The Food and Drug Administration said it is investigating a possible association between the widely used asthma medication Singulair and behavioral changes, including suicide.

Singulair, made by Merck & Co., is approved to treat asthma and allergy symptoms such as sneezing and stuffy noses, as well as to prevent exercise-induced asthma. The FDA said in a so-called early communication that it is reviewing postmarketing reports of behaviour and mood changes, suicidal thoughts and actions, and actual suicides by patients who took Singulair. The regulator also asked Merck to look at its own database for signs of trouble.

…

The FDA said Singulair is effective and that patients shouldn’t stop taking it without talking to their doctors.

Singulair has been used off-label to treat rosacea, some rosacea sufferers swear by it. Certainly some rosacea sufferers feel that there is a link between their allergies and their rosacea symptoms. Other rosacea sufferers have tried many antihistamines and not gotten any relief.

For some background here are two threads that are worth reading:

Rosacea Support Forum: Singulair in conjuction with an H1 & H2 blocker

Rosacea Forum Thread: Singulair is amazing

Accutane has also come under some scrutiny because of reports that it also might lead to behavioural changes. For sure all drugs have side effects and it is worth being reminded to be on the watch for anything out of the ordinary.

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Alluding to a link between rosacea and migraines, Dr. Joseph Bikowski says that aspirin should be the first line of defense against rosacea flushing. A recent article in Dermatology Times highlights the potential benefits (and risks) of taking low doses of aspirin long term for rosacea swelling and flushing.

From: Miracle-worker aspirin represses rosacea flushing

An informal study with his rosacea patients who took a daily aspirin (81mg) reported less flushing and shorter episodes of erythema.

Dr. Bikowski argues, “Aspirin therapy is safe. It’s great for the heart. It’s great for the colon. Why not the skin?” He further notes that there are few contraindications for aspirin use, it’s inexpensive and it can be taken in combination with most drugs.

The NRS also recommends aspirin: Tripwires – Foods and Beverages

Taking an antihistamine about two hours before a meal may counter the effects of histamine, while aspirin may reduce the effects of niacin-containing foods in sufferers affected by these substances.

And finally, Asprin forms part of Dr. Linda Sy’s rosacea swelling relief regimen.

At bedtime: Take 1 baby aspirin; 1 chlor-trimeton(4 mg) and 1 tab of Tums (Calcium Carbonate , an antacid to offset the gastric irritating effect of the aspirin.

In the AM: Take a B Complex vitamin that contains 50 mg. of B-6. Avoid
one w/ Niacin (Niacinamide is fine) and 1 Tagamet (200 mg). During bouts of flushing, apply a cool (not cold) compress on face. Do deep breathing 10 times slowly.

See Also:

• RSRP: Aspirin

How about you ? have you take aspirin specifically for rosacea swelling or flushing ? did it help any ?

A 4-week, randomized, double-blind, parallel group trial evaluating the efficacy and tolerability of sebum control product in male and female subjects with oily skin appearance and mild to moderate acne vulgaris, Ronald Rizer, PhD, Thomas J. Stephens & Associates, Colorado Springs, CO, United States; Nathan Trookman, MD, Rocky Mountain Laser Center, Colorado Springs, CO, United States; James Herndon, MD, Prsbyterian Hospital, Dallas, TX, United States; Thomas Stephens, PhD, Thomas J. Stephens & Associates, Carrollton, TX, United States.

Excessive production of sebum on acne prone individuals often leaves skin with an undesirable appearance that emphasizes facial shine, acne lesions, and enlarged pores. The factors that often contribute to this appearance include family history, hormonal activity changes, stress, and the use of certain types of birth control pills.

This randomized, double-blind, placebo-controlled trial was undertaken to evaluate a novel treatment containing an H-1 receptor antagonist designed to improve the appearance of oily facial skin in subjects with and without mild to moderate acne vulgaris.

The treatment product contained an H-1 receptor blocker, acrylic copolymer, and botanicals with oil control activity in a hydro-alcoholic gel base. Twenty (20) male and female adult subjects meeting the eligibility requirements were enrolled in this study. At the baseline visit, the investigator graded the severity of facial shine and oily feel on the face using an 11 point analog scale were 0 = none and 10 = severe. Subject’s acne severity was assessed by counting acne lesions and by using a global acne scale. Objective and subjective skin irritation was graded using a 4-point scale with 0 = none and 3 = severe. Triplicate sebum measurements were taken on forehead, cheeks and chin of subjects at each visit. Subjects’ faces were photographed with a digital camera. Subjects returned at 2 weeks and 4 weeks for repeat grading, sebum measurements and photography.

Clinical grading showed that treatment product provided both an immediate and sustained benefit in reducing oily skin appearance. Some subjects showed improved acne conditions. The significance of these findings is discussed in this poster.

Commercial support: None identified.

Poster Abstract P104, American Academy of Dermatology, 65th Annual Meeting February 2-6, 2007, Washington, DC. Published in Journal of the American Academy of Dermatology Volume 56, Number 2.

Further Reading:

• jojoba oil and oily skin
• Vita Oil vs. Jojoba Oil
• Sensitive Skin Products for Rosacea Sufferers
• choosing a moisturizer
• rosacea cleanser Linda Sy Mild Oatmeal Facial Cleanser
• rosacea sensitive dry and flaky skin, sebum and sebaceous glands
• zileuton reduces sebum production

Thanks for your effort in finding some excellent messages on this topic Aurelia.

