This is one of the most common causes of flushing & blushing, typically affecting half or women. This type of flushing may last for several minutes & occur multiple times a day. Flushing can be exacerbated by heat, stress, food, alcohol & changes in temperature. It typically affects the face, neck & chest & can be associated with sweating. Overlap with emotion & rosacea are common.

Your GP can discuss treatment options including HRT & estrogen replacement. If you are inclined towards a more natural solution, you may consider seeing a physician who specializes in bioidentical hormone replacement. 

Disclaimer: My job is procedural, I laser the result of flushing, namely background redress. It is in your best interest to address the causes of redness as this gives the highest remission rate. Lasers are useful for static redness, not intermittent flushing, or blushing.

There are many food groups that can cause & exacerbate flushing. They include alcohol, mono-sodium glutamate, nitrites & sulphites. Potassium sulphides are found in cured meat. Spicy foods contain red pepper, whilst gustatory flushing can be due to lemons. Histamine release due to allergies can also contribute to flushing, redness & blushing. Food intolerance to hot beverages can also be seen in rosacea patients.

A dietician can discuss elimination diets. This is beyond the realm of dermatologists.

Flushing may rarely be due to systemic disorders including carcinoid syndrome, pheochromocytomas, mastocytosis & cancers including thyroid, pancreatic and renal cancers. These conditions are usually associated with systemic changes including wheezing, gastrointestinal upset, weight loss, & changes in blood pressure. Your physician will exclude these cases where appropriate or refer you to a general physician or a medical dermatologist. Medications such as calcium channel blockers & other cardiac drugs can also cause flushing.

Facial blushing & flushing is common in people who have an anxiety disorder including social phobia. Patients experience extreme & persistent anxiety in social and performance situations, & fears being judged, criticised, ridiculed, or humiliated. For these cases pharmacological treatment coupled with psychotherapy such as cognitive behaviour therapy is indicated. See a psychologist.

*Brisbane patients are referred to The OCD Clinic In Bulimba.

I am the very last person to see for flushing treatments as my skill sets are laser & procedural based. A medical dermatologist can investigate & prescribe medications to stabilise your condition. Menopausal associated flushing can be treated by your GP.

If you are seeking a non-prescription natural remedy, do not see a specialist. A dietician can review your foods & appropriately prescribe a sensible diet. A naturopath can discuss herbs.

A psychologist can educate you on stress management as well as strategies such as cognitive behaviour therapy & habit reversal techniques.

Tablets can help reduce flushing episodes. There are three main groups.

Firstly, beta blockers include propranolol. Secondly, alpha adrenergic agonists such as clonidine. This works by changing the body’s response to chemicals, such as noradrenaline, that control the dilation and constriction of blood vessels. Thirdly anti-anxiety tablets including benzodiazepines. The risk benefit ratio of these tablets can be discussed with your treating physician.

Disclaimer: I do not prescribe medications as my practice is procedural. Be guided by your physician.

If you have intermittent flushing & blushing problems without static redness, lasers are of limited value. Lasers are best for persistent visible redness & or cases of redness due to broken capillaries.

In some cases I will induce flushing & redness in order to hit target vessels.

Patients with rosacea will benefit from lasers. Emotional & physiological flushing will not benefit from this treatment.

Vascular lasers are my go-to devices. I use 3 types of lasers/devices.

The pulse dye laser is the gold standard for treating broken capillaries & rosacea associated flushing. I also use IPL or intense pulsed light devices. A long pulse NdYag laser is also used in a special Laser Genesis setting to treat deeper redness.

For normal cases of redness, book an appointment with my nurses. I am more than happy to be involved in the management of severe, recalcitrant & persistent redness, as opposed to flushing without redness.

Botox is a highly effective treatment for most forms of flushing, including emotional, physiological, menopause & rosacea associated redness. It works by modulation of smooth muscles within blood vessel walls.

