Flushing of the face — characterized by warm skin and discoloration — can sometimes occur as one of the symptoms of multiple sclerosis (MS). This discoloration may appear red on lighter skin tones and darker or purplish on deeper skin tones. Flushing can also result from MS treatment or other reasons and often feels warm and uncomfortable. Many MyMSTeam members have experience with this “annoying” symptom of multiple sclerosis.

Rosacea, a skin condition that causes visible blood vessels and redness on lighter skin or brownish to purplish discoloration on darker skin, has also been linked to multiple sclerosis. “After 50 years, now I have rosacea. And it decides to appear on my face. It’s dry, burns, and is not easy to conceal,” wrote one MyMSTeam member.

Although a flushed face and rosacea can be embarrassing and frustrating to deal with, there are ways you can manage it with at-home remedies or medication changes recommended by your doctor. This article discusses possible causes of face flushing and rosacea with MS, as well as what you can do to prevent or reduce flushing.

What Does a Flushed Face With MS Feel Like?

Dealing with a flushed face can be difficult, especially combined with other MS symptoms. As one MyMSTeam member shared, “I have a flushed face daily. When my face is flushed, my face and scalp sweat. It’s embarrassing when I am in public.”

Many members report feeling generally overheated or feverish when their face becomes flushed. “I got up this morning with a fever and a flushed face,” wrote one member.

Some find that certain conditions make their flushed face worse. As one member described, they sat in “a strong breeze and sunshine all day — face is stinging and flushed!”

Another shared that they get so hot, they lie down in the bedroom with both the overhead and stand fans on.

Sometimes only one side of the face feels hot and sensitive, which may be related to flushing or other causes.

Rosacea and MS

Other dermatological conditions may also cause a flushed face with MS. One such condition is rosacea — an inflammatory skin disorder that leads to redness on lighter skin tones or darker patches on deeper skin tones, along with telangiectasia (visible blood vessels) on the face. It can also cause bumps that resemble acne or a face rash.

Notably, doctors can easily miss or misdiagnose rosacea in people with darker skin tones. This is because symptoms may be less visible than on lighter skin, often presenting as subtle dark patches or purplish discoloration. These symptoms can resemble other conditions like acne, eczema, or an allergic reaction. Additionally, telangiectasia may be less visible on darker skin, further making the condition harder to detect visually.

While the exact cause of rosacea is unknown, an overactive immune system is thought to play a role. Autoimmune diseases, like MS, are characterized by an overactive immune system and may affect various organs in the same person.

Many MyMSTeam members have experience with rosacea, MS, and other autoimmune diseases. “Since my MS diagnosis in 1983, I have been diagnosed with five additional autoimmune diseases including Hashimoto’s disease, colitis, diabetes, rosacea, and alopecia,” wrote one member.

“Rheumatoid arthritis, IBS, and just this week diagnosed with rosacea, on the face,” shared another. (IBS is short for “irritable bowel syndrome.”)

Research has shown a link between rosacea and other autoimmune diseases. For example, one study found a significant association between rosacea and four autoimmune diseases, including MS. The researchers found that the link between MS and rosacea was mostly observed among women, according to the study.

Rosacea tends to cause persistent facial discoloration. It also tends to worsen over time if left untreated. When rosacea is treated, symptoms of rosacea may go away and only come back during rosacea flare-ups or after exposure to triggers. Rosacea triggers include:

• Sun exposure
• Emotional stress
• Hot weather or baths
• Wind exposure
• Exercise
• Spicy food
• Alcohol or hot beverages

“I look pink when I’m happy, sad, nervous, excited, or simply after exercising or enjoying coffee or liquor,” wrote one member, describing their rosacea.

What Causes Flushed Face in MS?

MS and MS treatments can lead to various skin changes, including dryness, lesions, and flushing. Facial flushing is a paroxysmal symptom of MS. Paroxysmal symptoms are symptoms that appear suddenly and disappear after a short period, usually just seconds or minutes. Paroxysmal symptoms — which also include spasms, vision problems, and dysphagia (difficulty swallowing) — are caused by issues with the central nervous system in which nerve fibers send out the wrong signals at the wrong times.

The exact relationship between flushing and MS, in particular, is still somewhat of a mystery. It’s unknown whether flushing is a direct symptom of MS, but there is evidence that some MS medications can cause it.

There are many other reasons why people with MS experience a flushed face. Some foods can cause the face to flush, as can menopause and certain skin conditions like rosacea.

Speak to your neurologist or a dermatologist about your flushed face so that they can diagnose the underlying cause and help you manage this symptom.

