Cradling her newborn daughter just hours after giving birth, Somayya Gefuri suddenly felt a burning heat surge inside her body and rise to her skin, leaving her sweating and her face flushed.
Worried, the supermarket worker from Birmingham asked the midwives why she was so ‘crazily hot’.
Somayya’s temperature was slightly raised and staff were concerned she had sepsis, where the immune system dangerously overreacts to an infection. So they decided to give her antibiotics, and both mother and baby were kept in hospital for a week.
In fact, the flushing and the heat were the first signs of a serious condition that took more than a year to identify as Graves’ disease, an autoimmune disorder where the body produces too much of the hormone thyroxine.
‘I went to the GP about three times over 12 months, as I was always hot, flushed and sweating,’ says Somayya, 37.
‘My heartbeat would race and I was also exhausted. But as I was a new mum, the doctor always put it down to that.’
Finally, in 2021, blood tests showed that Somayya had an overactive thyroid – the butterfly-shaped gland that produces hormones that control our metabolism.
An overactive thyroid can be caused by a combination of genes and other factors, including stress, according to the British Thyroid Foundation. Hormonal fluctuations – triggered by giving birth, for instance – may also increase the risk for women.
Somayya believes her condition was triggered by an anxious pregnancy: she had pre-eclampsia (high blood pressure) and a difficult birth. Pictured with her daughter Elise, now four
Four out of five people with an overactive thyroid have Graves’ disease. Here, the body starts producing antibodies (normally targeted at ‘invaders’ such as bacteria) that bind to the thyroid gland, stimulating thyroxine production.
This speeds up metabolism, making the body work faster and causing a fast heartbeat, weight loss and tiredness.
The body may also produce excess heat, making those affected feel sweaty and hot – and in Somayya’s case, causing a deep flush across her cheeks, nose and forehead.
Somayya believes that her condition was triggered by an anxious pregnancy: she had pre-eclampsia (high blood pressure) and a difficult birth.
Even though she is now on medication to lower her thyroxine levels, Somayya is often hotter than others. If she finds herself on a till near the heaters at work, she can stay flushed all day.
The warm sensation of a red flush creeping over your face is familiar to most of us.
It occurs as a result of the brain stimulating nerves, unleashing chemical messengers – cytokines – which make the small blood vessels near the surface of the skin dilate. As they fill with blood, this shows through as red skin.
The effect is more obvious on the face because of its high density of tiny blood vessels and relatively thin skin, says Emma Wedgeworth, a dermatologist in London and spokesperson for the British Skin Foundation.
Somayya Gefuri found she had Graves’ disease – an autoimmune disorder where the body produces too much of the hormone thyroxine
As well as a flushed face, there can be an unpleasant sensation of burning and stinging. ‘Nerves and blood vessels tend to run together, so the flushing activates the nerve fibres, causing the stinging,’ Dr Wedgeworth explains.
‘Facial flushing can make some people extremely anxious. It can make them cancel social plans, or affects them at work if they’re worried they will flush during a presentation.’
Facial flushing can simply be a response to hot temperatures or exercise. The body needs to maintain a constant temperature as this is optimal for enzymes (proteins that support a range of vital functions, including digestion) to operate.
But when we exercise, our muscles produce more heat, and dilating the blood vessels closest to the surface of the skin is one way for the body to release this heat, Dr Wedgeworth says.
There are other triggers, too. For instance, blushing due to embarrassment or stress is driven by the body’s ‘fight or flight’ response. The adrenaline this produces pushes up our heart rate, which may also play a role in dilating blood vessels.
There could, too, be another evolutionary drive. A 2009 study in the Netherlands found that pictures of people blushing after a supposed mishap were judged more kindly by others, compared with those who weren’t blushing, potentially affording protection.
More direct physical causes of facial blushing include certain foods, such as chillies. These contain capsaicin, a compound that makes blood vessels dilate.
For many people, alcohol is a trigger. This is because the liver turns alcohol into a toxin, acetaldehyde, which can widen blood vessels in the face.
Generally, acetaldehyde is rapidly broken down by an enzyme and flushed out of the body; but some people produce lower levels of this enzyme, so flush deeply after even modest amounts of alcohol.
Certain skin conditions can also cause facial flushing, particularly rosacea, which is more common in women from their 30s.
An inflammatory condition causing reddened skin, rosacea is thought to be the result of immune cell malfunction, or the effect of a common tiny mite that lives on everyone’s skin.
The redness starts by coming and going, usually for minutes at a time, but over time the skin can become chronically reddened.
Morag Jarvis, 46, a GP and mother of three from Coventry, flushed deeply as a child, and realised in her 20s that this was caused by rosacea. She also developed the characteristic broken blood vessels on her face.
By her late 30s, she was experiencing almost daily facial flushes. They began with tingling redness on the tip of her nose, then spread across her nose, cheeks and up between her eyebrows.
‘My skin would throb, look swollen and be really uncomfortable,’ she says. ‘It was always worse by the evening.’ Heat, spicy food and alcohol were among her triggers.
The turning point for Morag came when she took a selfie with her children one morning and saw that her skin was already red and angry, even early in the day.
She’d previously been prescribed antibiotics, but with little effect. Now she sought private treatment and was recommended azelaic acid cream.
This calmed the redness ‘almost instantly’, she says.
Morag has also had laser treatment, to break down the blood vessel walls so they’re reabsorbed by the body. This eliminates thread veins and leaves fewer blood vessels to dilate and cause a flush. ‘Now I find I rarely flush and I don’t need to wear foundation any more,’ she says.
Many women get facial flushing in the run-up to menopause. It is thought that declining oestrogen levels disrupt the hypothalamus, the area of the brain controlling body temperature.
Some drugs can cause it, too, including the breast cancer treatment tamoxifen, which reduces oestrogen levels. An older form of antidepressant, monoamine oxidase inhibitors, and some high blood pressure medications, such as calcium channel blockers (for example, amlodipine), which make blood vessels relax, can also cause the symptom.
Anyone suffering medication-induced flushes should consult their GP about different doses or alternative medications.
An intolerance to histamine, a naturally occurring chemical found in foods including cheese, chocolate, red wine and tinned fish, can cause flushing in people who are deficient in the enzyme that breaks down histamine.
There are medical options for severe facial flushing. Botox jabs can disrupt the messages from the nerves that tell the blood vessels to dilate. Drugs called beta blockers can also reduce flushing by causing blood vessels in the skin to constrict.
A more drastic option is the same surgery that’s used for severe sweating – endoscopic thoracic sympathectomy. This involves severing nerves that carry messages to the face.
The procedure comes with the risks of significant surgery, and can cause unwanted symptoms, including severe sweating in other areas of the body.
‘Some people’s lives are destroyed by blushing, and I’ve seen people liberated by this procedure,’ says David Greenstein, a consultant vascular surgeon at London North West University Healthcare NHS Trust.
He says the operation should only be tried after other options have failed.
While Somayya’s facial flushing has dropped from almost constant to just a few times a week, it is still troubling. ‘Customers often comment on how red I am,’ she says. ‘That makes me feel embarrassed, so I then flush even more.’
