The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Endoscopic thoracic sympathectomy for primary facial blushing, in February 2014.

Description

Blushing or facial reddening is an involuntary reaction, usually as a result of a strong emotional response that stimulates the sympathetic nervous system to increase the flow of blood to the skin of the face. People with facial blushing may also have hyperhidrosis (excessive sweating).

Conservative treatment for facial blushing includes oral medications such as beta-blockers or anticholinergics. When anxiety is the cause of blushing psychological treatments such as cognitive behavioural therapy may be used.

If blushing fails to respond to conservative medical treatment or behavioural therapy, then surgical sympathectomy is an option: this can be done either by open or endoscopic approaches. Endoscopic sympathectomy is now usually the preferred technique.

Coding recommendations

Endoscopic thoracic sympathectomy using cauterisation:

A79.2 Destruction of thoracic sympathetic nerve NEC

Y74.2 Thoracoscopic approach to thoracic cavity NEC

Y11.1 Cauterisation of organ NOC

Endoscopic thoracic sympathectomy using laser:

A79.2 Destruction of thoracic sympathetic nerve NEC

Y74.2 Thoracoscopic approach to thoracic cavity NEC

Y08.3 Laser destruction of organ NOC

Endoscopic thoracic sympathectomy using clips:

A79.2 Destruction of thoracic sympathetic nerve NEC

Y74.2 Thoracoscopic approach to thoracic cavity NEC

Y07.2 Clipping of organ NOC

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)