Flushing (also known as rosy cheeks and blushing) is a common patient complaint. Because of the wide range of possible causes, accurate identification can be difficult, making appropriate treatment a challenge as well. The information that follows will give you an understanding of the common causes of rosy cheeks, flushing, and blushing. But when reading through this information, consider whether you may have experienced other possible associated symptoms. It is also important to consider the duration and frequency of your symptoms, along with other potentially aggravating factors.
Read on to learn about the potential causes of this skin condition. You may be able to determine the cause of your rosy cheeks and facial flushing, but as always, we encourage you to visit a medical professional when possible.
How do I know it’s flushing?
Flushing is redness that most commonly appears on the face but can also occur on the neck, ears, chest, and arms. The areas of redness are typically warm to the touch, sometimes uncomfortably so. Flushing may subside quickly or persist, depending on the cause.
The appearance of flushing can vary from person to person based on body temperature, the skin’s natural color, and the prominence of the blood vessels directly under the skin. Long-lasting facial redness and small blood vessels at the skin’s surface may appear in individuals who have experienced flushing over an extended period of time.
What causes flushing?
Flushing occurs when the blood flow to the skin increases as a result of the relaxation and dilation of the blood vessels leading to the affected area. Nerves and small muscles in these vessels control their normal functioning.
The same nerves that control flushing also control the sweat glands, which is why flushing is often accompanied by sweating. Physicians refer to flushing associated with sweating as a “wet” flush, and flushing in the absence of sweating as a “dry” flush.
What triggers an episode of flushing?
There are a number of factors that can cause the body to react with flushing. When caused by the inappropriate activation of nerves, it is often classified as thermoregulatory flushing, emotional flushing, and flushing related to a disorder of the central nervous system.
If you experience flushing, we recommend that you keep a diary of your reactions for two weeks. Record any associations with food, medication, exercise, and emotional stress. Also note other symptoms you experience, including headaches, coughing, abdominal pain, diarrhea, and skin rashes. Be sure to discuss any symptoms or sudden changes in your skin’s condition with your doctor.
The most common triggers of flushing include the following:
- Heat exposure
- Hot beverages
- Certain foods
Fever, exercise and heat exposure
These are all associated with sweating and result from the body’s natural response to bring the core body temperature back to normal.
Fever, diagnosed by an elevated body temperature (greater than 37.5°C), can result from a variety of infectious and non-infectious causes. An increase in body temperature, either by exposure (such as a very hot day) or strenuous exercise, will cause a similar response.
Consuming a hot beverage may trigger flushing due to the exchange between the major arteries and veins in your neck and the hot fluid as it passes down your throat. This results in a rapid sweating-and-flushing response. You can easily reduce this reaction by allowing a hot drink to cool slightly before drinking it, or you can avoid it completely by consuming your beverage cold or with ice.
Acne rosacea is a common inflammatory skin disorder that primarily affects the face. The typical age of onset is between 40 and 60, though earlier onset is not uncommon.
Rosacea is characteristically associated with tiny visible blood vessels, as well as small bumps and pimples. Flushing is one of the earliest reported symptoms, and some researchers have suggested that frequent flushing may be part of the disease course of the disorder. Rosacea-related flushing may be stimulated by emotion, heat or cold, exercise, spicy or hot foods, and alcohol. Patients often complain of a burning sensation. Abnormally dry skin, swelling and rash may all occur.
Diagnosis is purely clinical, with frequent flushing episodes and persistent facial flushing lasting longer than three months. For more information on rosacea, see our complete guide to rosacea treatment.
A frequently uncomfortable form of flushing is common around the time of menopause. Best known as a “hot flash,” this type of flushing results from decreasing levels of estrogen in the body and is accompanied by sweating.
Hot flashes typically consist of 3- to 5-minute periods of heat, intense sweating, and flushing that may occur up to 20 times per day. An estimated 50% to 80% of women over the age of 45 suffer from these symptoms. They are often very uncomfortable, anxiety-provoking, and can interfere both with sleep and normal daily functioning.
Flushing can be triggered by food additives and spicy foods, particularly those containing capsaicin, which is derived from red peppers. Other examples are foods containing sodium nitrate (for example, cured meats) and sulfites (used to maintain freshness).
Monosodium glutamate (MSG), a common ingredient in Chinese food, has been thought to cause a flushing reaction as part of a constellation of symptoms known as “MSG syndrome.” However, controlled clinical trials raise questions about whether MSG reliably causes symptoms in the people who believe they react to it. In large doses, however, MSG is known to cause an increase in a chemical that may lead to flushing in susceptible individuals.
Read more about the role diet plays in rosacea: here
Emotional flushing (blushing) can be a real source of discomfort is more common in women than men. Physicians do not yet know the exact cause of emotional flushing.
Some research suggests that individuals who blush easily are particularly concerned with how others perceive them. These patients often experience other heightened reactions to stress, including rapid heartbeats, dry mouth, and confusion. Even minor and healthy emotional responses can trigger flushing in some individuals.
Drinking alcoholic beverages can cause flushing through dilation of the blood vessels in the skin, related either to the alcohol itself or to acetaldehyde, a substance involved in metabolizing alcohol. In addition, fermented beverages such as wine contain other substances that affect blood vessel dilation and contribute to the flushing response.
The liver breaks down alcohol. The rate at which this occurs is an important indicator of whether flushing will occur. A deficiency in one of the enzymes involved in alcohol breakdown frequently occurs in individuals of Asian descent. This deficiency causes a buildup of a chemical called acetaldehyde, resulting in severe flushing in affected individuals after they drink alcohol.
When combined with alcohol, many medications can increase the flushing response. Disulfiram, used to treat alcohol addiction, may cause severe flushing, nausea and vomiting. Other medications that may cause flushing when ingested with alcohol include metronidazole, ketoconazole, griseofulvin, cephalosporins, antimalarials, and topical calcineurin inhibitors.
Treatment for flushing is tailored to the underlying condition or predisposing factor. For those individuals who are predisposed to flushing episodes, avoiding triggers such as hot beverages, spicy foods, cured meats, and alcohol may be helpful in managing symptoms.
Ioulios P, Charalampos M, Efrossini T. The spectrum of cutaneous reactions associated with calcium antagonists: a review of the literature and the possible etiopathogenic mechanisms. Dermatol Online J 2003; 9:6.
Morita M, Kumashiro R, Kubo N, et al. Alcohol drinking, cigarette smoking, and the development of squamous cell carcinoma of the esophagus: epidemiology, clinical findings, and prevention. Int J Clin Oncol 2010; 15:126.