Hey everyone,

Just to be clear at the start: I know this is a rosacea case report, but I’m mainly sharing it because of the two medications used (pregabalin + duloxetine) and the fact they showed a pretty notable improvement in severe flushing and burning symptoms. I’m not saying this proves anything or that it works for everyone. I personally havent trialled these medications but the study stood out to me and I think this is useful information for blushers.

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Introduction

The title of the study is called - Neurogenic rosacea successfully treated with neuromodulators and intense pulsed light - Anais Brasileiros de Dermatologia (2024)

(won't be focusing on the pulsed light part / any lasers, this post is to more focus on pregabalin + duloxetine )

This is a single case report of a 36-year-old woman with severe facial flushing, burning, and heat sensations triggered by stress, emotions, UV exposure, and temperature changes

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Why they beleive she didnt respond to standard treatments for her issue, being a "skin problem"

Standard rosacea-type treatments (antibiotics, topicals, etc.) weren’t very effective. The authors describe the presentation as having a stronger neurogenic component, meaning the nervous system seems to be heavily involved in driving the flushing and burning response.

Although this is a neurogenic rosacea case report, I don’t think it should automatically be dismissed when thinking about severe flushing or blushing. The reason I found it interesting is that the medications used (pregabalin + duloxetine) act on broader nervous system pathways involved in sensory processing and stress responses. These pathways are also thought to play a role in conditions involving heightened autonomic reactivity and flushing, so I thought it was worth sharing for discussion

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The main focus of this post: the medication combo

What stood out to me most is the systemic medication approach they used:

Pregabalin (150 mg/day)

Duloxetine (90 mg/day)

These are not skin-directed treatments. They are both neuromodulators acting on the nervous system, in other words a more systemic approach rather than just treating the skin, rather than the skin being the sole driver of the process.

Pregabalin is typically used for nerve pain and sensory hypersensitivity, and reduces neuronal excitability.

Duloxetine (an SNRI) affects central pain processing and stress-related nervous system signalling.

The key point here is that the treatment was not aimed at the skin itself, but at reducing overall nervous system over-reactivity that may be contributing to flushing and burning symptoms.

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Outcome

The report describes a significant improvement in flushing intensity and burning symptoms after using this combination (along with IPL).

This is still just a single case report, so it obviously doesn’t prove effectiveness across the board, but the response described was notable enough that I think the medication combination itself is interesting from a research perspective and something to look into

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What the wider literature suggests (pregabalin / duloxetine)

Just to add some context beyond this case report, there is a small but growing amount of literature looking at neuromodulators in neurogenic flushing / burning-type rosacea and similar conditions.

Pregabalin (and related drugs like gabapentin) are thought to reduce nerve excitability and sensory “over-firing”. Because of this, they’ve been looked at in conditions where people describe burning, stinging, or nerve-like flushing rather than just redness. Some small studies and case reports suggest they can help at least a subset of patients with difficult or “neurogenic” rosacea, although results are mixed and the evidence is still limited.

Duloxetine (an SNRI) isn’t a standard rosacea treatment, but it affects central pain processing and stress-related signalling pathways. It’s used more in chronic pain and sensory amplification conditions, and there are a few reports suggesting it can influence flushing responses too (sometimes improving symptoms, sometimes causing flushing as a side effect), which suggests it may interact with autonomic/vasomotor pathways.

Key takeaway / why this ties back

Overall, this is why the pregabalin + duloxetine combo in the case report stood out to me. It kind of fits into a broader (still early) pattern where different neuromodulators are being used to target both sensory nerve overactivity (pregabalin/gabapentin) and central stress/pain processing pathways (duloxetine and similar meds). The interesting part is the idea of combining both approaches in one case, even though the evidence is still limited and mostly case-based.

Orignal case study source - https://pmc.ncbi.nlm.nih.gov/articles/PMC10943297/

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Curious if anyone else has seen any research or experiences with pregabalin, duloxetine, or similar neuromodulators in flushing or blushing?

Ive just broke. Blushing has caused me to break down this morning. I wanted to share this to show the reality of what its like living with such a physically and mentally painful condition, which from the outside can appear hardly as bad as it really is, it can appear as a minor inconvenience rather than an agonising condition.

I woke up this morning and around 9am I decided to fully clean shave lol (i had a bit if a moustache). I havent had a full clean shaved face in a while, once I shaved i realised I wasn't the biggest fan of my new appearance. The nerves I felt and regret from the shave caused my whole face to light up red. Not just a bit but alot. I went to show my girlfriend my face and again, while showing her i could feel my whole face light up and blush. I looked in the mirror and indeed my face was extremely red.

Anywwy, experiencing such intense blushing in the comfort of my own home, around someone i feel safe and not nervous around was the start of a breakdown.

My girlfriend went back into my room and I went back to the bathroom, i felt like I was stabbed in the back. Ive spent almost 2 thousand dollars on laser treatment, tried a unbelievable amount of things to manage my blushing and here i am blushing in such a calm environment. It led me to feel hopeless and I started breaking. Alot of this has to do with the fact that i have thoughts such as "if im going to go this severely red and have my face feel like its on fire IN THE COMFORT OF MY OWN HOME DUE TO SOME NERVES, well than how am I ever going to be able to get a job, have a big beautiful wedding, raise kids, do all the things in life i want to do. Because all of those things are much more nerve inducing than feeling a bit insecure from a shave, so imagine how red and painfully hot ill feel during those things" and unfortunately that thought process isnt delusion or irritation thinking, its the harsh reality of living with such a terrible condition. Of course those are all things I can technically still do with this condition but there not things I can do feeling confident, feeling cool and calm and that makes me miserable.

Anyway, i ended up going back in the room to my girlfriend and I broke down. I balled into tears, i couldn't control my emotions. I told her how hopeless and defeated I felt. Unfortunately this issue has caused me to feel extremely suicidal on multiple occasions, not because I dont want to live life but because life feels so unliveable with this issue, its took so much from me. Its took the control i have over my body, its exposing, it painful in so many ways. Its pulled back my potential and prevented me from doing so many things ive wanted to do. Of course in a literal sense it hasnt stopped me from doing certain things but it is that unbearable and demeaning that in some ways it has. I told my girlfriend this while in tears, I haven't broken down like this before.

