The regulation of the cutaneous circulation is of paramount importance and is extremely complex. 3 While rosacea remains a disorder of uncertain etiology and pathogenesis, the abnormal flushing and persistent erythema have usually been theorized to arise from a dysregulation in the cutaneous vasomotor response, which, whether triggered by neurogenic, hormonal, thermal, topical, or other stimuli, has as its end result an abnormal and persistent dilation of facial blood vessels. It may be accompanied by facial edema, burning, or stinging. 1 - 3 Erythematotelangiectatic rosacea is the subtype of rosacea most characterized by its frequent episodes of transient facial erythema (flushing) and nontransient, or persistent, erythema. Rosacea is a common, chronic cutaneous disorder, the clinical manifestations and subtypes of which have been very well described and recently reviewed. Both patients had discontinued all other therapies directed toward their rosacea other than sunscreen use. At the last follow-up examination, patient 1 had continued treatment for 8 months and patient 2 for 17 months, with sustained effects. Neither patient experienced any adverse effects, has evidenced any rebound flares in erythema or other symptoms, or has demonstrated any tachyphylaxis to the current regimen. Patient 1 stated that “This is the first time my face has been normal in decades.” Six weeks after initiating once-daily application, patient 1 demonstrated continued control of the erythema and had complete relief of his facial stinging and burning.

Both patients elected to continue treatment on their own. She returned 3 months after initiating therapy and continued to evidence marked improvement in the erythema and had experienced no episodic flares or flushing.īoth patients were counseled that this treatment was “off label” and that even though the medication was over the counter, adverse effects could occur and could include the listed adverse effects of underlying heart disease, hypertension, thyroid disease, diabetes mellitus, and urinary retention. Two weeks after initiating therapy, she was so pleased with the response that she sent her physician (1 of us) (A.L.O.) a letter of thanks indicating that the treatment was still effective and that she had discontinued use of topical metronidazole, her most current treatment. Patient 2 reported a similar improvement in her appearance and symptoms.

Neither patient demonstrated a papulopustular component, phymatous component, or ocular component to their disease, and conventional therapeutic options had not been effective.īaseline photograph of patient 1 immediately prior to application of oxymetazoline, 0.05%, solution (A) and 3 hours after topical application (B), demonstrating marked improvement in macular erythema and fine telangiectasias. Our 2 patients demonstrate typical features of ETR rosacea with easily triggered, treatment resistant, socially embarrassing, persistent facial erythema and discomfort (stinging and burning). The pulsed-dye laser and, more recently, other nonablative laser and light therapies have been used to treat erythema and telangiectasias however, not all patients respond, multiple treatment sessions are required, recurrences are common, costs can be significant, and flushing is often persistent. Oral systemic agents such as β-blockers, clonidine hydrochloride, and spironolactone have little evidence of benefit these agents also have potential systemic adverse effects. Topical and oral antibiotics, standard treatment for papulopustular rosacea, are usually ineffective.

Shared Decision Making and CommunicationĮrythematotelangiectatic rosacea, in general, responds poorly to treatment.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.

Flushing side effect