Flushing: causes, red flags and when to seek help

Flushing happens when blood vessels in the skin widen suddenly, bringing more blood to the surface. It feels hot, may be visible as redness or blotching, and can involve the face, ears, neck and upper chest. It is typically episodic, lasting seconds to minutes, which separates it from the persistent redness of conditions such as sunburn or established rosacea.

On brown and black skin the colour change can be less visible, and the sensation of warmth, burning or tingling may be the main sign. The NHS makes this point for rosacea, noting that redness may be harder to see on brown or black skin.

Normal physiology comes first: embarrassment, anger, hot rooms, vigorous exercise, spicy food, hot drinks and alcohol all trigger harmless flushing in many people. Medical causes are worth considering when the pattern is new, frequent, severe or accompanied by other symptoms.

The NHS says symptoms of perimenopause and menopause vary widely, with changes to periods often one of the first signs, and hot flushes and night sweats common. It says symptoms usually last for 7 to 9 years, sometimes longer, and that women from a Black ethnic background are more likely to have hot flushes that are severe and continue longer. It advises contacting a GP if symptoms are affecting you and you want to know your options, if you have palpitations, if bleeding is heavier than before, or if you have any vaginal bleeding after 12 months without a period.

The NHS describes rosacea as a long-term skin condition mainly affecting the face, more common in women and people with lighter skin, with symptoms that can be worse in men. Early signs are blushing and a burning or stinging feeling with water or skincare products; later the redness may become constant, with tiny broken blood vessels, pink or red bumps and sometimes thickened skin on the nose. It cannot be cured, but treatment from a GP can control symptoms.

Flushing with swelling of the lips, mouth, throat or tongue, difficulty breathing or swallowing, a hoarse voice, wheeze, faintness or collapse could be anaphylaxis. The NHS says to call 999 if you think you or someone else is having an anaphylactic reaction, to use an adrenaline auto-injector if you have one, and to lie down with legs raised and not stand or walk even if you feel better.

Flushing with a fast or irregular heartbeat, chest pain or fainting needs urgent review. Flushing with persistent watery diarrhoea, wheezing, unexplained weight loss, or episodes with severe headache and sweating should be seen promptly, since a hormone-producing tumour or other endocrine cause may be responsible. Flushing in a man who has been losing weight, or one-sided flushing, is unusual and also merits assessment.

If you have rosacea, the NHS advises an urgent GP appointment or NHS 111 if your eye is painful, blurred, light-sensitive, red or gritty, which could signal keratitis.

Be ready to describe the triggers, how long each episode lasts, how often they come, which parts of the body are involved, and whether you sweat, feel your heart racing, wheeze, have diarrhoea or headaches. A list of medicines, supplements and alcohol intake is vital, as is date of your last period if relevant.

The examination includes blood pressure, pulse, skin inspection for rosacea bumps and telangiectasia, and a check of the eyelids and eyes. Observing an episode, or a smartphone photo taken during one, can be surprisingly helpful.

Most flushing needs no testing, because the history gives the answer. Where the picture is unclear, blood tests may include thyroid function, a full blood count, and hormone levels such as FSH if menopause is uncertain in younger women. Specific 24-hour urine or blood tests for carcinoid-type or adrenal causes are reserved for flushing with suggestive features, and are arranged by endocrinology or gastroenterology.

Keep a diary to find your triggers and then avoid or reduce the ones that matter. For rosacea the NHS lists alcohol, spicy foods, hot drinks, sunlight, temperature extremes, exercise and stress as common triggers; protecting the skin from sun, using gentle skincare and cooling the face can help. For menopausal flushes, layers of clothing, a cool bedroom and avoiding alcohol and caffeine are practical measures, and a GP can discuss medical treatments.