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Seasonal Allergies, Dermographism Urticaria, Anxiety. What Is The Cause Of Blotchiness On The Skin?

Posted on Tue, 10 Jul 2012

Question: Hello,

I have seasonal allergies and suffer from dermographism urticaria.

Today I was in the sun and it was hot outside. My cheeks got a little blotchy-a flushed look. It happened to my mother too and she has no history or allergies or any skin conditions. I usually get pretty red when I exercise too. The redness does not hurt or burn and goes away pretty fast after I exercise or am in the sun. I also get red from alcohol.

I also suffer from anxiety and today when I saw my face redden in the sun, I got anxiety more which made it worse.

Could the blotchiness on my face from sun and alcohol be cause by a release of histamine? My dermatologist says no to rosacea and said that people do flush in sun and from alcohol. I just do not remember this ever happening to me, but then again, maybe I just was not so aware.

I would appreciate an explanation of how sun, alcohol, exercise, hot showers makes people flush who have a history of allergies and urticaria.

I would like to add that sometimes when I drink a lot of caffeine, I will get blotches on my chest. I also have pressure urticaria, if I wrap my hair up in a towel after a shower and the towel is pressed down on my skin, my forehead will become blotchy

Thank you so much!

Answered by Dr. Gaurang Krishna (3 hours later)

Hello,

thanks for writing in and a very detailed information about your problem.
I appreciate it.

The problem you are having is called flushing and it is not necessarily Rosacea.

People who have an allergic background are more prone to the flushes but it is not restricted to them alone.

The basic cause is Vasodilation (which means dilatation of blood vessels). Triggers like SUn, heat, Alohol, Caffeine, Emotional disturbances..dilate the blood vessels under the effect of certain chemokines.

As a result there is more blood flow and hence the redness and blotchiness. Once the trigger is withdrawn, the stimulus for vasodilatation gets over and thus the calibre of the blood vessels return back to normal. Hence, the redness settles down.

I hope I have answered your query.

If there is anything else please do not hesitate to ask me.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gaurang Krishna (9 minutes later)

Dear Dr. XXXXXXX

Thank you so much for your detailed response! It really makes me feel better to hear that this is not necessarily rosacea. It just seems that when I research this on the internet like "flushing from alcohol and sun" rosacea comes up; so I figured I would ask a doctor on this site as I've had positive experience in the past with XXXXXXX

You wrote:

"The basic cause is Vasodilation (which means dilatation of blood vessels). Triggers like SUn, heat, Alohol, Caffeine, Emotional disturbances..dilate the blood vessels under the effect of certain chemokines."

Would you mind further explaining how chemokines dilate blood vessels and is this related to histamine?

Also, why are people with allergic backgrounds more prone to flushing?

It seems that I am "allergic to my own sweat as well" in that I will get blotchy areas on my upper forehead near hairline when I sweat.

Is this a type of urticaria and can caffeine worsen the "flushing?"

If I drink alcohol, I will flush and sometimes look noticeably redder the next day. I wonder if that has something to do with dehydration?

Also, is it "normal" to get a little flushy in hot sun if you have a fairer complexion?

I appreciate your help on this. Thank you so much!

Sincerely, XXXXXXX

Follow up: Dr. Gaurang Krishna (13 hours later)

Hello Dr. XXXXXXX

I have not heard back from you. Did you receive my response back to you?

Thanks, XXXXXXX

Answered by Dr. Gaurang Krishna (11 hours later)

Hello,

I apologize for the delay.

Chemokines are chemicals released by cells like mast cells, macropahages etc. these are acute phase reactants. After triggering factors like sun, caffeine etc these are released locally or sometimes generally. they stimulate relaxation of the blood vessel vasculature (vasa vasorum) and cause vascular dilatation.

Histamine in itself also causes vasodilatation and thus people with an allergic background are more prone to flushing.

Allergy to own sweat is now a recognised entity also known as sweat dermatitis. It is not an urticaria per se.

Caffeine increases flushing.

Alcohol increases flushing too. It is not related to dehydration.

It also normal for people of a fair skin to flush more than people with coloured skin.

I hope I have answered your queries.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gaurang Krishna (19 hours later)

Dr. XXXXXXX

Thank you for your follow-up.

What can be done about the sweat dermatitis- would taking an anti-histamine before exercise help?

Also, is there anything that could be done to decrease the blotchiness when consuming alcohol? Is this a form of hives or just flushing? My dermatologist said that it can be a form of Cholinergic urticaria. Is is common to still wake up and be a little flushed the next day after drinking alcohol?

So basically I should not worry about getting a little red in the sun and with exercise as that is normal for blood vessels to dilate?

Thank you again,' XXXXXXX

Answered by Dr. Gaurang Krishna (3 hours later)

Hello,
you may take antihistamines before consuming alcohol. That will help the blotchiness.

For sweat dermatitis the best bet is calamine lotion after exercise. If it is severe then take antihistamines.

Being flushed the next day after alcohol consumption, is OK.

There is no need to be worried about this.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gaurang Krishna (21 hours later)

Hello Dr. XXXXXXX

Thanks for your follow-up. I guess I get concerned about the redness when I exercise- I went walking today in 85 degree weather and was pretty red but was not experiencing any dizziness or sweating more than usual so I guess I should just assume that this is normal for me. Is is common to have skin like your parents as this happens to my mom as well-- she flushes easy like being in sun, with exercise, etc. It's embarrassing when it happens because I get so red when I workout but so does my sister.