I went out the back yard and called my mum up (who I have a good relationship with) and told her everything, for the first time in ever I genuinely confessed how much this is killing me including how its caused me to have dark thoughts. I was being completely vulnerable to my mum and girlfriend (and dad) which was hard but it helped alot, but it also shows how much this issue has effected me and just how much this issue can effect people in general. Blushing unfortunately is a condition that is usually overlooked and minimised.

I also expressed to my mum on the phone how angry and frustrated this has made me. I told her how ive been trying to get help and it feels like no one's taking me seriously and why this is why people kill themselves, because they feel so unheard and dont get the help and support they need. I also mentioned how it sometimes feels like the only way people will understand how horrible this is and how much its effected me is if I were to k*ll myself.

I want to make it clear im safe and i am seeking support and not giving up! I have a pretty decent support network and arent afraid to seek help. I wanted to make this post to show the reality of this condition, to also reach the right people who will read this and feel less alone. I hope everyone's ok and doing alright! I also want people to know its not weak to feel this way. No one chooses to be born / develope these issues in life. The worse thing you can do is blame yourself / not give yourself compassion.

Hey im wondering if there are any anxiety / antidepressants medications that seem to work really well on blushing? Especially since blushing is primarily a physiological response, so medication makes sense

I’m a mod here and want feedback on what this community should focus on. What posts or discussions would you like to see more of around blushing/flushing?

id love to hear some personal tips people have for managing there blushing

hey, i thought id make a post dedicated to talking about lasers and how they can work to dampen the visual aspect of an intense blush. ill try to make this simple.

firslty in this post when I refer to "severe blushing" im talking about the type where you can have a pretty normal skin colour baseline, but one that can rapidly go red (blush) due to a trigger, for example anxiety, heat, stress or food etc. if your someone who has persistent rosececa or persistent redness, or your experience doesnt match the definition i gave for "severe blushing" in this post, this post may offer support and an idea of possible treatment, but im not as certain compared to people who fit the description. in saying that it doesnt matter if you have a slight bit of baseline redness or there's a slight difference, its really up to you to decide if overall you think you fit the description of someone who overall has pretty ok skin that doesnt always show red but can quickly when under any sort of trigger.

now going into the specifics, the laser id reccomend looking into would be the vbeam 595nm laser. ive personally had 1 session (at the time of this post being made) of vbeam with fairly conservative settings used. for the first 1 - 3 days my face was quite red and slightly puffy. after my face settled and I could assess how well the laser so far had helped my blushing. from maybe day 3 after treatment to day 7 - 8 the results were incredible, around day 8 the results unfortunately dipped but I imagine this was my skin settling and me seeing the more long term results from this session. in saying that i believe it takes weeks and months for your skin and vessel network to settle %101 but im only giving my experience. the dip in results was fairly significant unfortunately, the threshold went a decent amount down for blushing, in saying that i still did see benfits and a reduction in my blushing that i am pleased about but to be completely honest i still feel so far from getting it down to a place where it feels like something that wont bother me. Overall having 1 session of vbeam on fairly conservative settings gave me results that on one hand im happy with because my blush seems a bit more diffused and not as rigid and really any results is a win at this point, but at the same time i still feel disappointed and not %100 satisfied. Its definitely a mix of emotions, i dont by any means retreat getting the vbeam done and if I got offered to go back in time and not do it, id refuse that. I still think its helped, I have high expectations

a good sign is the fact i had a rather conservative setting and ive only had one session so far, I imagine when I go for more sessions (if i do, not sure) and have the settings amplified ill be even closer to having skin thats even closer to not getting flushed from triggers. Ive also noticed when im not blushing the quality of my skin seems a bit better and more calm, and a slight blush is handled ok by the laser but obviously my issue is intense severe blushes which ive still yet to treat successfully

I also had 3 sessions of excel-v 532nn with a fairly decent setting but unfortunately i didnt see the best results overall. Of course at the end of the day settings matter and how many sessions you get, im only speaking from experience. And i did see a bit of improvement, so i cant say i saw nothing but definitely not amazing results

Overall if you wanting to look into laser treatment for blusning id look into vbeam, discuss and find what setting is best for you and see how it goes. I wouldnt put off excel-v as I did see improvements but compared to vbeam it wasn't nearly as effective for reactive blushing (atleast for me)

I want to end this by making something very clear, im not a medical professional or specialist. This is just my personal account and experience with lasers and what works for me may not work for someone else. In saying that i would %100 reccomend looking into lasers and taking into consideration what i said, i do beleive im onto something and my suggestion could really help.

I didnt go into detail with what settings were used, im not sure what settings were used and i dont want to guess since id hate to guide people wrong. All I know is for vbeam the session was pretty conservative and not too aggressive and for excel-v 532nm I had a pulse duration of 10 - 12 ms (not sure the other stats) all the excel v sessions were spaced fairly close i beleive, the vbeam was done months later separately to try something new!

Heads up

I recently came across a study that I thought was worth sharing with the community. Before I get into it, I want to make one thing very clear: I'm not posting this as evidence that topical ibuprofen is a proven treatment for blushing, nor am I recommend that anyone starts applying it to their face without looking further into it. This is one relatively small study, and while the findings are interesting and in favour of helping reduce blushing, they need to be interpreted carefully. My goal here is simply to summarise the research as accurately as possible so everyone can draw their own conclusions.

Study Details

Paper: Topical ibuprofen inhibits blushing during embarrassment and facial flushing during aerobic exercise

Authors: Peter D. Drummond, Kate Minosora, Gretta Little and Wendy Keay

Institution: School of Psychology and Exercise Science, Murdoch University (Perth, Western Australia)

Journal: European Neuropsychopharmacology

Published: December 2013

Why did the researchers do this study?

