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Erythrophobia - Problems of Diagnostics and Treatment

June 2012
Polish Journal of Surgery 84(6):322-7

DOI:10.2478/v10035-012-0054-8

Source
PubMed

Authors:

Tomasz Stefaniak

Medical University of Gdansk

Blushing subjectively evalauted by the patient at the level of 9 out of 10

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Content uploaded by Tomasz Stefaniak

Content may be subject to copyright.

POLSKI

 10.2478/v10035-012-0054-8

2012, 84, 6, 322–327

REvIEw PAPERS

ERytHROPHObIA – PRObLEmS Of dIAGNOStIcS ANd

tREAtmENt

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 

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   

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

 

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   

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     



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   

   

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   

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   

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

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-

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   

   -



  

-

   

-

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     

    

   

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

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   

    

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

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     -

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    

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  

    -

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   

    

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  

   



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   

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   

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   -

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   -



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

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   

   

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    -

-

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   -



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    



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324 

  



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

    

   





    

-



-

      

   

  -

   -

-

-





  







  



-







-

   

   











     

   



 



   -

-





-

-

-







 





   

    

   

   

-



    

  

   





-

     -



    



   



   



-

-

  

    

-



   





-



-

-



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   

    

















    

-



   



-

  

 







-

     

   





-

 



  -







  



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   



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

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





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      

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    



-





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



-





   

-

-

   









-

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  

    



   



     

    

-



3    

-

    

  

-

-





-



 



















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

     

326 

  





-



    



-

     





-



-





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

-



   

   

 





   





   

     -

   





-





-

    -

   



  







-

     







    



    



   







  



-

   

-

   -









    -





   

     



-

-

-





    





-

 



-









    



 



   

    

   





   

 



327





1. 



2. 





3. 



4. -

-





5. 



-

-

     



6.  

-





7. 

   



8. -

-



     -





10. -



11. 



    



12. 



-



13. 







14. -

      



275-77.

15.       

-

-





16. -

       

      

1601-08.

17. -

  





18.  

   











20. 

-

-

  



21. 



     



55-60.

22. -

    -



23. -

 

-

  



24. 







25. 



-

-



51.

26. 





27. 

   



28. 

-

    











30. -



   







On the psychodynamics of blushing

Article

Jul 2023

Simultaneous bilateral transthoracic sympathectomy through posterior access in Lin-Telaranta modification for primary hyperhidrosis

Article

Full-text available

Jan 2009
WIDEOCHIRURGIA TEC M

Introduction: Primary hyperhidrosis (PHH) is a genetic disease resulting in excessive sweating of hands, armpits, feet and sometimes face under emotional and/or thermal stimulation. The disease most frequently starts in early childhood and poses a significant problem to the patients, mostly by causing social embarrassment with serious psychological consequences. Aim: Thoracoscopic sympathectomy is one of the approved methods of treatment of PHH. The aim of this study is to make the first evaluation in Poland of results of simultaneous bilateral sympathectomy from a posterior approach with clipping as a method of sympathectomy. Material and methods: There were 73 bilateral thoracoscopic sympathectomies of Th3, Th4 and Th5 ganglia performed between May 2006 and May 2008 in both participating centres. Data were collected prior to surgery, immediately after it and during a 3-month follow-up visit. The examination consisted of a questionnaire for subjective evaluation of symptoms and gravimetry for the measurement of sweat production over time. Fifty-seven patients (75%) were available for a follow-up visit. Results: All procedures were completed with videoscopy. There was no mortality and no serious morbidity. Mean perspiration from the palmar region assessed gravimetrically reached 443.67 mg/min and dropped to 45.67 mg/min 3 months after the operation (p < 0.05). Mean intensity of disease-associated distress (measured on a visual scale from 1 to 10) was 9.46 prior to surgery and 1.03 during follow-up (p < 0.05). Conclusions: Transthoracic, posterior access sympathectomy is a safe and effective procedure. The discussed technique allows for simultaneous bilateral surgery without the need for troublesome patient repositioning, while CO 2 insufflation and careful, active pleural deflation need no post-operative pleural drainage, with very limited risk of pneumothorax.

Individuals with Fear of Blushing Explicitly and Automatically Associate Blushing with Social Costs

Article

Full-text available

Dec 2011

To explain fear of blushing, it has been proposed that individuals with fear of blushing overestimate the social costs of their blushing. Current information-processing models emphasize the relevance of differentiating between more automatic and more explicit cognitions, as both types of cognitions may independently influence behavior. The present study tested whether individuals with fear of blushing expect blushing to have more negative social consequences than controls, both on an explicit level and on a more automatic level. Automatic associations between blushing and social costs were assessed in a treatment-seeking sample of individuals with fear of blushing who met DSM-IV criteria for social anxiety disorder (n = 49) and a non-anxious control group (n = 27) using a single-target Implicit Association Test (stIAT). In addition, participants' explicit expectations about the social costs of their blushing were assessed. Individuals with fear of blushing showed stronger associations between blushing and negative outcomes, as indicated by both stIAT and self-report. The findings support the view that automatic and explicit associations between blushing and social costs may both help to enhance our understanding of the cognitive processes that underlie fear of blushing.