I used steroid anti-rhinitis and hay fever sprays such as Beconase for years until a pal said she wouldn’t try them because several of her friends had wound up with noses that were permanently swollen, sore and inflamed, thanks to the steroids! I’d had those problems for about as long as I’d used the sprays and never thought that there might be a link. It is possible that there was NO connection, but I strongly suspect that there was. That’s why I wish I’d never used them.

To be fair, there are rosaceans who’ve used steroid nasal sprays for up to 20 years and have not had any problems with them. Every rosacean is different and nothing works the same with all of us.

But how is the steroid supposed to reach the outside of the nose? Two ways: mist settling onto the face, or the drug working its way through the tissue. I was always careful to release the spray deep into the nostrils so no spray touched my face, but several RS posters attributed their rosacea to steroids working back through the skin.

In RSG Message 63047 Dr Nase wrote about a different steroid nasal spray: “The steroid is absorbed into the nasal blood vessels and transported underneath and around the entire nose, up through the cheeks and even into the eye. There are many documented cases and warnings by rosacea specialists.”

He cited a study titled “Rosacea induced by beclomethasone dipropionate nasal spray”, which was published in 1999, and Beth Adams kindly gave us the main findings in this post: RSG Message 74772

To summarise it very briefly, the doctors felt that the two cases of rosacea they examined were caused by “backspray” or leakage where the liquid actually got on the skin around the nose and mouth. They also stated:

“Beclomethasone dipropionate is a potent halogenated steroid, and in this form represents a surreptitious means of causing or worsening pre-existing rosacea. The means by which halogenated corticosteroids exacerbate rosacea is not well understood. Halogenated topical steroids can cause cutaneous atrophy, leading to erythema and increased telangiectasia.”

In RSG Message 8150 Rachel Priebee told the group about “a nasal spray which has been very effective in the past (Beconase) I was told by my dermatologist causes visible veins around my nostrils”. Horrors! That is SO not what we want to hear!

“The actual reason why sodium cromoglycate spray is better than a cortisone based spray” – well, that’s subjective. Not everyone agrees, but it looks like the scientific facts mostly line up that way. Personally, I switched to Rynacrom (sodium cromoglycate) aka Nasalcrom (cromolyn sodium) and it really did help my chronic allergic rhinitis, but mainly by stopping chronic severe throat inflammation caused by allergies. It’s a mast cell inhibitor.

If you want to read up on mast cell inhibitors, particularly Nasalcrom, here is a very good post from Steve Malone (“paulsmalone”) reproducing one of Geoffrey Nase’s posts from 1999: RSG Message 57650

Here is part of the explanation about mast cells:

“We are now learning that part of the problem with rosacea skin and vessels may be due to altered function and reactivity of mast cells. Mast cells are located in facial skin and are in close proximity to blood vessels. Mast cells are also in great abundance in the nasal passages. When activated, these mast cells open up (degranulation) and release substances that cause the nearby vessels to open up (increased blood flow) and leak (swelling). Mast cells release histamine, cytokines, prostaglandins and inflammatory enzymes that can cause intense bouts of inflammation. It has been speculated that these mast cells are hyperactive or hypersensitive to stimuli such that they release these inflammatory substances quite often and in great concentration.”"The reason why antihistamines sometimes help alleviate the redness, flushing, burning and itching associated with rosacea is because it blocks the actions of mast cell released histamine on blood vessels But …
mast cells release many other potent inflammatory substances. So the goal should be to stop the mast cell from releasing any of its contents. This can be done by stabilizing the cell membrane of mast cells — with certain drugs. The active ingredient in nasalcrom (cromolyn sodium) is one such drug — but it takes some time to stabilize the membrane of mast cells within your nasal cavity (so be patient). So yes, I highly recommend it.”

But you do have to start using it several weeks before your allergies are expected to kick in.

In RSG Message 70505 Logan, who used to post us a lot of excellent scientific stuff and is very much missed, turned up a research study that explained that the drug could only work when applied directly to the nasal lining, meaning that it wouldn’t work as well if the patient already had “nasal congestion and secretions”. It was also ineffective “in vasomotor rhinitis, exercise-induced rhinitis, or in the management of nasal polyps”.

In RSG Message 19352 dermatologist Dr Linda Sy posted that it could even be used as a topical, eg for infants with eczema, is sometimes used as an inhaler for asthmatics, and “Some doctors advise patients to use it for preventative purposes when they expect to be exposed – say, someone allergic to cats visiting a place with cats.”

It is a very gentle drug, however, someone I once recommended it to got back to say “the stuff really burns inside my nose”. Again, we’re all different!

Quite a few rosaceans are fighting allergies and chronic rhinitis by using antihistamines such as Astelin, and some swear by Singulair, and they say it actually helps their rosacea. Here are several interesting messages you might like to look at, with regard to allergies:

RSG Message 70379

RSG Message 63066

But again, there are rosaceans who’ve tried just about all the antihistimines and never found one that helps with their rosacea.

I hope this will be of help to you, Jasper. Do please let us know what you decide, and how you get on.

Kind regards,
Aurelia

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