IDENTIFYING THE FACTORS BEHIND UNUSUAL FACIAL FLUSHING OR SWEATING

If you have experienced your face and neck becoming suddenly hot and sweating, you are not alone. Facial flushes can affect anyone, often due to changes in temperature, emotional states such as anxiety and embarrassment, or hormonal fluctuations. In these cases, this symptom, despite how uncomfortable it may be, isn’t usually a cause for concern. 

However, facial flushing and excessive sweating can sometimes be the telltale signs of a more serious underlying condition that should not be left unaddressed. Understanding what’s causing your symptoms is the first step to finding adequate treatment and preventing more serious complications. 

In this guide, we’ll explore what facial flushes are, what causes them, and when you should see a doctor about your symptoms. We’ll also look at how the innovative protocol developed by Neuragenex Neurofunctional Pain Management – can help by targeting the underlying systemic inflammation at the root of your symptoms. Let’s get started. 

Defining Facial Flushing

When your face, neck, or chest suddenly feels hot to the touch and appears reddened, you may be experiencing facial flushing. Flushing results from increased blood flow which, in turn, is a consequence of the dilation of the blood vessels (vasodilation) beneath the surface of the skin. 

This widening of blood vessels allows more blood to flow through, which may occur due to emotional changes such as anxiety, anger, or embarrassment, as well as exercise, menopause, or certain medical conditions. The increased blood flow can cause you to feel warmth around the face, especially around the cheeks, neck, and upper chest. This symptom is often accompanied by patches of reddening, discoloration (if you have darker skin), visible blood vessels under the skin, raised skin bumps, and excessive sweating. 

Flushing, blushing, and facial rashes are often used interchangeably. However, there is a slight difference between these terms. 

• Blushing refers to an involuntary reddening of the skin of the face that occurs for emotional or psychological reasons (e.g. anger or embarrassment). It is common in people with social phobia or anxiety disorders.
• Flushing causes the same involuntary reddening of the face, but this is a term that tends to be used for more severe cases. Formally, it is a condition known as “idiopathic (without known cause) cranio-facial erythema”. It can occur with excessive perspiration or without (dry flushing). 
• Facial rashes occur when there is a breakout, inflammation flare-up, or skin lesions. Besides appearing red and warm, in facial rashes the skin may also be scaly, bumpy, itchy, or dry. 

While facial flushing isn’t life-threatening per se, it is a symptom that should not be overlooked. In the best-case scenario, regular flushing can cause embarrassment and feelings of discomfort, especially in social situations. On the other hand, in severe cases, it can be a sign indicating a serious, chronic condition that requires specialized treatment.

Can Facial Flushing Cause Sweating?

Flushing and excessive facial sweating are two different symptoms often associated with one another. 

In particular, increased perspiration (sweating) is thought to be caused by an overactive sympathetic nervous system. This is the aspect of the nervous system involved with regulating glands, organs, and the diameter of blood vessels in the face. Sympathetic overload can be caused by a wide range of conditions, including certain cancers, but it is often related to emotional states, such as excessive stress and overstimulation. Other causes of an overactive sympathetic nervous system include:

• Not getting enough sleep and sleep disorders
• Poor dietary choices, due to the gut-brain axis (the two-way connection between the central nervous system and the gastrointestinal system)
• Chronic pain and systemic inflammation

Problems with the sympathetic nervous system can also cause other symptoms, including increased heart rate, abnormal breathing patterns, higher blood pressure, flushing, and goosebumps. 

Besides an overactive sympathetic nervous system, facial flushing and sweating are symptoms of menopause. In this case, flushing episodes are accompanied by intense heat and copious sweating in the face, neck, and chest. Each episode usually lasts from one to five minutes. 

Identifying The Risk Factors

Facial flushing can affect anyone, at any stage of life. However, some risk factors may make you more prone to it, especially during certain stages of your life or following certain health events. These contributors include:

