Surgery for blushing involves making a number of incisions under the armpit, writes Dr Muiris Houston, Medical Correspondent
People with severe facial blushing typically experience symptoms that occur more frequently and last longer than normal blushing.
The blushing is intense, covering the face, neck and ears and lasts for a long period of time. And in extreme cases, those affected with severe facial blushing may develop a condition called social phobia, when they find it difficult to meet people because of their problem.
The condition, which sometimes occurs in combination with facial sweating, arises from hyperactivity of the sympathetic nervous system. A chain of nerves called the thoracic sympathetic ganglion chain go into overdrive in a person with severe facial blushing.
They lie in the chest cavity beside the vertebra. Overactivity of these nerves can also cause excessive sweating in the palms and in the armpit.
The first line of treatment is to ensure that the blushing is not caused by medication. Certain treatments for prostate and breast cancer can give rise to blushing and may need to be stopped. Medication in the form of a beta blocker drug (usually used to treat angina and high blood pressure) may bring some relief. A form of electrolysis called iontophoresis may help some sufferers. Recently, botox (botulinum toxin) injections have become popular. While these work they must be repeated every six months.
The surgical treatment of the condition involves dividing the thoracic sympathetic chain between the levels of the second and fifth vertebrae.
The procedure, known as endoscopic thoracic sympathectomy (ETS), involves making a number of incisions under the armpit. Using a tube with a light source, the surgeon can cut the nerves with instruments introduced via the endoscope. There is a risk of heavy bleeding in less than 5 per cent of cases; this occurs if the subclavian vessels are accidentally damaged.
The lung can also be punctured leading to a condition called pneumothorax. Other long-term side effects include compensatory sweating elsewhere on the body and an excessively dry hand. Damage to the nerve supplying the eye can also occur. However, success rates of 85-95 per cent have been reported for ETS.