This article is the third in a series featuring Neurogenic Rosacea. The first two articles are here: Neurogenic Rosacea: a new subtype for those with dysfunctional facial nerves and What is Neurogenic Rosacea?
Recently a group of doctors from Stanford became the first to publish a call for a new subtype of rosacea, called Neurogenic Rosacea. The current widely accepted list of rosacea subtypes was drawn up in 2002.
Once you have answered the question Do I have Neurgoenic Rosacea?, well what then – how do you treat it? Read on to see if this paper and the following comments can give you some starting points to take to your doctor.
No existing treatments works for you?
It seems from reading the paper Neurogenic Rosacea: A Distinct Clinical Subtype Requiring a Modified Approach to Treatment that the doctors were motivated by their patients being unsatisfied with the up-to-now proven rosacea treatments. A table of patient characteristics lists their ineffective treatments such as; topical steroids, topical metronidazole, oral antibiotics, azelaic acid and IPL.
Perhaps one of the clues that a new subtype of rosacea is applicable is when the existing official treatments for rosacea are just not effective.
So what might work, then?
According to the paper, most patients benefitted from neurologically focused treatments such as gabapentin, duloxetine, pregabalin, anti-depressants and memantine. Other topical neuroleptics were occasionally effective. A subset of patients benefited from beta blockers and alpha-1 adrenergic receptors.
Perhaps some of these treatments are new to you, so lets briefly look at these treatments in turn.
Originally developed to treat epilepsy, Gabapentin, sold as Neurontin, has been used to treat neuropathic (nerve related) pain.
The brand name for Gabapentin is Neurontin. The makers of Neurontin have been in the news in recent years for illegally promoting the use of Neurontin off-label. While using prescription drugs off-label is not illegal, promoting its use therein is. This would include promoting Neurontin to treat neurogenic rosacea of course.
Neurontin works by changing the way the body senses pain.
Considered to be a successor to Gabapentin, Pregabalin was also originally designated as a treatment for epilepsy. Lyrica is further approved for use in diabetic neuropathic pain, and in 2007 was also approved for use in fibromyalgia.
The description of how Lyrica works from MedLinPlus says; “It works by decreasing the number of pain signals that are sent out by damaged nerves in the body.”
In 2008 Duloxetine became the second drug approved by the FDA to treat fibromyalgia. Used to treat treat depression and generalized anxiety disorder, Duloxetine is also used to treat diabetic neuropathy.
Duloxetine is class of medications called selective serotonin and norepinephrine reuptake inhibitors (SNRIs).
The drug information page for Duloxetine at MedlinePlus has a big red warning box at the top. This drug needs careful input from your doctor to weigh up the benefits and risks of its use.
Memantine “can help people with Alzheimer’s disease to think more clearly and perform daily activities more easily”.
Beta-blockers have been used to treat high blood pressure and heart disease but many have found them to be helpful in controlling rosacea symptoms.
According to the National Rosacea Society: “In severe cases, a beta-blocker may sometimes be prescribed to help reduce emotionally triggered flushing that is controlled by the autonomic nerves — the nerves that control functions such as heart rate”.
Alpha-1 Adrenergic Blockers
This class of drugs includes Oxymetazoline, which has attracted some attention in rosacea circles due to some research into applying it topically for the redness and flushing of rosacea.
There is still some question in my mind about the potential rebound redness from oxymetazoline.
A Word of Warning
Some of these are serious drugs. They have potentially significant side effects. They may interact negatively with other medications you are taking. Make sure you are getting good advice and support from your doctor before embarking on these sorts of treatments.
Self Treatment – Ice and Fans
10 of the 14 patients studied experienced relief from cooling fans or cold compresses or ice both applied to the face or held in the mouth.
Are you encouraged?
If you suffer from a neurogenic type of rosacea, are you encouraged to see a paper published in a good journal highlighting your plight?
What additional advice would you offer other sufferers embarking on these sorts of treatments?