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  • Accutane-induced flusing - starting Remeron

    Hi all,

    I've been lurking on this forum for a couple months now. I finished a 6-month course of Accutane in October of this year. I weigh about 180lbs / 85kg and took 11,700mg over the 6 months (30, 60, 60, 80, 80, 80 mg per day). I'm male and in my early 30's and didn't have a problem with acne (aside from typical hormonal teenager/college-aged) until a few months after I got Ecoli food poisoning a couple years ago. I had mild, though very persistent acne for the past 2 years, until I started the Accutane which worked very well.

    When the overall facial redness from the Accutane started to dissipate I started noticing that my nose was still red and that I flush severely in hot rooms, when the sun was shining, from the television, from hot meals or hot drinks, and/or in anxiety situations. The flushing usually would come on in the mid-afternoon when the sun heats up my office a few degrees, and then it oftentimes hits at night between 8pm and when I fall asleep. The flushing persists for several hours and oftentimes is painful.

    I went to the derm in November (same one who gave me Accutane) and she said I had the early stages of Rosacea. She prescribed me Metrogel and the beta blocker Nadolol. I was concerned the Metrogel would make me redder and irritate my skin, so only tried it on my nose. It hasn't done anything. The Nadolol (20mg per day) I used for a couple weeks but gave me chest pains and severe tightness and trouble breathing sometimes, so I discontinued it. I'm waiting for another derm appointment in January.

    In the meantime, I went to my GP, told him my situation, and told him that I've heard good things about Remeron. I also told him that with my having changed jobs and recently buying a house, and now the flushing, I've been very anxious and depressed because of the flushing. He did some research, was not convinced and was a little suspicious about Remeron's effect on flushing, but prescribed it to me for 15mg once per day at night for one month and then to report back to him.

    What are your thoughts on its chances of working? Especially for post-Accutane flushers?

    Thanks in advance.
    Chris

  • #2
    Hi Chris,

    Welcome to the forum. I suffer from severe flushing and burning of my face to a multitude of triggers. Although I have never taken accutane, I do take remeron 15mg daily and also clonidine. I've been taking them both for a couple of months, and have noticed a little effect, although nowhere near enough to curb my flushing ( but I am quite a severe case).

    Are you based in the U.K? If so you may want to look into a consultation with Professor Tony Chu, based in London. A number of accutane induced flushers see him and he is known to prescribed a medication called Mepacrine- an anti-malarial type medication. ( Do a search on the forum, such as accutane mepacrine). Many post accutane flushers have found this medication helpful and even though I have never taken this medication I am looking into trying it. Although a private consultation is not cheap, it may be well worth it in the long run. It just depends on how severe you feel your flushing is. There is probably zero chance that a GP would/could ever prescribe this medication.

    I hope the remeron does have an effect though, but if not, please do not feel there is nothing else that could possibly help.

    Feel free to private message if you ever need someone to discuss it with!

    Take Care,

    Ben.

    Comment


    • #3
      Thanks for the info Ben. I'm based in the U.S., on the east coast, but if all else fails I'll plan for my next vacation to be to London so I can meet with him, maybe this summer.

      The flushing on my cheeks is very frustrating, and now there's a residual redness that's developed. My nose is always red too. A fair/light tinted moisturizer does a half-decent job of covering my cheeks, but not my nose (the moisturizer doesn't absorb into it). But a serious flushing episode will go right through the tint on my cheeks.

      My primary concern is whether the flushing will lead to a more serious form of rosacea? Are you aware of any flushers (particularly post-accutane flushers) who move on to the more serious subtypes of rosacea? Will mere persistent flushing of the face cause it to happen, or does there need to be something additional that causes the P&Ps, etc.?

      I'm hopeful that the remeron will work. The nadolol was not at all helpful and caused serious chest pain. I'm waiting until the weekend and the Christmas-New Year's week I'll spend at my family's, before starting the remeron, so someone is there with me just in case I have some reaction.

      What do you think about me (or generally post-accutane flushers) and the clonodine? Will I have a similar result (not helpful for flushing, and maybe painful for my chest)?

      Thanks again!
      Chris

      Comment


      • #4
        Hi Chris,
        I don't post on here too often, but I am one who took Accutane for about 8 months and was left disabled by severe and painful flushing that started from taking Ac****ane. Similar to you, I did not have much acne, but I was getting what seemed like acne under my left eye. The dr prescribed antibiotics and the so called acne would go away, but then it would return when I stopped, so the derm I was seeing felt Accutane was the answer. This was before you could just look things up easily on the internet, so I took his advice and took Accutane. Around month 3 I was flushing more and more and the derm told me it was rosacea and that it would stop when I stopped taking it. I wanted to stop, he wanted me to continue, so I stayed on a little longer, but then felt I had to start tapering off. Instead of getting better, I got much, much worse. Intense severe flushing and extreme pain that was only relieved by cooling. I am essentially legally disabled from this flushing with pain. I really feel it is more like Erythromelalgia (EM) than rosacea, which is why I don't post here as often, but technically, it overlaps with neurogenic rosacea. I have seen over 150 drs and tried countless meds and txs to help control the flushing and therefore the pain, and have found a few things that help a little, but nothing that has allowed me to function normally. I am bound by the needs for colder temps, medication and often a fan to help reduce and manage the pain. I don't want to frighten you, but there are others like me, that have had this reaction to Accutane and some who are like this for other reasons. Along with the flushing and pain, I have also stopped sweating, which was verified by the Mayo Clinic.

