While cradling her newborn daughter just hours after giving birth, Somayya Gefuri suddenly felt a burning heat surge within her body and rise to her skin, leaving her sweating and her face flushed.
Worried, the Birmingham supermarket worker asked midwives why she was so “incredibly sexy”.
Somayya’s temperature was slightly elevated and staff were concerned she had sepsis, a process in which the immune system dangerously overreacts to an infection. So they decided to give her antibiotics and both mother and baby remained in the hospital for a week.
In fact, hot flashes and flushing were the first signs of a serious condition that took more than a year to be identified as Graves’ disease, an autoimmune disorder in which the body produces too much of the hormone thyroxine.
“I went to the GP about three times in 12 months, because I was always hot, flushed and sweaty,” says Somayya, 37.
“My heart was racing and I was also exhausted. But since I was a new mother, the doctor always attributed it to that.’
Finally, in 2021, blood tests showed that Somayya had an overactive thyroid, the butterfly-shaped gland that produces hormones that control our metabolism.
According to the British Thyroid Foundation, an overactive thyroid can be caused by a combination of genes and other factors, including stress. Hormonal fluctuations, caused by childbirth, for example, can also increase the risk for women.
Somayya believes her condition was caused by an anxious pregnancy: she had pre-eclampsia (high blood pressure) and a difficult birth. Pictured with her daughter Elise, who is now four years old.
Four out of five people with an overactive thyroid have Graves’ disease. Here, the body begins to produce antibodies (usually targeting “invaders” such as bacteria) that bind to the thyroid gland, stimulating the production of thyroxine.
This speeds up the metabolism, making the body work faster and causing tachycardia, weight loss and fatigue.
The body can also produce excess heat, making those affected feel sweaty and hot and, in the case of Somayya, causing a deep blush on the cheeks, nose and forehead.
Somayya believes her condition was caused by an anxious pregnancy: she had pre-eclampsia (high blood pressure) and a difficult birth.
Although she is now taking medication to reduce her thyroxine levels, Somayya tends to be hotter than others. If it’s in a box near work heaters, it can stay on all day.
The warm feeling of a red blush creeping across your face is familiar to most of us.
It occurs as a result of the brain stimulating the nerves, releasing chemical messengers (cytokines) that cause the small blood vessels near the surface of the skin to dilate. As they fill with blood, this shows up as red skin.
The effect is most evident on the face due to its high density of small blood vessels and relatively thin skin, says Emma Wedgeworth, a dermatologist in London and spokesperson for the British Skin Foundation.
Somayya Gefuri discovered she had Graves’ disease, an autoimmune disorder in which the body produces too much of the hormone thyroxine.
In addition to redness of the face, there may be an unpleasant burning and stinging sensation. “Nerves and blood vessels tend to go together, so the redness activates the nerve fibers, causing the stinging,” explains Dr. Wedgeworth.
‘Facial redness can cause some people to feel extremely anxious. It can make them cancel social plans or affect them at work if they are worried about blushing during a presentation.’
Facial redness may simply be a response to high temperatures or exercise. The body needs to maintain a constant temperature as it is optimal for enzymes (proteins that support a variety of vital functions, including digestion) to function.
But when we exercise, our muscles produce more heat, and dilating the blood vessels closest to the skin’s surface is one way for the body to release this heat, says Dr. Wedgeworth.
There are other triggers too. For example, blushing due to embarrassment or stress is driven by the body’s “fight or flight” response. The adrenaline this produces increases our heart rate, which can also play a role in dilating blood vessels.
There could also be another evolutionary drive. A 2009 study in the Netherlands found that photographs of people blushing after an alleged mishap were judged more kindly by others compared to those who were not blushing, potentially providing protection.
More direct physical causes of facial flushing include certain foods, such as chili peppers. These contain capsaicin, a compound that dilates blood vessels.
For many people, alcohol is a trigger. This is because the liver converts alcohol into a toxin, acetaldehyde, which can widen the blood vessels in the face.
Generally, an enzyme quickly breaks down acetaldehyde and removes it from the body; But some people produce lower levels of this enzyme, so they turn deeply red even after consuming modest amounts of alcohol.
Certain skin conditions can also cause facial redness, particularly rosacea, which is more common in women aged 30 and older.
Rosacea, an inflammatory condition that causes redness of the skin, is believed to be the result of malfunctioning immune cells or the effect of a small common mite that lives on everyone’s skin.
The redness begins by coming and going, usually for minutes, but over time the skin can become chronically red.
Morag Jarvis, 46, a GP and mother-of-three from Coventry, blushed deeply as a child and, when she was 20, realized this was due to rosacea. He also developed the characteristic broken blood vessels on his face.
In my late 30s, I experienced facial redness almost daily. They started with a red tingling at the tip of my nose, then spread across my nose, cheeks, and between my eyebrows.
“My skin was throbbing, it looked swollen, and I felt very uncomfortable,” she says. “It was always worse at night.” Heat, spicy food and alcohol were among his triggers.
The turning point for Morag came when she took a selfie with her children one morning and saw that her skin was already red and angry, even early in the day.
He had previously been prescribed antibiotics, but with little effect. He now sought private treatment and was recommended a cream with azelaic acid.
This calmed the redness “almost instantly,” she says.
Morag has also undergone laser treatment, to break down the walls of blood vessels so they can be reabsorbed by the body. This eliminates threaded veins and leaves fewer blood vessels to dilate and cause redness. “Now I realize that I rarely wash and don’t need to wear foundation anymore,” she says.
Many women suffer from facial redness before menopause. Decreased estrogen levels are thought to alter the hypothalamus, the area of the brain that controls body temperature.
Some medications can also cause it, including the breast cancer treatment tamoxifen, which reduces estrogen levels. An older form of antidepressant, monoamine oxidase inhibitors, and some high blood pressure medications, such as calcium channel blockers (for example, amlodipine), which relax blood vessels, can also cause the symptom.
Anyone suffering from drug-induced hot flashes should consult their GP about different dosages or alternative medications.
Intolerance to histamine, a natural chemical found in foods such as cheese, chocolate, red wine, and canned fish, can cause flushing in people who are deficient in the enzyme that breaks down histamine.
There are medical options for severe facial redness. Botox injections can alter nerve messages that tell blood vessels to dilate. Medications called beta blockers can also reduce redness by causing blood vessels in the skin to constrict.
A more drastic option is the same surgery used for severe sweating: endoscopic thoracic sympathectomy. This involves cutting the nerves that transmit messages to the face.
The procedure carries the risks of major surgery and can cause unwanted symptoms, including heavy sweating in other areas of the body.
“Some people’s lives are destroyed by blushing, and I have seen people liberated by this procedure,” says David Greenstein, vascular surgeon at London North West University Healthcare NHS Trust.
He says the operation should only be attempted after other options have failed.
While Somayya’s facial redness has decreased from almost constant to just a few times a week, it is still concerning. “Customers often comment on how red I am,” she says. “That makes me feel embarrassed, so I blush even more.”