How do you treat Neurogenic Rosacea?

Written by on February 9, 2011 in depression & anxiety, Neurogenic Rosacea with 24 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 “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?

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

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24 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.


  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.

      • Karen vB says:

        I have neurogenic rosacea and the only thing that saved me was Cutanix. Now I’m trying MSM solutions. Too early to say for sure but I’m hopeful. Wish we could get a reasonable facsimile of Cutanix!

  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.

    • Karen vB says:

      I wonder if it has anything to do with Fibromyalgia since the going info suggests it’s a state of overactive nerve endings. I have both.

  8. jean burgess says:

    I have suffered from roscea for .A major spinal operation I have had bad nerve damage pain for which I have been taking pregabalin I have just realised I have not had any flare ups of roscea since taking pregabalin .no other treatment worked I tried it all.At last my face looks fairly normal..Jean

  9. jean burgess says:

    I Have just had another thought I was born with a cleft palette which meant nerve and sinuses were out of place in my face or as one specialist put it (I have a badly deformed face) looks ok to may be this answers a lot of glad I came across your is very interesting jean

  10. S says:

    I have been treated for rosace for over 20 years. Worked with dermatologist so real agressive last few years with trearments…
    IPL laser.solodyn, soolantra, metrogel and facial sunscreen micronized 50 zinc oxide. I have depression on wellbuterin for years…but my anxiety was going through the roof on me. When I would worry my face would flare in a few minutes with severe rosace attack despite all other treatments.I mean would flare so it FAST it was on fire burning…could only splash water ot cool with ice packs…then embarrassing anxiety would make worse. Called dermatologist see if he had heard of neurogenic rosace…said yea but he had no patients…another derm in same practice said had some luck with beta blockers for flushing. I did research and asked since my anxiety was possible factor if I could I try gabapentin..said yes and it has been Fantastic… Face quiet for entire wmonth skin that was always recovering from attack finally got a whole month where skin was quiet and feels smooth. I have less anxiety. and been sleeping like baby …blessing from God..thanked him mostly. Now one addition I am. washing face with cetaphil at night and put metrogel on at night with zinc oxide and have slept with plastic wrap over my cheeks and nose….I think it has helped restore moisture barrier at night…family makes fun at my plastic wrap mask but has gotten use to it…my goal now 2 months with no attack even went out in sun usually trigger didnt today..wish me luck and blessing to all hope this helps.

  11. Mark says:

    So, I was diagnosed with neurogenic rosacea. I hate it, seriously. I’m only 37, had since 30. It’s progressive and it’s damaged my social/family/life in many ways. I will not elaborate because it takes too long to type the details. 10 months ago I found a leading dermatologist at Palo Alto medical foundation, Dr. Murase, who felt confident and RX’ed me Hydroxychloroqine (plaquenil). I take 400mg/day split 200mg bid. Look up the study on pubmed or google scholar to see if it might help you. Then ask your dermatologist. It has changed my life. Flair-ups reduced, burning almost gone, cooler skin. Swelling reduced significantly. It’s not totally gone, but such a huge difference. I never thought this was possible. I don’t see much written about it on these forums, or in the scientific literature, so I’m hoping it can help others too. Most significant is the reduction in the daily 2-4pm flushes for no apparent reason, or the flushing at the checkout line in the grocery store, or the flushes during sex, etc. I still need Mirvaso and sunscreen to survive, but this is so much better. Try it, I was hesitant after trying beta blockers, antibiotics, gabapentin, clonidine, metrogel, IPL, etc. Nothing worked like this. Good luck! Feel free to respond, I’ll try to answer questions.

    • LH says:

      Hi Mark,

      Not sure if you’ll ever get this. I have the same cyclical flushes as well a(nd am also located in the Palo Alto area). Was wondering if your flushing was accutane-induced? From what I understand anti-malarials typically help in accutane-induced cases …. but since I’ve never used accutane before, I’d be curious if plaquenil helped for a non accutane case.

