Q: I recently began having flushing on my face. What is causing this and what can I do about it?

A: Flushing is defined as a sensation of warmth accompanied by visible reddening of the skin. Flushing results from an increase in facial blood flow, which in turn is caused by dilation of the blood vessels in the face.

There is a long list of medical causes of flushing, but the most common causes are an emotional reaction, certain foods and beverages, alcohol, and rosacea. Emotional flushing is an easy diagnosis to make; it is characterized by flushing which occurs when an individual is emotionally upset or has a feeling of embarrassment. If certain foods, beverages, or alcohol cause flushing, their avoidance will usually cure the flushing.

Rosacea is another very common cause of flushing. Rosacea is characterized by symptoms of facial flushing and a collection of other clinical signs such as facial redness, broken capillaries (medically called telangiectasias), coarseness of the skin, and an inflammatory eruption that may be similar to acne. The most likely areas to be affected by rosacea are the nose and cheeks, but in more severe cases the entire face and neck can be affected. Eventually, the redness of the face becomes permanent.

Rosacea is most likely to start in fair skinned people in their thirties and forties. Although there are many theories, the cause of rosacea is still unknown. Genetic and environmental factors such as sun exposure probably play roles in the development of rosacea.

The treatment of rosacea begins with sun protection. Patients who have rosacea should carefully monitor their exposure to the sun and routinely use sunscreen. Antibiotics, taken either orally or applied topically to the affected areas, are also regularly used to treat rosacea. Topical azaleic acid may also be used, especially if antibiotics do not give sufficient improvement. The redness and broken capillaries associated with rosacea are best treated with either laser therapy or intense pulsed light. These treatments have no downtime and lead to amazing improvement in the skin of rosacea patients. The good news is that by combining several skin care modalities, an experienced skin care professional will be able to control nearly every case of rosacea.