• Facts: Injections take 1-2 weeks before maximal results are seen. It can be delivered via a needle or microneedle.
• Duration: Injectables can last 3-6 months. Bigger doses are associated with longer duration.
• Side effects: Uncommon. Include transient muscle weakness.
• Costs: Varies depending on the number of units placed. Typically, $390 to $990. I suggest you see my injectable nurses as they are more cost effective.

The best option is with Botox. Apart from the wrinkle reduction effects, Botox can markedly reduce sweating & flushing/blushing. Aquagold micro-Botox is the most reliable method of delivery. The efficacy rate is over 80% & last 2-5 months.

Other options include glycopyrrolate wipes & lotions. You can source these overseas.

*This treatment is not covered by Medicare (unlike underarm sweating).

Endoscopic thoracic sympathectomy or ETS is one of the most reliable ways to treat flushing. It is effective in over 90% of cases. This procedure is conducted in a day surgery under general anaesthetic by a vascular surgeon.

My go to buddy is Dr Andrew Cartmill in Brisbane. Side effects include compensatory sweating as well as dry hands.

In many cases, emotional input can exacerbate flushing, redness & blushing. A laser is lousy at treating emotions. Psychologists are awesome at teaching procedures such as cognitive behavioural therapy to help you cope with situations that may trigger emotive responses. Do not underestimate the power of psychotherapy as it is more powerful than lasers, especially in treating social phobias.

A dermatologist is the last person to see if you are into natural treatments. The flipside is that natural remedies may be effective in some.  Meditation, yoga, & acupuncture are all recognised treatments. Depending on laws pertaining to the State or country you live in, CBD oil, Mary Jane, ganga, weed, pot, hash, grass, reefer, holy weed, spliff, or a joint can markedly reduce anxiety related flushing.

Natural relaxants & anti-inflammatories include camomile, lavender, oatmeal & aloe vera. Dietary restrictions include spicy foods & any dodgy Asian food high in monosodium glutamate (most foods).

*Dermatologists cannot condone any behaviour that involves illicit intake of drugs. Local laws apply.

Yes & no. Appropriate skin care can reduce skin irritation & calm redress. This is especially true in the management of rosacea. Look for formulations that contain azelaic acid or niacinamide. Avoid retinol, retinoic acid & ascorbic acid. AHAs should not be used if you have sensitive skin.

In rare cases, yes. The most common topical is Mirvaso or brimonidine. This can cause temporary constriction of blood vessels & can help a small minority of rosacea patients. Most patients will experience significant rebound on this medication.

Other prescription creams contain estrogen, bioidentical hormones & drugs that stabilize dilation of capillaries.

Disclaimer: I do not prescribe topical creams as my work is entirely procedural. If you would like to have a go at topicals, either your GP or a medical dermatologist can guide you.

This can help your physician and give you insights as to triggers. It can also differentiate between benign causes of flushing & one’s that require investigations. For example, rosacea is associated with burning & stinging but not with sweating, palpitations or systemic symptoms such as GI upset. The more accurate you are, the faster your physician & you can gain control.

This is when you subjectively visualise facial redness, but others do not see your problem. In this case you may-

1. Have intermittent redness & flushing not visible during the consultation. In this case interventional therapy with lasers & procedures are unlikely to make a difference. You are best seen by medical professionals who prescribe medications & work with cognitive behaviour therapy.
2. Suffer from BDD or body dysmorphic disorder. This is when you visualise a concern (such as facial redness) as having a major impact in your life. In short, your visualised problem is much more severe than it is. If your family & friends can not see your problem, chances are you do not objectively have a problem. The flipside is that subjectively this has a massive impact on your emotional well-being. A psychiatrist or psychologist can make a bigger difference than what lasers or procedures can.

Treatments vary depending on what is used & who performs it. My team & I are involved in procedural work, most often we are the last line of defence in the management of flushing & blushing. As a guide-

Laser treatment with me $690.

Laser & IPL treatment with my nurses & therapists $240-$290

Injectables (Botox, Dysport, Xeomin) range from $390 to $990.

In the context of lasers, you are better off seeing my team. I do get involved in complex cases of objectively persistent redness recalcitrant to lasers.