I will try the antihistamine before I drink alcohol and see if it helps. I don't ever recall getting red from alcohol but maybe I am just more aware of it now. Thank you for your help on this.
XXXXXXX

Answered by Dr. Gaurang Krishna (45 minutes later)

This problem tends to run in families, which explains why you, your sister and your mother have the same problem.

Take antihistamines only when the symptoms are very bothersome.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gaurang Krishna (46 hours later)

Hello-

Thank you for your answer. I will try taking an antihistamine, thank you.

I have another question- I just reloaded my account by paying more money.

I seem to break out into these white bumps on my face, but I cannot seem to figure out the problem. I had a food intolerance blood test and I am intolerant to sulphite in food in addition to beef/veal and XXXXXXX so I try to avoid those as much as possible-- but there are sulphites in a lot of foods so that is a difficult one. Can food allergies cause bumps on face. They seem to be sprinkled around my chin and cheek. There is also some blotchiness to my skin but not too bad. I do wonder if it's allergies- environmental/food.

I do not break out in red pimples-- just these white bumps that look like whiteheads. What is the cause of blotchy skin-- really, no one can notice except for me, but it is bothersome. My dermatologist says no to rosacea.
I have attached some photos.

Thank you.

Answered by Dr. Gaurang Krishna (24 hours later)

Hello,

Thanks for reverting.

I saw the pics you attached.

I am inclined towards rosacea.
The blotchiness is quite evident, something we usually associate with rosacea. Also the acneiform eruptions, tend to support this diagnosis.
However, the presence of these bumps mostly around the chin also raise a possibility of PCOD.

Do you have any menstrual irregularities or hair fall or oily skin?

This seems unrelated to the food allergy you have..

Awaiting your response

thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gaurang Krishna (8 minutes later)

Dear Dr. XXXXXXX

My skin does not always look that blotchy. This was after using a steroid cream which I do not use anymore and I believe that I was experiencing rebound. I probably should not have attached that picture because I do not truly look like that. In fact, my skin looks quite pale most of the day.

I thought that acne-like eruptions were red bumps with rosacea? I do not get red bumps, just the white ones. I did not think that white bumps came with rosacea. Also, nobody in my family has it.

I do not have any menstrual irregularities or hair that falls out.

So does everyone who has blotchy skin have rosacea?

I feel quite upset about this. I will look for a more recent picture to attach.

Thank you, XXXXXXX

Follow up: Dr. Gaurang Krishna (57 minutes later)

The first pictures are from when I was going through a topical steroid withdrawal- I did not realize those were the photos that I was including. I was using a steroid cream, locoid for a month for some dry skin and I had difficulty withdrawing from it. I flushed every night for a week.

My skin generally looks good except for some slight pinkness but really that is it. My naturopath said that food allergies can cause a lot of skin problems.

Why do you think that the white bumps are from rosacea when the literature says that pustles and papules present with rosacea. I do not have any of those and am quite disappointed in your response. I realize that the first photos showed some redness and apologize for attaching the incorrect ones, but you did not ask any further questions before diagnosing. Did you know that a rosacea diagnosis can be quite daunting and very upsetting for a young woman?

Please help me figure this out. I do not think that it's rosacea! Thanks

Answered by Dr. Gaurang Krishna (23 hours later)

Hello,
I am sorry if I caused distress.

I just spoke my mind. And I did not say that you HAVE rosacea. I said the picture that you have attached makes me INCLINED towards roscaea.

I hope you have read my earlier posts which have categorically said that the symptoms that you have mentioned are related to flushing and does not make me think of roscaea at all.

In my last post too I said that the presence of bumps around the chin raises the possibility of PCOD too. Acneiform eruptions in thirties, in a female, does raise a possibility of PCOD or rosacea. And thus I asked you about related sypmtoms..(which you do not have)

I was not informed that you have applied steroids in the past and the picture taken was immediately after steroid withdrawal, which clearly explains the erythema shown in the picture. It also explains the bumps that you may be getting.

I had a look at the new pics that you have attached. There doesnt seem to be any problem at all. No erythema, no eruptions. So no rosacea.

The occasional blotchiness may be related to your flushing only. There shouldnt be much to worry about.

The occasional bumps, well, they may be caused by creams, makeups, etc. And again shouldnt be a cause for worry. Using a retinoid cream (as required) on the bumps will be of great help.

I again apologise for causing distress and anxiety, But it is my job to keep my mind open and do not miss anything.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gaurang Krishna (2 days later)

Dr. XXXXXXX

I apologize for jumping down your throat if I did so. I did not inform you that a few months ago I went through steroid withdrawal after using a steroid for 6 weeks. I flushed horribly for a week and it was very painful. One of the pictures that I uploaded was from one of those episodes. I believe that some of my blotchiness that is barely noticeable is from flushing from the withdrawal. My dermatologist said that I was going through steroid withdrawal.

I believe that we are our own worst critics and I often scrutinize my skin and get very close up to the mirror. Sometimes I have some blotchiness after a hot shower or bath. My dermatologist said that could be related to my allergies and my dermographism. She also said that the redness of my face that I get when I drink also may be related to my allergies and histamine level. Are you familiar with any of that?

Thanks, XXXXXXX

Answered by Dr. Gaurang Krishna (46 minutes later)

Hello,

It was good to hear from you.

I second her opinion that the blotchiness and flushing you have is related to your allergies only.

This is a well established phenomenon.

The redness and the bumps in the initial pics is clearly explained by steroid withdrawal.

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar