This paper explores the different problems that may be causing flushing. The list of possible reasons other than rosacea is extensive. It is worth consider what other conditions may be causing your red face before embarking on any treatment regime. Treatments that are good for some of the conditions listed here may make your rosacea worse, so read as widely as you can.
The author was kind enough provide a full copy of this paper, so contact me if you’d like to read it.
If you would like some ideas about about how to treat a red face, see another popular article I wrote titled how to treat a red face
The flushing patient: Differential diagnosis, workup, and treatment, Journal of the American Academy of Dermatology, Volume 55, Issue 2 , August 2006, Pages 193-208. Leonid Izikson MD, Joseph C. English III MD and Matthew J. Zirwas MD, Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Abstract: Cutaneous flushing—a common presenting complaint to dermatologists, allergists, internists, and family practitioners—results from changes in cutaneous blood flow triggered by multiple conditions. Most cases are caused by very common, benign diseases, such as rosacea or climacterum, that are readily apparent after a thorough taking of history and physical examination. However, in some cases, accurate diagnosis requires further laboratory, radiologic, or histopathologic studies to differentiate several important clinicopathologic entities. In particular, the serious diagnoses of carcinoid syndrome, pheochromocytoma, mastocytosis, and anaphylaxis need to be excluded by laboratory studies. If this work-up is unrevealing, rare causes, such as medullary carcinoma of the thyroid, pancreatic cell tumor, renal carcinoma, and others, should be considered.
Learning objective: At the completion of this learning activity, participants should be familiar with the mechanisms of flushing, its clinical differential diagnosis, the approach to establish a definitive diagnosis, and management of various conditions that produce flushing.
Abbreviations: CS, carcinoid syndrome; 5-HIAA, 5-hydroxyindoleoacetic acid; 5-HT, 5-hydroxytryptamine; MCT, medullary carcinoma of the thyroid; NSAID, nonsteroidal anti-inflammatory drug; TMEP, telangiectasia macularis eruptiva perstans; VIP, vasoactive intestinal polypeptide
…
When evaluating patients with rosacea, it is important to exclude the diagnoses of polycythemia vera, photosensitive eruption, lupus erythematosus, mixed connective tissue disease, carcinoid syndrome, systemic mastocytosis, or side effects from long-termfacial application of topical steroids. Since rosacea is typically limited to the face, extra facial erythema is generally an exclusionary sign. Rosacea flushing is associated with burning or stinging but not sweating, lightheadedness, or palpitations. Erythematotelangiectatic rosacea, while considered by many to represent a separate entity, may in fact be difficult to distinguish from simple benign cutaneous flushing and sun-damaged skin. In attempting this distinction, it may be useful to assess the extent of baseline facial telangiectasia and the overall degree of poikiloderma. However, since these 3 conditions are all common, they may coexist in many patients. Also, since erythematotelangiectatic rosacea and benign cutaneous flushing may have common triggers for flushing, it may be reasonable to consider these 2 entities as different points on a single continuum, making distinction of academic value only.
…
Table II
Differential diagnosis of flushingCommon Causes
Benign cutaneous flushing
Emotion
Temperature
Food or beverageRosacea
Climacteric flushing
Fever
AlcoholUncommon, serious causes
Carcinoid
Pheochromocytoma
Mastocytosis
AnaphylaxisOther causes
Medullary thyroid carcinoma
Pancreatic cell tumor (VIP tumor)
Renal cell carcinoma
Fish ingestion
Histamine
CiguateraPsychiatric or anxiety disorders
Idiopathic flushing
NeurologicParkinson’s
Migraine
Multiple sclerosis
Trigeminal nerve damage
Horner syndrome
Frey syndrome
Autonomic epilepsy
Autonomic hyperreflexia
Orthostatic hypotension
Streeten syndromeMedications
Very rare causes
Sarcoid, mitral stenosis, dumping syndrome, male androgen deficiency, arsenic intoxication,
POEMS syndrome, basophilic granulocytic leukemia, bronchogenic carcinoma, malignant histiocytoma, malignant neuroblastoma, malignant, ganglioneuroma, peri-aortic surgery,
Leigh syndrome, Rovsing syndromeSummary: The differential diagnosis of cutaneous flushing is extensive and encompasses a variety of benign and malignant entities. Most flushing reactions result from benign causes. However, since flushing may be the presenting sign or symptom of several life-threatening conditions, it should prompt a thorough investigation to exclude such possibilities as anaphylaxis, systemic mastocytosis, carcinoid syndrome and other malignant tumors, pheochromocytoma, and autonomic epilepsy after more common benign causes have been ruled out and if there is no response to treatment. In the absence of an identifiable benign organic cause of flushing, psychiatric illness must be suspected and the patient should undergo appropriate evaluation. History and physical examination are critical in the evaluation of the cause of flushing and should be supplemented with laboratory and other investigations based on the clinical suspicion of an underlying cause. The most common causes of flushing – fever, emotional flushing, climacterium, and rosacea are obvious to most physicians and thus are likely to be promptly recognized and treated appropriately. Dermatologists have a unique role in the management of patients with flushing, as referred patients may be unresponsive to conventional therapy and are more likely to have a serious or life-threatening underlying cause. Accordingly, proper workup, recognition, and management of conditions that cause cutaneous flushing may have a significant impact on the patients’ morbidity and mortality.
Featured Products
Related Articles:
- anti flushing protocol controls angiogenesis between IPL treatments
- IPL: pre flush or not (angiogenesis)
- Botox and facial flushing
- rosacea flushing and propranolol
- ktp laser good for red face and facial vessels
- Eucerin Redness Relief (Licochalcone A) relieves red face
- how to cure a red face (facial erythema or redness)
109 Comments over 3 pages ↓
Could you please e-mail me this full article. Thank you.
I have had flushing for over 15-20 years. I never addressed the issue because I am alleergic to preservatives used in foods. I get really red in the chest up, I sneeze, and I have diarrhea after eating. Even when I watched what I eat, I still have the red chest, red face, and red scalp. Finally I decided that the pain in my left side below the ribs was not going away. The doctor thinks that I have carcinoid tumor. The next round of test are coming up. I pray to God that they find a noncancerous tumor.
I began having occasional flushing several years ago. Went to a dermatologist and she said I had “blushing capillaries”-still unsure what this means. In the last 2 years I am neon red from chest up and rarely my face feels like it is on fire. I have had rosacea ruled out. My blood pressure is under control and doesn’t spike. I have had left side facial tingling 2 weeks ago. My md said it was a mystery and couldn’t be serious since I had ran a 5 mile race 3 days prior. I am very concerned and would appreciate a recommendation. This is not normal- I mean I am a nuclear red female.
Cathy:
I would suggest that you make an appointment with a Romatologist who is trained to spot more specific symptoms of disease and can run some detailed tests that your internist won’t understand. Also, going to a Dermatologist at a teaching hospital where doctors are trained in diagnosing and treating inflammatory skin diseases. I happen to have severe rosacea but with the wonderful Dermatology staff at UCSF in n. CA, you would never know it if you met me because my doctor is also a Phd. who is trained to treat inflammatory rosacea and other skin diseases. I know how upsetting and frustrating these conditions can be, but don’t give up! Keep searching for a medical doctor who can give you an answer and diagnoses. It could be something simple or another issue that a specialist can treat.
Best wishes,
Nancy
ive recently been diagnosed with rosecea and also when at the the gym last week after a strenuous work out i was like a strawberry for 2 hours after, it was very scary because i thought what if this isnt the rosecea? eventually the next day i was left with a rash of some sort which were a combination of pustules and flat blemishes under the skin
ive been precribed rozex but its not made much difference but im giving it a chance and going to continue with it, most of the time my face is just red like other have mentioned on here,
I would love to get a copy of this the full article. I also have had flushing that has gotten much worse over the last 3-4 years. It now occurs 80% of the day for no reason at all and it is painful most of the time. It occurs from my chest up and I would love to get some answers!
ti have had rosacea from 2 years with significant flushing triggers but last year , i went on for v beam (pulsed dye laser) after 6 treatments my redness has gone away but still flushing is there but quite manageable, i dnt think that flushing has any cure….
Can you please send me a copy as well. I have been told I have rosacea however none of the medicines I’ve received have helped and now I have bright red blotches on my neck, under my jaw, both cheeks, and forehead
i also have flusing. Mine is caused by systemic mastocytosis. I gave up sales because I was very slef concious of it. I didn’t want my customers to think that I was lieing to them. I would explain my disorder. Have your doctor look into this disorder. It is also a very painful disordorder that affects the whole body.Good luck.