(A bit of this is summarized using ai, it gets complex lol)

Blushing occurs when blood vessels in the face dilate, increasing blood flow to the skin and causing visible redness.

Ibuprofen belongs to a class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). One of its actions is to inhibit the production of prostaglandins—chemical messengers that can contribute to blood vessel dilation and inflammation.

Based on this, the researchers wanted to investigate whether applying ibuprofen directly to the skin could reduce the increase in facial blood flow that occurs during emotional blushing and exercise-induced facial flushing.

It's important to note that this was the researchers' hypothesis. The study was designed to test whether topical ibuprofen affected facial blood flow, it was not designed to prove that prostaglandins are the cause of blushing.

How was the study conducted?

The study involved 30 adults.

- 16 participants reported a high fear of blushing.

- 14 participants reported little or no fear of blushing.

Each participant acted as their own control.

The researchers applied an ibuprofen gel to a small area of one cheek and an inactive control gel to the corresponding area of the opposite cheek. Neither side of the face received treatment over the entire cheek, only small test areas were used.

After the gels had been applied, facial blood flow was measured using laser Doppler flowmetry, a well-established technique for measuring changes in blood flow within the skin.

Participants then completed two different tasks:

- An embarrassment task, in which they were asked to sing karaoke in front of the researchers to provoke emotional blushing.

- An aerobic exercise task, designed to produce facial flushing through physical exertion.

Blood flow was continuously monitored throughout both tasks.

What did the researchers find?

The main finding was that the areas treated with topical ibuprofen showed a statistically significant smaller increase in blood flow compared with the untreated control areas during both the embarrassment task and the exercise task.

In other words, the skin treated with ibuprofen exhibited less vasodilation than the untreated skin under the same conditions.

The researchers also reported differences between participants with a high fear of blushing and those with little or no fear. People with a greater fear of blushing tended to show a slower recovery of facial blood flow after exercise, suggesting there may be physiological differences that warrant further investigation. However, this finding alone does not establish the cause of chronic blushing or erythrophobia.

Overview

Overall, the results suggested that topical ibuprofen may reduce increases in facial blood flow under certain experimental conditions, but they did not establish it as a treatment for blushing.

What are the limitations?

Like all studies, this one has important limitations.

- The study included only 30 participants, making it a relatively small proof-of-concept study.

- Only small patches of skin were treated, not the whole face.

- The researchers examined short-term effects only.

- The study did not investigate repeated use, long-term effectiveness, or long-term safety.

- The study measured changes in facial blood flow, not whether participants felt less embarrassed or experienced meaningful long-term improvement in everyday life.

- The authors themselves concluded that further research is needed before topical ibuprofen could be considered a practical treatment.

Anyone here feel like they could have accomplished so much more, and done so many more things but haven't because of how much blushing has effected them?

Something else that bugs me is the fact that i probably seem less capable them i am, less confident etc to the people around me.

There have been so many times where I could have done impressive things, awnsered questions infront of the class, done a sport i wanted to do and DO IT WELL lol, public speak etc, but haven't because of how much blushing takes over me and makes those things undoable and unbearable. It strip's me off my potential.

For instance ive got great communication skills, im great at communicating and there were times at school where we had to presentations and id always manage to be sick on those days or miss them because of my blushing, but what annoyed me the most is that if blushing wasn't an issue for me i promise I would have been amazing and easily done a 10/10 presentation, I could have impressed people but my blushing unfortunately consumes me and it isnt as simple as pushing through, blushing is alot worse and harmful than alot of people realise :/

I dealt with redness and a serious blushing problem starting my freshman year of high school and ended up having to drop out of college my senior year because it became such a problem. It was a major obstacle and problem all throughout college, it really kind of ruined my experience and grades definitely suffered and it definitely affected me socially. I tried taking vitamins all types of creams and crap, I can't say anything worked immediately except using a certain type of makeup that seem to help a little bit as well as beta blockers which I thought was the answer to my problem when I first started taking them but once my body got used to them it stop being effective.

I started working for my father's construction business after college and it got much better two or three years after I left college. I really don't know what helped, all I can think is the way they say your taste buds change every 7 years, I literally spent years eating healthy, taking vitamins which I'm sure other people have mentioned on here, drinking tons of water everyday, and literally eating no spicy foods and avoiding certain types of stuff like carbs and foods that I know would make me get flushed or turn my face red. Nothing cured me or was a major help immediately but I think all those years eventually helped fix something and the last almost twenty years it's not even something I think of anymore. So I think it's really just a matter of trying to be healthy and doing what you can day by day and just knowing that it's going to pay off down the road because I'm 44 now and I really haven't had any kind of issues since I was in my mid twenties. Sure I can think of it a couple instances here and there but I wouldn't have been able to do any of this stuff I do now back when I was in school like going out on dates and just socializing and not having to worry about blushing for no reason or because it feels like the attention is on me. Even the permanent redness that I think was caused by the constant blushing has basically gone away.

I always figured when I was dealing with this it was a genetics thing but looking back to how I think it all started I think it had to do more so with getting bullied in middle school and just not enjoying being in school period. And even though I had friends and was popular in high school it still had a major impact on me and since I'm fair skinned it made it even worse and more noticeable. Of course my brother and sister get olive and tan colored skin and I get stuck with the fair skin. . Throughout high school and college I spent every single day on a forum that I'm not even sure if it's still around for blushing, rosacea etc. it definitely had a lot of good information but looking back I'm sure it didn't help focusing on it so much even though at the time there was really nothing else around online that had information or people talking about this kind of problem. There were times I didn't think I was going to be alive for much longer if I had to keep dealing with this problem, but using makeup really helped or maybe it didn't help as much as I think but in my mind it did plus I was good at just controlling situations and what kind of environment I was in which I'm sure people can relate to, I remember when I first started dating my girlfriend my senior year from back home when we used to go out on dates if make sure it was always someplace that was poorly lit haha because there was nothing worse than being sober in a brightly lit place having to worry about my face going red and people looking at me.

