Erythematotelangiectatic Rosacea: A Patient Journey Case Report
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Keywords
Erythematotelangiectatic Rosacea, Rosacea, Flushing, Facial Flushing, facial erythema, Subtype 1 Rosacea
Abstract
Introduction: The flushing of erythematotelangiectatic rosacea (ETR) can be challenging to treat and a source of psychosocial impairment. Topical vasoconstrictors are currently the only FDA-approved medications, and patients may experience rebound erythema with use.
Case: We present a patient with early onset erythematotelangiectatic rosacea with intense flushing who failed topical vasoconstrictors but was successfully treated with nontraditional therapies, including aspirin, a botanical skin care regimen, and topical pimecrolimus. The patient also experienced cyclic flushing related to tricyclic combined oral contraceptive pill, which abated when switching to a monocyclic version.
Conclusion: For patients with flushing who fail vasoconstrictor therapy, alternative treatments may be valuable but are not yet well characterized. Aspirin therapy is described for niacin-induced flushing but is not widely recognized as a rosacea remedy. Hormonal fluctuations may be an underrecognized contributor to rosacea. Botanical skin care products may be of value to patients combatting redness; thus, more studies would be necessary to examine if the effectiveness is generalizable to other patients with flushing. Mainstays of ETR management are sunscreen, trigger avoidance, topical vasoconstrictors for patients who can tolerate, and visible light treatments (intense pulsed light and pulse dye laser).
References
2. Yang F, Wang L, Shucheng H, Jiang X. Differences in clinical characteristics of rosacea across age groups: A retrospective study of 840 female patients. J Cosmet Dermatol. 2023 Mar;22(3):949-957. doi: 10.1111/jocd.15470.
3. Okwundu N, Cline A, Feldman SR. Difference in vasoconstrictors: oxymetazoline vs. brimonidine. J Dermatolog Treat. 2021 Mar;32(2):137-143. doi: 10.1080/09546634.2019.1639606.
4. Rainer BM, Kang S, Chien AL. Rosacea: Epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017 Oct 4;9(1). doi: 10.1080/19381980.2017.1361574.
5. Choudry K, Humphreys F, Menage J. Rosacea in association with the progesterone-releasing intrauterine contraceptive device. Clin Exp Dermatol. 2001 Jan;26(1):102. doi: 10.1046/j.1365-2230.2001.00770-3.x.
6. Wu WH, Geng H, Cho E, Eliassen AH, Drucker AM, Li TY, Qureshi AA, Li WQ. Reproductive and hormonal factors and risk of incident rosacea among US White women. J Am Acad Dermatol. 2022 Jul;87(1):138-140. doi: 10.1016/j.jaad.2021.06.865.
7. Bubna AK. Aspirin in dermatology: Revisited. Indian Dermatol Online J. 2015 Nov-Dec;6(6):428-35. doi: 10.4103/2229-5178.169731.
8. O'Gorman J, Russell HK, Li J, Phillips G, Kurukulasuriya NC, Viglietta V. Effect of Aspirin Pretreatment or Slow Dose Titration on Flushing and Gastrointestinal Events in Healthy Volunteers Receiving Delayed-release Dimethyl Fumarate. Clin Ther. 2015 Jul 1;37(7):1402-1419.e5. doi: 10.1016/j.clinthera.2015.03.028.
9. Truitt EB Jr, Gaynor CR, Mehl DL. Aspirin attenuation of alcohol-induced flushing and intoxication in Oriental and Occidental subjects. Alcohol Alcohol Suppl. 1987;1:595-9.
10. Deng Z, Xu S, Peng Q, Sha K, Xiao W, Liu T, Zhang Y, Wang B, Xie H, Chen M, Li J. Aspirin alleviates skin inflammation and angiogenesis in rosacea. Int Immunopharmacol. 2021 Jun;95:107558. doi: 10.1016/j.intimp.2021.107558.
11. Zedmed.com. https://www.zedmed.com. Accessed June 25, 2024.
12. Semenescu I, Similie D, Diaconeasa Z, Danciu C. Recent Advances in the Management of Rosacea through Natural Compounds. Pharmaceuticals (Basel). 2024 Feb 6;17(2):212. doi: 10.3390/ph17020212.
13. Gentili G, Perugini P, Bugliaro S, D'Antonio C. Efficacy and safety of a new peeling formulated with a pool of PHAs for the treatment of all skin types, even sensitive. J Cosmet Dermatol. 2023 Feb;22(2):517-528. doi: 10.1111/jocd.15215.
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Sarah L. Taylor, 1. Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; 2 Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Dermatologist. MD, MPH. Associate Professor in the Department of Dermatology.
Steven R. Feldman, 1. Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; 2 Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; 3. Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; 4. Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
MD, PhD. Dermatologist. Professor in the Department of Dermatology. Professor of Social Sciences and Health Policy. Professor of Pathology.