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Blushing is the uncontrollable and involuntery reddening of the face, usually triggered by emotions such as embarassment or stress.

The neck, ears and upper chest can also be affected.

Blushing can also sometimes make the affected area feel hot - and sometimes the blush is not that perceptible, visibly, and instead the affected area just feels hot.

Blushing is the result of the dilation (widening) of the blood vessels in the face.

This causes an increase in the flow of blood into the blood vessels just belo the surface of the skin, causing your face to turn red and/or heat up.

Blushing is maybe best summarised as being 'an emotional response to an unconscious trigger' - by which we mean that blushing is normally outside of our conscious control.

For the overwhelmingly vast majority of people it is very very difficult for anyone to intentionally blush, on purpose, And, unfortunately, as many people know, it is probably even more difficult, no, let's say impossible, for someone to stop themselves blushing !

For example, many people have experienced being in a situation of blushing in response to maybe feeling that had been 'put on the spot' and feeling themslves to be the 'centre of attention', only to find their 'friends' helpfully pointing out something of which they were already only too well aware, that they were 'going red' ! And of course that makes the event and the situation even more embarassing ! And, or course, we just know that there seems to be nothing that we can do (consciously) to stop the blushing 'episode' ! All we can do it to try and sit it out, and wait for the blush to dissipate - whilst at the same time trying to divert and distract the attention of our 'friends' away from us, and our predicament, and on to something else !

Usually, the 'emotional response to an unconscious trigger' is caused by some kind of anxiety within the unconscious, and it is this that is being triggered unconsciously and creating the 'emotional response'. So some people that my be more predisposed to blushing will be those with some form of anxiety disorder, say:

• Social anxiety disorder (social phobia) – a persistent and excessive fear of social situations
• Generalised anxiety disorder (GAD) – a long-term condition that causes anxiety about a wide range of situations and issues

Other causes of blushing and reddening of the face can include:

• Rosacea – a common skin condition that mainly affects the face.
• The menopause – where a woman stops having monthly periods, usually between 45 and 55 years of age.
• Certain medications – such as the breast cancer medication tamoxifen.
• Drinking alcohol or hot drinks
• Eating hot or spicy food
• Fever (high temperature)
• Strenuous exercise
• Sudden changes in temperature (hot or cold).

Blushing can also sometimes be associated with other medical conditions, including:

• Rosacea – a common but poorly understood long-term skin condition that mainly affects the face
• The menopause – where a woman stops having monthly periods, usually between 45 and 55 years of age
• Mastocytosis – a rare condition caused by excessive amounts of histamine and other chemicals being released into the blood
• Carcinoid syndrome – a rare type of cancer known as a carcinoid tumour which affects the body's ability to produce certain hormones
• Hyperhidrosis - although it isn't a direct cause of blushing, excessive sweating (hyperhidrosis) is often associated with the condition.

Blushing can be caused by medication

Certain types of medication can also cause blushing. These include:

• Tamoxifen – often used to treat breast cancer.
• Calcium-channel blockers – used to treat high blood pressure and angina .
• Calcitonin – sometimes used to treat bone disorders such as osteoporosis.
• Glyceryl trinitrate and isosorbide dinitrate – sometimes used to treat angina.
• Buserelin, triptorelin, goserelin and leuprorelin – sometimes used to treat prostate cancer.

Speak to your GP if you're taking a medication that causes blushing and it's making you feel worried, stressed or self-conscious. They may be able to recommend an alternative medication.

A common cause of excessive and frequent blushing is having an irrational fear (phobia) of blushing, known as erythrophobia. People with erythrophobia often worry that they'll blush when interacting with others, and that other people will mock them because of this.

Unfortunately, this can trigger a vicious cycle. They become so worried about being the centre of attention in social gatherings that when it happens, they suddenly become very embarrassed and start blushing, which reinforces their phobia.

Erythrophobia is often associated with other phobias and mood disorders, such as social phobia and general anxiety disorder (GAD).

Most people blush from time to time, and it isn't usually a cause for concern.

But frequent and severe blushing can have a significant psychological impact, leading people to avoid certain situations and avoid interacting with other people, and it can have a seriously adverse affect on employement and career prospects.