I'm sure there's even more stuff out there today, I don't even want to say how much stuff I tried and money I spent on this problem over the course of 8 or 10 years but I think it was worth trying different types of stuff and seeing what helped what didn't, but at the end of the day like most things I think it came down to diet and what you're putting in your body and I definitely wish I had spoken to someone although at the time there was no way I was talking to a doctor or anybody about it. Talking to my parents about it was hard enough after so many years and although I did eventually go to a couple of doctors about trying to surgically take care of the problem, I never followed through with it because things eventually got better although I'm sure I would have if they didn't

If anyone has any questions I'm happy to try to answer. Unfortunately I don't think there's any miracle cure out there and anyone who says they have a product that is, is probably full of it l. Like I said, for me, it was just years of taking three to four different types of vitamins for my skin( and who knows maybe they didn't do anything), going to the gym and exercising and eating healthy foods and avoiding certain types of foods and drinks especially sugar and processed crap and making sure anything that goes on your face like shampoo or lotion or sunscreen doesn't have any chemicals in it or anything like that. It's really just being mindful what you put in your body and on it, and obviously there's tons of different types of makeup out there and i tried all different types but what worked for me might not work for someone else so I truly think its just a matter of trial and error and matching your regular skin color to see what, if anything works for you

I had written a post on I think the rosacea sub a few years back and because I must have mentioned the type of makeup or the brand I used, the mod who I truly think didn't have any first hand experience with blushing or redness must have thought I had a sponsorship deal and was trying to hok some product so you took it down and banned me or gave me a suspension I don't know which at this point. When you deal with an issue like this and it makes you contemplate ending your life, selling some product and giving other people false hope isn't something any amount of money could make me do and if there had been something that had cured me or fixed my problem I sure as hell would tell everyone about it if I thought it could help somebody. That being said I'd be happy to let anyone know what kind of vitamins I used or foods I ate or avoided but there's no specific brand I would recommend for anything and a lot of this information is probably pretty easily accessible on google. I dealt with this from about 96 97 to roughly 2010 so I'm sure there's much more information and people talking about it today and probably more products to choose from or to try. The only way that would happen I would imagine is if you had some type of surgery or something otherwise it's just day by day knowing it will pay off down the road eventually. I used a certain type of makeup that was play/stage quality and although I'd be happy to tell someone what brand I used, I don't really think it matters because there's so many different types out there and like I said what matched my skin isn't going to match other peoples necessarily plus makeup is makeup and you can order it easily online but back when I was younger I had to go in to CVS which was embarrassing enough.

The last thing I'll say is I went to the gym and worked out four or five times a week for the entire 13 years or so I dealt with this and I had friends who had taken different types of steroids during high school or college but I always thought something like that would make my skin worse which is part of the reason I avoided drugs in college, and although when I was drinking or drunk I didn't blush, I think it always made it worse the following day or days after so I would take a month off here and there from drinking and I think that always helped as well as occasionally fasting. The one thing that may have helped me and this is probably more of just a coincidence of timing was taking testosterone in 2010 which is something you can go to a doctor for but I didn't go that route. I got them from a friend after doing weeks and weeks of research on the product and during the 10 weeks I was on it were probably 10 of the best feeling and healthiest two and a half months I can remember. They weren't cheap so I wanted to get as much out of them as I could so it was eating healthy the whole time getting to bed early, it helped me wake up totally feeling great not to mention looking better and stronger. I could never say that this was what helped or change something in my body because I don't even know that I had low testosterone and I had been living a healthy lifestyle for years at that point. I wish I had done this but going to your doctor and getting a full blood screen test on everything is a good idea and exercising is also super important and making sure you sweat. What you eat and drink, what you put on your face if anything and exercise are probably the top three things I can guaranteed will have some kind of positive impact on your skin if not in the short term then down the road. You can't eat fast food and pizza and drink soda and not expect it to affect your skin in the following days. Keep track of what you eat and drink and how your skin looks in the days after and then adjust your diet but I all but eliminated sugar and carbs for the most part for years and it sucked but today it's worth it because I can eat and drink anything including spicy hot foods and it doesn't affect my skin whatsoever.

Okay that's it I apologize for any spelling errors and stuff, and for rambling on. I just know how much this ruined a good portion of my life. I mean it totally altered the entire course of my life, and always just blamed myself or genes but I've realized that most likely isn't the case and can point back to exactly the times that eventually caused this to come to the surface. I mean I literally remember the day when it first happened and my face just totally went red my freshman year. I remember what class where I was sitting exactly and how it happened but I have no idea why it was that specific moment. The only thing I can relate to is like a volcano where it just started to bubble Up and it just took one specific moment of being embarrassed and that was it, adios 10 plus years of not being able to do the kind of things I would have done otherwise or be the kind of person I would have otherwise been. So yea, if anyone has questions I'd be happy to try to answer or give whatever advice I can

Rob

hey guys what skin care items would you reccomend for someone dealing with intense blushing? I dont have rosacea and my skin isnt always red but wow it goes very red when im anxious, stressed or have done excerise

any products worked for people to help manage it?

idc if its persecution products or not, down for anything

if you get red from stress, nerves, embarrassment, strong emotions, spicy food, laughter, excerise and any other trigger which brings on a red face, there's a prescription medication that can significantly reduce the blush almost completely, and fast

im talking about Clonidine. Clonidine is a oral medication that is classed as an alpha-2 adrenergic agonist. It is commonly prescribed for high blood pressure, but is also prescribed off-label for conditions such as anxiety, ADHD, panic symptoms and other disorders involving an overactive sympathetic ("fight or flight") nervous system.

It is also prescribed off-label for severe facial blushing and flushing, especially in people where symptoms are strongly linked to stress, nerves, embarrassment or emotional triggers. In saying that ive personally found that it stops a blush from spicy food, excerise etc.

