Idiopathic Craniofacial Erythema: Understanding and Managing Facial Blushing

Facial blushing causes redness in your cheeks and can also cause your face to feel warm. In some people, the blush may extend to the ears, neck, and chest.

How does blushing differ from rosacea?

Rosacea is a chronic skin condition. Blushing may be a symptom of rosacea, but people with rosacea will also experience small, red bumps on the skin during a flare-up. Rosacea flare-ups can last a couple weeks or up to a couple months. By contrast, redness from blushing will go away once the trigger has been removed or shortly thereafter.

Various situations can cause you to blush. Blushing often occurs as the result of an embarrassing, awkward, or distressing situation that brings you unwanted attention. Blushing may also occur in situations where you think you should feel shame or embarrassment. How do your emotions trigger blushing, though?

Embarrassing situations can trigger the sympathetic nervous system and set off what is referred to as the fight-or-flight response. The sympathetic nervous system includes the muscles that dilate or constrict blood vessels. These muscles can become activated when your sympathetic nervous system is triggered. The face has more capillaries per unit area than other parts of the body, and the blood vessels in the cheeks are wider and closer to the surface. This makes the face subject to rapid change, such as blushing.

Idiopathic craniofacial erythema is thought to be caused by emotional or psychological triggers. Triggers can be any type of stress, anxiety, or fear. The onset of blushing often creates more of these feelings, which can make you blush even more. There’s limited research on blushing, but one study found that people who blush frequently were more likely to feel shame in connection with blushing than people who blush less frequently. The same study found that women blush more frequently than men.

Researchers don’t fully understand why some people blush more than others. It may be caused by an overactive sympathetic nervous system. Some people who blush a lot also experience excessive sweating, known as hyperhidrosis. Hyperhidrosis is also caused by the sympathetic nervous system.

You may also be more likely to blush a lot if you have a family member who experiences excessive blushing. Fair-skinned people may also be at greater risk for this condition.

Talk to your doctor if your blushing is affecting your quality of life or if you are concerned that you blush too much. Your doctor can help you manage your symptoms and develop a treatment plan if necessary.

If your blushing is thought to be caused by psychological distress, your doctor may recommend cognitive behavioral therapy (CBT). CBT is done with a therapist. It can be used to help you come up with coping tools to shift the way you view situations or experiences. CBT can help you feel more positive about social situations that typically trigger a blush response.

Through CBT, you explore why you view blushing as an issue. You could also work with your therapist to improve your emotional response to social situations where you do not feel at ease. Facial blushing is common in people with some type of social phobia. Your therapist may encourage you to put yourself into the very situations or activities that make you feel uncomfortable in order to overcome these feelings. You may also work on other emotions and anxieties related to blushing. Once you remove the stressful feelings about blushing, you may find that you blush less.

Lifestyle changes

Lifestyle changes may also help reduce excessive facial blushing.

• Avoid caffeine, sugar, and processed foods. They may increase feelings of anxiety.
• Wear green color-corrective makeup, which can help reduce the appearance of blushing.
• Drink cool fluids or use a cold compress when you begin to feel flushed.
• Practice meditation, breathing exercises, and mindfulness techniques. These may help you feel more relaxed and may reduce your incidences of blushing.

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Medication

If you have tried other treatments and found them to be unsuccessful, your doctor may prescribe medication. Anti-anxiety or psychotropic medication may be options if your blushing is caused by social or generalized anxiety disorders. Beta-blockers or clonidine (Catapres) may also be prescribed. These medications are often used to help manage blood pressure, but they may also help control the dilation of blood vessels in your face and reduce your episodes of blushing. Botox injections could be used to temporarily block your body’s ability to blush by paralyzing nerves in the skin.

Surgery

In some cases of severe blushing, surgery may be an option. The surgery is called endoscopic thoracic sympathectomy (ETS). In this procedure, a surgeon cuts the nerves that cause your facial blood vessels to dilate. Since the dilation of these blood vessels causes you to blush, the surgery can reduce your ability to blush.

Because of the possibility of serious side effects, this surgery is only considered if all other treatment options have failed. Talk to your doctor about the risks of this surgery.

Changing your perception about blushing is key to dealing with idiopathic craniofacial erythema. Some researchers have looked at the positive side of blushing, and suggest that it may be an adaptive tool to help people function in society. It’s also important to remember that you may not be blushing as much as you think. The feeling of warmth on your face when you blush may be more noticeable to you than the color on your cheeks is to others. Also, the more you think and worry about blushing, the more likely you are to respond by blushing.

Working with a therapist trained in CBT may help you to think more positively about blushing and feel less embarrassed or anxious about certain social situations. If CBT and lifestyle changes don’t help, other options include medication or, in extreme cases, surgery.