Woman with excessive facial blushing covering her mouth and smiling

Idiopathic craniofacial erythema, commonly known as facial blushing, is another manifestation of an overactive sympathetic nervous system. This condition is virtually impossible to control, and often results after professional or social situations that elicit feelings of anxiety, stress, or embarrassment. Often patients will have elements of chronic blushing in association with hyperhidrosis but more frequently it can occur as an isolated problem.

Though excessive facial blushing is not a life-threatening condition, it can have serious emotional and psychological effects on sufferers. In severe cases, individuals find themselves entirely unproductive at work and school during episodes severely impacting their performance.

What Causes Excessive Blushing?

People who experience excessive blushing often complain of seeing blushing that occurs not only on the face but also the neck and upper chest during stressful situations, such as public speaking or job interviews. This facial blushing brought on by high stress or embarrassing situations happens when the sympathetic nervous system is triggered and sets off the body’s fight or flight response. The muscles that dilate and constrict blood vessels, including those in the face and cheeks, are activated resulting in visible blushing. In those that suffer from excessive blushing as a result of emotional and psychological triggers, often the onset of blushing adds to these feelings making them blush even more.

In some cases, excessive blushing may be the result of certain psychological conditions in sufferers. Social phobia, generalized anxiety disorder (GAD), and even the fear of blushing, known as erythrophobia, have all been linked to facial blushing. Additionally, research has shown that individuals who have a family member that experiences excessive blushing are at a higher risk for blushing, as are fairer skinned people.

Excessive Blushing vs. Rosacea

Oftentimes excessive facial blushing is misdiagnosed as rosacea. Rosacea is a chronic skin condition that differs from excessive blushing in that in addition to blushing, symptoms also include the presence of small, red bumps. A rosacea flare-up can last between a couple of weeks to a couple of months. However, blushing episodes typically subside after an emotional trigger is removed.

Facial Blushing Treatment Options

It is recommended that those suffering from excessive blushing seek professional help when blushing begins to interfere with quality of life. A variety of medical therapies, including anxiolytics, antidepressants, psychotherapy, and biofeedback can sometimes help reduce the psychological impact of chronic facial blushing. However, in some individuals these therapies are ineffective and these people struggle to deal with the psychological effects of chronic blushing.

When more conservative excessive blushing treatment methods fail, blushing surgery may be recommended. The most common form of surgery to stop blushing is endoscopic thoracic sympathectomy (ETS) surgery. There is some controversy regarding the role of ETS in treating extreme blushing. At the Center for Hyperhidrosis at Columbia University Medical Center we have an extensive history with ETS and facial blushing. There is a unique set of patients with chronic facial blushing who do extremely well following T2 sympathectomy. These patients usually have a fair complexion, and exhibit patchy/blotchy erythematous patches over their upper chest neck and face which comes and goes in stressful embarrassing situations. The ETS–T2 sympathectomy is done in a similar fashion as for palmar hyperhidrosis. Two microscopic incisions placed in the armpit are used to identify and perform the sympathectomy. The T2 ganglion is separated from the sympathetic trunk along the superior aspect of the second rib. By doing so this prevents some of the other autonomic side effects such as bradycardia or severe compensatory sweating. After completing the procedure patients are discharged home after several hours.

For those still weighing the option to undergo surgery for blushing, there are few lifestyle changes that can be made immediately in an effort to reduce blushing:

  • Refrain from consumption of caffeine, processed foods, and sugar, which can increase feelings of stress and anxiety.
  • When beginning to feel flushed, apply cold compresses or drink cool fluids.
  • Learn breathing exercises and mindfulness techniques that can help you better cope with blush-inducing stress and anxiety.

Seriousness of Chronic Blushing

To those who do not experience it themselves, chronic blushing, also known as pathological blushing, probably appears as a mere flush of the face that could cause minor embarrassment to some in public. In reality, chronic facial blushing can have a profound impact on the men and women who live with it, negatively affecting their self-esteem, self-worth and confidence.

The psychological and social impact of chronic blushing can be debilitating and tormenting to many. Normal blushing typically indicates that a person is anxious, embarrassed, shy, lying, nervous, or hiding something. Those with chronic blushing send these false cues to those they interact with every day based on their appearance alone, which could cause them to be wildly misunderstood on a basic human level.


Brandon’s Chronic Blushing Story

People who live with chronic blushing are all affected by it in different ways. Many people have been able to overcome the psychological affects of chronic blushing, whereas others experience tease and torment that can cause deeper wounds. This was the case for a chronic blushing victim Brandon, who took his own life May 29, 2012 due to the despair and trauma caused by chronic facial blushing. He hoped that his passing would raise awareness to the crippling and unbearable effects of chronic blushing.

Devastatingly enough, Brandon actually had an appointment scheduled with us at the Center for Hyperhidrosis for an ETS surgery consultation, however he took his life several weeks prior to his appointment at the Center for Hyperhidrosis. If the appointment had been scheduled some weeks earlier, perhaps his life could have been saved.


Seek Help for Chronic Blushing

If you know anyone that lives with chronic blushing, encourage him or her to seek professional consultation from chronic facial blushing experts. ETS surgery for blushing is available to help lessen the physical symptoms of chronic facial blushing that can restore self-esteem and confidence. Below is a direct letter of thanks from a mother of one of our patients that underwent ETS surgery for facial blushing.

Thank you note

A Note of Thanks From A Chronic Blushing Patient

Hello Dr Gorenstein,

I just want to thank you for taking “blushing” issue seriously. When my son came to me with this issue, I was like the parents in the article about Brandon (who took his life due to facial blushing).  I was lucky that after researching doctors from Boston to California, I found you.  I know it’s only been about a week, but for [my son], it appears to have worked, and I am beginning to see the relief he feels from the inside out. A true gift. Now he can start living his life. Blushing was something that held him back in all areas of his life, his world was getting smaller and smaller.


Thank you for taking this issue seriously and giving these kids/adults options. Enjoy your summer and know you have made a huge difference in [my son]’s life!

Thank You
Woman with excessive facial blushing shocked with her hands on her face


    Start typing and press Enter to search