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When your face suddenly turns red, along with your neck and sometimes even your upper chest, you are said to be blushing. It does not occur only when you are angry, but maybe even when you are nervous, embarrassed, stressed or fearful. Many people blush during moments of high anxiety, especially when one is worried about being judged or criticized by other people. However, some people may blush even without any emotional stimuli. This can cause one to be embarrassed about blushing, which can lead to more anxiety and social phobia. Blushing is medically known as neurologic flushing, and an exaggerated fear of blushing is called erythrophobia.

What causes people to blush?

The body reacts to environmental stimuli or emotional stress by activating the "fight or flight" response, which is one of the functions of the sympathetic nervous system. This branch of the nervous system causes us to maintain our inner balance when confronted with a physical or emotional threat. It triggers the widening of the capillaries (the small blood vessels) on the surface of the skin and an increase in blood flow, which causes blushing, turning the cheeks red.

The widening of capillaries (vasodilation) in the body is usually an effect of the direct action of histamine, a natural chemical substance, which can also cause some itching. However, in the face, neck, and upper chest, the neurologic control of the blood vessels is exerted by the autonomic nerve fibers and the trigeminal nerve, which supply the skin in these areas. These nerve fibers also supply the sweat glands, and when activated, sweating may occur with flushing.

The cheeks easily turn red because the capillaries here are wider than those found elsewhere, and are more superficial, with less skin thickness to obscure them. With an increase in blood flow, the skin can turn red. Your color returns to normal when you feel less stressed or threatened and your "fight or flight" response is turned down.

Other causes of facial flushing include:

  • Overheating, which may occur due to exercise or using the sauna. This causes physiologic flushing, a result of the increase in body temperature, which triggers the thermoregulatory center in the brain to widen the blood vessels to release body heat.
  • Menopause (hot flushes), which is associated with hormonal changes and profuse sweating in women who are around 50 years old.
  • Alcohol intake, which occurs in some people who have a genetic enzyme deficiency and inability to metabolize the byproduct of alcohol (acetaldehyde).
  • Allergic reaction to foods, beauty products, or cold temperature
  • Reaction to certain foods (spicy or sour foods, MSG, etc)
  • Certain drugs, such as vasodilators, calcium channel blockers, morphine, tamoxifen, rifampin, etc.
  • Obesity, which may affect cardiac and circulatory system function
  • Certain medical conditions such as high blood pressure and carcinoid syndrome

How to Manage Flushing

It is important to know what causes facial flushing and to distinguish between physiologic (natural) causes and pathologic disorders. If blushing is related to anxiety, stress management and relaxation techniques for anxiety may be all that is needed to reduce its occurrence. If flushing is triggered by alcohol, drugs or food, then one may have to avoid these factors. One must also find out if an underlying medical condition may be causing the problem and seek proper treatment, not only for flushing but for general health.

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