From the Guidelines
Flushed skin is primarily caused by various factors, including certain medications, medical conditions, and physical or emotional responses, with the most notable causes being niacin, nicotine, catecholamines, angiotensin-converting enzyme inhibitors, and alcohol, as well as conditions like gastrointestinal and thyroid tumors, carcinoid syndrome, and pheochromocytoma 1. When considering the causes of flushed skin, it's essential to take into account the potential for certain medications and ingestants to induce flushing, as noted in the study published in the Journal of Allergy and Clinical Immunology 1. Some key points to consider include:
- Certain medications like niacin, nicotine, and angiotensin-converting enzyme inhibitors can cause flushing 1
- Medical conditions such as gastrointestinal and thyroid tumors, carcinoid syndrome, and pheochromocytoma can also lead to flushing 1
- Other factors like alcohol consumption, postmenopausal flush, and the red man syndrome caused by vancomycin administration should be considered as potential causes of flushed skin 1
- Laboratory analysis can be helpful in establishing the cause of flushing, especially when the symptoms are severe or persistent 1 It's crucial to approach each case of flushed skin with a comprehensive evaluation, considering both the potential causes and the underlying medical conditions that may be contributing to the symptoms, as highlighted in the study 1.
From the FDA Drug Label
The most commonly reported adverse reactions (incidence >5% and greater than placebo) in the niacin extended-release controlled clinical trial database of 402 patients were flushing, diarrhea, nausea, vomiting, increased cough and pruritus. In the placebo-controlled clinical trials, flushing episodes (i.e., warmth, redness, itching and/or tingling) were the most common treatment-emergent adverse reactions (reported by as many as 88% of patients) for niacin extended-release Spontaneous reports suggest that flushing may also be accompanied by symptoms of dizziness, tachycardia, palpitations, shortness of breath, sweating, burning sensation/skin burning sensation, chills, and/or edema, which in rare cases may lead to syncope.
Causes of flushed skin include:
- Niacin extended-release treatment, which can cause flushing episodes characterized by warmth, redness, itching, and/or tingling
- Flushing can also be accompanied by other symptoms such as dizziness, tachycardia, palpitations, shortness of breath, sweating, burning sensation, chills, and/or edema 2
From the Research
Causes of Flushed Skin
Flushed skin can be caused by a variety of factors, including:
- Physiologic or pathologic reactions 3
- Emotions 3
- Menopause 3, 4, 5
- Medications 3, 6, 7
- Alcohol 3
- Food 3
- Hypersensitivity reactions 3
- Rosacea 3, 6, 7
- Hyperthyroidism 3
- Dumping syndrome 3
- Superior vena cava syndrome 3
- Neurologic etiologies 3
- Carcinoid syndrome 6, 7
- Pheochromocytoma 6, 7
- Mastocytosis 6, 7
- Anaphylaxis 6, 7
- Medullary carcinoma of the thyroid 6, 7
- Pancreatic cell tumor 6, 7
- Renal carcinoma 6, 7
Specific Causes in Menopausal Women
In menopausal women, flushed skin is often referred to as hot flushes, which are thought to arise as a result of significant changes in the neuroendocrine circuitry underpinning the reproductive axis during menopause 5. The main causes of hot flushes in menopausal women include: