What Is Facial Plethora?

What does it mean to have facial plethora? 

Facial plethora involves facial swelling and redness. It’s a symptom of another condition, rather than a condition itself.

It occurs when blood flow to your face increases. It can also happen when the amount of blood in your body increases.

The underlying causes of facial plethora vary greatly, and treatment depends on the specific cause.

 What can cause a plethoric face? 

Several possible conditions can cause facial plethora. They include:

Cushing syndrome

Facial plethora is a main symptom of  Cushing syndrome , a rare condition that’s caused by high levels of cortisol, known as the stress hormone.

The hormone cortisol is produced by your adrenal gland. It’s involved in bodily functions like the stress response, metabolism, and inflammation.

 Too much cortisol  can happen if you have a tumor in the pituitary or adrenal gland. The tumor causes your body to overproduce cortisol, leading to high levels. It can also happen after taking  corticosteroid  drugs, like prednisone.

High levels of cortisol can increase blood pressure. This increases blood flow in the skin on your face, resulting in facial plethora.

Superior vena cava syndrome

T he superior vena cava (SVC) is a major vein in your body. It brings blood to your heart from your chest, head, neck, and arms.

Some types of cancer, like lung cancer, can partially or completely block the SCV. A blood clot can also block the SCV. If this happens, a group of symptoms called superior vena cava syndrome (SCVS) may develop.

In SCVS, the blockage of blood flow causes upper body swelling. This can lead to symptoms like facial plethora. 

Carcinoid syndrome

Neuroendocrine cells are involved in basic bodily functions. They work by sending information via hormones.

If neuroendocrine cells develop into a tumor, it’s called a carcinoid tumor. Carcinoid syndrome happens when the tumor spreads to your liver and makes too much serotonin.

The tumor releases chemicals into the bloodstream, causing a range of symptoms. Some chemicals widen the blood vessels and increase blood flow, resulting in facial swelling.

Polycythemia vera

Polycythemia vera is a rare blood disorder that causes excess production of red blood cells. This increases red blood cell mass, causing thickened blood and swelling.

The swelling can lead to plethora of the face and palms.


Rosacea is a chronic inflammatory skin disorder. The inflammation can cause facial flushing and swelling.

In people with lighter skin tones, the flushing appears red. In those with darker skin tones, it may look like brown discoloration.

Other symptoms of rosacea include:

  • acne-like breakouts
  • thickening skin
  • burning
  • warm skin


sunburn happens when ultraviolet rays from the sun damage skin cells. This causes your body to release inflammatory substances, resulting in dilated blood vessels and increased blood flow.

The increased blood flow leads to swelling and redness, or facial plethora.

 Is facial plethora a symptom of a syndrome? 

In some cases, facial plethora may indicate a syndrome.

According to a 2015 study, facial plethora is one of the first identified symptoms of Cushing syndrome. It’s also one of the first symptoms to get better as Cushing syndrome is treated.

Facial plethora may also be caused by SVCS or carcinoid syndrome.

 What are the features of facial plethora? 

Facial plethora involves a group of features, rather than a single characteristic. It generally involves facial symptoms like:

  • swelling and increased roundness
  • increased puffiness in your cheeks
  • redness (on lighter skin tones)
  • brown discoloration (on darker skin tones)

 Does facial plethora pose other health risks? 

The symptoms of facial plethora may be uncomfortable. But there’s no research stating that facial plethora itself is linked to complications.

However, if the underlying condition goes untreated, it may lead to complications. The condition may get worse or cause other side effects.

That’s why it’s important to contact a healthcare professional if you think you have facial plethora.

 How is facial plethora treated? 

Treatment for a plethoric face depends on the condition causing it. Treatment may include:


A healthcare professional may suggest using medication for the following conditions:

  • Cushing syndrome. A doctor can prescribe medications that lower your cortisol levels.
  • SVCS. If this condition is caused by a blood clot, a therapy called thrombolysis can be used to break down the clot. This procedure allows medication to get to the site of a blood clot and dissolve the blockage.
  • Carcinoid syndrome. Some medications can block the chemicals produced by a carcinoid tumor.
  • Polycythemia vera. If you have polycythemia vera, you might need medication to reduce red blood cell production.
  • Rosacea. A dermatologist can prescribe topical medication to manage rosacea symptoms.

Chemotherapy or radiation

Chemotherapy or radiation treatment may be used for tumors that cause:

  • Cushing syndrome
  • SVCS
  • carcinoid syndrome


In certain cases, you might need surgery. This option may be used for tumors that cause:

  • Cushing syndrome
  • SVCS
  • carcinoid syndrome

If SCVS is caused by a blood clot, surgery may be used to insert a stent or remove the blood clot.


