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Rosacea, chronic facial flushing, glandular fever, tiredness, triggers are hot weather, temperature fluctuation and sugar foods

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Dermatologist
Practicing since : 2005
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I have had a chronic condition for around 23 years. I know there is no cure but I want to become more adept at managing the symptoms, so I am hoping you maybe able to explain physiologically what is happening/over reacting in my body to cause the problem.

My primary diagnosis is rosacea. I am 37 years of age and the chronic facial flushing started at around 13 years of age. I found if I was in a hot atmosphere or drank a little alcohol, my cheeks would flush bright red.

As I got older I realised my triggers were also hot weather, any temperature fluctuation, eating (sugar XXXXXXX foods trigger an immediate flush), sugar or excess refined carbs also makes me spotty, caffeine.

I have managed my symptoms very well by not drinking, eating a very simple diet, extremely low in sugar etc, however I cannot control the flushing caused by physical activity/end of the day fatigue.

I have a physically active job with animals that sees me walking all day, cleaning out stables etc. By about midday my skin is starting to feel tingly and flushed. I cannot eat lunch at all as that would trigger an immediate hot, flushed face. Sometimes I am able to work another few hours until my face goes into a full flush, my eyes get bloodshot, and I get a crushing tiredness that makes me feel like a zombie. If I'm near a bed then I will fall into an immediate sleep, if not I am fighting the tiredness until the flush subsides hours later.

I've googled the symptoms and some people mention an overactive parasympathetic nervous system, but I wanted a medical opinion. My skin wll return to a normal state hours later where there is no residual redness or broken capillaries.

When I am not working my face is usually fine all day as long as I don't push my body too much physically.

Only other thing worth mentioning is I had glandular fever around the time this started, but it could be coincidental.

Thank you
Posted Thu, 7 Jun 2012 in Skin Hair and Nails
 
 
Answered by Dr. Sudarshan 6 hours later
Hi,
Thanks for writing in

I can understand your problem and will try to advise you accordingly.

Rosacea is a chronic disorder affecting the facial convexities, characterized by frequent flushing, persistent erythema and telangiectasia, interspersed by episodes of inflammation during which
swelling, papules are evident.

It can be controlled but not cured completely.

Etiology of rosacea is not completely known.

Infection by H .Pylori and demodex are thought to be causative in few cases.


Treatment of rosacea would be.
Oral antibiotics -Tetracycline antibiotics including doxycycline and minocycline reduce inflammation.

Sometimes other oral antibiotics such as cotrimoxazole or metronidazole are prescribed for resistant cases.

Topical treatment

Metronidazole cream or gel can be used intermittently or long term on its own for mild cases and in combination .

Azelaic acid cream or lotion is also effective.

-Isotretinoin

When antibiotics are ineffective or poorly tolerated, oral isotretinoin may be very effective.

Certain medications such as clonidine may reduce the vascular dilatation (widening of blood vessels) that results in flushing.

-Anti-inflammatory agents like diclofenac are useful.

-Calcineurin inhibitors such as tacrolimus are useful in rosacea.
In addition to the above medication, my trusted medication for rosacea is Dapsone.
Vascular laser: Persistent telangiectasia ( Visible blood vessels) can be successfully improved with vascular laser or intense pulsed light treatment.

Surgery with carbon dioxide laser may be helpful.



General measures in Rosacea would be.

Where possible, reduce factors causing facial flushing.
Avoid oil-based facial creams.
Use water-based make-up.
Never apply a topical steroid to the rosacea.
Protect yourself from the sun. Use light oil-free facial sunscreens.

Keep your face cool: minimize your exposure to hot or spicy foods, alcohol, hot showers and baths and warm rooms.

Please discuss these treatment options with your dermatologist as they are prescription medications.

Certain neutraceuticals like soya and XXXXXXX tree are available in market which are effective in reducing inflammation in rosacea.

Hope this helps you.

If you have any further queries ,feel free to ask them.

Regards
Dr Sudarshan
Dermatologist
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