The relationship between blushing propensity, social anxiety and facial blood flow during embarrassment

Article

Full-text available

Sep 2011
COGNITION EMOTION

To investigate blushing in relation to blushing propensity scores and core elements of social anxiety, facial blood flow was monitored in 86 normal volunteers during an embarrassing task (singing a children's song). Increases in facial blood flow were greater in women than men, as were scores on the Blushing Propensity and Fear of Negative Evaluation scales. In addition, high scores on the Blushing Propensity and Social Interaction Anxiety scales were associated with large increases in facial blood flow during singing. However, this appeared to be due primarily to social anxiety because the association between blushing propensity scores and changes in facial blood flow disappeared when social interaction anxiety scores were taken into account. These findings suggest that people generally base their beliefs about blushing on cues other than changes in facial blood flow. Social anxiety may augment increases in facial blood flow during embarrassment, independently of expected or perceived blushing.

Saved by the Blush: Being Trusted Despite Defecting

Article

Full-text available

Apr 2011

This study examined whether blushing after a sociomoral transgression remediates trustworthiness in an interdependent context. Participants (N = 196) played a computerized prisoner's dilemma game with a virtual opponent who defected in the second round of the game. After the defection, a photograph of the opponent was shown, displaying a blushing or a nonblushing face. In a subsequent Trust Task, the blushing opponent was entrusted with more money than the nonblushing opponent. In further support of the alleged remedial properties of the blush, participants also indicated that they trusted the blushing opponent more, expected a lower probability that she would defect again, and judged the blushing opponent more positively.

Recognizing the patient with social anxiety disorder

Conference Paper

Jul 2000
INT CLIN PSYCHOPHARM

JC Ballenger

Social anxiety disorder is a prevalent and highly disabling condition, affecting 7-13% of the population at some point in their lives. Most sufferers are not diagnosed however, even after visiting a healthcare professional. Social anxiety disorder need not be a difficult condition to diagnose. Characteristic features of the disorder include blushing as the principal symptom and an early age of onset. Social anxiety disorder is also easily distinguished from other anxiety disorders by the situations in which patients experience fear and avoidance; for the patient with social anxiety disorder, these situations always involve social interaction or scrutiny by other people. The consequences of untreated social anxiety disorder include social isolation, impaired educational attainment and career progression, depression, and alcohol abuse. Rating scales such as the Liebowitz Social Anxiety Scale (LSAS) give a consistent measure of severity of social anxiety disorder and so help physicians assess their patients' need for treatment and their improvement. Social anxiety disorder is an eminently treatable condition, as demonstrated by treatment-induced reduction in LSAS scores in clinical trials and by individual case histories. Appropriate therapy can give patients relief from their distressing and disabling symptoms and allows them to make substantial improvements to their quality of life. Int Clin Psychopharmacol 15 (suppl 1):S1-S5 (C) 2000 Lippincott Williams & Wilkins.

Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing

Article

Dec 2011
BRIT J SURG

The purpose of this study was to clarify the long-term effects, side-effects and overall satisfaction rates of endoscopic thoracic sympathectomy (ETS) used in the treatment of hyperhidrosis and facial blushing. Some 3015 patients had bilateral ETS from 1989 to 1998. A questionnaire follow-up was used. Some of the patients had participated in a previous follow-up study, and the answers in both surveys were compared. A total of 1700 patients responded (56·4 per cent); mean(s.d.) follow-up was 14·6(2·4) years. The best result was achieved for palmar hyperhidrosis (95·6 per cent) compared with axillary hyperhidrosis (68·9 per cent), facial hyperhidrosis (83 per cent) and facial blushing (72·8 per cent) (P < 0·001). Compensatory sweating, the main side-effect, was present in 80·0 per cent. Some 6·5 per cent were dissatisfied and 13·5 per cent regretted having the procedure. Patients with palmar hyperhidrosis were more satisfied (86·6 per cent) than those with axillary hyperhidrosis (66·0 per cent), facial hyperhidrosis (74 per cent) or facial blushing (73·5 per cent) (P < 0·001). Women were more satisfied than men (85·4 versus 71·4 per cent; P < 0·001). The procedure regret rate rose from 7·8 per cent in the first survey to 13·5 per cent in the present one. ETS had an excellent and lasting effect on palmar hyperhidrosis. The effect on facial and axillary hyperhidrosis and facial blushing was less rewarding. The procedure regret rate increased over time.

