Although flushing may be the most difficult component of rosacea to treat, it can be controlled with a variety of options that must be tailored to each individual -- including medications for severe cases -- according to physicians now developing standard disease management options as part of a consensus committee organized by the National Rosacea Society (NRS).
"Of course, avoiding personal rosacea triggers -- the environmental or lifestyle factors that cause a flare-up in a particular individual -- may be the best way to avoid flushing and redness," said Dr. Jonathan Wilkin, chairman of the NRS medical advisory board. "Many of the common trigger factors relate to flushing, and exposure can often be reduced with simple lifestyle modifications."
Patients can identify and then avoid their personal rosacea triggers by keeping a diary, and a diary booklet is available on request from the NRS at no charge. According to an NRS patient survey, the most common rosacea triggers include sun exposure, stress, hot or cold weather, wind, heavy exercise, alcohol, hot baths and spicy foods.
"In severe cases, medications are sometimes prescribed as adjunctive therapy to reduce the flushing associated with rosacea," Dr. Wilkin continued. "While no drugs have been approved by the Food and Drug Administration (FDA) specifically to reduce flushing, certain medications may be used to lessen the intensity and frequency of this prevalent sign of rosacea."
He emphasized, however, that there is no single medical therapy that is effective against all of the possible forms of flushing, and treatment must be selected according to the cause. For example, physicians may prescribe aspirin or similar agents, antihistamines and other medications to help reduce flushing from substances that cause the blood vessels to dilate -- such as alcohol, certain drugs, the vitamin niacin or certain of the body's own chemicals such as histamine.
On the other hand, he said, flushing controlled by the autonomic nerves -- that is, an unconscious response that causes flushing accompanied by sweating -- often results from such factors as warm temperatures, heavy exercise or hot beverages. In these cases, he said, flushing may be reduced or even blocked by cooling the neck and face with a cold wet towel or fan. Ice chips held in the mouth and drinking ice water may also be effective.
"In some cases, clonidine or a beta-blocker such as nadolol may be prescribed to reduce stress-related flushing," he said. For flushing that may be linked to the hot flashes of menopause, on the other hand, he advises women to consult their gynecologist or family physician about the appropriateness of hormone replacement therapy.
Flushing may also have emotional origins, Dr. Wilkin said, and these individuals may benefit from psychological counseling or biofeedback.
He stressed that medications to help reduce flushing may not be sufficient to control associated rosacea, and that long-term medical therapy specifically for rosacea may be needed to combat inflammation. Medications have been extensively studied, as well as approved by the FDA, to treat the papules (bumps) and pustules (pimples) of rosacea, and their long-term use has been shown to significantly reduce recurrence.1
- Physician's Desk Reference