DEAR DOCTOR K:

I seem to blush more than most people, and I find it a little embarrassing. Why am I more prone to blushing than others? Is there anything I can do about it?

DEAR READER:

Let's start with what blushing is and why your face gets red. Blushing occurs when the tiniest blood vessels in your face -- the capillaries -- suddenly get wider. When they widen, more blood flows through them, which gives your skin a reddened, rosy appearance.

Your blood vessels widen in response to signals sent by the brain through the nerves. Emotions such as embarrassment or anger can cause blushing. Spicy foods and alcohol can also trigger blushing in some people.

Occasionally, blushing may be a sign of illness. For example, people with a fever -- especially children -- may have bright red cheeks. Blushing easily is also a symptom of a common skin condition, rosacea.

In addition to these conditions, blushing can be a symptom of something called carcinoid syndrome. It is a rare disease in which a tumor releases chemicals into the body that dilate your blood vessels. The chemicals also cause other symptoms.

So if you blush suddenly, when you aren't feeling embarrassed or angry, eating spicy foods or drinking alcohol, I'd ask a few red-flag questions about other symptoms caused by carcinoid syndrome. When you suddenly blush, do you also have wheezing, diarrhea or hives? If your blushing is accompanied by any of these, talk to your doctor.

Typical blushing, however, is rarely due to any significant medical illness. The widening and narrowing of blood vessels are not under your conscious control. That means you can't make yourself blush or make yourself stop blushing. (I once had a patient who was an actress who claimed that she could make herself blush on cue. I never asked her to demonstrate that, however, so I just have to take her word for it.)

Blushing tends to occur only on the face, because there are more capillaries below the skin of the face than elsewhere and they're closer to the surface. So any signal to all the capillaries in your body to widen will make itself visible most often in your face.

That may explain why people blush only in their faces. However, it doesn't explain why some people blush more easily; such people don't have more capillaries under the skin of their faces than people who rarely blush.

It's possible that "blushers" have capillaries that dilate more in response to emotion compared with people who blush less often. And blushing may be more obvious in some people, like those with fair skin, than in others.

Cognitive behavioral therapy can help people be less bothered by their blushing. There is also a surgery used to treat excessive blushing, but its safety and effectiveness are not proven.

Although it bothers you, it may help if I remind you that blushing is often associated with positive things like youth and attractiveness. It can also project modesty and charm. Why else would millions of women apply blush to their cheeks each day?

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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