Facial Flushing Caused by Mastocytosis and Other Conditions

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If you're coping with episodic facial flushing you may be frustrated at how hard it is to get a diagnosis. What is facial flushing related to mastocytosis like and what are some of the conditions which could instead be the cause of your symptoms?

Mastocytosis Definition

Mastocytosis is a condition in which there are a greater than normal number of mast cells in the tissue. These mast cells cause a typical skin response called urticaria pigmentosa (hives) immediately after stroking the skin with a blunt object.

Mast Cells

Mast cells are cells of the immune system which are found around blood vessels in the skin, gastrointestinal tract, respiratory tract, and genitourinary tract. They contain granules of several substances, the most common of which is histamine. These granules are released in response to contact with certain foreign substances.

Histamine, in turn, causes many of the symptoms we equate with an allergic reaction, such as itchy, watery eyes and noses and tightening of the airways in our lungs.

Mastocytosis Symptoms

Theresa Chiechi / Verywell

Facial Flushing Symptoms

Facial flushing with mastocytosis usually comes on rapidly. It is most prominent on the face and upper trunk and may have reddish-brown bumps. The face usually becomes red and hot and can be very itchy (pruritic.) It may also feel like it is burning or on fire.

Other Mastocytosis Symptoms

In addition to facial flushing, people with mastocytosis often experience symptoms throughout their body caused by the release of large amounts of histamine or other chemicals.

Symptoms include:

  • Palpitations
  • Low blood pressure
  • Chest pain
  • Explosive diarrhea
  • Nausea and vomiting
  • Abdominal pain
  • Fatigue


Many people with mastocytosis cannot identify the triggers which result in flushing, but some people have found that exercise, heat, or anxiety are a possible trigger.

Medications such as opioid narcotics like morphine and codeine, and aspirin or other non-steroidal anti-inflammatory drugs like ibuprofen or naproxen can also start a flushing attack.


Mastocytosis can be difficult to diagnose and it can a very frustrating process. Correctly identifying the clinical symptoms aids in the diagnosis. Sometimes skin lesions and bone marrow are biopsied and the urine checked for increased levels of the chemicals contained in mast cells.

The diagnosis is made a bit easier in those who have the classic urticaria pigmentosa but can still be a challenge. It may be suspected when people have what appears to be a severe allergic reaction without exposure to any obvious allergens or if a person develops a very severe insect-related anaphylactic reaction.

Differential Diagnosis

As noted, mastocytosis can be very challenging to diagnose both due to the wide range of symptoms (which can be caused by a wide range of conditions) and due to other possible causes of facial flushing. These other causes may be a distinct clinical entity (a disease all on their own) or instead part of another condition or disease.

Some other conditions that may cause facial flushing and should be part of the differential diagnosis include:

  • Contact dermatitis
  • Photodermatitis: A rash from sun exposure
  • Rosacea
  • Menopausal hot flashes
  • Drug allergies
  • Heart disease
  • Carcinoid syndrome: Facial flushing in carcinoid syndrome can appear very similar to that with mastocytosis and is caused by chemicals released by the tumor.
  • Pheochromocytoma
  • Cushing syndrome
  • Anaphylaxis
  • Other tumors such as medullary carcinoma of the thyroid, pancreatic islet tumor, and renal carcinoma (kidney cancer)

Keep asking questions and be your own advocate in your care. Finding a diagnosis and determining a treatment can take time. If you're not getting answers, consider getting a second opinion.


There are numerous treatment options for mastocytosis depending on the main symptoms. Treatments may include:

  • Antihistamines
  • Aspirin and non-steroidal anti-inflammatory drugs, such as ibuprofen (although these medications can actually trigger flushing in some people)
  • Cromolyn sodium: A mast cell stabilizer sometimes used in the treatment of asthma
  • Topical steroid creams
  • PUVA: A type of phototherapy

A Word From Verywell

Whether you've been diagnosed with mastocytosis as the cause of your facial flushing or your healthcare provider mentioned that mastocytosis is just one of the possible causes of your symptoms, you're probably feeling very frustrated on top of being frightened.

Disorders such as mastocytosis (and other conditions in the differential diagnosis) are uncommon, and not every healthcare provider has seen the classic flushing reaction. That said, we have learned a lot about these conditions in recent years as our understanding of the immune and endocrine systems advance

Because these conditions are rare it's not likely that you have a support group in your neighborhood, but online support communities allow people to connect with others facing similar challenges around the world.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. da Silva EZ, Jamur MC, Oliver C. Mast cell function: a new vision of an old cellJ Histochem Cytochem. 2014;62(10):698–738. doi:10.1369/0022155414545334

  2. Izikson L, English JC, Zirwas MJ. The flushing patient: Differential diagnosis, workup, and treatmentJournal of the American Academy of Dermatology. 2006;55(2):193-208. doi:10.1016/j.jaad.2005.07.057

  3. Carter MC, Metcalfe DD, Komarow HD. MastocytosisImmunol Allergy Clin North Am. 2014;34(1):181–196. doi:10.1016/j.iac.2013.09.001

  4. Valent P, Akin C, Hartmann K. Advances in the classification and treatment of mastocytosis: Current status and outlook toward the futureCancer Research. 2017;77(6):1261-1270. doi:10.1158/0008-5472.can-16-2234

Additional Reading

By Heather L. Brannon, MD
Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years.