Facial plethora is characterized by facial swelling and puffiness. It can cause redness in lighter complexions and brown discoloration in darker skin tones.

It’s a main symptom of Cushing syndrome, but it may also be a symptom of SVCS and carcinoid syndrome. Other causes include polycythemia vera, rosacea, and sunburn.

Treatment depends on the specific cause. If you experience facial swelling and discoloration, reach out to a healthcare professional for a diagnosis.

Resolution of the physical features of Cushing’s syndrome in a patient with a cortisol secreting adrenocortical adenoma after unilateral adrenalectomy

A 37-year-old woman developed clinical manifestations of Cushing’s syndrome over a span of 2 years. Physical examination revealed features that best describe Cushing’s syndrome, such as wide purple striae (>1 cm) over the abdomen, facial plethora and easy bruisability.1  Other features observed were hypertension, moon facies, acne, a dorsocervical fat pad, central obesity and dyslipidaemia.

The diagnosis of hypercortisolism was confirmed using a 1 mg overnight dexamethasone suppression test (19.7 ng/dL, N: <1.8) and 24 h urine free cortisol (185.9 μg/24 h, N: 3.5–45). A suppressed adrenocorticotropic hormone (ACTH) level (4 pg/mL, N: 5–20) and a lack of hyperpigmentation suggested ACTH-independent Cushing’s syndrome. Further work up using CT with contrast of the adrenals showed a 2.4×2.3×2.4 cm right adrenal mass. The patient then underwent laparoscopic adrenalectomy of the right adrenal gland. Steroids was started postoperatively and tapered over time. Histopathology results were consistent with an adrenocortical adenoma (2.5 cm widest dimension). Six months after surgery, there was resolution of the physical features, weight loss and improvement in blood pressure.

Figure 1 is a serial photograph of the physical features seen in Cushing’s syndrome, such as moon facies, a dorsocervical fat pad and wide purple striae, taken preoperatively, and at 3 and 6 months after surgery. With treatment, physical and biochemical changes of Cushing’s syndrome both resolve through time.2 The time course of the resolution of these changes, however, is varied.2 ,3 We observed that the physical features were ameliorated at 3 months and resolved at 6 months.

Learning points

  • Physicians as well as patients should be aware that improvement of the features of Cushing’s syndrome after treatment does not occur immediately.

  • Dramatic resolution of the physical features of Cushing’s syndrome, however, can be observed as early as 6 months after surgery.

Figure 1

Physical features of Cushing’s syndrome (top to bottom: moon facies, a dorsocervical fat pad and wide purple striae (>1 cm) over the abdomen) documented before surgery, and at 3 and 6 months after surgery.


  • Twitter Follow John Paul Quisumbing at @jpquisumbingmd

  • Contributors JPMQ worked up the case and wrote the case report. MASS reviewed the case report and critically appraised it. JPMQ incorporated his suggestions.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.


From http://casereports.bmj.com/content/2016/bcr-2016-215693.short?rss=1

Identification Of Potential Markers For Cushing’s Disease

Endocr Pract. 2016 Jan 20. [Epub ahead of print]



Cushing’s disease (CD) causes a wide variety of nonspecific symptoms, which may result in delayed diagnosis. It may be possible to uncover unusual combinations of otherwise common symptoms using ICD-9-CM codes. Our aim was to identify and evaluate dyads of clinical symptoms or conditions associated with CD.


We conducted a matched case-control study using a commercial healthcare insurance claims database, designed to compare the relative risk (RR) of individual conditions and dyad combinations of conditions among patients with CD versus matched non-CD controls.


With expert endocrinologist input, we isolated 10 key conditions (localized adiposity, hirsutism, facial plethora, polycystic ovary syndrome, abnormal weight gain, hypokalemia, deep venous thrombosis, muscle weakness, female balding, osteoporosis) with RR varying from 5.1 for osteoporosis to 27.8 for hirsutism. The RR of dyads of these conditions ranged from 4.1 for psychiatric disorders/serious infections to 128.0 for hirsutism/fatigue in patients with vs. without CD. Construction of uncommon dyads resulted in further increases in RR beyond single condition analyses, such as osteoporosis alone had RR of 5.3, which increased to 8.3 with serious infections and to 52.0 with obesity.


This study demonstrated that RR of any one of 10 key conditions selected by expert opinion was ≥5 times greater in CD compared to non-CD, and nearly all dyads had RR≥5. An uncommon dyad of osteoporosis and obesity had an RR of 52.0. If clinicians consider the diagnosis of CD when the highest-risk conditions are seen, identification of this rare disease may improve.


Cushing’s disease; delay in diagnosis; disease markers; insurance claims; relative risk

[PubMed – as supplied by publisher]

From http://www.ncbi.nlm.nih.gov/pubmed/26789346

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