General considerations in flushing
A blush is a sudden transient reddening of the face, generally thought to be physiological. A flush is a more marked blush, often associated with a hot feeling, perspiration and piloerection (goose bumps), that occurs on the face and other areas (eg neck, upper chest, epigastrium). Both conditions are caused by transient vasodilation. The terms ‘blush’ and ‘flush’ are often interchanged.
Vasodilation can be caused by emotional, autonomic or endocrine factors, or the action of vasoactive drugs on the skin. Factors and disorders associated with flushing are listed in Factors and conditions associated with flushing.
Flushing is common. Flushing at menopause (hot flushes) can occur as a result of declining estrogen concentration (estrogen stabilises heat regulation). Flushing in nonmenopausal people is most commonly due to rosacea, and these patients may have associated erythema, telangiectases, papules and pustules. For management of flushing in rosacea, see here.
commonly associated with flushing | emotional stress rapid changes in temperature hot or spicy foods and beverages high fever alcohol exercise wind hot baths drugs with vasoactive properties (eg calcium channel blockers, sildenafil, nicotinic acid, tamoxifen, cyproterone, systemic corticosteroids, ciclosporin, vancomycin, opioids, long-term topical corticosteroids) |
less commonly associated with flushing | food additives (eg monosodium glutamate, nitrites and nitrates in cured meats, sulfites) neurological disorders (eg brain tumours, spinal cord lesions, Parkinson disease) carcinoid syndrome systemic mastocytosis |