title: [Results of video-assisted thoracoscopic sympathectomy for facial blushing].
abstract: BACKGROUND
  Involuntary craniofacial erythema, or blushing, due to autonomic dysfunction can be a cause of psychological distress. Although anecdotal reports have suggested that pharmacologic treatments or cognitive behavioral therapy can be used to treat the condition, no rigorous analyses of their efficacy have been reported.
  
  
  OBJECTIVE
  To assess the efficacy of video-assisted thoracoscopic sympathectomy and to study phobic anxiety and other personality traits in a series of patients with involuntary facial blushing.
  
  
  METHODS
  We carried out a retrospective observational study of patients treated with bilateral video-assisted thoracoscopic sympathectomy for blushing over a 7-year period (2001-2008). All the patients were treated by a dermatologist, a psychologist, and a thoracic surgeon and were informed of the predicted outcomes.
  
  
  RESULTS
  A total of 204 patients with a mean age of 34 years (range, 15-67 years) were included; the numbers of males and females were similar. Only 10% had unpredicted outcomes; in such cases, either the procedure was insufficiently effective or postoperative reflex sweating developed (and was considered serious in 2%). There were no deaths and only 1 case of transient Horner syndrome. Video-assisted thoracotomy was required for pleural symphysis in 1 patient; 5 patients developed pneumothorax, but only 1 of them required pleural drainage.
  
  
  CONCLUSIONS
  Video-assisted sympathectomy is a safe, effective and definitive treatment for disabling blushing. Anxiety that is detected before surgery is a reaction to blushing rather than a cause of it.
authors.affiliation: Unidad de Cirugía Torácica de Acceso Mínimo, Hospital Platón, Barcelona, España. 7891mcp@comb.cat
authors.forename: M A
authors.initials: MA
authors.lastname: Callejas
authors.forename: R
authors.initials: R
authors.lastname: Grimalt
authors.forename: S
authors.initials: S
authors.lastname: Mejía
authors.forename: J M
authors.initials: JM
authors.lastname: Peri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications; D001821:Blushing / Q000523:psychology; D003131:Combined Modality Therapy; D019091:Critical Pathways; D004351:Drug Resistance; D005260:Female; D005483:Flushing / Q000188:drug therapy / Q000523:psychology / Q000601:surgery*; D006732:Horner Syndrome / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006945:Hyperhidrosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010551:Personality; D010698:Phobic Disorders / Q000150:complications; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012021:Reflex, Abnormal; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods*; D013684:Telangiectasis / Q000150:complications; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult