Approach to flushing in adults
- Sara B Fazio, MD
Sara B Fazio, MD
- Associate Professor of Medicine
- Harvard Medical School
Flushing, a common problem encountered in the practice of medicine, has a broad differential diagnosis. A vigilant history of associated symptoms, duration, tempo, and environmental exposure is important to determine the underlying etiology and to formulate a management plan.
This topic reviews the pathogenesis, differential diagnosis, evaluation, and treatment of flushing. The management of benign excessive sweating as well as the approach to the patient with night sweats are discussed separately. (See "Primary focal hyperhidrosis" and "Approach to the patient with night sweats".)
Flushing is a sensation of warmth accompanied by transient erythema that most commonly occurs on the face, but also may involve the neck, ears, chest, epigastrium, and arms or other areas . The predilection for specific anatomical areas is likely to relate to the volume of visible superficial vessels and differences in the relative amount of cutaneous blood flow compared to other body areas .
It is important to differentiate "true flushing" from other disorders that lead to facial erythema, such as the butterfly rash associated with systemic lupus erythematosus or photosensitivity reactions . It is also important to distinguish flushing from excess sweating alone.
Flushing is a consequence of increased cutaneous blood flow secondary to vasodilation and represents part of a synchronized physiologic response of cutaneous vascular smooth muscle to a variety of autonomic or vasodilator stimuli. Flushing may be episodic, transient, or constant, depending on the etiology.
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- Autonomic mediated flushing
- - Thermoregulatory flushing
- Emotional flushing
- Neurologic disorders
- Vasodilator mediated flushing
- - Rosacea
- - Medications
- Nicotinic acid
- Other medications
- - Food ingestion
- - Alcohol
- - Carcinoid syndrome
- - Mastocytosis
- - Pheochromocytoma
- - Medullary thyroid carcinoma
- - Serotonin syndrome
- - Anaphylaxis
- - Pancreatic tumor/VIPoma
- - Renal cell carcinoma
- - Other
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS