FLUSHED FACE (PLETHORA)
FLUSHED FACE (PLETHORA): Excerpt from Differential Diagnosis in Primary Care
Not everyone with a red face should be classified as an alcoholic. The
causes of this symptom can best be established with the help of
physiology. A flushed face may result from an increased amount of
circulating blood (polycythemia) or from any factor that may dilate the
blood vessels in the face.
Polycythemia may be primary, as in polycythemia vera, or secondary, as in
Cushing syndrome, unilateral renal disease, hypernephroma, and pulmonary or
cardiovascular disease associated with chronic anoxia. Capillary dilatation
may result from serotonin output in carcinoid syndrome, from vasomotor
instability of menopause, from chronic alcoholism (which causes direct
capillary dilatation), from sunburn or any burn that damages the capillaries
and precapillary arterioles so that they cannot contract, and from mitral
stenosis, where the back pressure from the heart causes congestion of the
capillaries. It is less commonly found in the use of belladonna, alkaloids,
histamine headaches (usually unilateral), and cirrhosis of the liver, but it
is common in chronic skin diseases of the face such as acne rosacea.
Approach to the Diagnosis
The clinical picture will often point to the diagnosis. For example, a
flushed face with obesity would suggest Cushing syndrome. A flushed face
with a heart murmur would suggest mitral stenosis or a right to left shunt
with polycythemia. A flushed face with wheezing would suggest pulmonary
emphysema. A flushed face and chronic diarrhea would prompt one to consider
a carcinoid syndrome.
The initial workup should include a CBC, chemistry panel, arterial blood gas
analysis, urinalysis, chest x-ray, and ECG. If carcinoid syndrome is
suspected, a urine test for
5-HIAA is ordered. If alcoholism is suspected, a blood alcohol level can be
done. If menopause is suspected, serum follicle-stimulating hormone (FSH)
and luteinizing hormone (LH) levels should be ordered. If Cushing syndrome
is suspected, a serum cortisol level and a cortisol suppression test could
be done. If systemic mastocytosis is suspected, a skin or muscle biopsy may
be done.
Other Useful Tests
-
Blood volume (polycythemia vera)
-
Serum erythropoietin level (primary and secondary polycythemia)
-
Serum gastrin level (gastrinoma)
-
Pulmonary function tests (pulmonary emphysema)
-
24-hour vanillylmandelic acid (VMA) test (pheochromocytoma)
-
Bone marrow examination (polycythemia vera)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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