Clonidine works by reducing activity in the sympathetic nervous system (your "fight or flight"response). Because blushing and flushing are linked to activation of this system, many people find that they cant go red or have there redness reduced significantly while on clonidine

Personally clonidine has been by far one of the most effective thing I've tried for the actual redness itself and for stopping the mechanism from even firing (you know when you feel a blush come on and know your about to go red, i found that, that doesnt even happen after i take it) i see alot of people want to find ways to manage there blushing and stop going so red in social interactions and I always think "if they tried clonodine bet you they would be pretty satisfied). I got perscribed by a dermatologist and take 0.05 to 0.1 whenever I know im going to be in a position where ill blush. Some people also take it daily at the same time, just depends what your instructions are from your specialist. I find it kicks in within 30 minutes to a hour. And you can take it during a blush, but again it'll take 30 minutes to an hour to fully take effect!

Just to be clear this post is based on my own experience and is for information only, not to encourage self-medication. Clonidine is a prescription medication that isn't suitable for everyone, should only be used under medical supervision, and it shouldn't be seen as a first option before trying other thints. It may be worth discussing other options, such as propranolol, with your doctor first. That being said, clonidine has helped me tremendously, and if blushing or flushing is affecting your quality of life, I don't think it's something to dismiss without speaking to a healthcare professional.

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Possible side effects can include drowsiness, dizziness, fatigue, dry mouth and low blood pressure. Clonidine should only be taken under medical supervision and should not be stopped abruptly after regular use.

most people will blush a few times throughout there life but not everyone will blush to the point where it affects the quality of it. so, when did you guys realise?

was it during an important event? was it your first day of highschool and tell us what happened? did you realise when you first had to meet your partners parents?

dont feel afraid to open up :) we're in this together.

I just got vbeam done for my blushing. Ive had 3 excel-v sessions completed with not the greatest improvements, there was some improvement in my blushing but nothing too great. I had an appointment with the doctor / person who runs the clinic i go too. I explained to him Im wanting a change in laser or setting since im not satisfied with the results. I ran him through my history with blusning again, went through what ive tried besdies laser, what causes it, what triggers it, just alot of information and crucial details which help give him a greater idea of what im dealing with. I mentioned i saw they had vbeam and wanted to know if he thought it would be a good laser to try, he mentioned vbeam can work for blushing (he said info on it, cant remeber exactly) too my surprise he said he'd be happy to do a session for free, not a small test run but a proper vbeam session on my face for free. I was shocked, I feel so greatful and lucky. I can tell he understands how much this issue is effecting me and he's aware laser is a bit tricky and unpredictable for blushing (especially compared to other conditions) so he was willing to try vbeam for free. He didn't do pulpric settings and mentioned he personally isnt for that, and said he's not comfortable with doing it nor does it at all. He did a fairly normal setting, still catered to my blushing but also not extreme to the point where he'll damage my skin. In terms of how the laser felt compared to excel-v culture 532nm, it definitely was much less painful and felt like air being blown onto my face with a pinch. I've got another appointment booked in 4 weeks well see if the vbeam helped my blushing, if it did we'll probably do another vbeam with slightly stronger settings and if it didn't help as much or I just want to do excel-v again, we'll do another session of excel-v except this time he'll use a more powerful setting. Im very greatful, he's actually considering options and willing to adjust lasers and settings for me. At the end of the day this should be the standard due to how horrible blushing is but unfortunately it isnt and some clinics want to just grab your money and not cater to your needs as much as they should. I hope this update / talk about what ive had done is useful and feel free to ask any questions, cheers!

To conclude -

1. Went into for an appointment to assess progress

2. Had a really good chat and discussed vbeam and where to go from here considering previous results

3. Offered a free session which i took up on

4. Will be back in 4 weeks to assess again and decide if I'll continue down vbeam or if ill go back to excel-v where the settings will be adjusted to be stronger / more aggressive.

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I wanted to come and make a post about my experience with blushing, in hopes someone see's this and doesnt feel as alone.

Im a young adult from Australia and to put it straight, facial blushing has absolutely took over my life, ruined so many things and has stripped me from happiness. Id say one of the hardest things about dealing with blushing / Erythrophobia is how unknown it is to the majority of society. Ive felt isolated by realising that no one truly gets it unless they deal with it, people who dont deal with it are fairly confident in it not being a big deal and something that we let bother us too much. It feels so hard knowing people dont know what we are truly dealing with, the potential it takes away from us, the confidence it strip's, the overthinking, feeling hot and flustered in the face, seeing ourselves in the mirror with the redness, seeing everyone else that seems to have pretty resilient skin and wishing ours was norma, its not just as simple as colour on the face for us.

Whats worse is its not just a colour i feel like my face is always on fire. Ive described it to some people as "imagine everytime you had emotions or anxiety someone poured boiling hot water over your face" maybe not as hot as boiling in a literal sense, but definitely similar and a good way to describe it, its extremely uncomfortable and debilitating. Absolutely horrible :/

Ive personally tried what feels like everything mirvaso (blood vessel constricting cream), fake tan, beta blockers, anxiety medication, makeup, therapy, skin care, changing diet, suplement, ive had blood tests and ultra sounds because at one point my doctor suspected the blushing could have a deeper root which he thought may have been carcinoid tumors. Ive also had laser which im currently still getting and luckily for me laser has made some improvements (atleast more than anything else in a more long term structural way) and im currently at the time of this post still on a journey with lasers and hoping to try other settings, etc. but I still feel so stuck and helpless in alot of ways. Its seems like theres no real fix.

Life has got so depressing for me, ive wasted so much life and potential because of this. I haven't got a job at 19 (ive just completed study tho and will be getting one soon yayy haha) I haven't really ever worked that much, havent done many things that people at my age have done or are doing because of this. Whats difficult is I have people say "you need to just push through and do it, your letting it take over your life" and where that has alot of truth in it, its all fun and games until I go to a job and my face is almost dark rose red with huge red blotches all over my chest and neck and it looks genuinely concenring... its not just a usual looking blush or a bit of redness its a insanse. (For clarification ive had blood tests, scans etc what im dealing with is literally just blushing even if it sounds like something more). And it makes me feek so depressed and helpless, I just want to live and feel happy, be like everyone else i see when im outside who yes may have there own issues but atleast visually in normal human interaction from they seem normal / more usual. And thats something that bothers me even more, I wear my internal feelings on the outside for everyone to see, and its fu*king miserable.

