Psychiatric causes Anxiety Disorder: panic disorder, social phobia and other phobias, apprehension as part of other psychiatric diseases
Medications: can be caused by several medicines, e.g. ACE inhibitors, calcium-channel blockers, nitroglycerine, PDE5 inhibitors, glucocorticoids, antioestrogens, tamoxifen, stopping hormone replacement therapy, disulfiram, disulfiram-alcohol reaction, combined use of e.g. metronidazole and alcohol, opioids.
Anaphylaxis Anaphylaxis: urticaria, angioedema, hypotension, bronchial obstruction, abdominal symptoms, elevated serum tryptase only during the reaction. Skin prick tests or serum allergen-specific IgE testing.
The mainstay of treatment is the avoidance of factors that, based on the patient's observations, aggravate the condition.
Concealing cosmetics may be used.
The flush reaction in rosacea generally reacts fairly poorly to topical treatment.
Some patients benefit from a low-dose beta blocker, e.g. propranolol 10-40 mg 2-3 times daily, carvedilol 3.125-6.25 mg 1-2 times daily or atenolol 12.5-25 mg once daily to attenuate the flushing reactions.
Prophylactic beta-blocker medication has also been used, e.g. propranolol 10-40 mg 1 to 2 hours before entering a situation that is expected to cause flushing.
Patients with symptoms of apprehension, anxiety and panic may benefit from antidepressive medication, primarily selective serotonin reuptake inhibitors (SSRIs).
Specialist consultation
An appropriate specialist should be consulted, if necessary, regarding the treatment of an underlying cause.
References
Logger JGM, Olydam JI, Driessen RJB. Use of beta-blockers for rosacea-associated facial erythema and flushing: A systematic review and update on proposed mode of action. J Am Acad Dermatol 2020;83(4):1088-1097. [PubMed]