Emotional Flushing | Flushing Triggered by Tension and Stress

1. What is Emotional Flushing?

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Emotional flushing is a phenomenon where the face turns red due to tension, stress, or emotional stimuli. It commonly appears in situations such as presentations, interviews, or interpersonal interactions, and is characterized by the fact that sweating may accompany the redness.

This reaction occurs due to the overactivation of the sympathetic nervous system, part of the autonomic nervous system. When the sympathetic nerves are stimulated, blood vessels in the face dilate, causing flushing, and simultaneously, sweat glands react, leading to accompanying perspiration. This is because the sympathetic nervous system controls both blood vessels and sweat glands.

2. Differences from Neurogenic Rosacea

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Severe facial redness in specific situations is a common symptom in both these conditions. It commonly appears in neurogenic rosacea. Although outwardly similar, their causes and treatment directions differ.

Item	Emotional Flushing	Neurogenic Rosacea
Sweat	May accompany	Not present
Sensation	Heat sensation	Stinging · Burning · Soreness
Main Triggers	Tension, emotion, stress	Heat, spicy food, alcohol
Pathway	Sympathetic nerves → Blood vessels + Sweat glands	Sensory nerves TRPV1 → CGRP · Substance P

The key distinguishing point is the presence or absence of sweat. If sweating accompanies the redness, it is highly likely to be flushing via the sympathetic nervous system pathway. However, the absence of sweat does not necessarily confirm neurogenic rosacea, thus objective differentiation through HRV testing and TEWL testing is required.

3. Differential Diagnostic Tests

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If you visit us with flushing that suddenly worsens in specific situations, we identify the cause through autonomic nervous system testing and TEWL testing.

• Sympathetic hyperactivity + Normal TEWL → Suspect flushing via the sympathetic nervous system pathway
• Normal autonomic nervous system + Elevated TEWL → Suspect neurogenic rosacea