Causes of Facial Flushing

There are many possible causes for red, hot cheeks in adults, commonly known as facial flushing. Physiologically, it occurs when blood vessels just below the surface of the skin, called capillaries, widen and fill with blood.

The trigger for facial flushing can range from common conditions like fever, menopause, and changes in body temperatures to uncommon ones like carcinoid syndrome (caused by a rare, slow-growing cancer). Emotions can also cause facial flushing, referred to as blushing.

This article looks at seven possible causes of facial flushing, both benign (harmless) and malignant (cancerous).

Benign Causes of Facial Flushing

Facial flushing can occur spontaneously for any number of reasons, most of which are relatively mild.

Extreme Emotions

When you are embarrassed, angry, or experience any strong emotion, your body may release a hormone called epinephrine (adrenaline) which causes blood vessels to dilate (widen). Epinephrine is one of the hormones associated with the "fight-or-flight" instinct that helps our body respond to threats.

When epinephrine is spontaneously released, dilated blood vessels cause the overlying skin to turn red and hot.

Changes in Body Temperature

When the body becomes overheated, it responds by dilating blood vessels. The dilation allows heat to be dispersed into the environment while triggering sweating to cool the body down.

A high fever is a common cause of facial flashing. Other causes include exercising strenuously or being overheated in hot climates or places like a sauna or steam room.

Taking an antipyretic drug like aspirin or Tylenol (acetaminophen) can help ease fever. Placing a moist, cool cloth on the face can help ease facial flushing.

Menopause

Menopause is characterized by hot flashes. Hot flashes are caused when sudden changes in hormones spontaneously change the body temperature.

Estrogen, the hormone that helps regulates menstrual periods, also influences a part of the brain called the hypothalamus which acts as the body's thermostat. Fluctuating estrogen levels during menopause can make it difficult for the hypothalamus to regulate temperature, leading the hot flashes and facial flushing.

Estrogen-replacement therapy (ERT) may help ease hot flashes during menopause.

Spicy Foods

The heat in spicy foods like chilis and curries is caused by a chemical called capsaicin found in chili peppers and paprika.

When you eat capsaicin, it stimulates a receptor in the digestive tract called capsaicin receptor TRPV1. The stimulation of these receptors makes your body feel warmer so that you can sweat and cool it back down. Facial flushing occurs with the sudden rush of heat.

The degree of flushing can vary from person to person but tends to correspond to the heat of a chili pepper as measured by Scovill heat units.

Rosacea

Rosacea is a chronic skin condition characterized by redness and skin bumps. It is more common among adults over 30, especially those with lighter skin tones.

Rosacea often begins with episodes of flushing, followed in time by symptoms such as burning and stinging sensations, papules (skin bumps), pustules (pimples), and permanent redness.

The cause of rosacea is unknown but may be due to genetics, environment, an overactive immune system, or a combination of these. Rosacea is not contagious or caused by poor hygiene. Antibiotics or acne medications may help reduce symptoms of rosacea and prevent disease progression.

Alcohol Use

Alcohol flush reaction is a condition common among many Asians who experience facial flushing after drinking alcohol. Also referred to as Asian flush syndrome, Asian flush, or Asian glow, it affects up to 36% of East Asians, including people of Japanese, Chinese, and Korean descent. Nausea, headache, and rapid heart rate can also occur.

Alcohol flush syndrome is caused by the lack of an enzyme that helps break down alcohol. Without this enzyme, alcohol is only partially broken down into a substance called acetaldehyde. As acetaldehyde accumulates, the immune system will respond with inflammation, causing blood vessels to dilate in the face.

Medications

Some medications used to treat high blood pressure, thyroid disease, and other conditions can also trigger an inflammatory reaction that leads to facial flushing.

These include:

• ACE inhibitors
• Calcium channel blockers
  
• Cholinergic drugs
• Corticosteroids (oral, injected, or intravenous)
• Cyclosporine
• Morphine
• Niacin
• Nitroglycerin
• Tamoxifen
• Thyroid releasing hormone
• Vasodilators
  

Malignant Causes of Facial Flushing

Carcinoid syndrome is a rare condition typically affecting people with advanced carcinoid tumors. These rare, slow-growing tumors affect hormone-releasing neuroendocrine cells. The tumors can develop in different parts of the body, including the digestive tract, lungs, and ovaries.

Some carcinoid tumors—most often those of the digestive tract—release a hormone called serotonin. Among its many functions, serotonin regulates body temperatures, moods, sleep, hunger, and sexual behavior.

With carcinoid syndrome, the excessive release of serotonin can cause symptoms like:

• Facial flushing
• Diarrhea
• Wheezing
• Rapid heartbeat
• Spider veins of the lips and nose

Carcinoid syndrome is diagnosed with a urine test that measures a byproduct of the breakdown of serotonin called 5-hydroxyindoleacetic acid (5-HIAA).

Carcinoid syndrome is treated by removing the tumor and administering a drug called octreotide that slows the production of hormones. Heartburn medications like Tagamet (cimetidine) have also been used to treat facial flushing in people with carcinoid syndrome.

The treatment of carcinoid syndrome usually involves treating the underlying cancer. But because most of these tumors don't cause carcinoid syndrome until they are advanced, the cancer may be incurable. In such cases, the treatment will be focused on easing symptoms and slowing the progression of the disease.

Summary

Facial flushing can occur for many relatively harmless reasons, including strong emotions, menopause, and eating spicy foods. It can also develop with a fever. when drinking alcohol, or as part of a chronic skin condition called rosacea. A rare, cancerous cause is carcinoid syndrome, most often caused by a carcinoid tumor in the digestive tract.