Blushing - Treating blushing

Blushing only needs to be treated if it's affecting your quality of life or is the result of an underlying condition.

The types of treatment recommended will depend on the cause.

Psychological conditions

If your blushing is caused by an irrational fear of blushing (erythrophobia), social phobia or generalised anxiety disorder (GAD), your GP may suggest that you try a psychological treatment.

A widely used treatment for these conditions is cognitive behavioural therapy (CBT). This is a type of therapy based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way.

For example, many people with a fear of blushing think others will make fun of them if they blush. As part of treatment, the therapist could suggest that this fear is based on an unrealistic thought. Most people are generally supportive and don't take pleasure in the embarrassment of others.

So a more realistic thought would be: "I may come across as a person who is shy, but other people will usually be happy to accept this and often will make extra effort to engage with me".

A course of CBT on the NHS usually consists of around six weekly sessions, with each session lasting an hour.

Medications, such as a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), can also be used to reduce feelings of fear and anxiety.

Read more about treating treating phobias and treating generalised anxiety disorder.

Rosacea

If blushing is the result of rosacea, avoiding potential triggers such as stress, prolonged exposure to sunlight and spicy foods may help.

Blushing can also be camouflaged using a green colour-corrective moisturiser. This type of moisturiser is also useful for covering up broken veins. Some colour-corrective moisturisers can be used under a foundation. Others can be particularly useful for men with blushing problems. Hypo-allergenic brands for sensitive skin are available.

Few medications have been shown to be effective in reducing blushing caused by rosacea, although laser and intense pulsed light (IPL) treatments can sometimes help by shrinking the blood vessels in your face.

Menopause

Many women experience hot flushes and blushing when they go through the menopause. In such cases, it can help to:

avoid possible triggers, such as stress, spicy foods, caffeine, smoking and alcohol
exercise regularly
lose weight if you are overweight or obese
wear light clothing

Hormone replacement therapy (HRT) or a medication called clonidine can also often help reduce menopausal hot flushes. Certain antidepressants – such as venlafaxine and fluoxetine – may be useful too, although these medications are not licensed for this use.

Read more about treatments for the menopause.

Surgery

In the most severe cases of facial blushing, where other treatments haven't helped, a type of surgery called endoscopic thoracic sympathectomy (ETS) may be considered.

This is a surgical procedure where the nerves that cause the facial blood vessels to dilate (widen) are cut. The operation is performed under a general anaesthetic, which means you will be asleep during the procedure, and you will not feel any pain while it is carried out.

During the procedure, small incisions (cuts) will first be made beneath one armpit, and a thin, flexible tube with a camera on the end (endoscope) is inserted through an incision. The surgeon can then locate the nerve that controls the blood vessels in one side of your face. Special surgical instruments are then inserted through another incision, and are used to cut the nerve.

When this is complete, the surgeon will repeat the process on the other side of your body.

Although most people are satisfied with the results of the ETS, the procedure does not always work, and some people experience short-term complications or long-term problems afterwards.

Some of the main risks of the ETS procedure include:

excessive (compensatory) sweating – as the cut nerves also control sweating in some areas of the body, the procedure can cause other areas of your body to sweat more
Horner’s syndrome – where nerve damage causes the upper eyelid on one side of the body to droop
pneumothorax – where air gets into the chest cavity and needs to be drained by inserting a temporary tube

Due to problems such as these, particularly excessive sweating, some people who have the ETS procedure end up regretting it. If you are considering this type of surgery, make sure you discuss the possible risks and benefits with your doctor or surgeon beforehand.

For more information, see guidelines from the National Institute for Health and Care Excellence (NICE) on endoscopic thoracic sympathectomy for primary facial blushing.