The effect of niacin on facial blood flow in people with an elevated fear of negative evaluation

Article

Aug 2011

The vasodilator niacin may provoke greater facial flushing and other symptoms of anxiety in patients with social anxiety disorder than in non-anxious controls. To determine whether this also applies in non-clinical samples, niacin (100mg) or placebo was administered double-blind to 33 young adults and flushing was investigated in relation to fear of negative evaluation (a cardinal feature of social anxiety). Increases in facial blood flow were greater in people with high than low fear of negative evaluation in the niacin condition, but were similar in both groups in the placebo condition. However, changes in pulse rate and ratings of embarrassment, anxiety, blushing and facial heat were similar in both groups in both drug conditions. These findings suggest that the facial vessels of people with a heightened fear of negative evaluation are particularly responsive to niacin under conditions of low anxiety and embarrassment.

Dealing with Fear of Blushing: A Psychoeducational Group Intervention for Fear of Blushing

Article

Nov 2012
CLIN PSYCHOL PSYCHOT

Unlabelled: The clinical impression is that people who fear blushing do not easily seek psychological help for their complaints. Therefore, we designed a low-threshold psychoeducational group intervention to reduce fear of blushing. The intervention followed a cognitive-behavioural approach, but in a course setting, e.g., with 'participants' and 'teachers' instead of 'patients' and 'therapists'. The effectiveness of the course in reducing fear of blushing and social anxiety was tested in a group of blushing-fearful individuals (n = 47) by using an uncontrolled study design. The course consisted of six weekly sessions and one booster session 3 months after the last regular session. Assessments took place upon application, immediately before the intervention, after the sixth session, before the booster session, and at 1-year follow-up. Results showed that the course was effective in reducing fear of blushing as well as symptoms of social anxiety. The positive effect of the course on anxiety measures suggests that it might be a promising approach for treating fear of blushing. Key practitioner message: The course 'dealing with fear of blushing' is a cognitive-behavioural group intervention in a course setting, e.g., with 'participants' and 'teachers' instead of 'patients' and 'therapists'. The course was effective in reducing anxiety complaints. An effect size of 1.4 and a reduction of approximately 30 points on this Blushing, Trembling and Sweating Questionnaire are comparable with what was reported for individual cognitive-behavioural treatments. Participants evaluated the course positively.

Blushing propensity in social anxiety disorder: Influence of serotonin transporter gene variation

Article

Jun 2009
J NEURAL TRANSM

Blushing is considered to be one of the prime pathophysiological markers of social anxiety disorder, potentially mediated by serotonergic function. Therefore, in the present study 62 patients with social anxiety disorder and 62 age- and sex-matched healthy controls were investigated for the influence of serotonin transporter (5-HTT) gene variation (5-HTTLPR, rs25531) on blushing propensity as measured by the blushing propensity scale (BPS). The less active 5-HTTLPR genotypes were nominally significantly associated with increased blushing propensity in patients with social anxiety disorder as compared to controls with an equidirectional trend for the less active 5-HTTLPR/rs25531 haplotypes. Even when statistically controlled for influence of depression, this association remained significant. In summary, the present pilot study suggests a potential role of functional serotonin transporter gene variation in blushing propensity warranting replication and encouraging genetic analyses of further intermediate phenotypes of social anxiety disorder.

Prospective study of percutaneous radiofrequency sympathicolysis in severe hyperhidrosis and facial blushing: Efficacy and safety findings

Article

Jun 2011
EUR J CARDIO-THORAC

Hyperhidrosis (Hh) and facial blushing (Fb) are conditions caused by hyperactivity of the sympathetic system; they affect around 2% of the population. Severe cases have been typically treated with thoracic sympathectomy through a minimally invasive approach. We sought to determine if severe Hh and/or Fb patients, who are reluctant to go through an operation with general anaesthesia, could benefit from receiving percutaneous radiofrequency ablation of the sympathetic chain. Prospectively collected data obtained from May 2007 to May 2010 were analysed to compare the treatment efficacy and effects on quality of life of the two procedures. From a total of 58 patients enrolled in the study, 31 were treated with radiofrequency procedures, whereas 27 received surgical sympathectomy. Patients with Hh had better results with surgery than with radiofrequency sympathicolysis in terms of efficacy (p=0.0001) and quality of life (p=0.0002). However, there was still a significant improvement in quality of life in the group of patients treated with radiofrequency sympathicolysis (p=0.004). Patients with Fb had good results with surgical procedures and poor outcomes with radiofrequency ablation, resulting in significant differences in treatment efficacy (p=0.005) and in quality of life (p=0.003). Fb patients treated with radiofrequency procedures had no improvement in quality of life after the intervention (p=0.28). Our results support the view of surgical sympathectomy as the gold-standard treatment in severe cases of Hh and Fb. Radiofrequency sympathicolysis is useful as a second-treatment choice for Hh patients. Fb patients do not benefit from radiofrequency sympathicolysis.