[30M] Experiencing daily facial, ear, and hand flushing with associated symptoms

Patient Description

A 30-year-old male reports experiencing daily episodes of facial, ear, and hand flushing characterized by redness and intense heat, lasting for one to two hours. These episodes have been occurring for approximately one year. The flushing is sometimes triggered by heat, but can also occur without any identifiable triggers. Accompanying symptoms include mild shortness of breath, dizziness, chest pressure, and occasional abdominal pain. The patient also reports experiencing loose stools most days. There is no unintentional weight loss. The patient has started new medications in the past year, including hydroxychloroquine, pamelor, lisinopril, and prednisone, but has not noticed any changes in symptoms since starting these medications. There is no consumption of alcohol, caffeine, or recreational drugs, and no known family history of similar symptoms or related conditions such as carcinoid syndrome or neuroendocrine tumors.

Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations:

Carcinoid Syndrome: This condition can cause flushing, diarrhea, and wheezing due to the release of certain chemicals into your bloodstream. It is often associated with neuroendocrine tumors. Testing might include blood and urine tests to check for specific markers, as well as imaging studies to look for tumors.
Mast Cell Activation Syndrome (MCAS): This condition involves episodes of flushing, dizziness, and gastrointestinal symptoms due to the inappropriate release of histamine and other chemicals from mast cells. Diagnosis often involves blood tests, urine tests, and sometimes a skin biopsy.
Medication Side Effects: Some of the medications you mentioned, like prednisone, can cause flushing and other symptoms. It's important to discuss these potential side effects with your healthcare provider.

What you can do

Flushing and associated symptoms:

Consult a healthcare provider: It's important to discuss your symptoms with a doctor who can perform the necessary tests to determine the underlying cause.
Track your symptoms: Use MDandMe to journal your symptoms, noting any potential triggers, frequency, and severity. This information can be helpful for your healthcare provider.
Avoid known triggers: Since heat seems to trigger your flushing, try to stay cool and avoid hot environments when possible.

Shortness of breath and dizziness:

Monitor your symptoms: Keep track of when these symptoms occur and any activities that might exacerbate them.
Practice breathing exercises: Techniques such as pursed-lip breathing can help manage mild shortness of breath.

Diarrhea and abdominal pressure:

Stay hydrated: Ensure you are drinking plenty of fluids to prevent dehydration from diarrhea.
Consider dietary changes: A bland diet may help manage diarrhea. Avoid foods that are high in fat or fiber, as they can worsen symptoms.