Another manifestation of hyper-sympathetic activity is seen with patients whose faces develop reddish discoloration in certain heightened social or emotional situations. The fact that this is seen in many patients with palmar hyperhidrosis (hand sweating) led clinicians to suggest that facial blushing alone was also a result of hyper-sympathetic activity. Facial blushing is noted to affect young patients especially in their teens and early twenties. It should be separated from those instances when subjects have red discoloration on a steady basis. There are some skin disorders such as rosacea that should be mixed with the entity of facial blushing.
It was noted that in a significant number of cases there was an association between palmar hyperhidrosis and facial blushing in certain social situations. It was also noted that when ETS was done to treat palmar hyperhidrosis there was an initial improvement with facial blushing. It led to the assumption that doing sympathectomy for isolated cases with facial blushing would also help. Early reports which were published about this led to the thought that ETS could help with solving this socially and functionally embarrassing problem. Unfortunately those reports were pre-mature and the initial enthusiasm about this solution faded. At present those surgeons who are leaders in the field of endoscopic thoracic sympathectomy are not recommending ETS for facial blushing. The reason for this recommendation is a high failure rate when ETS is done for facial blushing and also the association of very high incidence of unwanted side effects.
In contrast to views that were held in the past it is now not recommended to treat facial blushing with surgical intervention such as ETS. A patient should exhaust all other options such as medications, bio-feedback, behavior modification etc in an attempt to help this condition.
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