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.
FLUSHED FACE (PLETHORA)
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 like acne rosacea.
Approached 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 for 5-HIAA is ordered. If alcoholism is suspected, a blood alcohol level can be done. If menopause is suspected, serum FSH and 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 VMA (pheochromocytoma)
- Bone marrow examination (polycythemia vera)
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- 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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