Cyclosporine as a treatment for neurogenic rosacea

Written by on January 11, 2024 in Neurogenic Rosacea, Ocular Rosacea with 0 Comments

There has been some relatively recent research into a possible variant of rosacea called neurogenic rosacea. Different from typical rosacea, papules, pustules, and swelling changes are not present in this group of patients.

This short correspondences from DermatologicaSinica, the journal of the Dermatological Association of Taiwan documents 3 cases where patients with possible neurogenic rosacea were treated successfully with cyclosporine.

Use of cyclosporine in the treatment of patients with possible neurogenic rosacea presenting as persistent facial edema with burning sensation: A case series

Dermatologica Sinica, November 10, 2023. | DOI: 10.4103/ds.DS-D-23-00041

… Neurogenic rosacea has additional characteristics compared to erythematotelangiectatic rosacea, such as rare papules and pustules, improved alleviation by cold stimuli and erythema mainly distributed on bilateral lateral cheeks to mandibular angles, sparing the nose, forehead, and central chin. Conversely, erythematotelangiectatic rosacea patients are more likely to develop erythema on the nose and medial cheeks. Another common feature for patients with neurogenic rosacea is the constant use of a portable electric fan when the patients appear in the clinic.

… Finally, patients with neurogenic rosacea often have very sensitive skin. The use of oral cyclosporine obviates exposure of any topical agents, including the atrophogenic corticosteroid and irritating topical calcineurin inhibitors.

In conclusion, while not currently considered a standard therapy, oral cyclosporine may be a viable alternative for the cases of neurogenic rosacea that do not respond to conventional rosacea treatments, neuroleptic agents, or antidepressants. Further high-quality studies with larger patient populations are needed to assess the long-term efficacy and safety of this treatment.

What is Cyclosporine?

Cyclosporine, is a calcineurin inhibitor, used as an immunosuppressant medication. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn’s disease, nephrotic syndrome, eczema, and in organ transplants to prevent rejection.

Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. Restasis (the brand name for cyclosporine eye drops -ophthalmic emulsion 0.05%) has attracted some attention as a possible treatment for ocular rosacea.

Neurogenic Rosacea Main Symptoms

  • burning or stinging pain
  • facial swelling (edema)
  • facial redness (erythema)
  • flushing
  • facial blood vessels

How do you treat Neurogenic Rosacea?

Patients typically benefit 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. See Neurogenic Rosacea: a new subtype for those with dysfunctional facial nerves for more details.

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

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