FACIAL FLUSHING

Ask the Following Questions:

1. Is the flushing constant or intermittent? Intermittent flushing suggests menopause, carcinoid syndrome, systemic mastocytosis, pheochromocytoma, and Zollinger-Ellison syndrome. Constant flushing might suggest alcoholism, polycythemia, or the malar flush of mitral stenosis.
2. Is there associated obesity? Associated obesity would certainly bring to mind Cushing's syndrome, but it may also be associated with alcoholism.
3. Is there associated rash on the face or elsewhere? A rash would most likely bring to mind rosacea if it is on the face, but if it is elsewhere, one might consider systemic mastocytosis or dermatomyositis.
4. Are there associated systemic symptoms and signs? Diarrhea would suggest carcinoid or Zollinger-Ellison syndrome. A headache along with the flushing would suggest a systemic mastocytosis. Fainting might suggest pheochromocytoma or epilepsy.

DIAGNOSTIC WORKUP

Urinalysis for 5-HIAA should be done if carcinoid syndrome is suspected. Urine samples may be taken for drug and alcohol screen in all cases in which there is any doubt about drug or alcohol history. Tests for serum FSH and estradiol should be done in patients suspected of having menopause. A 24-hr urine collection for catecholamine should be done for patients suspected of having pheochromocytoma. Serum gastrin tests should be done for patients suspected of having Zollinger-Ellison syndrome. In patients with systemic mastitis or dermatomyositis, a skin biopsy or muscle biopsy can be done. In patients with suspected Cushing's disease, a serum cortisol and cortisol suppression test can be done.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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