Systemic Therapy for Rosacea

H. E. Baldwin, MD


Skin Therapy Letter. 2007;12(2) 

In This Article

Drugs That Antagonize Flushing

Many anecdotal reports exist regarding the use of agents that antagonize the flushing reaction, including vasoconstricting agents, and drugs that alter flushing reactions in response to emotional stimuli.

Beta blockers in low doses (i.e., nadolol,[9] naloxone,[42] ondansetron,[43] aspirin,[44] and numerous selective serotonin reuptake inhibitors[19]) have been reported in isolated cases to be effective. However, there is no evidence-based research to support their use.

Craige and Cohen recently revisited the use of propranolol in the control of flushing and blushing.[45] At starting doses of 10mg t.i.d., none of their nine patients improved. Six of nine patients improved when doses were escalated to 20-30 mg t.i.d. At such high doses, three patients withdrew from the study due to side-effects. This study shows that the perceived ineffectiveness of beta blockers may be due to inadequate dosing.

Clonidine has also been reported to improve flushing and blushing reactions at doses of 0.05mg b.i.d.[46] At this dose there was no reduction in blood pressure, but lower baseline malar temperature may have been reduced by peripheral vasoconstriction. Although some patients do remarkably well on clonidine, responders are not clinically identifiable before treatment. Since control of this feature of rosacea is so difficult, a trial course may be indicated.


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