Once considered a harmless reaction to emotions, flushing is now known to be associated with more serious conditions in some cases.
“If a patient has an acute change, meaning they’ve never experienced flushing but now it’s occurring or occurring more frequently, plus, they have other symptoms — that’s a red flag. There are so many different types of cancers that can have flushing as a side effect which is why it’s important to screen patients and take a comprehensive review,” said Azeen Sadeghian, M.D., of Dermasurgery Center in Baton Rouge, La. Dr. Sadeghian is the author of two articles published in the September issue of Journal of the American Academy of Dermatology. One article focused on non-malignant causes of flushing and the second on malignant causes.
Dermatologists should be prepared to identify and investigate the cause of atypical flushing beginning with a full medical history, a review of symptoms, physical exam and laboratory and imaging tests, she said.
While most causes of flushing are benign, there causes that tend to be more insidious and sometimes, difficult to differentiate during presentation, Dr. Sadeghian said.
“It is not to say that a patient with hyperthyroidism or medication-induced flushing will not experience exacerbation of flushing responses to typical benign flushing stimuli. They can overlap. However, there are typically other notable aspects in their history that can help physicians differentiate between the two,” she says.
Defining what may be a serious problem associated with flushing can mean different things to different patients. Menopause-associated flushing can be embarrassing, but it’s not life-threatening. But there are cases in which flushing could signal an extensive list of neurologic issues.
“Usually neurologic forms of flushing are associated with other symptoms or they have a unique presentation. They can manifest on one half of the face, but not the other half. Or, they may appear on just a segment on the face,” Dr. Sadeghian said.
Medications can sometimes cause flushing, which can be problematic because it can lead to noncompliance.
While a life-long struggle with flushing might not bring a patient to the dermatologist’s office, new flushing, acute flushing changes or noticeably increased flushing might. These changes could be indicative of a more serious condition.
Life threatening conditions associated with flushing can include malignancy, serotonin syndrome, superior vena cava syndrome or other untreated systemic conditions. Red-flag symptoms include vague abdominal pain, diarrhea, back pain, random blood pressure spikes and severe headaches.
“Of these, we are the most cautious about catching an undiagnosed malignancy. For example, mastocytosis, thyroid cancer, bronchogenic cancer, pheochromocytomas, neuroendocrine tumors, renal cell carcinoma and others have been associated with flushing,” she says.