        Nadolol is a beta blocker and did not help me, nor did Remeron, but both are worth trying. Remeron can make you sleepy, so many people take it before bedtime. I took clonidine for many years and it helped for awhile, but that wore off and it was really hard to taper off of. I was very ill from clonidine withdrawal and it took a long time. Finding relief is trial and error of medications and treatments. If I can be of help to you, feel free to email me directly and I can discuss medications and txs that might help.

        I hope you are able to get your flushing under control. It sounds like you do not have the pain, which is very lucky.
        Take care,
        Meg

        Originally posted by chris1234 View Post
        Thanks for the info Ben. I'm based in the U.S., on the east coast, but if all else fails I'll plan for my next vacation to be to London so I can meet with him, maybe this summer.

        The flushing on my cheeks is very frustrating, and now there's a residual redness that's developed. My nose is always red too. A fair/light tinted moisturizer does a half-decent job of covering my cheeks, but not my nose (the moisturizer doesn't absorb into it). But a serious flushing episode will go right through the tint on my cheeks.

        My primary concern is whether the flushing will lead to a more serious form of rosacea? Are you aware of any flushers (particularly post-accutane flushers) who move on to the more serious subtypes of rosacea? Will mere persistent flushing of the face cause it to happen, or does there need to be something additional that causes the P&Ps, etc.?

        I'm hopeful that the remeron will work. The nadolol was not at all helpful and caused serious chest pain. I'm waiting until the weekend and the Christmas-New Year's week I'll spend at my family's, before starting the remeron, so someone is there with me just in case I have some reaction.

        What do you think about me (or generally post-accutane flushers) and the clonodine? Will I have a similar result (not helpful for flushing, and maybe painful for my chest)?

        Thanks again!
        Chris

        Comment


        • #5
          So sorry to read all the posts here.. I sometimes feel like invading accutane/ acne forums to WARN people for the possibility of developing rosacea from the accutane GRRRRRRR. So unnecessairy and terrible.

          I hope the remeron will help you, it helped me and I was having debilitating 24/7 flushing. I was prescribed clonidine and propranolol (another beta blocker, different from nadolol) with it and the combo knocked the flushing back quite a few notches. I would try different things if I were you and see what helps you best. I am also a patient of Dr Chu and he believes that once you can break the flushing cycle, the rosacea can reduce with time. I think he is right in this.
          Mepacrine is indeed another med that can help with the flushing and overall inflammation. I can't handle it personally but plaquenil (another antimalarial, like mepacrine, that is sometimes prescribed for rosacea/facial flushing) does help me. I wrote some info on my blog, fyi.
          The remeron does a pretty good job at improving depression and anxiety I find. 15 mg is prescribed often for rosacea but 30 mg, or 22,5 (1,5 tablet) have a stringer effect on the depression symptoms, and still help with the flushing. Try it out..

          best of luck
          My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

          Comment


          • #6
            I totally know what you mean about wanting to warn people about accutane and the negative side effects. However, the truth of the matter is that this medication helps some people in positive ways. I had a long discussion about this with a top dermatologist and I can see why it's a life saver for some people who suffer from severe acne. It's just also sad and upsetting that in some cases like mine, it can actually take a life as well. My guess is that for now, the good outweighs the bad, so it continues to get prescribed. And we can warn people, but anyone who feels desperate would likely try it no matter what we told them. I recognize that my case is rare, although there are others similar to me, perhaps not many as severe, but plenty with negative flushing after effects.

            Meg

            Originally posted by nat007 View Post
            So sorry to read all the posts here.. I sometimes feel like invading accutane/ acne forums to WARN people for the possibility of developing rosacea from the accutane GRRRRRRR. So unnecessairy and terrible.

