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Flushing of the face — characterized by warm skin and discoloration — can sometimes occur in people with 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 it often feels warm and uncomfortable. Many MyMSTeam members have reported experiencing this frustrating symptom.
Rosacea — a skin condition that causes visible blood vessels and red, brown, or purple discoloration, depending on skin tone — 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 feel embarrassing and frustrating, you can manage it with home remedies or medication changes recommended by your doctor. This article discusses possible causes of facial flushing and rosacea with MS, as well as what you can do to prevent or reduce flushing.
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. One member described sitting 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 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.
Other dermatologic conditions may also cause a flushed face with MS. One such condition is rosacea, an inflammatory skin disorder that can cause symptoms including:
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 showing up as subtle dark patches or purplish discoloration. These symptoms can resemble other conditions, such as 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.
Some MyMSTeam members with rosacea have experience with autoimmune diseases in addition to MS. “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 … and just this week diagnosed with rosacea on the face,” shared another.
Research has shown a link between rosacea and other autoimmune diseases. For example, a study in the Journal of the American Academy of Dermatology found a significant association between rosacea and four autoimmune diseases, including MS. The link between MS and rosacea was mostly observed among women, according to the researchers.
Rosacea tends to cause persistent facial discoloration. It also tends to worsen over time if left untreated. When rosacea is treated, symptoms may go away and return only during flare-ups or after exposure to triggers.
Rosacea triggers include:
“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.
MS and MS treatments can lead to various skin changes, including dryness, itching, and flushing. Facial flushing often appears suddenly and disappears quickly — a pattern similar to paroxysmal symptoms. These MS symptoms, such as spasms, vision problems, and difficulty swallowing, stem from nerve fibers misfiring in the central nervous system.
However, facial flushing is not considered a classic paroxysmal symptom. The exact relationship between flushing and MS remains somewhat of a mystery. While it’s unclear whether flushing is a direct symptom of MS, there’s 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 skin conditions like rosacea.
Speak to your neurologist or dermatologist about your flushed face so that they can diagnose the underlying cause and help you manage this symptom.
Many MyMSTeam members have shared that their MS treatments are responsible for facial flushing.
Dimethyl fumarate (Tecfidera), in particular, is a common culprit of a flushed face. Facial flushing is listed as a common side effect of this medication, and up to 40 percent of people who take it experience flushing.
“I am taking Tecfidera for my MS,” wrote one MyMSTeam member. “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 same symptoms with dimethyl fumarate: “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.”
Facial flushing is a common side effect of diroximel fumarate (Vumerity), which has the same active metabolite as dimethyl fumarate. Reports also say that around 40 percent of people who take it experience facial flushing.
Another member said 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 with natalizumab may be a sign of an infusion reaction, so be sure to mention any facial flushing and warmth to your doctor.
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 conditions that can cause discoloration or flushing of the face include:
Alcohol intake can also lead to facial flushing, especially in those who have difficulty metabolizing it.
Treatment options for a flushed face include switching medications, using makeup, and making dietary adjustments. If you have rosacea, managing the condition itself may help reduce flushing. If you find that your facial flushing lasts for a while, 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.
Very often, flushing is a product of the 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 reducing this symptom.
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’ll work with you to find the best way of managing your MS while avoiding unwanted side effects such as a flushed face.
Doctors and researchers recommend taking dimethyl fumarate with food to help reduce flushing. 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.”
Additionally, taking aspirin 30 minutes before the dimethyl fumarate may also help minimize flushing. It’s important to discuss this strategy with your doctor first to ensure it’s safe and appropriate for you.
Foundation and concealers can help mask a flush and may be especially useful in situations where you don’t want to appear flushed, such as during a job interview or a presentation. Makeup with a green tint can mask redness on lighter skin tones, and a yellow tint can mask discoloration on both lighter and darker skin tones.
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.
If you’ve been diagnosed with rosacea, work with a dermatologist to manage and treat it. Management of rosacea involves both lifestyle changes and a skin care routine. Consider the following tips to get relief from rosacea:
If these home remedies don’t help, talk to your dermatologist or healthcare provider. They may prescribe medication, a prescription-strength gel or cream, or laser treatment to reduce rosacea symptoms.
On MyMSTeam, people share their experiences with MS, get advice, and find support from others who understand.
Have you experienced MS-related facial flushing or rosacea? What has helped improve it? Let others know in the comments below.
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This is so me!! I swear its menopause but no it's just MS!! I tell people its menopause tho!! It's easier to explain!! 🤣🤣
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