Matija,

Sorry for replying so late. You are asking a $64,000 question and I have to give you a $64,000 answer (sic)!

We (derms) all wish we have the answer to your question as to how to treat swelling in rosacea.

I thought a lot about it and if the group members are willing to try this – do this for at least a month (unless there is problem) continuously and please post your responses. The body does not respond pronto – it takes its own sweet time…….

I believe that the swelling of the cheeks in rosacea, is due to flushing which causes hyperemia (an abnormally large amount of blood) to the face.

If one can control the flushing effectively, then the edema (swelling) will GRADUALLY subside. Of course, in the more severe cases of rosacea, inflammation also contributes to the edema but my guess is that the inflammation will also be controlled if the flushing is controlled.

Avoid Triggers

First, avoid triggers (which you all know).

Soothe the Skin

Second, control the target organ (skin) by soothing the inflammation and good skin regimen and use your appropriate topicals.

Control Flushing

Third, control the flushing, which is the hardest. Unfortunately, flushing can be caused by a myriad of chemical mediators such as histamine, prostaglandins, serotonin, lysyl- bradykinins, acetaldehyde, to name a few.

Flushing can also be caused by neural mediators as controlled by the autonomic nervous system. It seems that some people have blood vessels that are hypersensitive due to increased beta-adrenergic receptors in the muscles of the blood vessels walls or increased catecholamines in the nerve endings.

Some oral meds that help control flushing, may be hard on the system for some people. Examples are betablockers such as Propanolol; alpha adrenergic antagonist such as clonidine.

There are however, other OTC meds that are easier on the system such as: aspirin (blocks prostaglandin synthetase), antihistamines – ex. Chlor-trimeton which blocks H1 receptors; Cimetidine (Tagamet) which blocks H2 receptors. Pyridoxine (vit.B-6) has also been found to be helpful as a prophylaxis.

Swelling Relief Regime

Here’s a suggested regimen:

At bedtime:

• Take 1 baby aspirin;
• 1 chlor-trimeton (4 mg)
• 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)
• 1 Tagamet (200 mg).

During bouts of flushing, apply a cool (not cold) compress on face. Do deep breathing 10 times slowly.

Linda Sy M.D.
Linda Sy Skin Care

—–Original Message—–

From: ruizdelvizo@_.com>
To: rosacea-support@_.com>
Date: Friday, March 26, 1999 1:42 PM
Subject: [rosacea] ? For Dr. Sy

Hi Dr. Sy,

I have a question regarding swollen cheeks.

My cheeks always seem to be swollen, except when I’m absolutely relaxed AND not flaring. (In other words, even a little pink tone on my skin makes my cheeks swell up.) I’ve asked doctors about this and they say to cut back on the salt or lose weight.

I am pretty sure that this is related to rosacea since I’m at normal weight and don’t eat a lot of salty foods.

Do you know why this happens to people with rosacea? Could it be related to the leaky mast cells that Dr. Nase was talking about?

Also, do you know how to “depuff” the cheeks? They seem to be a symptom that I can do the least about (& ,of course, am the most frustrated with).

Any insight into this topic would be most appreciated!!

Thank you very much,

Matija

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