Flushing

Flushing
ICD-10	R23.2
ICD-9	782.62

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

For a person to flush is to become markedly red in the face and often other areas of the skin, from various physiological conditions. Flushing is generally distinguished, despite a close physiological relation between them, from blushing, which is milder, generally restricted to the face or cheeks, and generally assumed to reflect embarrassment. Flushing is also a cardinal symptom of carcinoid syndrome – the syndrome that results from hormones (often serotonin or histamine) being secreted into systemic circulation.

Causes

Causes by Organ System

Cardiovascular	Accelerated hypertension
Chemical / poisoning	No underlying causes
Dermatologic	Mastocytosis, Rosacea, POEMS syndrome
Drug Side Effect	Acipimox, Adenosine, Ambrisentan, Amlodipine, Amlodipine and Benazepril, Amyl nitrite, Aspirin, Betahistine, Bosentan, Bromocriptine, Butyl nitrite, Cabergoline, Calcitonin, Calcium channel blockers, Caspofungin, Chlorpropamide, Cholinergics, Cyclosporin, Cyclosporine, Cyproterone acetate, Danazol, Dinoprostone, Epoprostenol, Erythropoietin, Ethanol, Felodipine, Fenoldopam, Gemeprost, Gestrinone, Glatiramer acetate, Glyceryl trinitrate, Granulocyte-macrophage colony stimulating factor, Isosorbide dinitrate, Isosorbide mononitrate, Isradipine, Licorice, Lysuride, Methionine, Metrifonate, Micafungin, Morphine, Nasal decongestants, Nicorandil, Nicotinic acid, Nifedipine, Nitrendipine, Nitroglycerin, Opioids, Pergolide, Physiological response to vasodilators , Piribedil, Prostaglandins, Protamine sulfate, Psychedelics, Quinidine,Reboxetine, Regadenoson, Reproterol, Retinoids, Rifampin, Ropinirole, Salbutamol, Serotonin, Sildenafil, Sodium nitrite, Sulprostone, Tadalafil, Tamoxifen, Thyrotropin releasing hormone, Thyrotrophin releasing peptide, Triamcinolone, Trilostane, Vancomycin, Vardenafil
Ear Nose Throat	No underlying causes
Endocrine	Carcinoid syndrome, Thyrotoxicosis, POEMS syndrome, Carcinoid tumour, Medullary thyroid carcinoma, Phaeochromocytoma
Environmental	No underlying causes
Gastroenterologic	WDHA, Pancreatic cancer
Genetic	Erythromelalgia
Hematologic	Polycythaemia, Polycythaemia rubra vera, Primary thrombocythemia, Thrombocytosis, Basophil chronic granulocytic leukemia
Iatrogenic	No underlying causes
Infectious Disease	Viral hemorrhagic fever, Yellow fever
Musculoskeletal / Ortho	No underlying causes
Neurologic	Auriculotemporal nerve syndrome, Frey's syndrome, Harlequin syndrome, Monoamine oxidase deficiency, POEMS syndrome, Spinal autonomic dysreflexia, Trigeminal Neuralgia, Vegetative dystonia, Erythromelalgia
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	Menopausal flushing
Oncologic	Adrenal neoplasm, Basophil chronic granulocytic leukemia, Carcinoid tumour, Insulinoma, Medullary thyroid carcinoma, Neuroendocrine tumors, Pancreatic cancer, Phaeochromocytoma, Renal cell carcinoma, VIPoma
Opthalmologic	No underlying causes
Overdose / Toxicity	Acipimox, Adenosine, Ambrisentan, Amlodipine, Amyl nitrite, Aspirin, Betahistine, Bosentan, Bromocriptine, Butyl nitrite, Cabergoline, Calcitonin, Calcium channel blockers, Caspofungin, Chlorpropamide, Cholinergics, Cyclosporin, Cyclosporine, Cyproterone acetate, Danazol, Dinoprostone, Epoprostenol, Erythropoietin, Ethanol, Felodipine, Fenoldopam, Gemeprost, Gestrinone, Glatiramer acetate, Glyceryl trinitrate, Granulocyte-macrophage colony stimulating factor, Isosorbide dinitrate, Isosorbide mononitrate, Isradipine, Licorice, Lysuride, Methionine, Metrifonate, Micafungin, Morphine, Nasal decongestants, Nicorandil, Nicotinic acid, Nifedipine, Nitrendipine, Nitroglycerin, Opioids, Pergolide, Physiological response to vasodilators , Piribedil, Prostaglandins, Protamine sulfate, Psychedelics, Quinidine,Reboxetine, Regadenoson, Reproterol, Retinoids, Rifampin, Ropinirole, Salbutamol, Serotonin, Sildenafil, Sodium nitrite, Sulprostone, Tadalafil, Tamoxifen, Thyrotropin releasing hormone, Thyrotrophin releasing peptide, Triamcinolone, Trilostane, Vancomycin, Vardenafil
Psychiatric	Acute stress disorder, Limerence
Pulmonary	No underlying causes
Renal / Electrolyte	Hypermagnesemia, WDHA , Renal cell carcinoma
Rheum / Immune / Allergy	Allergy, Anaphylaxis, Quincke's edema
Sexual	Pseudocarcinoid syndrome in secondary male hypogonadism, Sexual arousal
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcohol, An abrupt cessation of physical exertion, Anger, Anxiety, Dehydration, Embarrassment, Exercise, Extremes of emotion, Heat, High fever, Hot beverages, Hypertonic crisis, Rapid changes in temperature, Red plums, Spicy foods, Straining, Stress, Tomatoes, Valsalva maneuver, Vigorous coughing