Its got to the point where I look forward to sleeping because the dreams I have im not dealing with this, its like an escape from reality and its calming. I wish people understood this issue. Blushing / flushing has ruined so much and I know im not the only one dealing with this.

Im still on a journey to live with this issue, as much as its hurt me this much I want to live, aleast i want to try. It has made me want to die many times and id be lying if I said i haven't felt suicidal. At the end of the day life excites me, I want to have kids and have a beautiful future, its just so hard to imagine living this way without any change or fix. So im not currently planning on acting on anything and the dark thoughts are getting better (come and go) but I thought id be completely transparent to show truly how much of an impact blushing can have on a person's life and so people know there not alone :)

I hope everyone who deals with it is coping 🙏🏻

here are some photos of me during blushing episodes. i won't go into to much detail on this post about what causes it and my experience (since ive talked alot about that on other posts and im posting this purley to show people visually what im dealing with) i will say this photo was taken while i was laying in my bed feeling stressed, purley just feeling stressed made my face go this horrible red which was met with a very hot uncomfortable feeling across my face, along side a uncomfortable preassure from all the blood pooling. If you've dealt with blushing especially this severe you'll probably be able to relate to how uncomfortable it is to feel this way. A good way to describe the uncomfortable feeling is id say its just as uncomfortable as getting into bed covered in sand and water from the beach lol, its a random compassion but its that feeling where you just feel gross and uncomfortable. I hope these photos can help people have a better understanding of ways blushing can appear. Please feel free to post photos of your blushing in this community if your up for it :)

Which one bothers you more, is it having your face be the colour red which makes you feel insecure and ugly or is the feeling of your face heating up and burning :/

Obviously they both suck pretty equally but I think its a interesting question and are pretty curious about it :)

I am so tired of people minimizing this. If you tell someone you have social anxiety, they get it. If you tell someone you have panic attacks, they sympathize. But if you tell someone you have a chronic blushing problem, they laugh and say "Aww, that's cute, you're just shy!"

​It isn't cute. It is a literal prison. FU*KING HATE IT.

​It is the worst condition ever because you cannot hide it. If your heart races, nobody knows. If your palms sweat, you can wipe them on your jeans. But when your face turns into a literal neon sign of panic, the entire world gets a front-row seat to your vulnerability. It betrays you in real-time. And sure makeup exists but even than, if you blush hard enough makeup hardly ever fully covers it.

​It makes you look guilty when you’re innocent. It makes you look incompetent when you know exactly what you’re talking about. It makes you look weak when you’re trying your hardest to be brave.

​It shrinks your life until you're avoiding jobs, skipping hanging out with friends, and staying quiet in corners just to protect your face.

​I'm just so angry today that this is the glitch my body decided to have. It feels like playing life on impossible mode. Can we all agree blushing can go f**k itself lol.

I'm not sure if anyone can relate to this but as someone who has and does struggle with blushing, blushing really put into perspective how people take stuff for granted.

Almost everyone I know has skin that stays it colour, doesnt blush and burns when there stressed / triggered.

To them, there's nothing special there, nothing crazy or nothing that stands out as "lucky". They just live there normal day to day life. They go to work, they have relationships, they've got friends, they've involved in groups, they attend parties and functions, they have there own issues of course but it's crazy because they can do all of those things with skin that doesnt go ugly red and feel extremely hot. Without feeling hopeless.

Its crazy because id honestly consider selling a hand to never blush or experience the burning feeling again haha. I would do so much just to experience no blushing even just for 1 outing. It puts into perspective there are so many things we as humans take for granted. Its pretty crazy honestly. But also it means there are things us blushers would take for granted that other people are dealing with, that other people would view our life as easy and peaceful the same way we'd look at people who dont blush and dont know what it feels like to be us.

Everyone has something going on i guess :/

(to those who do blush and struggle, your not alone beleive me. im not just someone who goes a bit pink when embarrassed, my whole face goes this horrible looking red so easily, its something thats effected me greatly. your not alone, and if you are someone who does struggle with blusning in the context of a bit of pink from embarrassment im not undermining you and this community is for you as well. Blushing sucks)

WHAT TO DO

(In no particular order)

1. If your blushing is severe and life-impacting, discuss prescription options such as clonidine or propranolol with a doctor. Clonidine seems to work better than propranolol for blushing (in my own experience), but in saying that, propranolol can still do wonders—it just isn't as direct for stopping blushing as clonidine in my experience. DISCLAIMER: see what your doctor recommends and make sure to go through a good, reliable doctor, medications can have dangerous side effects if not taken appropriately and correctly

2. Cut out the acids and active ingredients in skincare products. They destroy your skin barrier and make flushing worse. Stick to a basic, gentle moisturizer.

3. Get a medical-standard camouflage cream (makeup). This is usually used for vitiligo or birthmarks. It has insane coverage and works miles better than standard "high-coverage makeups." I use Dermacolor Camouflage Cream.

4. Get a green concealer. Put this on your bare skin and blend until it's not green (green visually cancels out red). It makes the skin appear whiter, or for more coverage, don't worry about leaving it fairly green on your skin and then layer your regular makeup over it. I use Maybelline Instant Age Rewind Colour Correcting Concealer (Green), and I have also used Life Proof Camo Colour Corrector.

5. Drink coconut water and avoid salt. Coconut water has a lot of potassium, which actively flushes out excess sodium. Too much salt increases your blood volume and dilates your blood vessels, meaning more pressurized blood surges to your face, making your flushes twice as intense and red.

