Blushing is not just a sign that you are embarrassed, it could be an indication that you are suffering from these serious health conditions

While cradling her newborn daughter for several hours after giving birth, Somayya Gefuri suddenly felt a searing wave of heat in her body that rose to her skin, causing her to sweat and her face to turn red.

Concerned, the supermarket worker from Birmingham asked the midwives why she was so ‘hot’.

Somayya’s temperature was slightly elevated and staff feared she had sepsis, in which the immune system dangerously overreacts to an infection. So they decided to give her antibiotics, and both mother and baby were kept in the hospital for a week.

In fact, the flushing and heat were the first signs of a serious condition that took more than a year to identify as Graves’ disease, an autoimmune disease in which the body produces too much of the hormone thyroxine.

“I went to the doctor about three times in 12 months because I was always hot, red and sweating,” says Somayya, 37.

‘My heart rate was racing and I was also exhausted. But because I was a new mother, the doctor always attributed it to that.’

Ultimately, blood tests in 2021 revealed that Somayya had an overactive thyroid – the butterfly-shaped gland that produces hormones that control our metabolism.

According to the British Thyroid Foundation, an overactive thyroid can be caused by a combination of genes and other factors, including stress. Hormonal fluctuations – for example caused by childbirth – can also increase the risk for women.

Four out of five people with an overactive thyroid have Graves’ disease. Here the body begins to produce antibodies (normally directed against ‘invaders’ such as bacteria) that bind to the thyroid gland, stimulating the production of thyroxine.

This speeds up metabolism, causing the body to work faster and causing rapid heart rate, weight loss and fatigue.

The body can also produce excess heat, making those affected feel sweaty and hot – and in Somayya’s case, causing a deep flush to her cheeks, nose and forehead.

Somayya believes her condition was caused by an anxious pregnancy: she had preeclampsia (high blood pressure) and a difficult delivery.

Although she now takes medication to lower her thyroxine levels, Somayya often feels warmer than others. If she stands on a cash register near the heater at work, she can stay red all day.

The warm feeling of a red blush creeping across your face is familiar to most of us.

It occurs as a result of stimulating the nerves in the brain, releasing chemical messengers – cytokines – that cause the small blood vessels near the skin’s surface to dilate. As they fill with blood, this is visible as red skin.

The effect is more apparent on the face due to the high density of small blood vessels and relatively thin skin, says Emma Wedgeworth, a dermatologist in London and spokesperson for the British Skin Foundation.

In addition to a red face, an unpleasant burning and stinging sensation may also occur. ‘Nerves and blood vessels tend to run together, so the flush activates the nerve fibers and causes the stabbing sensation,’ explains Dr Wedgeworth.

‘Facial flushing can make some people extremely anxious. It can cause them to cancel social plans, or cause them trouble at work if they worry about blushing during a presentation.”

Facial flushing can simply be a response to high temperatures or exercise. The body needs to maintain a constant temperature as this is optimal for the functioning of enzymes (proteins that support a range of vital functions, including digestion).

But when we exercise, our muscles produce more heat, and dilating the blood vessels closest to the skin’s surface is one way the body can release this heat, says Dr. Wedgeworth.

There are other triggers too. For example, blushing due to embarrassment or stress is caused by the body’s ‘fight or flight’ response. The resulting adrenaline increases our heart rate, which can also play a role in dilating blood vessels.

There could also be another evolutionary driver. A 2009 study in the Netherlands found that photos of people blushing after a perceived accident were viewed more favorably by others than photos of people who did not blush, which may have been protective.

More direct physical causes of facial flushing include certain foods, such as peppers. These contain capsaicin, a substance that dilates blood vessels.

Alcohol is a trigger for many people. This is because the liver converts alcohol into a toxin, acetaldehyde, which can dilate blood vessels in the face.

In general, acetaldehyde is quickly broken down by an enzyme and flushed from the body; but some people produce lower levels of this enzyme, causing them to blush deeply after even a modest amount of alcohol.

Certain skin conditions can also cause facial flushing, especially rosacea, which is more common in women in their 30s.

Rosacea, an inflammatory condition that causes red skin, is thought to be the result of a malfunction in immune cells, or a common tiny mite that lives on everyone’s skin.

The redness starts out coming and going, usually for minutes, but over time the skin can become chronically red.

Morag Jarvis, 46, a GP and mother of three from Coventry, blushed deeply as a child and realized in her 20s that it was caused by rosacea. She also developed the characteristic broken blood vessels on her face.

In her late thirties, she suffered from facial flushing almost every day. They started with tingling redness at the tip of her nose and then spread across her nose, cheeks and between her eyebrows.

“My skin was throbbing, looking swollen and feeling very uncomfortable,” she says. “It was always worse towards evening.” Heat, spicy food and alcohol were among her triggers.

The turning point for Morag came when she took a selfie with her children one morning and saw that her skin was red and angry early in the day.

She had previously been given antibiotics, but with little effect. Now she sought private treatment and was recommended azelaic acid cream.

This calmed the redness “almost immediately,” she says.

Morag also underwent laser treatment to break down the walls of the blood vessels so that they can be reabsorbed by the body. This eliminates thread veins and allows fewer blood vessels to dilate and cause a flush. “Now I find that I rarely rinse and I don’t have to wear foundation anymore,” she says.

Many women experience facial flushing in the run-up to menopause. Falling estrogen levels are thought to disrupt the hypothalamus, the area of ​​the brain that regulates body temperature.

Some medications can also cause this, including the breast cancer treatment tamoxifen, which lowers estrogen levels. An older form of antidepressant medication, monoamine oxidase inhibitors, and some high blood pressure medications such as calcium channel blockers (for example, amlodipine), which relax blood vessels, can also cause the symptom.

Anyone experiencing medication-induced hot flashes should consult their doctor about different dosages or alternative medications.

An intolerance to histamine, a naturally occurring chemical found in foods such as cheese, chocolate, red wine and canned fish, can cause flushing in people who are deficient in the enzyme that breaks down histamine.

There are medical options for severe facial flushing. Botox injections can disrupt the messages from the nerves that tell blood vessels to dilate. Medicines called beta blockers can also reduce flushing by causing the blood vessels in the skin to constrict.

A more drastic option is the same surgery used for severe sweating: endoscopic thoracic sympathectomy. This involves cutting nerves that carry messages to the face.

The procedure carries the risks of significant surgery and can cause unwanted symptoms, including severe sweating in other parts of the body.

‘Some people’s lives are destroyed by flushing, and I have seen people freed by this procedure,’ says David Greenstein, consultant vascular surgeon at London North West University Healthcare NHS Trust.

He says the surgery should only be attempted after other options have failed.

Although Somayya’s facial flushing has decreased from almost constant to only a few times a week, it is still disturbing. “Customers often say I’m so red,” she says. “I’m ashamed of that, so I’m blushing even more.”