Dr Slobodan Mirosavljev
+381 64 17 05 947 slobodan777@yahoo.com

Dr. Giudiceandrea Alberto
+39 3333740186 agiudi@yahoo.com

Facial Blushing


The fear of blushing is also called erythrofobia

Blushing is a physiological process that can occur after exertion, heat, or irritation of the skin. However, when blushing takes on extreme forms such as blushing in daily situations (for example, paying at the baker’s) for no reason or even thought, conflict situations can arise which lead to isolation of the person and impoverishment of human contacts. Your life Runs away to avoid blushing situations to avoid conflicts with yourself, which leads to a flight-like behaviour in the eyes of others, these people seem shy or anxious without being in reality.



Technically, blushing can be kept in check by mind control. Autogenic training is a preferred treatment option. Even exercises in front of the mirror to find the triggering factors or exercises to increase self-confidence and acceptance are suitable. At home or in a sheltered environment, these protections can work, but not in stressful situations (such as disputes with supervisors). Psychotherapy is the first therapeutic step and can improve in mild cases. It is also the therapy most often recommended by the doctors.


If psychotherapy alone does not help you can add a drug therapy. Fluoxetine  belongs to the group of the “specific serotonin reuptake inhibitor” o “SSRI” and works by keeping the serotonin (neurotransmitter) in the brain constant. Allows to maintain a positive and optimistic vision of things, thus interrupting the “vicious circle” of anxiety and depression. The clonidine  is an antihypertensive drug with central action; can be used a half hour before a situation where you can theoretically blush. Propanolol o Atenolol (Tenormin): belongs to the class of beta blockers which cause vasoconstriction and also have an anxiety-inhibiting effect. These are some of the common drugs that all have side effects and are not always successful.


The treatment of erythrofobia, which is neither medically nor psychologically affected, is surgical. A thoracoscopic sympathectomy is performed whereby the ganglia are not removed as in classical sympathectomy, but a clip is placed above and below the 2 ganglion (T2). The top clip for safe removal of the sympathetically induced blush is just below the “Ganglion Stellatum” set. If a Kuntz nerve is seen, it must also be clipped. The detection of the “Ganglion Stellatum” (responsible for a Horner syndrome) is a prerequisite for a safe operation. The advantage of the clip is that it does not cause heat-induced necrosis of the surrounding tissue. It can also be removed if the side effects (compensatory sweating and dry hands become annoying.) The operation is performed ambulant (70% of patients) or short stay bilateral. Two small scars (5mm) are placed in the persistent part of the armpit Recovery phase lasts 2 weeks, but sitting work can be started after 4 days. With sports, 2-3 weeks are required.T he results are good: there is a reduction in seizure frequency and intensity by 80%.

Not all redness is suitable for sympathectomy. The form that responds best is the sudden onset of redness that is spread all over the face. Isolated redness in the neck and mandibular area, as well as central redness in the mouth and nose area are not so successful. With the surgery, the sudden onset of redness disappears, not or to a lesser extent, the slow onset of redness after effort or heat exposure.

Apart from the redness, the patients experience an opening of their own character postoperatively. One is no longer inhibited and enjoys human cactuses with more freedom.

Some patients describe a feeling of “coolness” postoperatively. Postoperatively, a psychological effort is necessary to reduce the behavioural patterns used for years.


Success? The success rates are very good if the indication for surgery is correct

Hospitalization? The intervention will be outpatient or “short stay” (one night)

Where can I be operated on? In Brescia or in Zrenjanin (Serbia)


Endoscopic sympathectomy is characterized by high safety and a very low complication rate.

Horner’s syndrome: The most dreaded but also extremely rare complication, which can lead to an asymmetry of the face because of a lowered upper lid. It results from damage to the stellate ganglion, the lowest cervical ganglion, or the uppermost thoracic ganglion of the sympathetic trunk, but can be easily avoided if the surgeon accurately identifies the ganglia and uses the correct technique.

Bleeding and infection and deep leg vein thrombosis: Not common with experienced surgeons. A bleeding can be from the a. intercostal or from a vein near the Sympathetic Nerv (can be large!). The bleeding is stopped by means of a suture or thermocoagulation. The infection of the wound is treated with antibiotics and thrombosis (very rare) is treated as usual with elastic bandage and anticoagulation. These complications are extremely rare in experienced hands. But can occur. In this sense, there is no 100% safe intervention.

Pneumothorax: This is a residual amount of carbon dioxide or air between the lungs and chest wall, either due to incomplete suction of the gas or due to a small

Injury to the lungs. A smaller pneumothorax requires no special measures, but disappears within a few hours to 1-2 days by itself. A larger pneumothorax (rare occurrence) should be aspirated with a drainage for 1 day. This complication can almost always be avoided by careful procedures when inserting the instruments or sucking out the gas.


Side effects?

After the procedure, all (100%) patients notice an increase in sweating (compensatory sweating). Statistically, this is most often localized to the back and then to the legs. Inguinal region, abdomen. This phenomenon is usually triggered by physical exertion or high outside temperatures, d. H. in situations where the body requires a lowering of body temperature ..

In many patients, sweating increases slightly or moderately and is experienced by them as more tolerable than the original condition.

In our latitudes, the compensatory sweating is only exceptionally bothersome (but it can even go so far that you would like to undo the procedure most like). Unfortunately, this development can not be predicted by preoperative diagnostic measures, but we know the age over 40, male gender, already existing sweating on the back and muscular build are risk factors.

In some cases it has been observed that compensatory sweating subsides somewhat over the course of months, but in many cases there is no improvement.

If compensatory sweating reaches such levels, drug therapy with atropine supplements is helpful (robinul, ditropan, especially if the situations in which sweating occurs are known (e.g., mid-August afternoon exertion), but compensatory sweating is experienced as a lesser evil.

30 to 40% of patients report gustatory sweating (sweating on the face after taking certain foods)

A small number of patients report thermoregulatory problems (overheating in the head area and undercooling of the extremities).

Other negative long-term effects of sympathectomy are unknown. This is proved by several prospective studies


Severe cardiovascular or pulmonary insufficiency

Conditions after severe diseases of the pleura with dense adhesions of the pleural space, as after TBC, empyema and the like