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Facial blushing is an involuntary reddening of the face due to embarrassment or stress. It is thought that facial blushing is caused by an overactive sympathetic nervous system. This system helps to regulate glands and organs without our conscious effort, and controls the diameter of blood vessels to the face. In some people, these nerves are unusually sensitive to emotional stress. Given the right stimulus (such as embarrassment), the nerves prompt the blood vessels to open wide, flooding the skin with blood and causing the characteristic reddening of the face. In some people, the ears, neck and chest also blush. Severe facial blushing is common in people who have social phobia, an anxiety disorder in which the person experiences extreme and persistent anxiety in social and performance situations, and fears being judged, criticised, ridiculed or humiliated.
Symptoms
The symptoms of severe facial blushing can include:
- Intense blushing, often for no apparent reason.
- Sensation of heat in the face.
- Shame and embarrassment.
- Avoidance of eye contact.
- Avoidance of any possible triggers, including meeting new people or talking in front of groups, for fear of going red.
Severe blushing (idiopathic cranio-facial erythema)
Severe cases of blushing are known as idiopathic cranio-facial erythema. Just about any situation at all can bring on intense blushing (for example, the trigger can be as simple as casual conversation with friends) and it may take one or two minutes for the blush to disappear. Severe blushing can make it difficult for the person to feel comfortable in either social or professional situations. People who have social phobia are particularly prone to idiopathic cranio-facial erythema.
Hyperhidrosis
Hyperhidrosis means excessive sweating. A person with hyperhidrosis can sweat heavily enough to soak their clothes. Once again, an overactive sympathetic nervous system is thought to be the cause, which explains why some people who have idiopathic cranio-facial erythema suffer from hyperhidrosis as well.
See your doctor for proper diagnosis
The menopause or certain skin disorders can cause severe facial blushing. It is important to see your doctor to make sure that your blushing isn’t caused by an undiagnosed medical problem.
Psychological treatment options
Involuntary blushing is common to people who have social phobia. In most cases, these disorders respond well to treatment. Psychological treatment options can include:
- Cognitive behaviour therapy (CBT) - this treatment aims to help people change the way they think, feel and behave in social situations.
- Breathing techniques - many of the symptoms of anxiety are triggered by hyperventilation (rapid, shallow breathing), which depletes the blood of carbon dioxide. Slow, deep breaths can reduce anxious feelings.
- Confronting fears - with the guidance of a professional, the person ranks their social fears in order of ‘threat’, then confronts less threatening fears first.
Drug therapies
Medications to help treat facial blushing can include:
- Anxiety medications - these can help calm the person and reduce the frequency or severity of blushing.
- Beta-blockers - these drugs can help manage some of the symptoms of anxiety, such as blushing and heart palpitations.
- Clonidine - this medication is sometimes used to treat uncontrollable facial blushing. It works by changing the body’s response to naturally occurring chemicals, such as noradrenaline, that control the dilation and constriction of blood vessels.
Surgical options
Endoscopic thoracic sympathectomy (ETS) is an operation to cure severe facial blushing. The operation is performed under general anaesthesia. Using keyhole (laparoscopic) surgery, slender instruments are inserted into the chest cavity via the armpit. The involuntary nerves that control the diameter of the blood vessels are partially removed. The cure rate for facial blushing is around 90 per cent. This operation can also cure hyperhidrosis of the head, armpits and hands. Complications of this operation could include:
- Risks of surgery - including allergic reaction to the anaesthetic, haemorrhage and infection.
- Droop to the eyelid caused by nerve damage (Horner’s syndrome).
- Compensatory sweating, which means other areas of the body such as the legs and chest sweat heavily instead.
- Chronically dry hands.
Where to get help
- Your doctor
- Surgeon
- Psychologist
- Counsellor
- Anxiety Recovery Centre Victoria Tel. (03) 9886 9377
Things to remember
- Facial blushing is an involuntary reddening of the face due to embarrassment or stress.
- Severe blushing, known as idiopathic cranio-facial erythema, is common in people who have social phobia, which is a type of anxiety disorder characterised by extreme and persistent anxiety in social and performance situations.
- Treatment options include cognitive behaviour therapy, medications and surgery.
You might also be interested in:
Anxiety disorders.
Social phobia.
Want to know more?
Go to More information for support groups, related links and references.
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