Causes in Alphabetical Order

Accelerated hypertension Acipimox Acute stress disorder Adenosine Adrenal neoplasm Alcohol Allergy Ambrisentan Amlodipine Amyl nitrite An abrupt cessation of physical exertion Anaphylaxis Anger Anxiety Aspirin Auriculotemporal nerve syndrome Basophil chronic granulocytic leukemia Betahistine Bosentan Bromocriptine Butyl nitrite Cabergoline Calcitonin Calcium channel blockers Carcinoid syndrome Carcinoid tumour Caspofungin Chlorpropamide Cholinergics Cyclosporin Cyclosporine Cyproterone acetate Danazol Dehydration Dinoprostone Efavirenz Embarrassment Epoprostenol Erythromelalgia Erythropoietin Ethanol Exercise Extremes of emotion Felodipine Fenoldopam Frey's syndrome Gemeprost Gestrinone Glatiramer acetate Glyceryl trinitrate Granulocyte-macrophage colony stimulating factor Harlequin syndrome Heat High fever Hot beverages Hypermagnesemia Hypertonic crisis Insulinoma Isosorbide dinitrate Isosorbide mononitrate Isradipine Licorice Limerence Lysuride Mastocytosis Medullary thyroid carcinoma Menopausal flushing Menopause

Methionine Metrifonate Micafungin Monoamine oxidase deficiency Morphine Nasal decongestants Neuroendocrine tumors Nicorandil Nicotinic acid Nifedipine Nitrendipine Nitroglycerin Opioids Pancreatic cancer Pergolide Phaeochromocytoma Physiological response to vasodilators Piribedil POEMS syndrome Polycythaemia Polycythaemia rubra vera Primary thrombocythemia Prostaglandins Protamine sulfate Pseudocarcinoid syndrome in secondary male hypogonadism Psychedelics Quincke's edema Quinidine Rapid changes in temperature Reboxetine Red plums Regadenoson Renal cell carcinoma Reproterol Retinoids Rifampin Ropinirole Rosacea Salbutamol Serotonin Sexual arousal Sildenafil Sodium nitrite Spicy foods Spinal autonomic dysreflexia Straining Stress Sulprostone Tadalafil Tamoxifen Thrombocytosis Thyrotropin releasing hormone Thyrotoxicosis Thyrotrophin releasing peptide Tomatoes Triamcinolone Trigeminal Neuralgia Trilostane Valsalva maneuver Vancomycin Vardenafil Vegetative dystonia Vigorous coughing VIPoma Viral hemorrhagic fever WDHA Yellow fever

Sex flush

Commonly referred to as the sex flush, vasocongestion (increased blood flow) of the skin can occur during all four phases of the human sexual response cycle. Studies show that the sex flush occurs in approximately 50-75% of females and 25% of males, yet not consistently. The sex flush tends to occur more often under warmer conditions and may not appear at all under cooler temperatures. It has also been commonly observed that the marked degree of the sex flush can predict the intensity of orgasm to follow.

During the female sex flush, pinkish spots develop under the breasts, then spread to the breasts, torso, face, hands, soles of the feet, and possibly over the entire body. Vasocongestion is also responsible for the darkening of the clitoris and the walls of the vagina during sexual arousal. During the male sex flush, the coloration of the skin develops less consistently than in the female, but typically starts with the epigastrium (upper abdomen), spreads across the chest, then continues to the neck, face, forehead, back, and sometimes, shoulders and forearms.

The sex flush typically disappears soon after orgasm occurs, but this may take up to two hours or so, and sometimes, intense sweating will occur simultaneously. The flush usually diminishes in reverse of which it appeared.

See also

• Pallor
• Erythema
• Rash