“My daughter's skin looks very pale and flushed out. What could be wrong?”
My daughter's skin looks very pale and often flushed out. However, she is not complaining of any serious symptoms. What could be wrong?
4 Answers
Pale skin could indicate some type of anemia, most commonly iron deficiency but needs to be checked by your regular pediatrician or general physician. Redness of the skin is more complicated but a good history and exam by those docs would give some ideas to pursue and also get some lab testing to see if anything is amiss. Questions about sleep pattern, general fatigue, bowel functions etc also may provide some clues to pursue so call your primary physicians to get it checked out. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com
Maybe it's signs of healthy child?
Flushing or blushing (milder form of flushing) is a sensation of warmth followed by marked reddening of the affected skin of the body. Flushing is a response to increased blood flow, and causes blood vessels just below the skin to widen and fill with more blood. Flushing can take place any where in the body but mostly it happens on the face cheeks, ears neck and upper body (torso).
Flushing could be caused by physiological factors or pathological processes. It could be episodic (transient) or persistent in nature. Episodic flushing is usually due to mediators known as vasoactive substances in the vessels or medications that trigger flushing, while persistent flushing is due to fixed facial redness secondary to large superficial skin vessels filled with slow moving blood.
Some times flushing is normal physiologic response to hot spicy food, some drinks, heat, exercising, and emotional responses. These conditions and social situations that cause flushing are not harmful in themselves. However there are pathological conditions that can cause either episodic or persistent flushing that need to be considered seriously. Benign conditions that cause flushing are fever (scarlet, slapped cheek disease), rosacea, menopause, hyperthyroidism, cluster headaches, niacin, sun burn etc. While worrisome causes of flushing include, Cushing syndrome, Pheochromocytoma, Mastocytosis, pancreatic tumors, neuroendocrine tumors, medullary thyroid cancer, Carcinoid syndrome, autonomic dysfunction, errors of metabolism, different cancers and certain medications. Of the endocrine and neuroendocrine disorders only carcinoid syndrome has flushing as a serious presentation. The rest manifest flushing rarely, and may present the flushing at the advanced stage of the disease.
The first step in the evaluation of flushing is to see your physician. The doctor will take a detailed medical history. The physician will take extensive history of the flushing and any symptoms that may accompany or proceed the flushing. Taking detailed history will allow the physician to narrow the causes of the flushing. He/she will document all the signs and symptoms and any other symptoms that accompany the flushing. When flushing is dry, then it may be due to vasoactive substances in the vessels while flushing accompanied with sweating may be due to autonomic hyperactivation. A detailed physical exam will further narrow the possible causes of the flushing. For example Cushing syndrome or disease may have facial and body characteristics of Cushing ( moon face, buffalo hump, purple striae etc.), while others can be deciphered from the characteristic of flushing, such as carcinoid syndrome.
Laboratory studies, imaging and other testing will be the next step in differentiating the causes of the flushing. When a complete medical evaluation is done the different causes of flushing including emotional, stress, extreme psychological state, tumors, hormones allergic reaction, environmental factors, medications and any other pathological process will be determined. Once the possible causes of flushing are identified, the next step is removing or treating the cause. Therapy could be medical, surgical or psychotherapy, depending on the cause.
Going back to your daughter: Your daughter look pale which may indicate anemia or other medical conditions. Usually in flushing the skin is mainly reddish though it may assume a slightly different color than reddish color since it may mainly reflect a venous blood (deoxygenated blood) instead of capillary blood. Make sure your daughter does not have anemia. On the other hand your daughter has flushing which seems to be harmless, which is often the case for most flushing. This may be due to social issues, heat, stress, exercise, some anger, embarrassment and other none serious conditions. Flushing may not be avoidable but you can lessen the effect by reassuring your daughter, avoidance of any triggers of the flushing, using relaxation techniques, meditation, by handling stress better, exercising regularly and eating a healthy balanced diet.
