Facial Flushing: Why Your Face Turns Red

Why the face flushes

The skin of the face, neck and upper chest has many small blood vessels close to the surface. They widen in response to nerve signals (as in blushing, emotion or heat) or chemicals in the blood (such as alcohol, histamine, hormones or medicines). The result is visible redness and a feeling of warmth.

• Wet flushing comes with sweating. It is usually nerve-driven: heat, exercise, emotion, fever and hot flashes.
• Dry flushing has no sweating. It is usually chemical: alcohol, niacin, histamine and hormone-producing tumors.

Common causes of facial flushing

Blushing and emotions

Embarrassment, anxiety and anger cause flushing through the nervous system. Some people blush intensely and often (idiopathic craniofacial erythema).

Heat, exercise and fever

Hot weather, saunas, hot drinks and exercise widen skin vessels to release heat. A fever also causes a flushed face.

Alcohol

Alcohol widens blood vessels. Many people of East Asian heritage carry a gene variant that slows the breakdown of acetaldehyde, causing marked flushing, a fast heart rate and nausea after small amounts of alcohol. This is a sign of slower alcohol metabolism and is associated with higher esophageal cancer risk in those who drink regularly.

Spicy food and food additives

Capsaicin in chili peppers, hot soups and, in some people, MSG and sulfites trigger flushing.

Menopause and hot flashes

Hot flashes affect most women around menopause. Sudden heat spreads over the face, neck and chest for a few minutes, with sweating and sometimes palpitations, then chills. They can continue for several years.

Rosacea

Rosacea is a long-term skin condition of the central face. It starts with frequent flushing, then persistent redness, visible small blood vessels and sometimes pimples on the cheeks, nose, chin and forehead. Common triggers are sun, heat, alcohol, spicy food, hot drinks and stress. It is most common in fair-skinned adults over 30.

Medicines

• niacin (vitamin B3), especially immediate-release forms
• calcium channel blockers, such as nifedipine and amlodipine
• nitrates and sildenafil-type drugs
• steroids
• opioids, which release histamine
• some chemotherapy drugs and contrast dye
• tamoxifen and medicines that lower estrogen or testosterone

Less common but important causes

• Anaphylaxis and allergic reactions: flushing with hives, swelling and breathing trouble.
• Carcinoid syndrome: neuroendocrine tumors, usually with liver spread, release serotonin and other substances. Flushing lasts minutes, often with watery diarrhea and wheezing.
• Mastocytosis and mast cell activation: flushing, itching, hives, belly cramps and low blood pressure.
• Pheochromocytoma: an adrenal tumor that causes episodes of headache, sweating, palpitations and very high blood pressure, sometimes with flushing but more often with pallor.
• Hyperthyroidism: warm, flushed skin, sweating and heat intolerance.
• Lupus: a red rash across the cheeks and nose (butterfly rash), worse in the sun.
• Medullary thyroid cancer: rare; can cause flushing and diarrhea.

Clues from accompanying symptoms

How doctors investigate flushing

Most flushing has an obvious trigger and needs no tests. A flushing diary noting time, triggers, duration, sweating and other symptoms is very helpful. If flushing is unexplained or comes with other symptoms, tests may include:

• thyroid function
• 24-hour urine 5-HIAA or blood tests for carcinoid tumors
• plasma or urine metanephrines for pheochromocytoma
• serum tryptase for mast cell disorders
• antinuclear antibodies for lupus
• hormone levels if menopause status is unclear

Treatment and self-care

• Identify and avoid triggers: alcohol, hot drinks, spicy food, hot rooms and sun.
• Keep cool: use a fan, layered clothing and cool drinks.
• Rosacea: sun protection every day, gentle skin care, prescription creams that reduce redness, and laser or light treatment for visible vessels.
• Hot flashes: hormone therapy is the most effective treatment for suitable women. Non-hormonal medicines are available for those who cannot use hormones.
• Medicine-related flushing: for niacin, taking it with food or a non-aspirin pain reliever beforehand can help. Ask before stopping any medicine.
• Medical causes: treatment of the underlying tumor, thyroid disorder or mast cell disorder.

Frequently asked questions

Why does my face suddenly turn red?

Sudden facial redness is most often from emotion, heat, exercise, alcohol, spicy food or a hot drink. In women around menopause, hot flashes are common. If it happens often without a trigger, or with other symptoms, see a doctor.

What causes facial flushing after drinking alcohol?

Alcohol widens skin blood vessels, causing redness in many people. Marked flushing after small amounts is often due to a genetic variant that slows the breakdown of acetaldehyde, a toxic by-product of alcohol. Rosacea and some medicines also make alcohol flushing worse.

Is facial flushing a sign of high blood pressure?

Usually not. High blood pressure rarely causes symptoms, and most flushing is unrelated. However, some causes of flushing, such as alcohol and a rare adrenal tumor called pheochromocytoma, can raise blood pressure. Checking your blood pressure is reasonable if flushing is frequent.

When should I worry about facial flushing?

Seek emergency care for flushing with swelling, hives, wheezing or dizziness. See a doctor for frequent unexplained flushing, or flushing with diarrhea, wheezing, palpitations, headaches, weight loss or persistent facial redness.

Can anxiety cause facial flushing?

Yes. Anxiety and embarrassment activate the nervous system and widen the blood vessels of the face, causing blushing. Some people blush very easily and find it distressing. Cognitive behavioral therapy and, in some cases, medicines can help.