Facial Blushing | Hyperpyrexia | Red Burning Face Symptoms and Treatment

Facial blushing, (Erythrophobia) is often mis-diagnosed as rosacea. Blushing commonly originates at the upper chest or base of the neck and extends up to the forehead, ears and can even spread down to include the trunk and legs. Facial sweat often accompanies blushing and feelings of burning or tingling.

Hyperpyrexia (feelings of burning or tingling) is commonly associated with blushing and is actually much more debilitating to the individual than the mere appearance of blushing on the skin. This condition of hyperpyrexia associated with facial blushing is little understood and not typically recognized by many physicians. Functional impairment arises from the intense "burning" sensation that becomes so uncomfortable that the individual has to actually stop what they are doing because of the severe inability to concentrate or follow through with the task at hand. Many patients have described the feeling they experience from hyperpyrexia as "hot flash or burning." This sensation envelops their face/head/neck to such an extent that they seek seclusion to "cool off".

Medications are seldom helpful for this intense "hot or burning" feeling. Beta blockers (i.e.: Propranolol are commonly used but to little avail).

Even when the individual is relaxed, blushing episodes may occur. Sometimes excess sweating of the scalp and face is associated with blushing / hyperpyrexia attacks. This condition often causes the individual to become self-conscious, nonproductive at work or school during the episodes, and to develop a low self esteem. Some patients that Dr. Nielson has treated have actually become so severely dysfunctional that they quit work and would move from job to job.

Many physicians don't recognize that these blushing episodes are commonly associated with hyperpyrexia of the face which is actually what is so debilitating and causes the severe functional impairment. The combination of facial blushing with the warm/burning sensation of the head commonly makes the individual extremely anxious and quite uncomfortable. This uncomfortable feeling can be so intense that the individual can lose all ability to concentrate and function properly.

Medications commonly used to prevent or control blushing include beta blockers (Inderal) and anxiolytics (sedatives). These medications are usually of limited benefit in reducing blushing intensity and frequency of episodes.

Effective treatment for facial blushing with hyperpyrexia is Micro ETS of T2. Precise division of the sympathetic nerve exactly where it crosses the upper edge of the second rib and any kuntz nerve branches present crossing the second thoracic rib as well. Dividing all kuntz nerves as they cross the second thoracic rib is essential for successful treatment of facial blushing.

Persistent facial blushing after sympathectomy can occur if any kuntz nerve that crosses the second thoracic rib is left intact, and can therefore continue to carry nerve signals to the face.

In the many redo's Dr. Nielson has performed for persistent facial blushing, he has found that the most common reason for persistent blushing has been missed Kuntz nerves crossing the second thoracic rib. He has also found, less commonly, the sympathetic nerve had been divided at the T3 level by mistake rather than the T2 level.

T2 Sympathetic Innervation to The Sweat Glands of the Face

Over several years of experience in treating patients with recurrent and/or persistent sweating of the face after undergoing T2 sympathectomy, Dr. Nielson has found that persistence of any sympathetic nerve innervation across the second rib level, just above the T2 ganglion, plays a significant role in persistent sweating conditions of the face after undergoing a T2. T3, or T4 sympathectomy.

It is apparent in some patients that there are neuronal contributions from lower levels such as the T3 that pass up over the second rib level on their way to the face that participate in the sweating symptoms of the face. Some physicians misunderstand the sympathetic nerve innervation of the face and believe in order to cure facial sweating it is important to cut the sympathetic nerve at the T1 level or above, thereby causing the dreaded Horner’s Syndrome. In Dr. Nielson's experience, he has found this not to be the case.

In summary, for successful treatment of facial sweating, it is imperative that all sympathetic nerve innervation crossing the second rib level be divided as opposed to clamped or having lower levels cut or clamped. Also, accessory nerve branch pathways bypassing the T2 ganglion can or may contribute to persistent facial symptoms.

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