Differential Diagnosis for Intermittent Flushing of the Face

Single Most Likely Diagnosis

• Rosacea: This condition is characterized by intermittent flushing of the face, particularly across the nose and cheeks, and is often triggered by sun exposure. The use of levonorgestrel (a progestin) and thinly estradiol (an estrogen) may also contribute to the symptoms, as hormonal fluctuations can exacerbate rosacea.

Other Likely Diagnoses

• Carotenemia: This is a harmless condition caused by an excess of carotenoids in the blood, which can lead to a yellow or orange discoloration of the skin, but it may not fully explain the flushing triggered by sun exposure.
• Flushing associated with hormonal changes: The patient's symptoms may be related to the hormonal effects of levonorgestrel and estradiol, which can cause changes in blood vessels and lead to flushing.

Do Not Miss Diagnoses

• Carcinoid syndrome: Although rare, this condition can cause flushing of the face and is often triggered by certain stimuli, including sun exposure. It is essential to consider this diagnosis due to its potential severity and the need for prompt treatment.
• Pheochromocytoma: This is a rare tumor of the adrenal gland that can cause episodic flushing, hypertension, and other symptoms. Although unlikely, it is crucial to rule out this diagnosis due to its potential for severe consequences if left untreated.

Rare Diagnoses

• Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, but it can also cause flushing of the face in some cases.
• Mastocytosis: A condition caused by an accumulation of mast cells in the skin, which can lead to flushing, itching, and other symptoms. However, it is relatively rare and would require further evaluation to confirm.