Differential diagnosis of flushing

Common Causes

Benign cutaneous flushing

Emotion
Temperature
Food or beverage

Rosacea*
Climacteric flushing
Fever
Alcohol

Uncommon, serious causes

Carcinoid
Pheochromocytoma
Mastocytosis
Anaphylaxis

Other causes

Medullary thyroid carcinoma
Pancreatic cell tumor (VIP tumor)
Renal cell carcinoma
Fish ingestion
Histamine
Ciguatera

Psychiatric or anxiety disorders
Idiopathic flushing
Neurologic

Parkinson’s
Migraine
Multiple sclerosis
Trigeminal nerve damage
Horner syndrome
Frey syndrome
Autonomic epilepsy
Autonomic hyperreflexia
Orthostatic hypotension
Streeten syndrome

Medications

Very rare causes

Sarcoid, mitral stenosis, dumping syndrome, male androgen deficiency, arsenic intoxication, POEMS syndrome, basophilic granulocytic leukemia, bronchogenic carcinoma, malignant histiocytoma, malignant neuroblastoma, malignant, ganglioneuroma, peri-aortic surgery, Leigh syndrome, Rovsing syndrome

* Rosacea

“Rosacea is a chronic cutaneous disorder, primarily of the central face. It is often characterized by remission and exacerbation and it encompasses various combinations of such cutaneous signs as flush, erythema, telangiectasias, edema, papules, pustules, ocular lesions, and rhinophyma. Primary features considered as necessary for diagnosis include flushing, erythema, papules, pustules, and telangiectasias. A variety of secondary features are listed that may be absent or present as a single finding or in any combination.”