symptoms of the body are like:
- Change in level of consciousness
- Anxiety and palpitation
- Fatigue, dizziness
- Flu-like symptoms such as fever, sore throat, headache, cough, nasal discharge, acne
It may be accompanied by other disorders of the skin such as acne and rosacea. The symptoms in those cases will be as follows:
- Itchiness of skin
- Irregularity and blotchiness of skin
Complication of flushing of skin is due to the underlying disorders which cause flushing of the skin. These complications can be life-threatening or in some cases long terms
Complication of flushing due to carcinoid syndrome is:
- Obstruction of the gastrointestinal tract
- Bleeding from the gastrointestinal tract
- Loss of weight, etc.
Serious or life-threatening disorders like anaphylaxis if untreated, it can cause shock, coma and heart failure.
Treatment of flushing of face
Hot flushes in most of the cases are self-limiting and do not require any treatment. If hot flushes do not resolve in time and are associated with other symptoms that affect the daily activities. Treatment is required. Most effective treatment of hot flushes is hormone replacement therapy with estrogens. These are effective in treating hot flushes in a menopausal woman but is also linked with side effects such as endometrial carcinoma. To prevent carcinoma it should be taken with progesterone.
Antidepressants such as paroxetine, fluoxetine, and venlafaxine also decrease hot flushes. Paroxetine is the only drug approved for treatment of hot flushes. Antidepressants are less effective therapy than hormone replacement therapy but are good for women opting against hormone replacement therapy or in women where hormone replacement therapy is contraindicated.
Gabapentin, an anticonvulsant drug is moderately effective in preventing hot flushes.
Clonidine, an antihypertensive drug provides relief from hot flushes. It is found in two forms (pills and patch). Patches are more effective than pills as it avoids hepatic 1st pass metabolism.
Treatment of underlying disorders like anaphylaxis with an injection of epinephrine, hyperthyroidism with antithyroid drugs like methimazole etc. is highly effective against hot flushes.
Use of medicines such as vitamin B complex, vitamin A and ibuprofen provides relief from the hot flushes.
Diagnosis of flushing of face
History of the patient and physical examination is diagnostic in many causes of flushing. Sometimes the diagnosis cannot be made until lab investigations, radiographic evaluation is done.
- Blood tests: Complete blood count, blood serotonin help in diagnosing carcinoid tumor as the cause of flushing of face thyroxine, triiodothyronine, and thyroid stimulating hormone levels in the blood helps to diagnose hyperthyroidism
- Urine test: 24-hour urine analysis for 5-HIAA (a metabolite of serotonin helps in diagnosis of the carcinoid syndrome)
- Barium meal X-ray, barium enema, endoscopy, CT scan, colonoscopy etc, can be done to diagnose carcinoid tumor.
Prevention of hot flushes of face
- Hot flushes may not be preventable in menopause, but the severity can be reduced flushes in other individuals can be prevented by avoiding the use of caffeine, restricting alcohol consumption, refraining from smoking, avoiding hot and spicy foods etc.
- Staying in a cool environment which means keeping your workplace cool by either using a fan or air conditioner which helps in preventing flushing of face
- Wearing light cotton clothes
- Taking a deep and slow abdominal respirations that are about 8 breaths per minute. Abdominal respiration should be tried 15 minutes each in the morning and evening and during the episode of hot flushes.
- Regular physical exercise
- Using chill pillows
- Mentioning the drug allergies to your doctor and avoiding the known allergies can prevent hot flushes as well as serious life-threatening Drug reactions and anaphylaxis.