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Chapters

0:00 Introduction
0:32 Causes of skin blushing
1:24 Treatment for skin blushing
2:21 When to see a doctor





Blushing is the reddening of a person's face due to psychological reasons.[1][2] It is normally involuntary and triggered by emotional stress associated with passion, embarrassment, shyness, fear, anger, or romantic stimulation.

Severe blushing is common in people who have social anxiety in which the person experiences extreme and persistent anxiety in social and performance situations.
Blushing is generally distinguished, despite a close physiological relation, from flushing, which is more intensive and extends over more of the body, and seldom has a mental source. If redness persists for abnormal amounts of time after blushing, then it may be considered an early sign of rosacea.[3] Idiopathic craniofacial erythema is a medical condition where a person blushes strongly with little or no provocation. Just about any situation can bring on intense blushing and it may take one or two minutes for the blush to disappear. Severe blushing can make it difficult for the person to feel comfortable in either social or professional situations. People who have social phobia are particularly prone to idiopathic craniofacial erythema. Psychological treatments and medication can help control blushing.

Some people are very sensitive to emotional stress. Given a stimulus such as embarrassment, the person's sympathetic nervous system will cause blood vessels to open wide, flooding the skin with blood and resulting in reddening of the face. In some people, the ears, neck and upper chest may also blush. As well as causing redness, blushing can sometimes make the affected area feel hot.

Erythrophobia is the fear of blushing,[4][5] from Ancient Greek: ερυθρός, lit. 'red' and Ancient Greek: φοβία, lit. 'fear' literally "fear of redness".
Physiology

A blush is a reddening of the cheeks and forehead brought about by increased capillary blood flow in the skin. It can also extend to the ears, neck and upper chest, an area termed the 'blush region'.[6]

There is evidence that the blushing region is anatomically different in structure. The facial skin, for example, has more capillary loops per unit area and generally more vessels per unit volume than other skin areas. In addition, blood vessels of the cheek are wider in diameter, are nearer the surface, and visibility is less diminished by tissue fluid. These specific characteristics of the architecture of the facial vessels led Wilkin in an overview of possible causes of facial flushing to the following conclusion: "[...] increased capacity and greater visibility can account for the limited distribution of flushing".[7]

Evidence for special vasodilation mechanisms was reported by Mellander and his colleagues (Mellander, Andersson, Afzelius, & Hellstrand. 1982). They studied buccal segments of the human facial veins in vitro. Unlike veins from other areas of the skin, facial veins responded with an active myogenic contraction to passive stretch and were therefore able to develop an intrinsic basal tone. Additionally Mellander et al. showed that the veins in this specific area were also supplied with beta-adrenoceptors in addition to the common alpha-adrenoceptors. These beta-adrenoceptors could exert a dilator mechanism on the above-described basal tone of the facial cutaneous venous plexus. Mellander and his colleagues propose that this mechanism is involved in emotional blushing. Drummond has partially confirmed this effect by pharmacological blocking experiments (Drummond. 1997). In a number of trials, he blocked both alpha-adrenergic receptors (with phentolamine) and beta-adrenergic receptors (with propranolol introduced transcutaneously by iontophoresis). Blushing was measured at the forehead using a dual channel laser Doppler flowmeter. Subjects were undergraduate students divided into frequent and infrequent blushers according to self-report. Their mean age was 22.9 years, which is especially favorable for assessing blushing, since young subjects are more likely to blush and blush more intensively. The subjects underwent several procedures, one of which was designed to produce blushing. Alpha-adrenergic blockade with phentolamine had no influence on the amount of blushing in frequent or in infrequent blushers, indicating that release of sympathetic vasoconstrictor tone does not substantially influence blushing. This result was expected since vasoconstrictor tone in the facial area is known to be generally low (van der Meer. 1985). Beta-adrenergic blockade with propranolol on the other hand decreased blushing in both frequent and infrequent blushers. However, despite complete blockade, blood flow still increased substantially during the embarrassment and blushing inducing procedure. Additional vasodilator mechanisms must therefore be involved.

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