How do you treat Neurogenic Rosacea?

Written by on February 9, 2011 in depression & anxiety, neurogenic rosacea with 8 Comments

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.

Gabapentin (Neurontin)

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.

Pregabalin (Lyrica)

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.”

Duloxetine (Cymbalta)

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

Memantine “can help people with Alzheimer’s disease to think more clearly and perform daily activities more easily”.

Beta Blockers

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?

Related Articles

About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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8 Reader Comments

  1. Brady Barrows says:

    Excellent article David. Thanks for all the work you put into it.

  2. shantelle says:

    Pindolol (also known as Visken) (Beta Blocker) is helpful.

  3. Anita T. Monroe says:

    I am so discouraged. I have had Rosacea for SO long. It gets worse in the winter and seems to be moving to larger areas of my face. I take the mild antibiotic, use the cream, not the gel which is too strong. I try to avoid triggers, but that is impossible in the winter when indoor heating is a necessity and outdoor cold is just as problematic.

    I know that this is not the world’s worst condition. People who have cancer, heart problems, etc. have a much worse time. This condition is just debilitating because it is emotionally upsetting. I fear going out in public because people ALWAYS remark when I have an attack. Make-up helps a little, but not very much.

    The new therapies that you mentioned might be of help, but to tell you the truth, my doctor does not know enough about this condition to know what to do.

    Sorry for complaining. When I first developed this condition, there was not even a name for it, and the head of the dermatology department at a research hospital in Atlanta didn’t know what was wrong or what to do about it. He thought that I just had a unique problem that was only for my emotional self and I would just have to live with it.

  4. Steve says:

    I ‘m sure they are on to something, and more studies need to be done on this type of treatment. I am a 62 year old male with the type of red face shown in the picture above the article. I have tried everything, I mean everything, to help the red face go away, with no luck. The red face and and zit nose has affected me pychologically to the point I no longer feel comfortable in social situations and I hate to say this but quit my job because I was tired of people asking me if I’d been out in the sun to long. If any studies come up using this type of meds, I would be sooo happy to take the part. My derms don”t get it, but they are so happy to take my money.

  5. Anita T. Monroe says:

    Steve, We are in the same boat. My own husband does not understand and often asks, “Why is your face so red?” I lived for many years in Key West, Florida, and I know for sure that climate affects the condition. I was MUCH better when I lived there. I stayed out of the direct sun as much as I could, but the salt water climate was wonderful.

    Here in South Carolina, one of the pollen capitals of the world, the condition is worse and getting “worser” as the years go by. I am trying to convince my husband that we should move back to Florida. Unfortunately, he hated living there, so my options for a move are limited. Divorce is SO difficult. (-:

    There is one tip that I can give you that might be of help. There is a cream called “Amazing Concealer” that was originally developed as a coverup for scars. I apply a light moisturizer (Nutraderm), then sparingly dot on this concealer and blend it into the most affected areas. It is a good cover-up and seems also to be a protection from too much sun. I know that guys don’t like to wear “make-up”, but these products – Nutraderm and Amazing Concealer are more like medicinal treatment than anything else.

    Nutraderm was recommended by one of my more competent dermatologists, saying that it is a moisturizer that is actually good for the skin and is not expensive. You have to be careful to get the ORIGINAL one because the flankers are likely to be irritating. My druggist orders it for me because most pharmacies do not carry it anymore. Amazing Cosmetics is available on-line. You have to choose if your skin tone has a blue or yellow undertone. Blue undertone means white skin that is so white that you can see the blood color through it (the term Blueblood comes from this). Yellow undertone means the opposite, just a slight yellow cast to the skin.

    When you wear these products, they are not noticable and no one embarrasses you wanting to know if you are wearing make-up.

    Best of luck. All of us need it.

    Anita

  6. alex says:

    Very interesting article. I have had this since I was 40 – now 53 and clearly it has got worse. I was originally treated with all the usual meds for Rosacea until I was referred to a specialist . I have had various treatments along the way including laser . I still take 20 mg Roaccutane daily . The pain and burning is minimal but the flushing with the normal triggers still continues. Cutting out wine has helped a lot – I now drink a spirits. The best thing really has been finding Cover FX concealer – made in the States but you can buy it in the uk. It has changed my life ! The coverage is amazing and if you match the colour up well – you can hardly see it. I am thinking of having IPL as laser is so agressive – has anyone tried IPL?

    • KC says:

      Alex, if you have non neurogenic Rosacea (not a lot of burning) in the proper trained hands you should be good trying IPL. For those w. a strong neurological component to the Rosacea, I have read that it can make the situation worse. If anyone has additional feedback on this I would welcome it. In the same article I read that it is really important to go to someone highly qualified. Determining that I should think is the challenge.

  7. KC says:

    I wonder if besides the neurologic, digestive, opthalmic and dermatologic components if there isn’t something about this disease Rosacea that is psycologial.. It may be my own perwsonality foible, but lately it just seems there is so much global injustice and corruption – in short- a lot to be burned up about. Is part of this an anger issue? Comment? Also, please don’t suggest therapy as insurance does not allow for.

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