MS Treatments and Flushed Face

Many MyMSTeam members have shared that their MS treatments are responsible for facial flushing. Dimethyl fumarate (Tecfidera), in particular, is a common culprit. Facial flushing is listed as a common side effect of this medication, and up to 40 percent of people who take it experience flushing. As one member wrote: “I am taking Tecfidera for my MS. I get a reaction to it: burning, itchy, flushed skin on my face, neck, and chest. I only get the reactions with my morning dose and every second day.”

Another member shared that they have the exact same symptoms with Tecfidera: “Itching, rash, and burning. It is sporadic, and I never know when it will hit. It seems to be worse if I’m already hot when it occurs.”

Another member shared that natalizumab (Tysabri) causes them to become flushed and warm: “My flushed face usually occurs during the afternoon or evening. I’m on Tysabri infusion every four weeks. The flushing is usually accompanied by skin itching and hot flashes.”

Flushing may be a sign of an infusion reaction to Tysabri, so be sure to mention any facial flushing and warmth to your doctor.

Stress and Flushed Face

Another potential factor that can bring about a flushed face or make flushing worse is stress. Flushing can be stress-related whether or not you have MS.

Other Causes of Flushed Face

Other conditions that can cause redness or flushing of the face include Cushing’s syndrome (often caused by long-term steroid use), hyperthyroidism (in which the thyroid gland is overactive and produces excess hormones), and menopause. Alcohol intake can also lead to facial flushing, especially in those who have difficulty metabolizing it.

Managing Flushed Face With MS

Treatment options for a flushed face can vary from changing medications to using makeup or adjusting your diet. If you have rosacea, tips for managing rosacea itself may help reduce flushing. If you find that your facial flushing lasts for long periods, remains for longer than usual, or appears more and more frequently, it’s time to go to the doctor. Check in with your neurologist or visit a dermatologist to get to the bottom of this symptom.

Identify and Avoid Common Triggers

Very often, flushing is a product of our environment, and it goes away just as quickly as it arrived. Take note of when your flushed face appears and what may be responsible. Did you drink a hot beverage or eat spicy foods? Have you been dealing with high levels of stress? Noticing what spurs episodes of facial flushing or skin irritation can help you avoid those triggers, potentially alleviating the symptom.

Consider Changing Medication

If your facial flushing appears to be related to your MS medications, talk to your doctor about the possibility of adjusting your dose or changing medications entirely. They will work with you to find the best way of managing your MS while avoiding unwanted side effects such as a flushed face.

Take Medication With Food

One MyMSTeam member offered the following tip: “I have found that eating a spoon of peanut butter after you take your Tecfidera helps with the flushing. Also, if peanut butter isn’t for you, an egg will help, as well.”

Experts also recommend taking Tecfidera with food to help reduce flushing. Additionally, taking a low-dose aspirin shortly before Tecfidera may also help minimize flushing. It’s important to discuss this with your doctor first to ensure it's safe and appropriate for you.

Use Makeup

Foundation and concealers can help mask a flush. Concealing flushing with makeup may be useful in situations where you don’t want to appear flushed, such as during a job interview or a presentation.

Keep Cool

When dealing with flushing, it may help to remove a layer of clothing or turn on the air conditioning or a fan. Keeping cool can also help you avoid triggering other MS symptoms that are sensitive to heat.

Try These Tips for Relief from Rosacea

Management of rosacea involves both lifestyle changes and a skin care routine. Consider the following tips to get relief from rosacea:

• Keep a record of what seems to trigger rosacea symptoms, such as exercise, sun exposure, or certain foods or beverages, and do what you can to avoid these triggers
• Wash your face twice a day with a gentle cleanser that’s rosacea-friendly (ask a dermatologist for recommendations).
• Use moisturizer frequently, including after washing your face.
• Wear sunscreen with SPF 50 or higher year-round to provide protection from broad-spectrum UV radiation.
• Avoid irritating skin care products, such as those containing alcohol or exfoliants or topical steroids.
• Use makeup with a green tint, which can mask redness on lighter skin tones, or a yellow tint, which can mask discoloration on both lighter and darker skin tones.
• Test out products, such as lotions or makeup, before applying them to your face to see how your skin reacts.

If these at-home remedies don’t help, talk to your dermatologist or health care provider. They may prescribe medication, a prescription-strength gel or cream, or laser treatment to reduce rosacea symptoms.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 215,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you experienced MS-related facial flushing or rosacea? What has worked to improve it? Share your thoughts and tips in the comments below or by posting to your Activities feed.