Flushing: Types, Patterns & Systems

[Guest guest]

cea Flushing: Types, Patterns & Systems

Each of the following items is part of a complex interaction of several systems.

Clock rosacea or systemic flushing- The body does operate on a clock!

Universally, hospital physicians have known for years that the lowest body

temperature of the 24 hour day is at usually around 3:00 A.M. while the highest

temperature of the day is around 8:00 P.M. The average rosacea sufferer does not

have hospital waking and sleeping hours therefore their temperature lows and

highs may vary 3 to 5 hours each way. A high temperature for some may be as

early as 3:00 P.M. Flushing usually occurs when the body becomes fatigued and/or

stressed which stimulates the sympathetic nervous system. The key to this is the

autonomic nervous system (more specifically,the sympathetic postganglionic

efferent nerves). Any activation of these nerves causes vasoconstriction of

" body blood vessels " -- except in the " facial blush/flush areas " where it

induces potent vasodilatation or flushing with the resulting " rosacea flush " . A

typical rosacea sufferer would flush in the fifth grade even when the answer was

known when the teacher asked a question, and obviously the flushing would be

noticed by the other kids. Once again the sympathetic nervous system.

a.. Stress stimulates the sympathetic nervous system

b.. Lack of sleep stimulates the sympathetic nervous system

c.. Anxiety (fight or flight) stimulates the sympathetic nervous system

d.. Increase in internal body temperature stimulates sympathetic nervous system,

whereas obviously a decrease in body temperature decreases the sympathetic

system due to the parasympathetic system calming the system.

The sympathetic nervous system is especially important to rosacea patients who

tend to have either:

e.. Genetically weak blood vessels

f.. Damaged blood vessels from years of sun

g.. Damaged support system for blood vessels (collagen-elastic of skin)

h.. Increased number of blood vessels.

cea sufferers have more facial vessels or the vessels that we have are

severely damaged. The result being that anything that stimulates facial dilation

" cannot " be handled easily or properly.

Heavy meal flushing and sugar/carbohydrate flushing- This flushing is caused by

more stress on the digestive system with a resulting larger blood flow to the

digestive system and with the residual blood being heavier to the face.

Therefore, three small meals with breakfast being the most important and grazing

in between meals is better for limiting this kind of flushing, however it is

important to keep the daily calorie intake within one's calorie budget to

maintain your ideal weight. The type of food that you eat is also very important

as various foods stimulate blood flow differently. Simple carbohydrates such as

donuts, sugars, alcohol, etc. enter the blood stream quickly causing

hyperglycemia (high glucose spikes). This rapid influx of sugar into the blood

stream is a potent vasodilator. Fiber intake decreases the amount of food that

the stomach has at one time and prolongs digestion, therefore there is not the

sudden influx into the blood stream with the resultant flushing. Carbohydrates

are needed for energy and as a part of every meal, however, let's try to enjoy

the baked potatoes, beans, corn, apples (fruit but still a carbohydrate), etc.

instead of simple carbohydrates.

Steroid flushing - When a rosacea patient is erroneously treated for a prolonged

time with topical steroids the disorder may at first respond, but inevitably the

signs of steroid atrophy emerge with thinning of the skin and marked increase in

telangiectases. The complexion becomes dark red with a copper-like hue. Soon the

surface becomes studded with round, follicular, deep papulopustules, firm

nodules, and even secondary comedones. The appearance is shocking with a flaming

red, scaling, papule-covered face. Steroid rosacea is an avoidable condition

which in addition to disfigurement is accompanied by severe discomfort and pain.

Withdrawal of the steroid is inevitably accompanied by exacerbation of the

disease, a trying experience for a patient and physician. (Drs. Gerd Plewig and

Albert Kligman).

For information on steroid use, please see First World Congress of the

International Academy of Cosmetic Dermatology.

Adrenalin flush rosacea - This kind of flushing is caused by an adrenaline rush

or a large supply of adrenaline under pressure with immediate or instant

flushing. It is the same as sympathetic nerves, but it is hormone released.