• Genetics. If you have an inherited intolerance to alcohol, you may experience what’s known as an alcohol flush reaction, which most commonly affects people of East Asian descent. Other hereditary and genetic disorders – such as Harlequin syndrome – may also cause excessive flushing.
• Spicy foods. Eating spicy or hot foods can impair the way your body regulates its internal temperature, thus leading to momentary skin flushing, redness, and excessive sweating. Spicy foods that may lead to this effect are those derived from the capsicum family of plants, such as cayenne peppers, chili peppers, and paprika. 
• Alcohol. If you are intolerant or allergic to alcohol, your body will be unable to metabolize it. When this happens, a build-up of a toxic chemical (acetaldehyde) ensues, which triggers the body to release a pro-inflammatory chemical known as histamine. Histamine reacts by widening the blood vessels in the face, thus leading to facial flushing. This symptom may also occur in people who drink alcohol excessively, which doesn’t give the body enough time to process the ethanol contained in alcoholic drinks. 
• Caffeine. Although caffeine is known to be a vasoconstrictor (causing the narrowing of blood vessels) it can sometimes act as a vasodilator, causing flushing in the face and other areas of the body. 
• Stress and anxiety. Psychological blushing occurs when you experience high levels of stress, anxiety, anger, or embarrassment. In these situations, the body releases chemicals, such as adrenaline, increases the heart rate, and redirects blood toward muscles. Alongside this increased blood flow, nerves signal the muscles in the blood vessels to relax, thus causing the widening of blood vessels in the face and, in turn, blushing. 
• Certain medications. Certain medications tend to have a widening effect on the blood vessels, leading to facial flushing. Some of these drugs include vasodilators (to treat heart failure or high blood pressure), opiates, morphine, and erectile dysfunction medications such as sildenafil citrate. Consult your doctor if you suspect that your facial flushing is rooted in your pharmacological treatment plan. 
• Hormonal changes. Hormonal changes, such as those experienced during menopause, perimenopause, and pregnancy, may lead to “hot flashes,” or “hot flushes,” which combine flushing and sweating. We’ll look at this risk factor in more detail below.
• Medical conditions. Medical conditions that may lead to flushing involve certain cancers, abnormal reactions to medications such as topical corticosteroids, hereditary conditions, infections, and disorders of the nervous system. They include:
  • Red skin syndrome 
  • Carcinoid syndrome
  • Medullary thyroid carcinoma
  • Frey’s syndrome
  • Fifth disease (“slapped cheek” disease)
  • Harlequin syndrome
  • Lupus 
  • Scarlet fever and yellow fever

Below, we’ll look at how certain medical conditions may be directly associated with facial flushing. 

What Medical Conditions Are Possibly Associated With Facial Flushing?

Feeling that your face is turning red and warm to the touch when you are angry or embarrassed isn’t something to worry about. However, unusual or chronic flushing can impact your life in more ways than one. It can affect your self-esteem and confidence and, in the worst-case scenario, it can indicate an underlying condition that needs adequate treatment. 

While facial flushing alone isn’t the specific symptom of any certain disease, other symptoms and reactions you may be experiencing can say a lot about what’s affecting your health. For example, if your face becomes red after exercise, the culprit may be the increased body temperature. On the other hand, if you have noticed flushing accompanied by swelling in the neck, anxiety, difficulty sleeping, and mood swings, you may be dealing with thyroid problems. Nearly 86% of patients with an overactive thyroid (hyperthyroidism) experience a warm, moist face. 

Below, we’ll look at the most common medical conditions that are usually associated with facial flushing. 

Sunburn

Sunburn is an extremely common condition that occurs after prolonged exposure to sunlight. But despite how common sunburn is, it should not be considered a normal or healthy part of life. 

When ultraviolet radiation from the sun reaches the skin, it damages the cells in the epidermis (the outer layer of the skin) and causes mutations in their DNA. When this happens, a series of reactions takes place. Immune cells start to cause further damage to cells that have been weakened and begin to clean out cells that are dead or damaged beyond repair. This process can make your skin itchy and cause the formation of blisters, processes necessary to get rid of damaged cells. 

At the same time, the immune response leads to surrounding blood vessels expanding and beginning to leak fluid around the damaged areas to deliver repair and healing agents, such as immune cells. This can make your skin red, swollen, hot to the touch, and painful. This process peaks 24-48 hours after sun exposure and continues to cause symptoms for several days. Although your skin will heal on its own, it is important to notice that around 33,000 cases of sunburn annually require emergency care in the US alone, and most skin cancers arise from unprotected sun exposure. 

Rosacea

Rosacea is a chronic inflammatory condition that leads to reddened skin in the face and several other symptoms, including:

• Frequent blushing and flushing
• Facial redness 
• Chronic redness (such as a sunburn that does not improve with time)
• Solid bumps on the skin, usually reddened
• Pus-filled pimples
• Visible blood vessels
• Burning or stinging sensations
• Swelling 
• Skin thickening 
• More rarely, eye problems 

These symptoms can come and go over time and flare up – or relapse – after exposure to certain triggers, such as spending time in the sun, experiencing stress, eating spicy foods, or drinking alcoholic beverages. Rosacea today affects an estimated 16 million adults in the US alone. 

Cluster Headache

Flushing can be a symptom associated with certain types of headaches, such as cluster headaches and migraines. 

Cluster headaches are characterized by a series of painful headaches, each of which lasts between 15 and 180 minutes. Each attack can last multiple days, and people with this condition can experience up to eight headaches a day, usually at night. 

The pain, which is described as piercing or deep burning, is usually localized in one side of the head and can spread to the forehead, temples, nose, neck, and teeth. Besides pain and facial flushing, cluster headaches can also cause excessive tearing, eye redness, sensitivity to light, swelling, nausea, and constricted pupils. 

Migraine Headache

A migraine attack is more than just a headache. It involves an abnormal surge of electrical activity in the brain, which leads to a cascade of symptoms, including pain, sensitivity to light, nausea, vomiting, confusion, and blurred vision.

