Blushing and sweating: What is the link?

Written by: Mr David Greenstein
Edited by: Carlota Pano

Blushing and sweating are common physiological responses of the human body. Although they are a natural response, excessive or constant blushing or sweating can affect quality of life.


Here to provide a detailed insight into blushing and sweating of the face and the hands is Mr David Greenstein, foremost consultant vein surgeon. He explains the causes of blushing and sweating, the treatment and management options available, and the role of anxiety, among other important points.



What are the main causes of facial blushing? Is it purely due to feeling embarrassed?


People can suddenly go red and and/or feel that they are red in situations in which they know that they are going to feel embarrassed. For example, amongst strangers or before giving a presentation.


The simple fear of going red is often the triggering factor for going red; it is a nervous reflex that occurs in awkward situations. The sudden redness tends to last for about 10 to 15 minutes, but it can sometimes be longer, in which the process typically involves a feeling of warmth and redness that starts from the chest or the neck and spreads to the face. Once people are out of the awkward situation, the blush reflex stops.


People can also go red in other situations, but they can predict those. For example, if people are red or hot due to exercise, catching the sun or drinking alcohol, then that is not the same as an acute facial blushing. Acute facial blushing tends to occur mainly as a nervous reflex caused by feeling awkward or being caught in embarrassing situations. There are other rare causes of facial blushing or flushing, such as abnormal hormones involved within thyroid disease or menopause, but they do not tend to be the commonest cause.


Overall, facial blushing - and certainly, facial blushing that is amenable to treatment with a sympathectomy - tends to be an acute onset, caused by being caught in embarrassing and awkward situations. If people go red in situations that do not relate to these awkward or embarrassing situations, then these are an atypical cause of facial blushing. These causes will need to be investigated to find out the reason behind them.


Is facial sweating linked to facial blushing? What can cause facial sweating?


Facial sweating can be linked to facial blushing, because the sympathetic nervous system that causes facial sweating, can also cause facial blushing. People may blush and sweat at the same time, for example, if they feel anxious due to embarrassment, they can both blush and sweat - although one of the two tends to be the dominant one, such as, blushing that is then followed by sweating.


People can also get facial sweating on its own without any evidence whatsoever of facial blushing. This sweating often occurs if they feel anxious or if they are caught in awkward or embarrassing situations that cause facial blushing. For instance, if they have to give a presentation, they may break out into a sweat.


Some people may also sweat on their face all the time due to an overactive sympathetic nervous system, which tends to come from the hypothalamus (the part of the brain that keeps the body in a balanced state). This may then be triggered by different factors, for example, anxiety, outside temperature or just an individual’s overall genetic makeup.


To summarise, facial blushing and facial sweating do go hand in hand. There is a complete overlap with the cause of facial sweating and facial blushing, but the triggering factors may be slightly different with the two.


Is hand sweating a potential sign of an underlying condition?


Hand sweating is generally caused by an overactive nervous system. Most of the time, it is a spontaneous one-off event for which there is no underlying cause; it is just part of the body's makeup. In rare cases, an overactive sweating of the hand can be caused by a medical pathology (a serious medical condition).


Hand sweating can occur in both teenagers and in elderly people, but often, the overactive nervous system responsible for hand sweating starts in the younger age group and may continue into the twenties, thirties, forties, or even later.


Many who get hand sweating are very embarrassed by it, are afraid to shake other people’s hands, can lack confidence, have low self-esteem, and can avoid job which requires them to use their hands. For example, in accountant roles which involve considerable paperwork, people will feel embarrassed if the paper that they write on or the computer keyboard that they use is full of sweat.


How can I manage my facial blushing and sweating?


The management of facial blushing is unique to each individual.


The majority of people who blush considerably can live with it; they may not like the blushing, but it does not dominate or affect their quality of life. Others are quite confident except in certain situations, which they may learn to manage.


Some people, however, seek professional treatment and help for facial blushing, due to the big impact that blushing has on their quality of life. It is such the effect of facial blushing that some people will avoid leaving their house and others will avoid getting certain jobs if these involve social interaction, for fear of blushing.


Many people seeking treatment will consult their options with a GP or a family doctor, who may not be aware of facial blushing as a condition, and thus, may be unfamiliar with the treatment options.


Generally, the best option to try is self-help, investigating ways to overcome the anxiety and the phobia of going red. This can start off with therapy, including mindfulness, strategies for mental wellbeing, psychotherapy, hypnotherapy or cognitive behavioural therapy.


If medication is considered, then anti-anxiety medication of choice such as Beta blockers (Propranolol is the classic one) can help. Antidepressants can also have a beneficial effect at helping people to feel better in themselves and increase confidence.


If these treatments are not effective, there is an operation called a sympathectomy that can be performed. However, I would suggest to try it as a last resort if it is felt necessary, never as a first option.


There is an overlap in some of the treatment for facial sweating and facial blushing. However, psychotherapy, hypnotherapy and cognitive behavioural therapy recommended for facial blushing will not be able to stop the production of sweat for people with facial sweating. Instead, there are tablets available (called anticholinergic drugs) that can be taken as a first line of treatment for facial sweating.


Again, most people will be able to live with their facial sweating, but in some individuals, it can become so profound that they seek treatment, because of how embarrassed and awkward they feel. In these situations, a sympathectomy (which is also performed for patients with profound facial blushing) may be useful.


How closely related to anxiety are facial blushing, and facial and hand sweating?


Anxiety has a big part to play in facial blushing, facial sweating and hand sweating. This is because anxiety causes the discharge of the sympathetic nerves and the other functions of the sympathetic nervous system. Not only does this produce anxiousness, but the heart rate also speeds up. For this reason, keeping calm can help some individuals to manage their blushing or sweating.


Despite this, there are many people who despite being calm, may experience any slight trigger of emotion that causes the flooding of the sympathetic nervous system, leading to sweaty hands, facial sweating and sudden redness. These triggers can be simple minor thing where there is no time for preparation and people are caught unaware, such as someone saying hello. This can be all it takes for this sympathetic cascade to occur from the brain and for people to suddenly go red or have hand sweating.


There are also people who sweat a lot on their hands and face that can be related to the temperature of the environment. If you are in a hot environment, you are more likely to sweat more, but that is not always the case.



If your quality of life is being affected by blushing and/or sweating, do not hesitate to visit Mr Greenstein’s Top Doctors profile today.

By Mr David Greenstein
Vascular surgery

Mr David Greenstein is a foremost consultant vein surgeon. Based at the British Varicose Vein Centre at the Hospital of St John and St Elizabeth, London, he is known for his friendly and approachable manner. He has an interest in the modern management of venous disease, deep vein thrombosis (DVT), and the swollen leg.

Mr Greenstein offers pioneering laser treatment for varicose veins, thread veins, and leg ulcers including VNUS treatment and ClariVein treatment, as well as venous superglue and infra-red assisted sclerotherapy, and has published numerous peer-reviewed articles on venous disease and varicose veins treatment. He also has an interest in pelvic venous congestion syndrome, and has recently been involved in pioneering new treatments and pathways in deep vein thrombosis (DVT) management using thrombolysis and intravenous stents, aimed at returning the leg to normal size and function.

He regularly organises workshops and is a member of the European Venous Forum Faculty. Mr Greenstein graduated at Leeds University in 1989, and has since trained in a number of major vascular units in Nottingham, Sheffield and Adelaide, Australia.

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