Blushing vs Rosacea

Chronic Blushing vs Rosacea

Living with chronic blushing or rosacea is hard enough – but both conditions are similar in many ways, and you can find yourself asking “do I have chronic blushing, or do I have rosacea? – or do I have both?”  

Whilst similar in appearance, chronic blushing and rosacea are two different things and have different treatment approaches, so let’s dive in and take a deep look at both.

If you'd like the information below in a nutshell, you can download my Bloom Byte: Blushing vs Rosacea where you'll get a short comparison summary all on one page:

1. Introduction

Let’s first look at what makes chronic blushing and rosacea similar:

• They both lead to facial redness.
• They both affect our appearance.
• They both affect our quality of life.
• Many people with Rosacea, also have frequent blushing.

2.  What is Chronic Blushing?

One of the first researchers to seriously investigate chronic blushing is Dr Mark Leary. Back in 1992 he published an article entitled ‘Social Blushing’ where he defined blushing as “the transient facial (and/or neck) redness that develops during emotions such as embarrassment, guilt, or shame[1]” Blushing also happens with positive emotions such as pride or pleasure.

Chronic blushing develops in social situations when we experience being the focus of attention and believe others’ opinions of us will be negative. If it happens again, our body ‘remembers’ it and with enough similar experiences over time, our body makes the association between social situations and blushing - even when we’re not embarrassed. Psychologists call this self-conscious emotional reactivity. It’s just like that famous experiment by Mr Pavlov:

Pavlov rang a bell before feeding his dogs, and after a while, the dogs started drooling just hearing the bell – even if there was no food in sight. Similarly, our blush reflex gets ‘trained’ to react automatically – even if there’s nothing to be embarrassed about. Making us feel like we’ve got our own little internal alarm bell that rings any time we think someone might be judging us. Instead of making us drool, it makes us blush. This 'training' can either be because of repeated low-grade blushing experiences over time, or a huge blushing experience that was registered as traumatic. 

This suffering causes us to worry about future social situations – psychologists call this anticipatory anxiety, and the constant worry keeps our bodies ticking over in low-grade stress. It’s like raising the thermostat in your home:

: the temperature increases and stays at the new level. Similarly, our nervous system stays on high alert, keeping us constantly on edge. Doctors call this an over-active nervous system.

What causes chronic blushing in the first place?

• Emotional Triggers: anxiety, embarrassment, stress
• Psychological Factors: social isolation, alienation, emotional inhibition (for example not being able to show your emotions growing up)
• Genetic predisposition: some of us may be more prone to blushing due to our genetics.

Symptoms:

• A sudden, pronounced redness or blotchiness in the face or neck.
• A sensation of warmth or heat in the face
• Sweaty hands and face
• Racing heart rate
• Can be associated with Social Anxiety Disorder (SAD)[2]

3.  What is Rosacea?

Rosacea is a skin condition that causes redness and flushing, but unlike chronic blushing, which usually affects the entire face or neck (or both), rosacea typically appears in a "butterfly" shape. This means the redness is concentrated along the central line of the forehead, nose, and chin, and radiates out to the cheeks. This can sometimes look like the facial changes of people who abuse alcohol, and it can feel bad to be wrongly labelled by people who don’t know us in this way.

Another difference with blushing is that rosacea is also often accompanied by visible blood vessels (telangiectasias), red bumps, and pus-filled pimples. And in some cases, rosacea can cause the skin to thicken, especially on the nose.

People with rosacea can find it hard, especially men who may not feel comfortable wearing redness-covering make-up. It can cause social stigma, social anxiety and even depression. It can also be accompanied by chronic blushing.

Rosacea is three times more common in women than men, although seems to be more severe in men. Men also seem suffer more from the psychological aspects of rosacea – perhaps because of the increased severity and also because it’s harder for them to wear redness-covering make-up.

What causes Rosacea?