Stress is the body's reaction to a perceived threat. Adrenaline and hormones are

released, and the nervous system is activated, sharpening our senses, but

simultaneously our pulse rises, our muscles tense and our immune system begins

to shut down. Those that can not relieve stress as needed may experience

fatigue, upset stomach, and frequent headaches, and a flushing face. Long-term

stress can contribute to family breakdown, job fatigue, with resulting long-term

health problems such as depression, heart disease, high blood pressure, and

rosacea. Also, adult acne is adrenal related in both " men and women " as a

reaction to mental stress or body stress. In women testosterone is produced by

the ovaries with the other half of testosterone in women being produced by the

adrenal glands. Obviously, estrogen smoothes out the testosterone produced by

the ovaries, but when the estrogen level drops several days before the menstrual

periods, sometimes resulting acne occurs especially when the adrenal glands over

produce due to stress or fatigue. Likewise, the adrenal glands can be stressed

continually in both men and women resulting in too much testosterone with the

resulting over stimulation of the sebaceous glands. The adrenal glands produce

testosterone directly or via peripheral conversion of DHEAS

(dihydropiandrosterone sulfate), DHEA (dihydroepiandrosterone), and

androstenedione which are the three major adrenal androgens. Similarly, in the

male an over abundance of testicular testosterone especially with overly

stimulated adrenal glands causes the overly stimulated sebaceous glands. Quite

often more stress is placed on the adult after puberty, with the current

stressful period of having gameful employment, progressing in employment and

marriage, child raising and the resulting continuing financial problems which

causes stress of great magnitude. While we can not produce more estrogen to

level out the testosterone, we can drink much more water which will help relieve

stress and assist both acne and rosacea. Also getting enough sleep and finding

ways to relax will help relieve stress and reducing the adrenaline reaction that

follows. You will read considerably more about stress under Lifestyle changes

later. Also,there within, you will find many ideas on limiting your stress.

Exercise flushing is caused by the cardiovascular system pumping harder and

faster due to exercise. While keeping the body in good shape by burning calories

and toning muscles, exercise should be done moderately in a cool area with the

body well hydrated with water to minimize the redness. The body, hydrated well

with water, will result in less redness. The body should adapt slowly over time

to the exercise so that the body is aerobic (with oxygen) instead of anaerobic

(without oxygen causing redness-you remember when you tried holding your breath

for a minute with the result of your facial skin immediately turning pink or

red). Therefore, the body can handle more vigorous exercise as your exercise

training increases. Better cardiovascular shape and exercise means more oxygen

in the blood and more oxygen in blood constricts vessels. Also, there is a

myriad of benefits of water for exercise and metabolic waste build up. Also,

water is absolutely necessary for strong, flexible plasma membranes of all

cells. See more details in the Lifestyle Changes.

Cigarette flushing - Smoking, which depletes the skin of vitamin C, essential

for the formation of collagen, accelerates the crosslinkage of collagen and the

hardening of elastin and furthermore creates a trillion free radicals, which

destroy the capillary structure. Smoking, which additionally robs the skin of

oxygen, is a potent initiator of telangiectasis. Also, the smoker may have a

variety of medical problems such as high blood pressure, and mineral

deficiencies, which can cause the appearance of telangiectasis. Remember what

cigarette smoking does to the lungs. The lung tissue is less pliable, receiving

less oxygen. Well, a similar thing happens overall to the skin with the

epidermis being less pliable and receiving less oxygen with the result being

that the " Marlboro Man " has more wrinkles. Most importantly is that the blood

vessels are not as pliable and receive less oxygen therefore compounding the

problem. Usually, noticeable smoking symptoms are not visible to the lungs nor

the face as blushing is minimal for weeks, months, or years, however, there is

continual damage to the lungs and the skin that is very hard to regain.

Hot shower/bath flush rosacea- Obviously the skin is redder by the stimulation

of hot showers/baths or hot weather. Overall, it is better to shower in tepid

water below body temperature of 98.6 or in the range of 85 to 95 to cool the

body. You may choose to shower with warmer water to open the pores up to clear

them or for relaxing, however, remember to begin to lower the temperature to a

much lower degree for cooling off and to prevent the skin from turning red or to

reduce the redness from the prior higher temperature.