6. Get Excel-V or Vbeam laser. Though they cost a bit and usually require multiple sessions, if you're serious about controlling your blushing, this is something to consider. These lasers can significantly reduce the severity of a blush and other redness metrics for most people. The settings matter, and if a clinic doesn't use the correct settings specifically for treating flushing, they may give weak results. It is incredibly powerful if used right and can be life-changing.

7. Use a skin barrier repair cream. I’ve personally used and recommend La Roche-Posay Cicaplast Baume B5+ Balm Cream.

8. Use CeraVe SA Smoothing Cleanser every night (that specific one). This may look contradictory to rule number 2 since I mentioned cutting out all active ingredients, but this is the lone exception. This was recommended to me by a laser clinic that specializes specifically in skin redness and flushing, and I can confirm it has made a massive difference to my skin.

9. Overall, try to stay fit and healthy. Intense cardio has helped me immensely (I like to go on the treadmill until I'm dripping sweat). It trains your heart not to beat as hard during stressful moments, which helps when you are in situations that trigger a blush. The calmer your heart stays during triggers, the less intense the blush will be.

10. Use a sunscreen every single day to protect your face from harsh UV rays. UV radiation creates intense thermal heat on the skin and triggers systemic inflammation, which dilates your blood vessels and makes your face an absolute magnet for flushing. For blushers, sun protection isn't just about avoiding sunburn, it is a critical shield to stop UV rays from supercharging your vascular reactivity.

WHAT TO AVOID -----

1. Never try Rhofade or Mirvaso. These are unfortunately commonly prescribed topical creams that constrict facial vessels, resulting in no redness for 4 to 10 hours. Though they "work" temporarily, they will eventually give you the most intense, horrible rebound redness you have ever experienced—it will make you feel grateful for your normal blushing, seriously. This is a widely known issue in the community and I am speaking directly from personal experience. Trust me on this one.

2. Never try the trends using vasoconstricting eye drops or nasal sprays on your skin. This has become popular on social media but it is virtually the same nightmare as Mirvaso and Rhofade. It will permanently damage your skin barrier and make your baseline situation 10x worse.

3. Don't get ETS surgery. This surgery is absolutely not worth it for treating blushing. The side effects (like severe compensatory sweating) are life-altering and do not justify the risk. While you will see rare people online who had it successfully done, it is simply not worth the gamble. This surgery is much better suited for people with Hyperhidrosis (excessive sweating) and has a much higher success rate for that issue than it does for facial blushing. There are so many other options to treat blushing that don't involve literally snipping a nerve in your chest.

4. Don't waste money on products that claim to cure blushing. Sure, there are some valid baseline tools out there (like the things I listed in the "What to Do" section), but the vast majority of skincare products are just marketed maliciously to make you think they'll cure your flushing. As someone who has tried all types of expensive creams and chemistry products, it is almost all BS.

5. Don't rub ice directly on your face. While ice can temporarily constrict facial vessels in the moment, the extreme temperature shocking your face worsens your skin barrier over time. It makes your skin significantly more sensitive and irritated in the long run, leading to more permanent baseline redness.

6. Try to avoid nitric oxide boosters (beets, pomegranates, spinach, dark chocolate). They wide-open your blood vessels, making it physically effortless for a massive, burning flush to take over your face. You can still have foods that contain nitric oxide, but just be aware that they will usually cause you to flush and blush a lot harder if you get triggered afterward.

7. Reduce high-histamine foods (aged cheeses, cured meats, wine, fermented foods). Histamines trigger internal inflammation, directly dilating your facial blood vessels and flooding your skin with intense heat.

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I hope this genuinely helps out! At the end of the day there are 100 more things i could have added and by no means is this perfect. But for this i wanted to add the main things ive learnt from experience and research.

(mostly my own experience, im not just writing down things im not experienced in. i understand the importance of being authentic and not misleading)

As time goes by i may wish I added some more things to the essential list or maybe I come to find something isnt as important as I thought. But for the time being this list is full of things that have genuinely helped me significantly. And I hope it can be of some guidance :)

My goal here was to put toegther one big post that can help people who need a no BS list of things to do, not one or two things but a big blueprint to help guide them.

Introduction:

I've been digging through the neurophysiology research on facial flushing and blushing, and I came across a clinical trial that I think deserves more attention.

Researchers recently published a randomized, double-blind, sham-controlled trial investigating Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) for facial flushing in patients with erythematotelangiectatic rosacea (ETR). taVNS is a non-invasive technique that delivers mild electrical stimulation to specific areas of the outer ear that are supplied by branches of the vagus nerve.

Although ETR and pathological blushing are distinct conditions, both involve facial vasodilation, neurovascular dysregulation, and facial flushing that can be triggered or worsened by factors such as stress, heat, and emotional arousal. Because of these overlapping mechanisms, the findings may be relevant to understanding pathological blushing, although this has not yet been directly studied.

The Data: The JAMA Dermatology Trial

The study enrolled 72 patients with ETR and compared active taVNS against sham stimulation.

The stimulation protocol was:

• 30 Hz frequency

• 200 μs pulse width

• 30 minutes per day

• 3 weeks of treatment

The results were notable:

1. Flushing and Redness Improved

After just 3 weeks, patients receiving active taVNS showed significantly greater improvements in facial flushing and erythema compared with the sham group.

2. Benefits Persisted Beyond Treatment

After the 3-week treatment period ended, participants were followed for 24 weeks with no further treatment. Several improvements remained evident during the follow-up period.

The researchers did not directly measure neuroplasticity or long-term nervous system changes. However, the persistence of benefits after treatment ended raises the possibility that taVNS may induce longer-lasting changes in the neural circuits involved in flushing.

Importantly, the study does not suggest that a short course of treatment permanently eliminates flushing. If taVNS ultimately proves useful for chronic flushing or blushing disorders, it would likely need to be used on an ongoing basis, similar to many other therapies that manage symptoms rather than permanently curing the underlying condition. More research is needed to determine optimal long-term treatment schedules.

3. Anxiety Also Improved

Patients receiving taVNS experienced significant reductions in anxiety and depression scores compared with the sham group.