The short answer is “they don’t know”. But it seems to be multi-factorial:

• Genetic factors: family history of rosacea[3]
• Microbial factors: Dermodex mites and H. pylori bacteria have been implicated in some cases[4]
• Environmental factors[5] like extremes of temperature, humidity, hot baths, sun, strong wind, heat or cold.
• Emotional factors like anger, rage, stress or embarrassment
• Straining like weight training, or a chronic cough
• Food like soy sauce, vanilla, dairy products
• Beverages like red wine, hot drinks or alcohol
• Creams like corticosteroids, retinoid, acetones, and cosmetics (sometimes)
• Drugs like Niacin, Nitro-glycerine, Tobacco
• Gut microbiome: There's increasing anecdotal evidence that small intestinal bacterial overgrowth (SIBO) could be implicated in rosacea symptoms.

4.  

   Similarities between Chronic Blushing and Rosacea 

• Facial Redness: both cause facial redness but the distribution of the redness differs: with blushing the redness is uniform or blotchy across the entire face and/or neck. With Rosacea is distributed in a typical ‘butterfly’ pattern.
• Triggers: Emotional stress can exacerbate both, along with environmental factors such as heat and certain foods and drink
• Psychological Impact: both can lead to self-consciousness and social anxiety and significantly impact quality of life[6]

5.  Differences between Chronic Blushing and Rosacea 

• Causes: chronic blushing is primarily caused by psycho-social situations. It’s an emotional reaction. Whereas Rosacea is a complex interplay of genetic, environmental and microbial factors.
• Symptoms: Chronic blushing is characterised by episodic and transient blushing, whereas Rosacea is more persistent and often accompanied by visible blood vessels, red bumps and puss-filled pimples
• Treatment:
  • Chronic Blushing / Erythrophobia: the recognised treatments for chronic blushing are cognitive behavioural therapy (CBT), exposure therapy, relaxation techniques and beta-blockers to cope with the associated anxiety. But there are other treatments and therapies that haven't (yet) made it into blushing treatment. So I put together the Top 12 Blushing Therapies Guide here.
  • Rosacea: it’s important to see a skin doctor (dermatologist) as there are different varieties of rosacea, each requiring a specific treatment regimen. However, for the moment, there is no cure. Treatment is symptomatic and includes creams with azalic acid, sulfur or antibiotics and oral antibiotics. Laser treatment and micro botox has also been successfully used. There’s some buzz on the internet about using “Horse Paste” to treat Rosacea because it contains an anti-parasite medication called ivermectin, which targets both the inflammation of rosacea as well as the Dermodex mite (most of us have these on our skin as part of the natural skin flora, but people with rosacea can have more of them, contributing to the redness and inflammation. [CARE! Horse Paste is meant for animals and has not been tested or approved for humans!]. Finally, the stomach bacteria H. Pylori can trigger an immune reaction that exacerbates rosacea. So, eradicating this bacterium can also sometimes improve symptoms. overgrowth of other types of normal bacteria could also be implicated. 

6. Conclusion

In summary, chronic blushing and rosacea share similarities but are two separate conditions, with distinct causes and treatment pathways. Proper diagnosis is important, because blushing can be healed with the appropriate psychological and behavioural programs, whereas rosacea requires a medical approach and the expert analysis of a dermatologist as well as life-style factors to remove the triggers above.

7.  Some common Questions

• Can chronic blushing develop into rosacea?
  • This question was specifically studied by Dr Peter Drummond in 2011[7] and contrary to expectations, the answer seems to be: No. Dr Drummond divided people into two groups: one group had rosacea, the other didn’t. Then he got both groups to do embarrassing tasks like singing or giving an impromptu speech and measured their blushing. Both groups actually blushed about the same – but the rosacea sufferers thought they blushed more intensely and felt more embarrassed than the others.

• Is chronic blushing or rosacea genetic?
  • Rosacea has a stronger genetic component, whereas chronic blushing is more influenced by psychological and nervous-system factors.

 References: 

[1] Leary MR, Cutlip WD, Britt TW, Templeton JL, Social Blushing. Psychol Bull. 1992; 112:446-60

 [2] Heimberg, RG & Becker RE, 2002

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[4] Parodi A et al, 2008

[5] Culp B & Scheinfeld N, 2009

[6] Dalgard FJ et al, 2018

[7] Drummond P and Su D, 2011