While a lot about migraines isn’t well understood yet, it has been seen that this condition causes autonomic symptoms, which are alterations of body functions we don’t have direct control over. These include breathing, digestion, sweating, and blood pressure. Studies have found that altered function of the autonomic nervous system occurs in people with migraines, which can lead to symptoms such as excess sweating and flushing. It is estimated that between 56% and 70% of migraine sufferers experience autonomic symptoms, such as flushing, excessive tearing, eye redness, and facial swelling. 

Anaphylactic Urticaria

Anaphylaxis refers to an acute reaction of the body to an allergen. This reaction usually involves several organs and systems across the body, including the respiratory and cardiovascular systems. Anaphylaxis can sometimes be fatal, especially if not properly addressed, but can also be characterized by symptoms such as swollen eyes, hands, feet, and lips. 

Other symptoms of this condition include flushing and urticaria, which can cause your skin to become swollen, warm, and reddened. It is vital to seek immediate medical attention if you are experiencing the symptoms of an anaphylactic shock. 

Menopause

With over two-thirds of perimenopausal women experiencing hot flashes, this is one of the most common symptoms of menopause. These sudden changes in body temperature are a consequence of the sudden drop in estrogen levels that occurs during menopause. As estrogen levels lower, hormone-releasing glands produce higher amounts of other chemicals, which interfere with the body’s ability to regulate its internal temperature. 

In menopausal women, hot flashes are accompanied by other symptoms, including flushing, sweating, vaginal dryness, low mood, reduced sex drive, and depression. While hot flashes aren’t dangerous in their own right, they can have profound consequences on a person’s life by impacting sleep, mood, and mental health. 

Carotid Sinus Syndrome

The carotid arteries are two essential blood vessels that run on each side of the neck. Their main role is to supply blood to the brain. Carotid artery disease is responsible for 30% of strokes, which occur when the blood supply to the brain is cut off. 

Carotid sinus syndrome is a condition that causes you to faint (syncope) or experience lightheadedness. It occurs if you have what’s known as carotid sinus hypersensitivity. 

The carotid sinus is a dilated area at the base of the internal carotid artery. If your carotid sinus is hypersensitive, you’ll experience abnormal reactions when pressure is applied to it, including vasodilation, low blood pressure, and slow heart rate. In turn, daily activities that press on the carotid sinus (such as turning the neck or looking upward), can cause flushing, lightheadedness, and, in some cases, fainting. 

When To Seek Medical Attention

In most cases, flushing isn’t something to worry about. You may experience this symptom when you are angry, stressed, anxious, or embarrassed. In these cases, the blushing will only be temporary, and you can learn to manage this inconvenient symptom through relaxation techniques, breathing exercises, and stress management practices. 

However, when the flushing becomes persistent and starts to get in the way of your everyday life or sleep, you should seek medical attention. In particular, you should see your doctor if the sensation of warmth and redness is accompanied by:

• Pain
• Spots
• Rashes
• Diarrhea
• Shallow breathing 
• Hives
• A swollen neck 
• High fever

You should also contact your doctor if the flushing occurs without a reason, is worsening, or becomes chronic, as this symptom can impact your social and professional life. Sleep disruptions and other symptoms associated with anxiety disorders should also be discussed with a medical professional. 

A specialized healthcare provider will be able to carry out an accurate diagnosis of your symptoms and help you select the best course of treatment for your needs. 

How Is Unusual Facial Sweating Or Flushing Diagnosed?

Because facial flushing is a non-specific symptom, it can be hard to determine what’s causing it. However, with the right tools, your doctor will be able to pinpoint any underlying condition that might be causing your symptoms. 

Some of the most commonly used tools to diagnose unusual facial flushing include:

• Medical history. Your doctor will begin your examination by looking at your medical history, which can help determine whether your symptom is caused by conditions such as menopause, rosacea, or sunburn, as well as hereditary disorders. 
• Physical examination. During a physical examination, your doctor will ask questions about your symptoms, their duration, location, and frequency, and whether they occur alongside other reactions. You may also be asked questions about your lifestyle, alcohol and caffeine consumption, stress levels, and sleep quality.
• Allergy testing. If your doctor suspects that your facial flushing is caused by an allergic reaction, they may recommend further allergy testing. This can also help you prevent severe reactions such as anaphylaxis, which can occur when you are re-exposed to an allergen.
• Trigger identification. If caffeine, alcohol, or stressors are behind your symptoms, learning to identify and avoid your triggers can help you better manage facial flushing episodes. Be aware of the triggers of your migraine or cluster headache (e.g. stress, tension, lights, odors, or foods) to prevent attacks.
• Differential diagnosis. Differential diagnosis involves making a list of possible conditions that may be behind your symptoms. For example, if you experience facial flushing and mood swings, these symptoms may be associated with some types of headaches, anxiety disorders, and menopause. Through further testing, this multi-step process can help you achieve the right diagnoses and guide treatment decisions. 

Your doctor may refer you to a specialist if they suspect that a certain condition is at the root of the flushing. For example, if your symptoms match the ones of rosacea, you may be recommended to consult a dermatologist for further testing and treatment recommendations.