Excessive Sweating

Facial Flushing

Facial flushing refers to sudden blushing of the face in response to a strong emotion such as anger, embarrassment or excitement. It may also cause a feeling of warmth around the face. Although it is a normal response, it can be triggered by the following factors as well:  

• Medications: These include vasodilators, tamoxifen, raloxifene, calcium channel blockers, calcotonin, glyceryl trinitrate and isosorbide dinitrate. A number of medications used for treatment of prostate cancer also cause flushing.

• Medical conditions:  Certain medical conditions that are sometimes associated with facial flushing include rosacea, carcinoid syndrome, erythrophobia, menopause and mastocytosis.

• Other common triggers: These may include alcohol consumption, hot or spicy food, hot drinks, fever above 101ºC, vigorous exercise, food additives such as monosodium glutamate and sudden change in the temperature.

Treatment

Facial flushing usually reduces on treatment with a cold compress or by intake of cool fluids. However, frequent and severe facial flushing may negatively impact the personal and professional life of the patient. A consultation with a doctor is required to diagnose the underlying cause of facial flushing and get an appropriate treatment.

Treatment for facial flushing depends on the underlying cause and may include change of causative medications, treatment of the underlying medical condition or avoidance of common triggers. Psychotherapy may be recommended if facial flushing is secondary to social phobia. Medications such as beta blockers or clonidine may also be used to manage facial flushing. Administration of Botox injections provides a temporary treatment for facial flushing, the effect of which lasts for about six months.

 Surgery for Severe Flushing

Severe facial flushing accompanied with excessive sweating (hyperhidrosis) and not responding to conservative treatment, is called Idiopathic Craniofacial Erythema. It is caused by overactivity of the autonomic nervous system and endoscopic thoracic sympathectomy surgery may be recommended in these cases.

Endoscopic thoracic sympathectomy is a minimally invasive surgery that is performed through a very small incision under the armpit. The surgery is performed under general anaesthesia and involves ablation of the sympathetic nerves in the thoracic ganglia that control the extra blood supply to the blood vessels of the face and secretions from the sweat glands on the hands and face. Both sides can be treated at the same time.

Endoscopic thoracic sympathectomy provides a permanent cure for Idiopathic Craniofacial Erythema and has a high success rate. It is relatively safe but may be rarely associated with a small risk of injury to the chest and droopy eyelid or Horner’s syndrome.