IIf abnormal blushing is affecting your quality of life, you may benefit from treatment.

Available NHS Treatments for Blushing

The specific treatment offered will depend on the underlying cause of your blushing.

• If the underlying cause is thought to be psychological, such as an irrational fear (phobia) or anxiety disorder, a talking treatment called cognitive behavioural therapy (CBT) can be offered. This is psychotherapy treatment at the conscious level of the psyche - this might help a little but, to put it simply, CBT is unable to access and resolve any of the causes within the unconscious, which is where the problem usually lies - as a general rule psychological treatment using therapeutic Hypnosis is simply not commonly available from the NHS.
• Medications such as selective serotonin reuptake inhibitors (SSRIs) can also help to reduce any associated feelings of anxiety and worry.
• If the underlying cause is physical, such as the menopause or rosacea, you may be advised to avoid common triggers such as stress, alcohol and spicy foods. Hormone replacement therapy (HRT) can also help women with menopausal hot flushes.
• A surgical procedure called endoscopic thoracic sympathectomy (ETS) may be considered if your blushing is particularly severe and other treatments haven't been effective. But this type of surgery carries a risk of long-term problems such as excessive sweating (hyperhidrosis). 

NHS Treatment for Rosacea blushing

If blushing is the result of rosacea, avoiding potential triggers such as stress, prolonged exposure to sunlight and spicy foods may help

Blushing can also be camouflaged using a green colour-corrective moisturiser. This type of moisturiser is also useful for covering up broken veins. Some colour-corrective moisturisers can be used under a foundation. Others can be particularly useful for men with blushing problems. Hypo-allergenic brands for sensitive skin are also available.

Few medications have been shown to be effective in reducing blushing caused by rosacea, although laser and intense pulsed light (IPL) treatments can sometimes help by shrinking the blood vessels in your face.

NHS Treatment for Menopausal Blushing

Many women experience hot flushes and blushing at the time of the menopause. In such cases, it can help to:

• avoid possible triggers, such as stress, spicy foods, caffeine, smoking and alcohol
• exercise regularly 
• lose weight if you're overweight or obese
• wear light clothing
• Hormone replacement therapy (HRT) or a medication called clonidine can also often help reduce hot flushes caused by the menopause. Certain antidepressants – such as venlafaxine and fluoxetine – may be useful too, although these medications are unlicensed for this use. "Unlicensed" means the medication hasn't undergone clinical trials to see whether it's a safe and effective treatment for your condition. However, doctors sometimes consider using an unlicensed medication if they think it's likely to be effective and the benefits outweigh any associated risks.

Surgical NHS Treatment for Blushing

In the most severe cases of facial blushing, where other treatments haven't helped, a type of surgery called endoscopic thoracic sympathectomy (ETS) may be considered.

This is a surgical procedure where the nerves that cause the facial blood vessels to dilate (widen) are cut. The operation is carried out under a general anaesthetic, which means you'll be unconscious during the procedure and won't feel any pain while it's carried out.

At the start of the procedure, small incisions will be made beneath one armpit, and a thin, flexible tube with a camera on the end (endoscope) will be inserted through an incision.

The surgeon will be able to locate the nerve that controls the blood vessels in one side of your face. Special surgical instruments can then be inserted through another incision and used to cut the nerve.

When this is complete, the surgeon will repeat the process on the other side of your body.

Although most people are satisfied with the results of ETS, the procedure doesn't always work and some people experience short- or long-term complications afterwards.

Some of the main risks of ETS include:

• Excessive (compensatory) sweating – as the cut nerves also control sweating in some areas of the body, the procedure can cause other areas of your body to sweat more
• Horner's syndrome – where nerve damage causes the upper eyelid on one side of the body to droop
• Pneumothorax – where air gets into the chest cavity and needs to be drained by inserting a temporary tube

Due to problems such as these, particularly excessive sweating, some people regret having ETS. If you're considering this type of surgery, make sure you discuss the possible risks and benefits with your doctor or surgeon beforehand.

The National Institute for Health and Care Excellence (NICE) will have more information about endoscopic thoracic sympathectomy for primary facial blushing.

The Surrey Hypnotherapy Clinic TM

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Acknowledgements

https://www.nhs.uk/conditions/blushing/

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