Topical ibuprofen inhibits blushing during embarrassment and facial flushing during aerobic exercise in people with a fear of blushing

Abstract

Cite this article as: Peter D. Drummond, Kate Minosora, Gretta Little, Wendy Keay, Topical ibuprofen inhibits blushing during embarrassment and facial flushing during aerobic exercise in people with a fear of blushing, European Neuropsychopharmacology, http://dx.doi.org/10. 1016/j.euroneuro.2013.07.013 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The flush that develops during whole-body heat stress depends partly on prostaglandins production in the skin. Variations in the strength of this local mechanism may contribute to individual differences in susceptibility to blushing and associated anxiety. To investigate this in the present study, the anti-inflammatory agent ibuprofen (which blocks prostaglandins formation) was applied topically to a small area of the cheek in 16 participants with a fear of blushing and in another 14 without this fear. Changes in skin blood flow were monitored at the ibuprofen-treated site and at a mirror image control site while participants sang (to induce embarrassment and blushing) and during aerobic exercise (to induce flushing). The topical ibuprofen treatment inhibited increases in cheek blood flow in both groups during both of these tasks. However, increases in cheek blood flow were greater in participants with high than low fear of blushing immediately after exercise. These findings suggest that prostaglandins contribute to dilatation of facial blood vessels both during emotional arousal (embarrassment) and aerobic exercise. Furthermore, fear of blushing may be associated with mechanisms that delay the resumption of normal vascular tone after a period of vasodilatation. Whether topical ibuprofen gel is suitable for intermittent or long-term use as an aid for blushing control requires further investigation.

Treatment Options for Fear of Blushing

“…Encouraging leads have emerged recently concerning the basic neuroscience [71] and physiological mechanisms of blushing [23,24]. However, this has not been matched by advances in treatment-only one randomised controlled trial of psychotherapy for fear of blushing has been published the past few years [52•], and we are not aware of any new pharmaceutical trials.…”

“…Another promising lead is the probable involvement of inflammatory mediators in blushing [20,21]. Local application of the NSAID ibuprofen to a small area of the face inhibited blushing [23], but the efficacy and feasibility of this as a treatment for blushing require further investigation. More generally, selective serotonin reuptake inhibitors and serotoninnorepinephrine reuptake inhibitors are effective treatments for SAD [43••] and thus are likely to help at least a subgroup of patients with fear of blushing.…”

“…Niacin induces the formation of prostanoids which, in turn, relax vascular smooth muscle and generate facial flushing. In a small pilot study, topical application of ibuprofen, which blocks prostaglandins formation, inhibited blushing during embarrassment and flushing during exercise at the site of application in the cheek [23]. Hence, rapid surges in blood flow through facial vessels may trigger inflammatory responses that amplify and maintain blushing.…”

Facial Erythema of Rosacea – Aetiology, Different Pathophysiologies and Treatment Options

“…Blushing is a more pinkish, lighter erythema that is not predominantly located in the facial T-zone (central face), but more homogeneously distributed in the central face and peripheral cheeks, as well as behind the ears, which is not present in flushing. Blushing is mediated by the sympathetic nervous system as a response to emotional or stressful events (51). We believe that the pathophysiological mechanism of blushing is the same in rosacea patients as in the healthy population and, importantly, that it is different from the flushing mechanism.…”