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Cosmetic dermatology and cosmetic science move closer together

Editor – The editorial on blushing in black skin by Dr Felix I D Konotey-Ahulu is very interesting. Pathological facial blushing is not merely a visible facial coloration, as many people blush severely with minimal or no discomfort, whereas others become more or less incapacitated in their social, emotional and professional life. I do agree with Dr Konotey-Ahulu that the skin is often a gateway into something more profound. Facial blushing is the cardinal symptom in social phobia and often results in avoidance behaviour. The patients’ greatest concern is what they believe others think of them and their blushing. Visible redness of the face should thus be a prerequisite for their incapacitation in the interaction with other people. If it requires a mother to disclose the blushing in black-skinned people, as Dr Konotey-Ahulu points out, the concerns should probably be less severe. To my knowledge, there are no studies on the importance of facial blushing in black-skinned people with social phobia. We have previously reported our experience of upper thoracic sympathetic denervation as treatment for severe facial blushing in this journal. Our total number of patients operated on for blushing is now well over 2500, none of them with black skin. On the contrary, fair skinned and blond people are in the majority. The objective degree of facial redness, however, correlates poorly with the subjective feeling of shame and humiliation from blushing experienced by the patients. Interestingly, Charles Darwin already described in 1872 that black people blush and experience a feeling of embarrassment. It should be very interesting to know if black-skinned people get the same great relief of symptoms as fair-skinned from treatment of erythrophobia.