      Anyway, hope the plaquenil is still helping, and best of luck to you.

  12. LH says:

    Hi Mark,

    Not sure if you’ll ever get this. I have the same cyclical flushes as well a(nd am also located in the Palo Alto area). Was wondering if your flushing was accutane-induced? From what I understand anti-malarials typically help in accutane-induced cases …. but since I’ve never used accutane before, I’d be curious if plaquenil helped for a non accutane case.

    Anyway, hope the plaquenil is still helping, and best of luck to you.

    • Sara says:


      Your comment is the first mention I have seen of neurogenic rosacea being accutane induced and I really think this happened to me. I am only 22 and wanted to take accutane because of the “perfect skin” so many people promised. I think it was a terrible mistake. Coming off accutane (~3 weeks ago) initially caused small pustules around my nose and mouth. I started doxy which got rid of these. But then, I started getting big red blotches around my nose and mouth any time I ate. So, I stopped eating around other people and honestly my skin has really devastated my mental/social health. Because my next symptom has been intense pain and burning, often accompanied by bright redness but not always, all through my face. I can hardly sleep because it hurts so badly. NSAIDS and putting aloe/lidocaine on my face, as well as sitting in front of a fan seem to help a little. Any moisturizer I use seems to cause a severe reaction. I recently moved and my dermatologist back home has given me a new regimen of rhofade and moisturizers to use. The dermatologist I saw here said it was just “normal flushing and blushing” that happens a lot in whites. I’m trying the regimen that my old dermatologist recommended but it’s not going so well since nearly anything I put on my skin burns a lot. I’m going to see another dermatologist here (Madison, WI) in a few days and I really hope it’s helpful. Several doctors have told me that the after effects of accutane only last a few months so this should get better soon; but I don’t know what to believe. It seems like if I do have neurogenic rosacea, it’s here to stay. I know everyone on here is suffering but since this is so new for me, I am really devastated and scared and heart-broken. I will try to talk to my doctor about the plaquenil…

      • Mark Christie says:

        As per my reply above, plaquenil still working well at same 400mg/ day dose. Also use Metoprolol prn. Have only seen improvement since beginning Plaquenil some 2+ years ago. I still see Dr. Murase at PAMF in Mountain View. I recommend her for neurogenic Rosacea. I had also seen Dr. Martin Steinhoff and Dr. Berger at UCSF prior. I believe these are some of the most knowledgeable in the world about neurogenic rosacea. Hope you find equal care.

  13. lea says:

    Can anyone recommend a doctor that specializes in the treatment or Rosaeac or at least is sophisticated in their treatment of it? The dermatologists I have seen only offer IPL or Excel V treatment.

    • LH says:

      Hi lea,

      I don’t think there are too many who are sophisticated in their treatment. I suggested some of the meds described above and my primary care agreed to try some of them. Treatment is generally trial and error anyway. Most derms get boxed in to the “rosacea” diagnosis and only know to prescribe soolantra, metrogel, finacea, lasers etc when those will likely not be effective for neurogenic rosacea.

      Dr. Berger (UCSF) in the study has seen many with neurogenic rosacea. Essentially, he is recommending that I try the different meds described above one at a time to see what I respond to.

      Good luck.

      • Avery says:

        Thank you LH! Derm today was not familiar with neurogenic rosacea. It is very frustrating. She won’t help with try the different drugs.

        • LH says:

          Sorry to hear that, but I’ve totally been there. Perhaps going a different route with a rheumatologist or neurologist would be more helpful at a large teaching hospital if you can. If you get a Dr who is not helpful, ask them if they can refer you to someone knowledgable in flushing/burning…. Derms in private practice in particular will TYPICALLY just be knowledgable about standard cases. My 2 cents. Keep on trying 🙂

          • Avery says:

            Thank you! I am definitely going to get to a large teaching hospital. I have an appointment with a endocrinologist Monday.

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