Alcohol flushing- The best way to avoid this type of flushing is not to drink

any alcohol! All alcohol is fermented, but because beer and wines (red wine

being the worst) are not further distilled, they can cause allergy redness for

many rosacea sufferers. Alcohol is a diuretic which pushes water out of the body

cells. In this state of " dehydration " , the body is prone to flushing. Alcohol is

a concentrated source of calories and is metabolized very quickly. This causes

the blood vessels to dilate and cause redness. If you feel you need to drink

alcohol at social functions or to relax, here are some recommendations to

minimize the flushing effect. Avoid beer as it is higher in carbohydrates,

however, if you like beer, drink your domestic beer from your own country as it

is usually sold within six weeks of production. Foreign beers imported into your

country usually have preservatives which makes for more redness. And obviously,

domestic 'light beer' usually does not have as much carbohydrates and often less

alcohol content making it the beer of choice. And likewise wine is heavy in

carbohydrates and even higher in preservatives/sulfides and alcohol causing even

more flushing with the red wines usually being the worst for most of us.

Instead, drink " very, very small, weak portions " of gin, vodka or whiskey,

ideally with water instead of sugared soft drinks or mixes which also can

stimulate the cardiovascular system. An ideal mixed drink would be a Long Island

Ice Tea and even better yet would be the Long Island Ice Tea without the mix and

replacing it with water and diluting it. Or simply use another glass, and mix

the drink to " cut " it in half with twice as much water. Small amounts of gin are

less stimulating than vodka or whiskey to many drinkers. You should " chase " any

alcoholic drink with water, and water again in between drinks. Although these

recommendations can help to minimize flushing, still the best thought is " not to

drink any type of alcohol " .

This 3-year old daughter of a rosacean flushes from enjoying the snow for only

an hour. She also flushes with laughter, anger, and playing hard during the

summer. Obviously, she does not use alcohol, tobacco, coffee or harsh soaps,

etc. However, she does have the genetic propensity for rosacea and may develop

rosacea if her skin is abused by all of these elements during the next several

decades.

Chilly or cold weather flushing - These flushing flare ups result from coming in

from the chilly cold into a room where the normal room temperature ranges from

70 to 75 degrees. While the rosacea sufferer is outside in the cold weather the

cardiovascular system is pumping hard as it normally does, however the

extremities such as the feet, hands, ears, nose get less blood supply than the

rest of the body and are directly exposed to the cold along with the facial

skin. Its partially due to direct contact, but it is more a cause of

conservation of heat by internal thermostat -- causing constriction of vessels

by decrease sympathetic activity to vessels which also happens when you take a

'cool' shower. When the rosacea sufferers come into the warm office or home with

normal temperatures, the warmer temperatures quickly warm the facial skin areas

and extremities while the cardiovascular system is still in a moderately high

exercise mode. The rosacea sufferer should try not to enter the cold if possible

or minimize the extreme cold exposure by warming up the car prior to use,

wearing a facial mask/hat/scarf depending on length of exposure and severity of

cold temperatures, or whatever else can be done to minimize cold exposure. After

being exposed to the cold for a long period, prior to arrival in the warm office

or home, try to slow down the exercise, walking, etc. so the cardiovascular

system will not be as stimulated. Also, you might choose to remove the overcoat

or some outer wear if possible just prior to arriving at the office, home or

building with normal temperatures. If possible enter slowly at a foyer or

vestibule, or corridor, take a break in that area by reading a newspaper, etc.

for five minutes, or reviewing plans for the next few hours, etc., then proceed

slowly into the warmer office/home with the normal temperature to minimize

flushing.

These are some of the primary types of flushing, and there are other types of

rosacea flushing such as sun exposure flushing, drug medication flushing or

drug/sun sensitivity flushing (see list later under Lifestyle changes), laughter

flushing, allergy/histamine flushing, and the list goes on and on.

cea is a progressive skin disorder unless treated. The blood vessels

continue to grow with age and are stimulated and damaged by stress, food/drinks,

dehydration, weather, sun exposure, abrasive soaps/exfoliating medications, hot

bath, exercise, etc. The more blood vessels one has near the surface of the

skin, the more one is likely to flush and stay flushed.

In a message dated 2/7/02 7:45:07 PM Eastern Standard Time,

mlramsey@... writes:

My derm told me many patients tell her they flush the same time each day.

My flushing is definitely related to my " down time " each day - the time of

day when my body is most tired. I seem to perk up after that time.