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Flushing and flushing syndromes



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Synonyms • Blushing • Hot flushes • Hot flashes Flushing is intermittent redness, often accompanied by a sensation of warmth or burning due to cutaneous vasodilation. This is usually most evident on the face and neck but less conspicuous changes may occur over the entire body. Flushing may arise from the action of a circulatory vasodilator substance, for example histamine, or it may be caused by changes in the neurological control of the cutaneous vasculature in the affected areas. In the face, neck and upper trunk, where flushing is most apparent, vascular tone is predominantly influenced by autonomic vasodilator nerve fibres rather than by relaxation of vasoconstrictor tone [1] . These fibres are found in somatic nerves supplying the affected skin, including the trigeminal nerve [2] . Since autonomic nerve fibres also supply sweat glands, neurally activated flushing is frequently associated with sweating (‘wet flushing’) whereas flushing due to circulating vasodilator mediators usually does not involve sweating (‘dry flushing’). The presence or absence of sweating has therefore been proposed as a clinical guide to the mechanisms of flushing [3] . This is not entirely reliable in practice and it should be noted, in particular, that severe sweating occurs in some cases of carcinoid syndrome. Causes of flushing are summarized in Table 43.2 . Table 43.2 Causes of flushing. ... log in or subscribe to read full text

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