- Best Results2-6 months
- Treatment Recovery0- 2 days
- Procedure Time5 to 10 minutes
- Skin SpecialistDermatologist (medical)
- Duration of ResultsVariable
- Back to Work0-1 day
Flushing & facial redness is a common skin concern. Some cases are secondary to conditions such as rosacea & menopause. Another common cause is exaggerated physiological flushing. This usually has a psychological element. In many cases there are multiple factors contributing to flushing & facial redness. A medical dermatologist can guide you through the treatment algorithms.
FactsFacts on flushing, blushing & redness
- Symptoms of flushing include a sensation of warmth coupled with sweating
- Signs of chronic flushing include facial redness & broken capillaries
- Medications such as propranolol & blood vessel modulators are helpful
- Bioequalevant hormones are indicated if hormone levels are low
- Cognitive behaviour therapy can be helpful for anxiety associated flushing
- Anti-inflammatory skin care is helpful if flushing is secondary to rosacea
- Lasers are useful if there are broken blood vessels or background redness
- A medical dermatologist can investigate & initiate effective treatments
What causes flushing?
Flushing may be defined as a sensation of warmth accompanied by visible reddening of the skin. Normally, it is part of a coordinated physiological response to heat that is modulated by emotions & other stimuli.
Abnormal flushing occurs when this response is exaggerated or prolonged. The causes of flushing are the treatment algorithm can be very complex. Hopefully this page can help you better understand the causes & guide you accordingly.
Disclaimer: Though I can systematically work through diagnosis & treatment options for flushing, my skill set nowadays is entirely procedural, namely I laser persistent cases of redness. You will get the most benefit from a medical dermatologist or general physician.
What is the difference between normal flushing & abnormal flushing?
In a nutshell if you are reading this sentence, you have abnormal flushing. Abnormal flushing is when flushing & blushing has an impact on your life. Examples include signs such as persistent redness & broken capillaries or symptoms such as burning, stinging, social phobia or embarrassment.
How do you know if rosacea contributes to redness & flushing?
Rosacea is the most common cause of flushing that presents to dermatologists. It is a clinical diagnosis that can be complex as there are many types of rosacea including flushing, papular pustular, ETR (capillaries), phymatous rosacea & ocular rosacea.
Chronic flushing & blushing can lead to fixed redness due to increased superficial capillaries. In some cases, there may be an overlap between rosacea, menopausal flushing & emotional causes. A dermatologist can assist in the diagnosis & prescribe suitable medications. For a non-pharmacological approach, see the relevant sections in this website. My job is purely laser & procedural based. If required I will refer you to suitable specialists for further management.
What is emotional or physiological flushing?
This group of flushing/blushing is common. It is triggered by emotion, (as there is an overlap with anxiety related flushing) as well as temperature changes, foods & situational triggers. It is more common in young adults. This type of flushing can be more resistant to treatment.
A medical dermatologist & a psychologist should be your first point of contact. A trial of propranolol & psychotherapy should be considered. Lasers are not indicated as first line treatment.
View our Treatment Gallery
What is menopausal flushing?
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.
What foods can cause flushing?
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.
What are other rare causes of flushing?
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.
What is anxiety related or social phobic 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.
Who to see before me?
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.
What tablets are used to treat flushing?
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.
What can lasers achieve?
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. Patients with rosacea will benefit from lasers. Emotional & physiological flushing will not benefit from this treatment.
What lasers do I use to treat facial redness?
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.
What can Botox achieve?
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.
How can facial sweating associated with flushing be treated?
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 3-6 months.
Other options include glycopyrrolate wipes & lotions. You can source these overseas.
*This treatment is not covered by Medicare (unlike underarm sweating).
What surgical techniques can treat flushing?
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.
How can a psychologist help?
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.
What natural treatments are there?
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.
Can skincare help reduce flushing & redness?
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.
Can prescription creams treat redness & reduce flushing?
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.
Why is a treatment diary helpful?
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.
What is body dysmorphic disorder flushing & redness?
This is when you subjectively visualise facial redness, but others do not see your problem. In this case you may-
- 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.
- 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.
How much are treatments?
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.
Davin’s Viewpoint on flushing treatments
This is one of the harder conditions to manage, especially non-pharmacologically. Lasers are good for treating static redness, namely broken capillaries & telangiectasia or spider veins. They have a role to play in treating inflammatory skin conditions including rosacea. They are less useful for carpet bombing normal skin. If you have normal looking skin, & flush intermittently, the best person to see is a medical dermatologist. Procedures are not indicated as first line management.
The top four conditions that cause flushing, & blushing are physiological (with emotive input), rosacea, hormonal & a combination of these. The treatment algorithms are very complex, ranging from pharmacological, through to psychological therapy. A medical dermatologist (not me) can help exclude super-rare conditions like carcinoid syndrome, & neoplastic causes & co-ordinate a treatment program using drugs such as beta blockers & clonidine. Treatments such as ETS or endoscopic thoracic sympathectomy can be extremely effective, albeit side effects such as compensatory hyperhidrosis (sweating).
I play a very narrow role in the management of flushing, namely using lasers & neurotoxin to treat vasculature. I am not addressing the cause but treating the end result of chronic flushing. Lasers can decrease background redness & broken capillaries. Lasers are much less useful in treating normal skin with a tendency to intermittently flush.
Novel treatments include Botox. This can be delivered via Tixel or microneedles using Aquagold. These delivery systems are much safer than traditional intradermal injections as less diffusion occurs.
If you have benign cutaneous flushing, meaning flushing not related to rosacea, menopause, or rare secondary causes, a psychological assessment is of great value. This especially applies to young adults who may suffer from anxiety & social phobias. Lasers have very little to offer in comparison to cognitive behaviour therapy with psychologists.
Join the conversation
Join Dr Davin Lim on Instagram to stay up to date