Rosacea option - Brimonidine gel
Rosacea is one of those diseases that seems to either be really easy to control or absolutely frustrating to treat adequately. In UpToDate it specifically mentions that trial and error is the most common approach to treatment options. As with all skin things, there's a good summary up on Dermnet (although I was surprised by the Rosex advert at the top of the screen!) that confirms we don't really know the aeitology. This goes some way to explaining why it's hard to treat in some cases. The basics apply to all patients with avoidance of precipitating factors coming front and centre (hot showers, spicy food, caffeine, alcohol all common triggers - monastic living could be useful), but I recently found out that there's a newish treatment option available for rosacea erythema which seems to be getting a good wrap on patient support group websites. Brimonidine tartrate gel was approved by the TGA in August last year lagging behind the FDA approval in 2013. The research appears to show a significant difference between the active ingredient and the carrier alone in reducing facial erythema. It's a highly selective alpha2-adrenergic receptor agonist and works through cutaneous vasoconstriction. Makes sense it can reduce erythema. Noted though are the potential adverse effects reported as: erythema, pruritus, flushing and skin burning sensation! Contraindicated in concurrent use of TCA, MAOI, tetracyclic antidepressants. Use is once daily and results are usually seen pretty quickly. Might be worth a try. References: http://dermnetnz.org/acne/rosacea.html https://www.tga.gov.au/artg/artg-id-212325 CMI and PI http://www.dermnetnz.org/treatments/brimonidine.html http://emedicine.medscape.com/article/1071429-overview










