By Danielle Eaton, Cedarville University PharmD Student
Imagine for a moment walking into a room and expecting to sit down in a seat quietly to watch a presentation put on by one of your co-workers. Now picture as you walk toward your seat being approached by an individual who calmly informs you that your friend is sick and you must present the material to the entire audience. Not having prepared, you slowly walk up to the podium and meet the eyes of an attentive audience.
Social interaction, public speaking, and various other social encounters come easily and naturally to some individuals and produce very little anxiety or fear. For those who are not so fortunate to have the ability to remain composed during “all eyes on you” encounters,” blushing or redness of the cheeks can be a troublesome problem. Blushing is a characteristic of normal human functioning but individuals differ in their blushing propensity and intensity.1 During social encounters, people with social anxiety frequently experience autonomic and motor signs of anxiety, including blushing.2 For some individuals there is an increase in fear of negative evaluation by others which can increase the blushing.3 When we blush there are neurally mediated increases in blood flow to the cheek area and that is what causes the red “flushed” appearance. The increase in blood flow then liberates substances like the vasodilator (makes blood vessels wider) nitric oxide (NO) and prostaglandins (usually involved with injury or pain) which prolong and intensify the effect of the cheek discoloration.4 An article posted by the Australian Associated Press (AAP) in September of this year claims to have a potential remedy for those who are prone to blushing in embarrassing situations.
The article posted on Yahoo News from the AAP references a study conducted at Murdoch University in Western Australia. This study looks at the use of ibuprofen gel placed on the cheek to decrease blood flow and prevent the production of compounds that aid in producing cheek redness (prostaglandins). For the study 30 adults were hooked up to blood flow measuring equipment. Each study participant had one cheek rubbed with a small amount of ibuprofen gel, and the other with ultrasound gel to act as a control. The participants were then asked to perform a variety of seemingly embarrassing tasks like singing karaoke to “I Will Survive” and performing physical exercise.5 No therapeutic recommendations can be made from the study, but that the “findings provide preliminary support for a pharmacological approach to blushing control.” 4 The inhibitory effect of ibuprofen on the blood flow to the cheek lasted throughout both the singing and exercise phases of the study.
The article definitely makes a good case for the use of ibuprofen gel in reducing the incidence of blushing during embarrassing situations. The use of the gel is an interesting idea, but I would be concerned about some of risks involved and the potential for inappropriate use. Ibuprofen in tablet formulation is an over-the-counter medication typically use to treat pain and fever. Even though the gel formulation is a topical preparation some the active drug can be absorbed systemically and should be a cause for concern in patients with active peptic ulcers, asthma, history of kidney disease, or use on broken/damaged skin. If I were to recommend ibuprofen gel it would be in an instance where the patient had severe facial redness and social anxiety. Since using ibuprofen gel for facial blushing is a fairly new concept there are not many standards to reference for frequency and dosing. For self-care purposes, I would try to recommend strategies for coping with stress and anxiety before recommending the gel.
One limitation to this study is the use of a non-diverse sample. The participants were recruited from a student population instead of a clinical setting and was only conducted once through. There is also need for more in depth studies on whether ibuprofen in this form and for this purpose is safe and effective for repeated use. Although there is literature on the topical use of NSAIDs like ibuprofen, it is dealing with outcomes of reducing pain and not with reducing facial blushing. It is hard to compare this study to others when it is dealing with a novel use of this medication.
With all of this information in mind there are many things for both healthcare providers and patients to consider. If ibuprofen gel was available over-the-counter, would you feel comfortable rubbing a gel on your cheek before you know you could potentially be embarrassed? Is it necessary for this type of option to exist, or should we learn to cope with anxiety and embarrassment in other ways?
- Leary, M.R., Britt, T.W., Cutlip, W.D., Templeton, J.L., 1992. Social Blushing. Psychological Bulletin 112, 446-460.
- S.M. Bögels, L. Alden, D.C. Beidel, L.A. Clark, D.S. Pine, M.B. Stein, M. Voncken. Social anxiety disorder: questions and answers for the DSM-V. Depress. Anxiety, 27 (2010), pp. 168–189
- M.J. Voncken, S.M. Bögels. Physiological blushing in social anxiety disorder patients with and without blushing complaints: two subtypes?. Biol. Psychol., 81 (2009), pp. 86–94. Available at: http://ac.els-cdn.com/S0301051109000301/1-s2.0-S0301051109000301-main.pdf?_tid=5fc3ff1a-3765-11e3-990e-00000aacb35f&acdnat=1382039609_546edb66e54f8da675e97f25dc852a9f. Accessed October 16, 2013.
- Peter D. Drummond, Kate Minosora, Gretta Little, Wendy Keay. Topical ibuprofen inhibits blushing during embarrassment and facial flushing during aerobic exercise in people with a fear of blushing. European Neuropsychopharmacology. Available at: http://www.sciencedirect.com/science/article/pii/S0924977X13002137. Accessed: October 16, 2013.
- Gel could stop embarrassing blushes. Yahoo News. 2013. Available at: http://nz.sports.yahoo.com/news/gel-could-stop-embarrassing-blushes-052419052–spt.html. Accessed October 16, 2013.
Posted in: Preventative Health