Chronic blushing: When it goes beyond embarrassment

A teacher calls on you when your hand isn't raised, and you feel the familiar sensation as your classmate's eyes immediately dart toward you. Mrs. So-and-So watches expectantly, smirking. A surge of blood races from your gut to your head and your cheeks become warm. Hot. A sheepish smile involuntarily follows. You know you're bright red, and that embarrasses you even more.

Everyone knows what it feels like to blush—whether from embarrassment, emotional stress, or even just receiving a compliment. Perhaps worse than the act itself is knowing that everyone else can see the physical manifestation of your discomfort, which inconveniently functions to further redden your face.

But for 5-7% of the population, blushing is a chronic problem—happening both more frequently and with greater magnitude than the average person. Physically, it's rather harmless—but psychologically, it can be devastating.

In late May, Brandon Thomas, a 20-year-old University of Washington student, committed suicide by jumping from his 11-story dorm. "I am tired of blushing," read his suicide note. "It is exhausting to wake up everyday and have to find little ways to avoid blushing situations."

Stress and the sympathetic nervous system

It is thought that blushing is the result of an overactive sympathetic nervous system, the branch of the nervous system responsible for the "fight or flight" response to stress. You know—that feeling of standing in front of the crowd, ticking down the minutes until you have to speak. Every molecule in your body is telling you to run away. Or perhaps you've felt your body aroused into gear more suddenly, such as after hearing an unexpected loud noise.

When you're fearful or nervous, blood is shunted away from your gut to your muscles, halting digestion and preparing your muscles to flee. Your pupils dilate, your heart races, your blood pressure increases, and you may feel an unusually thick sweat glossing over your skin.

The muscles responsible for dilating or constricting blood vessels are also part of the sympathetic nervous system, and the face is especially prone to rapid change. The skin of our face has more capillaries per unit area, and blood vessels in the cheeks are both wider and closer to the surface than in other areas of the body.

Exactly why or how some people have "overactive" sympathetic nervous systems, and whether that is truly the cause of chronic blushing, is not well understood.

A drastic approach

There are a range of options available for blushers depending upon severity and cause—from green color-corrective makeup (to counteract the red); cognitive behavioral therapy to help remove unwanted, stressful thoughts; breathing techniques to induce calm; and even medications such as beta blockers or SSRIs (selective serotonin reuptake inhibitors) for those who blush due to social anxiety.

A more recent, controversial, and drastic solution is called endoscopic thoracic sympathectomy, or ETS. Originally, the procedure was performed for the treatment of hyperhidrosis, or excessive sweating. Regardless, the goal of the surgery is the same: sever the nerves between the stress-induced sympathetic nervous system and the affected organ of the body.

During an ETS procedure, a surgeon punctures the side of an anesthetized person's chest. A small camera is then fed in for viewing, and gas is introduced to the chest cavity. This inflation allows the camera a clear view of the nerves.

One side of the T2 ganglion branch (pointed out in the image above) is destroyed with heat, cut with scissors, or clamped. The procedure is then repeated on the other side, as the spinal nerves exit the vertebral column from either side (left, shown in yellow). Specifically, the T2 nerve is targeted because of its innervation to sweat glands in the face and palms, small arteries in the face and hands, and to the heart, which normally speeds its rate.

For the treatment of facial blushing, the success rate is around 90%. Most patients go home the day after surgery, and return to work two or three days thereafter.

Other than typical surgical risks, strange effects may arise as a result of the surgery. Some 15% of patients cite that they regret having the procedure done due to compensatory hyperhidrosis—in other words, the sweat reduction in the upper body is compensated by increased levels in the lower body.

Another possible severe side effect is corposcindosis, or split-body syndrome. Since sympathetic nerve function is subsequently divided into two distinct regions—functional and nonfunctional—some patients feel as though they are living in two separate bodies.

Pioneered in Sweden in the 1980s, ETS was banned in 2003 due to overwhelming complaints of disability in patients. Notoriously, it is an unregulated procedure in many countries.

Regardless of the measures a chronic blusher may take to hide or extinguish their problem, it is important to be honest and forthright about this uncontrollable, non-dangerous, yet embarrassing affliction. Says Brandon Thomas' mother Dawn, "One of the reasons he took his life is that if he took this drastic measure, it would raise awareness. He wanted his death to have an impact." Currently, his family is working to create a website providing information about their son's condition.

Photos courtesy Pacific Prime Blog, Acne Horror, Cedars Sinai, House Call M.D., and MSNBC.