Blushing is caused by your sympathetic nervous system – the network of nerves responsible for triggering your ‘fight or flight’ reflex.

This is a series of involuntary physical changes to your body when faced with a stressful or dangerous situation.

A sudden and strong emotion – such as embarrassment or stress – causes your sympathetic nervous system to widen the blood vessels in your face. This increases the blood flow to your skin, producing the redness associated with blushing.

In addition to emotional triggers, other causes of blushing can include:

• alcohol
• hot or spicy foods
• hot drinks
• a high temperature (fever)
• sudden hot or cold temperatures
• strenuous exercise
• certain medical conditions or medication (see below)

Medical conditions

There are a number of medical conditions that can cause a person to blush frequently, including both psychological and physical problems.

A common cause of excessive and frequent blushing is having an irrational fear (phobia) of blushing. This is known as erythrophobia. People with erythrophobia often worry that they will blush when interacting with others, and that other people will mock them because of this.

Unfortunately, this can trigger a vicious cycle. They become so worried about being the centre of attention in social gatherings that when this does happen, they suddenly become very embarrassed and start blushing, which reinforces their phobia.

Erythrophobia is often associated with other phobias and mood disorders, such as social phobia and general anxiety disorder (GAD).

Blushing can also sometimes be associated with other medical conditions, including:

• rosacea – a common but poorly understood long-term skin condition that mainly affects the face
• the menopause – where a woman’s ovaries stop producing eggs, and periods stop
• mastocytosis – a rare condition caused by excessive amounts of histamine and other chemicals being released into the blood
• carcinoid syndrome – a number of symptoms caused by a rare type of cancer known as a carcinoid tumour

Although it is not a direct cause of blushing, excessive sweating (hyperhidrosis) is often associated with the condition.

Medication

Certain types of medication can also cause blushing. These include:

• tamoxifen – often used to treat breast cancer
• calcium-channel blockers – used to treat high blood pressure and angina 
• calcitonin – sometimes used to treat bone disorders such as osteoporosis
• glyceryl trinitrate and isosorbide dinitrate – sometimes used to treat angina
• buserelin, triptorelin, goserelin and leuprorelin – sometimes used to treat prostate cancer

If you are taking a medication that causes blushing and it is causing you significant problems, discuss this with your GP. They may be able to recommend an alternative medication.

Blushing is the involuntary reddening of the face, usually triggered by emotions such as embarrassment or stress.

Other areas of the body – such as the neck, ears and upper chest – can also be affected. As well as causing redness, blushing can sometimes make the affected area feel hot.

What causes blushing?

“Normal” blushing happens when a strong emotional trigger stimulates the nervous system to widen the blood vessels in the face. This increases the flow of blood into the blood vessels just underneath the skin, causing your face to turn red.

Abnormal (severe or frequent) blushing can have both psychological and physical causes, including:

• social anxiety disorder (social phobia) – a persistent fear of social situations and being around people
• general anxiety disorder (GAD) – a long-term condition that causes you to feel anxious about a wide range of situations and issues
• rosacea – a common skin condition that mainly affects the face
• the menopause – where a woman’s ovaries stop producing eggs and periods stop
• certain medications – such as the breast cancer medication tamoxifen

Blushing can also be triggered by drinking alcohol or hot drinks, eating hot or spicy food, strenuous exercise and sudden changes in temperature.

Read more about the causes of blushing.

When to seek medical advice

Most people will blush from time to time, and it’s not usually a cause for concern.

However, frequent and severe blushing can have a significant psychological impact and can lead to the person avoiding certain situations and interaction with other people.

You should consider speaking to your GP about your blushing if it occurs frequently and is affecting your quality of life.

What treatments are available?

If abnormal blushing is affecting your quality of life, you may benefit from treatment. The specific treatment offered will depend on the underlying cause of your blushing.

If it is thought that the underlying cause is psychological, such as an irrational fear (phobia) or anxiety disorder, a talking treatment called cognitive behavioural therapy (CBT) can often be effective.

Medications such as selective serotonin reuptake inhibitors (SSRIs) can also help relieve any associated feelings of anxiety and worry.

If the underlying cause is physical, such as the menopause or rosacea, you may be advised to avoid common triggers such as stress, alcohol and spicy foods. Hormone replacement therapy (HRT) can also help women with menopausal hot flushes.

A surgical procedure called endoscopic thoracic sympathectomy (ETS) may be considered if your blushing is particularly severe and other treatments have not been effective, although this carries a risk of long-term problems such as excessive sweating. 

Read more about treatments for 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.

Read more about treating rosacea.

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.