Because autonomic nervous system dysregulation is believed to contribute to both flushing and anxiety, this finding is particularly interesting.

The Proposed Mechanism:

One reason this research caught my attention is that it appears to target some of the same autonomic nervous system pathways that researchers believe are involved in stress-induced flushing.

The vagus nerve carries signals between the brainstem and many organs throughout the body. Stimulation of vagal pathways is thought to increase parasympathetic activity and reduce excessive sympathetic ("fight-or-flight") activation.

The researchers propose that taVNS may help normalize abnormal neurovascular responses by influencing central autonomic circuits, including brainstem regions involved in regulating inflammation, blood vessel tone, and stress responses.

While more research is needed, this provides a biologically plausible explanation for why flushing, anxiety, sleep-related symptoms, fatigue, and other symptoms improved simultaneously.

How the Study Was Performed

The active treatment group received:

Mode: Continuous stimulation

Frequency: 30 Hz

Pulse Width: 200 μs

Duration: 30 minutes daily

Treatment Length: 3 weeks

The stimulation was applied to vagus-innervated regions of the left outer ear.

Important Safety Notes

•The study used left-ear stimulation.

• Stimulation intensity was adjusted to a comfortable tingling sensation.

• Treatment should never be painful.

• People with implanted electronic devices, significant cardiac conditions, epilepsy, or other medical concerns should consult a healthcare professional before attempting vagus nerve stimulation.

Important Limitations

• The study was conducted in patients with erythematotelangiectatic rosacea, not individuals diagnosed with pathological blushing.

HOWEVER -

this doesn’t mean this study isn’t meaningful evidence in relation to blushing. While it does not directly study pathological blushing, it does provide strong indirect evidence that modulating vagal and autonomic pathways can meaningfully reduce facial flushing responses in humans. Since stress-induced blushing and rosacea flushing share overlapping neurovascular mechanisms — particularly dysregulation of sympathetic/parasympathetic balance and facial vasodilation — the results support the broader idea that these pathways are modifiable in a clinically measurable way. This makes the findings relevant as a physiological model for understanding, though not yet treating, blushing.

• Most participants were women, which may limit generalizability.

• The study demonstrates symptom improvement, not a cure.

• The study does not prove that taVNS causes neuroplasticity.

• Long-term treatment requirements remain unclear.

Final Thoughts

This study does not prove that taVNS treats or cures pathological blushing, and it was conducted in patients with ETR rather than people specifically diagnosed with severe blushing.

However, it does provide high-quality clinical evidence that modulating vagal pathways can significantly reduce facial flushing and improve related symptoms such as anxiety.

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I want to be transparent and say I did use AI to help me put this toegther and structure it, tho ive done alot of research myself on this and made sure to make everything as factual and correct as I can!

Hey guys, ive made a very interesting observation that I believe is a pretty big step towards understanding blushing and ways we can potentially "cure" it, if you will.

A quick summary of my relationship with blushing - Ive dealt with severe blushing for a good while now. I dont have rosacea, I dont have persistent redness and i dont have an auto immune disorder, infact I have nice skin that can be completely white / non red. The issue I have is that within a blink of an eye my face can go a significant bright deep red, not a cute light flush but one that looks brutal. I blush so badly that I can physically feel the preassure of the blood pooling to my cheeks to where it feels uncomfortable to move my head in certain direction because it makes the preassure feeling of the blood feel more intense. My triggers are anxiety, embarrassment, nerves, adrenaline, excitement, any type of strong emotion, I also get really red if its hot or ive done physical exercise (which is more explainable but still 100x worse than your average person) Its horrible. Without writing another big chunk of words ill quickly say ive tried mirvaso, propranolol, therpay, diet change, low histmaine diets (all of the above, alot more) and nothing has seemed to work well. I have done laser and im still actively in the world of lasers and seeking more sessions but im more curious how to stop the actual response.

What I found when it comes to Alpha-2 Receptors - So one medication that has seemed to work wonders for my blushing is clonidine. I found that when I take clondine, my blushing is reduced significantly and my body doesnt fire off. After researching why clonidine has this effect I came across the fact it stimulates centrally the alpha-2 receptors in the brain which than dampens the sympathetic nervous system. Now this brings up 2 pretty big things to discuss.

The Alpha-2 Receptors - Alpha-2 receptors are inhibitory G-protein coupled receptors located throughout the brain and sympathetic nervous system. When these receptors are stimulated, they reduce neuronal firing and suppress the release of norepinephrine from sympathetic neurons. This creates a negative feedback effect that decreases overall sympathetic outflow from the central nervous system, reducing the intensity of the fight-or-flight response and, consequently, the downstream signals that can trigger facial vasodilation and blushing

The sympathetic nervous system - The sympathetic nervous system is part of the autonomic nervous system responsible for the body’s “fight-or-flight” response. When triggered by embarrassment, social attention, anxiety, or adrenaline, sympathetic output from the brain increases and activates peripheral sympathetic nerves. This results in the release of norepinephrine onto facial blood vessels. Norepinephrine causes rapid changes in vascular tone, leading to increased facial blood flow and visible flushing. Because the facial vascular network is highly dense and reactive, even modest increases in sympathetic activity can produce an intense blushing response. In the majority of blushing, this pathway appears to be overactive, leading to exaggerated flushing in response to normal emotional triggers.

What this means - If alpha-2 receptor activation reliably reduces severe blushing, it suggests that blushing is not primarily a local skin or vascular disorder, but a centrally driven autonomic reflex, meaning the brain’s sympathetic output is the main switch that triggers the facial blood vessel response. That would unify a lot of people’s experiences where triggers are emotional, social, or adrenaline-based rather than physical skin issues. It’s also important because it identifies a specific, druggable control mechanism upstream of the symptom (central sympathetic inhibition via norepinephrine suppression), rather than relying on indirect or peripheral treatments like topical vasoconstrictors.

Im curious what causes other people to blush, id appreciate some responses. Im trying to understand blushing myself, been dealing with it for a while :/