Definition
The flush syndrome is usually also called “blushing” in the vernacular. From a medical point of view, flush syndrome is a symptomatology that can have many different causes. Flush is an attack-like reddening of the skin that occurs in the affected patients, especially in the face and décolleté area and is therefore easily visible. As quickly as the redness appears, it usually disappears on its own. Flush syndrome does not necessarily affect the entire face or upper body, but can also occur only locally in some areas.
Causes
A large number of different diseases and circumstances can be considered for the Flush Syndrome. Psychological stress or increased arousal can lead to flush syndrome. This applies equally to greater physical exertion on the part of the patient.
A detailed anamnesis can often quickly identify the aforementioned triggers of stress and exertion, so that in these two cases no further diagnosis seems necessary. Eating spicy food can also trigger a flush syndrome. Substances such as capsaicin, which is found in chilli peppers, play a particularly important role in this.
It promotes the blood circulation in the tissue and thus causes the flush syndrome with redness and a feeling of heat in the area of the face. Elevated temperatures and fever are also possible causes of flush syndrome. These often occur in the context of viral or bacterial infections and do not occur in everyday life after surviving the infection.
Flush syndrome can also occur in older women in the context of menopausal symptoms. The chronic inflammatory skin disease rosacea can also be the cause of flush syndrome. Flush syndrome can also occur as a side effect of taking medication.
In this context, so-called calcium antagonists or nitrates, which are used in the context of high blood pressure therapy, should be mentioned in particular. But also the drug cortisone can be a possible cause of flush syndrome. With the drugs just mentioned, the dilation of the small blood vessels leads to increased blood circulation in the skin and thus to flushing.
Taking cortisone can also lead to an increase in blood pressure, which in turn promotes the development of flush syndrome. In addition, a possible hypersensitivity to cortisone must be mentioned as a reason for flush syndrome. To the same extent, taking the drug Tecfidera® can under certain circumstances lead to reddening of the face with a sensation of heat.
The drug Tecfidera® contains the active ingredient dimethylfumarate. It is used in the treatment of multiple sclerosis, a nervous disease in which the nerve fibers of the central nervous system are destroyed. Flush syndrome is closely related and closely timed to the intake of Tecfidera®.
Flush syndrome is a common side effect and usually decreases with the duration of taking Tecfidera®. Arterial hypertension, known as high blood pressure, is another possible cause of flush syndrome. In most cases, flush syndrome occurs only after a long period of time when blood pressure levels are significantly elevated, so that other symptoms usually occur first.
Possible accompanying symptoms are headaches or dizziness, for example. The high blood pressure causes the small blood vessels of the skin to be supplied with more blood than would be the case with normal blood pressure. This leads to reddening of the affected skin areas, mostly in the face, and the flush syndrome sets in.
Especially in so-called blood pressure crises, when the blood pressure temporarily rises uncontrollably, the symptoms become more severe. An allergy can also cause flush syndrome. An allergy is a hypersensitivity reaction of the body to certain substances (allergens).
If one is allergic to a certain substance, for example to certain flower pollen, then contact with the allergen causes a massive release of histamine from the body’s cells. Histamine is a kind of messenger substance. At the blood vessels, histamine causes the vessels to dilate and increases the permeability for fluid.
This finally leads to an increased blood circulation of the skin and thus, among other things, to the occurrence of a flush syndrome. Drinking alcohol can also lead to flush syndrome. It occurs more frequently in the context of disorders in the breakdown of alcohol.Affected are mostly people from the Asian region, because their genetic modification reduces the enzyme activity of the so-called acetaldehyde dehydrogenase.
However, this enzyme plays an important role in the breakdown of alcohol. Low activity does not allow the alcohol to be broken down properly and this leads to flush syndrome with a feeling of heat and blushing of the face. This “disease” is also known as alcohol intolerance.
With regard to alcohol and flush syndrome, the so-called acetaldehyde syndrome should also be mentioned. This is a “poisoning” with alcohol due to a degradation inhibition. The cause of the alcohol’s inhibition of degradation can be the intake of certain drugs such as antibiotics from the group of cephalosporins, e.g. cefuroxime.
Similarly, the drug disulfiram, which is used in the context of alcohol weaning, can cause an inhibition of the degradation of alcohol. Since the alcohol is not broken down properly, an accumulation of the toxic acetaldehyde occurs, which is an intermediate stage in the breakdown of alcohol. This mechanism then leads to the development of flush syndrome.
A further cause of flush syndrome can also be benign and malignant tumors. Here, tumor diseases that produce the messenger substances serotonin or catecholamines are in the foreground. Important representatives in this context are carcinoids, which are often found in the appendix, but also the so-called pheochromocytoma, which is a tumor of the adrenal medulla. The adrenal gland is located at the upper pole of the kidney and consists of cortex and medulla and is used for hormone synthesis (see hormones of the adrenal gland). In the case of carcinoid tumors, a flush syndrome only occurs when the tumor has already metastasized to the liver.
