Facial swelling - causes and symptoms

Facial swelling - causes and symptoms

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Swelling of the face means an acute or chronic, diffuse or localized, red or skin-colored, painful or painless swelling of the face. It can have many causes and have different symptoms.

The angioedema

It affects those affected like a bolt of lightning: they were sitting unsuspecting at breakfast, then they looked in the mirror and a monster looked at them. The lips look like a botox overdose, the cheeks are bloated like a croaking frog, and the eyes swell like a hooligan that has had a mass brawl.

In fact, the face swells in response to violence, blows, kicks, or accidental contact with the curb.

On the other hand, it is hardly known that the face takes the form of an unsuccessful cosmetic surgery even with completely different stimuli: medication, allergies to food, infections, cold or vibrations can trigger the swelling in exactly the same way: water collects in the vessels and tightens the skin.

It's not just an aesthetic problem - although walking around with a disfigured face is bad enough.

If you suddenly have angioedema on your face, you should immediately go to a hospital. If the tissue around the throat, larynx and tongue swells, the affected person can die. The swelling then closes the airways and there is a risk of death from suffocation.

How does angioedema develop?

The facial skin swells because water accumulates in the deeper tissue. The messenger substances make the blood vessels of the subcutaneous tissue porous, and water flows in from the veins. The skin does not become red because the swelling is under the surface. But it takes on a grotesque shape, especially on the lips, mucous membranes and eyes.

The swelling will go away on its own, but it can come back again and again if the cause is not eliminated.

For one thing, histamine is the cause. We then speak of histamine-mediated angioedema and include allergic angioedema as well as angioedema in response to certain medications.

Second, there are people who are genetically C1 deficient in inhibitors. So they lack a protein in the blood that strengthens the body's defenses. Either the affected person's body produces too little of the C1 inhibitor, or the substance is defective, or the body cannot process the inhibitor.

Angioedema is not a disease of its own, but a symptom of a basic disease, usually an effect of hives: the body's own messenger histamine mediated the swelling from the mast cells.

Acute hives have 20% of all people at least once in a lifetime. However, only one in 100,000 suffer from genetically caused angioedema.


Angioedema is a swelling that is deep in the skin and painful but not itchy on the epidermis.

In the throat and larynx, this swelling causes shortness of breath.

Other symptoms correspond to the basic illness:

Histamine-mediated angioedema almost always affects the face, especially the lips and eyes.

If such an angioedema develops on the tongue and larynx, it is shown by:

- hoarseness
- Difficulties swallowing
- deep voice
- Whistle when breathing
- acute shortness of breath

Angioedema from intolerance

ACE inhibitors help against high blood pressure and heart failure. 0.1 to 2% of patients develop angioedema because they cannot tolerate the medication. As with other edema, the symptoms are dangerous if they spread in the larynx.

Unfortunately, it can take months for those affected to develop angioedema and neither they nor the doctor can easily overlook the connection to the ACE inhibitors.

The protein bradykinin is probably responsible. Triggers are enalapril, ramipril and lisinopril.

Affected people should talk to their doctor about whether they have suffered from angioedema in the past, which is the biggest risk known to date that water from intolerance will accumulate.


There are many triggers for facial swelling, and the doctor first asks about external factors: did the edema occur after the patient ate a certain food? Then the person concerned should avoid it.

An ice cube test shows whether the edema is caused by cold.

If it is hereditary angioedema, it is an indication that the problem has occurred in the family several times.

Age also plays a role here, since inherited angioedema usually occurs for the first time during puberty. Markus Magerl from the Charité says: "If angioedema suddenly occurs in an elderly person without wheals, one must always think of an acquired disease."

The doctor also asks what medication the patient is taking and examines whether there are diseases in the immune system.


Histamine-mediated angioedema usually resolves on its own. The doctor relieves the eyes and lips by injecting antihistamines or cortisone. In the event of edema on the larynx, the medicine must act immediately: adrenaline spray and oxygen masks remedy acute shortness of breath. Infusions with cortisone, adrenaline and antihistamines push back the swelling. In an emergency, only artificial ventilation helps.

Anyone who has ever had angioedema on the face or even in the throat should always have an emergency kit ready and avoid triggers if they are known.

Other causes of facial swelling

Angioedema is characterized by the fact that it hurts and presses, but does not itch and does not redden the skin. With eczema on the face, triggered by a contact allergy or toxins, the situation is different: here the skin swells and turns red.

With edema as a result of chronic alcohol abuse, the structure of the skin changes, it turns red and the pores widen.

With many other swellings on the face, the skin does not become red: Examples are facial edema in kidney diseases and kidney weakness such as an underactive thyroid.

Hunger edema and edema after surgery do not usually turn red.

The "big cheek"

If a single cheek swells, it is usually not due to angioedema, but to infections. Inflammation of the teeth and gums is often the cause, for example acute periodontitis, root infection with fistulas, blowing dry a drilled root canal, or the breakthrough of a wisdom tooth.

Those affected usually know the causes, since they suffer from severe toothache.

Treatment here means seeing a dentist who removes the vital tooth, fills the hole, takes out the fistula, or administers antibiotics that stop the inflammation.

It can also be an inflammation of the parotid gland or an abscess in the hypodermis.

An abscess arises, for example, from an injury, for example when a bone splinter bores into the skin of the throat and gets stuck there. The wound becomes inflamed, festering, and the focus of the infection swells. Such an abscess is associated with pain, so that those affected know the cause.

Be careful with partial facial paralysis. People with paralysis are in constant danger of developing a pressure ulcer. This sore develops when the area of ​​skin in question has been in one place for too long.

Usually our nerves signal us "the pressure is too high, turn around". But if you no longer feel these nerves, the same processes still take place in the body - the pressure point is no longer supplied with blood and dies.

Such a sore penetrates deep into the skin, often to the bone, and is very difficult to heal. The infection causes toxins to enter the organism, which is why those affected have to have the wound constantly cleaned.

Lip swelling

Lip swelling may be due to herpes simplex labialis and then goes hand in hand with painful, small, itchy blisters.

A lip furuncle, an inflamed wound on the lip, a deep-lying pimple or ingrown whiskers can also be the cause. In the worst case, it is a lip tumor in the development phase.

Home remedies for facial swelling

Facial puffiness can be alleviated with home remedies. Doctors recommend cooling compresses in the morning, which can be soaked with herbal or black tea.

If there is a possible allergy or a sensitive reaction to external stimuli such as cold, it is important to avoid these triggers. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch


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