However flushing can sometimes be a sign of an underlying disease conditions that should not be ignored. If the flushing is associated with other symptoms such as palpitations, abdominal pain, diarrhea, vomiting, extreme emotional states and if the symptoms are persistent or getting worse, she needs to see her doctor for complete evaluation. Your doctor will take a detailed history and thorough physical exam and may proceed with more work up with labs or imaging if deemed necessary to rule out conditions such as Cushing syndrome/disease, carcinoid syndrome, pheochromocytoma, mastocytosis etc. if indicated. He may also refer you to a specialist if indicated. If there is Anemia, it should be treated right away. Anemia is very common in this age group. Please see your doctor and discuss about these issue in detail and explore all avenues if your daughter needs more help.
Good Luck
Flushing could be caused by physiological factors or pathological processes. It could be episodic (transient) or persistent in nature. Episodic flushing is usually due to mediators known as vasoactive substances in the vessels or medications that trigger flushing, while persistent flushing is due to fixed facial redness secondary to large superficial skin vessels filled with slow moving blood.
Some times flushing is normal physiologic response to hot spicy food, some drinks, heat, exercising, and emotional responses. These conditions and social situations that cause flushing are not harmful in themselves. However there are pathological conditions that can cause either episodic or persistent flushing that need to be considered seriously. Benign conditions that cause flushing are fever (scarlet, slapped cheek disease), rosacea, menopause, hyperthyroidism, cluster headaches, niacin, sun burn etc. While worrisome causes of flushing include, Cushing syndrome, Pheochromocytoma, Mastocytosis, pancreatic tumors, neuroendocrine tumors, medullary thyroid cancer, Carcinoid syndrome, autonomic dysfunction, errors of metabolism, different cancers and certain medications. Of the endocrine and neuroendocrine disorders only carcinoid syndrome has flushing as a serious presentation. The rest manifest flushing rarely, and may present the flushing at the advanced stage of the disease.
The first step in the evaluation of flushing is to see your physician. The doctor will take a detailed medical history. The physician will take extensive history of the flushing and any symptoms that may accompany or proceed the flushing. Taking detailed history will allow the physician to narrow the causes of the flushing. He/she will document all the signs and symptoms and any other symptoms that accompany the flushing. When flushing is dry, then it may be due to vasoactive substances in the vessels while flushing accompanied with sweating may be due to autonomic hyperactivation. A detailed physical exam will further narrow the possible causes of the flushing. For example Cushing syndrome or disease may have facial and body characteristics of Cushing ( moon face, buffalo hump, purple striae etc.), while others can be deciphered from the characteristic of flushing, such as carcinoid syndrome.
Laboratory studies, imaging and other testing will be the next step in differentiating the causes of the flushing. When a complete medical evaluation is done the different causes of flushing including emotional, stress, extreme psychological state, tumors, hormones allergic reaction, environmental factors, medications and any other pathological process will be determined. Once the possible causes of flushing are identified, the next step is removing or treating the cause. Therapy could be medical, surgical or psychotherapy, depending on the cause.
Going back to your daughter: Your daughter look pale which may indicate anemia or other medical conditions. Usually in flushing the skin is mainly reddish though it may assume a slightly different color than reddish color since it may mainly reflect a venous blood (deoxygenated blood) instead of capillary blood. Make sure your daughter does not have anemia. On the other hand your daughter has flushing which seems to be harmless, which is often the case for most flushing. This may be due to social issues, heat, stress, exercise, some anger, embarrassment and other none serious conditions. Flushing may not be avoidable but you can lessen the effect by reassuring your daughter, avoidance of any triggers of the flushing, using relaxation techniques, meditation, by handling stress better, exercising regularly and eating a healthy balanced diet.
However flushing can sometimes be a sign of an underlying disease conditions that should not be ignored. If the flushing is associated with other symptoms such as palpitations, abdominal pain, diarrhea, vomiting, extreme emotional states and if the symptoms are persistent or getting worse, she needs to see her doctor for complete evaluation. Your doctor will take a detailed history and thorough physical exam and may proceed with more work up with labs or imaging if deemed necessary to rule out conditions such as Cushing syndrome/disease, carcinoid syndrome, pheochromocytoma, mastocytosis etc. if indicated. He may also refer you to a specialist if indicated. If there is Anemia, it should be treated right away. Anemia is very common in this age group. Please see your doctor and discuss about these issue in detail and explore all avenues if your daughter needs more help.
Good Luck
Paleness could be a sign of anemia. Take your daughter to your primary care doctor to run some tests.
