Differential Diagnosis for Intermittent Flushing on the Face

• Single most likely diagnosis
  • Rosacea: This condition is characterized by recurrent episodes of flushing, often accompanied by visible blood vessels (telangiectasias) on the face, particularly across the nose and cheeks. The symptoms can be exacerbated by factors such as spicy foods, sun exposure, and emotional stress, which aligns with the patient's experience.
• Other Likely diagnoses
  • Menopausal flushing (less likely given the patient's age, but possible with premature menopause): Although less common in a 32-year-old, hormonal changes can lead to flushing.
  • Carcinoid syndrome (if the patient has other systemic symptoms): This rare condition involves flushing, among other symptoms like diarrhea and wheezing, due to a neuroendocrine tumor secreting serotonin.
  • Mastocytosis: A condition where there's an accumulation of mast cells in the skin, leading to flushing, itching, and hives, often triggered by similar factors.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic flushing, hypertension, and other symptoms due to excessive catecholamine release. Although rare, it's critical to rule out due to its potential severity.
  • Thyrotoxicosis: Excessive thyroid hormones can cause flushing, heat intolerance, and other symptoms. While not directly related to the described triggers, it's a condition that requires prompt diagnosis and treatment.
• Rare diagnoses
  • Harlequin syndrome: A rare condition characterized by asymmetric flushing and sweating of the face, typically without other systemic symptoms.
  • Erythromelalgia: A disorder that causes burning pain, heat, and redness in the hands and feet, and sometimes the face, often in response to heat or exercise.
  • Medullary thyroid carcinoma as part of MEN syndrome: This can be associated with flushing as part of a broader syndrome that includes other endocrine tumors.