Facial Flushing and Carcinoid Syndrome

Facial flushing is a physiological response that can be attributed to many causes. For example, alcohol flush reaction, fever, exercise, emotions, inflammation, allergies, or hormonal changes such as menopause are just some of the reasons behind a markedly red face and other areas of the body.

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In rare cases, facial flushing can be a sign of a much bigger problem, including being a symptom of carcinoid syndrome. Carcinoid syndrome is a group of signs and symptoms that are associated with tumors of the enterochromaffin cells, a type of neuroendocrine cell found in the gastrointestinal tract.

When rare cancerous tumors called carcinoid tumors secrete certain chemicals and hormones into your bloodstream, they cause a variety of symptoms. These cancerous tumors can be found in the intestines, appendix, rectum, lungs, stomach, pancreas, and thyroid.

Facial flushing caused by carcinoid syndrome varies with the location of the tumor.

Carcinoid Syndrome Symptoms

Carcinoid syndrome typically occurs in people who have advanced carcinoid tumors. The signs and symptoms of carcinoid syndrome will be different depending on the chemicals secreted into your bloodstream. Some of the most common signs and symptoms include:

• Facial flushing: Your skin may feel hot and change color when experiencing facial flushing, which can be triggered by stress, exercise, or alcohol, or have no obvious reason at all. Your neck and upper chest may also be involved and this symptom can last from a few minutes to a few hours or longer.
• Skin lesions on the face: Welts, spider-like veins, along with purplish discolored areas, may appear on the nose and upper lip.
• Diarrhea: Abdominal cramps, along with frequent visits to the bathroom, may occur in individuals with carcinoid syndrome.
• Breathing difficulties: Wheezing and shortness of breath may occur while facial flushing is happening.
• Heart abnormalities: A rapid heartbeat or heart valve problems could be a sign of carcinoid syndrome.

Causes

Physiologically speaking, flushing is caused by increased blood flow under the skin. When blood vessels widen, this is known as vasodilation. It results from relaxation of smooth muscle cells within the blood vessel walls.

Areas such as the face, ears, neck, upper chest, and upper arms have countless blood vessels under the skin, and a surge in blood flow can cause these blood vessels to widen and fill with blood.

In the case of carcinoid syndrome, the flushing is caused by the sudden release of the vasodilator chemicals produced by the enterochromaffin cells. Some of these chemicals are serotonin, 5-hydroxytryptamine (5-HT), substance P, histamine, and catecholamines.

Carcinoid syndrome is diagnosed by a specialized urine test that measures a chemical called 5-HIAA.

Treatment

The facial flushing of carcinoid syndrome is treated by removal of the tumor and administering a medication called octreotide aimed at reducing the secretion of the vasodilating chemicals.

Traditional antihistamines and H2-blockers like cimetidine and ranitidine used to treat acid reflux have also been effective in treating the facial flushing of carcinoid syndrome.

Treatment for carcinoid syndrome usually involves treating the underlying cancer. However, because most carcinoid tumors don’t cause carcinoid syndrome until they’re advanced, a cure may not be possible. In those cases, medications may relieve your carcinoid syndrome symptoms and make you more comfortable.

Frequently Asked Questions

• What causes a flushed face?

  Flushing, or blushing, happens when you have increased blood flow to the face. It’s commonly caused by strong emotions, exercise, certain medicines, spicy foods, temperature change, or drinking alcohol. In some cases, it can be caused by medical conditions, such as rosacea, menopause, high fever, and carcinoid syndrome.

• When should you see a doctor about facial flushing?

  Contact your doctor if your flushing happens persistently, or if you have other symptoms such as diarrhea, hives, wheezing, or trouble breathing.

• How can you get rid of a flushed face?

  It depends on what is causing it. You can avoid some causes, such as spicy foods, extreme temperatures, or drinking alcohol. For health conditions like carcinoid syndrome, see your doctor for treatment.