            I hope the remeron will help you, it helped me and I was having debilitating 24/7 flushing. I was prescribed clonidine and propranolol (another beta blocker, different from nadolol) with it and the combo knocked the flushing back quite a few notches. I would try different things if I were you and see what helps you best. I am also a patient of Dr Chu and he believes that once you can break the flushing cycle, the rosacea can reduce with time. I think he is right in this.
            Mepacrine is indeed another med that can help with the flushing and overall inflammation. I can't handle it personally but plaquenil (another antimalarial, like mepacrine, that is sometimes prescribed for rosacea/facial flushing) does help me. I wrote some info on my blog, fyi.
            The remeron does a pretty good job at improving depression and anxiety I find. 15 mg is prescribed often for rosacea but 30 mg, or 22,5 (1,5 tablet) have a stringer effect on the depression symptoms, and still help with the flushing. Try it out..

            best of luck

            Comment


            • #7
              I know what you mean Meg and when people have bad acne I also understand that they will do whatever it takes to treat it. I had a mild eczema flare and forced the GP to prescribe me a steroid cream and that gave me the rosacea, how stupid.
              But what does bother me is that it isn't clear for people starting with accutane that it can cause rosacea with a certain % of people. It would be better perhaps if the pharmaceutical companies would be honest about side effects, instead of brushing it away as usual. When people with a history of blushing, fair skin and minor acne are put on accutane (as is the case in Holland sometimes), it might be worthwhile for them to be told by their doctor about the possibilities of developing rosacea and what this actually means. I know people who would now trade their acne for the rosacea they developped a hundred times and there are so many cases of this, yet there is no clear warning. I understand that that can be bad for business of course..
              My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

              Comment


              • #8
                If you have Accutane-induced rosacea flushing, it might be worth your while to do some reading about low-level red light therapy. It's a non-drug, external treatment that can help rebuild your facial skin and make it more tolerant to triggers while suppressing flushing, redness, and the inflammation that causes it. You should also see pain/stinging/burning reduced. Low-level RLT is gentle, non-irritating, and non-thermal and should not exacerbate your condition.

                If you have specific questions about how it relates to your own symptoms, please feel free to PM me.

                Best,

                David
                35 year-old male
                Erythmatotelangiectatic rosacea & Ocular
                20 + laser treatments.
                Toleraine Soothing Light Facial Fluid for moisturizer. I don't use a special cleanser. Clonidine daily; klonopin sometimes.
                BEST and CURRENT TREATMENT I use: Low-Level Red Light Therapy LED array.
                Please feel free to PM me with your low-level red light therapy (LLRLT) questions. I'm happy to help if I can.

                Comment


                • #9
                  I totally agree with you. All known side effects should be clearly stated up front. When I took it, I don't think this effect was widely known, but I did report it. The more people to report it, the more they will have to acknowledge this possible outcome.

                  Meg

                  Originally posted by nat007 View Post
                  I know what you mean Meg and when people have bad acne I also understand that they will do whatever it takes to treat it. I had a mild eczema flare and forced the GP to prescribe me a steroid cream and that gave me the rosacea, how stupid.
                  But what does bother me is that it isn't clear for people starting with accutane that it can cause rosacea with a certain % of people. It would be better perhaps if the pharmaceutical companies would be honest about side effects, instead of brushing it away as usual. When people with a history of blushing, fair skin and minor acne are put on accutane (as is the case in Holland sometimes), it might be worthwhile for them to be told by their doctor about the possibilities of developing rosacea and what this actually means. I know people who would now trade their acne for the rosacea they developped a hundred times and there are so many cases of this, yet there is no clear warning. I understand that that can be bad for business of course..

                  Comment


                  • #10
                    The remeron is working! I'm on 15mg and there's a noticeable reduction in frequency, severity, and painfulness of flushing episodes. Not a total elimination though, so I'm going to ask my GP to increase my dosage to 30mg or 45mg.

                    I'll keep everyone posted.

                    Comment


                    • #11
                      Weirdly enough the remeron usually works best at 15 mg... Sorry..
                      At 30 it still works but it might work slightly less than and at 45 mg there is a very low probability that it will work for the rosacea.
                      The reason is probably that remeron has a dual action mode; at 15-30 mg it works on serotonin levels mostly and at 30 mg and above it works more on noradrenaline
                      receptors. Both work for depression but at 15 mg it has significant anti histamine actions. hence why you gain most weight at that dose and are more hungry at 15 mg than on 45 mg. I find that at 30 mg the remeron is not as effective as at 15 mg and wrincledclue noticed the same thing recently she wrote. I would stick to 15 mg for a bit longer personaly if I were you and see, because it does get more effective over time as it builds up. 30 mg is an option as well (youll feel even less depressed then) but be aware of a potential reduction of its effectiveness then.
                      My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

                      Comment


                      • #12
                        Thanks for the information. I've been upped to 30 mg daily and it seems to be working somewhat but no better than before. If serotonin receptors are what I need to target, than would Prozac or another SSRI be better? Does Prozac or another SSRI have antihistamine effects as well?

                        Also, I think I may have developed a couple of rosacea plaques on my cheek. I have two small red irritated and very dry patches of skin that have developed in the past few days. They are flat with my skin, maybe raised a tiny bit. Could I be devleping subtype 2 rosacea already? Since I just came off accutane not even 3 months ago, shouldn't this be improbable?

                        Has any accutane users developed rosacea subtype 2 or worse?

                        Thanks

                        Comment


                        • #13
                          I don't know of any other antidepressant that targets rosacea and mainly rosacea flushing to be honest.. Mirtazapine is one of the only ones as far as I know that is also an antihistamine. It does affect the serotonine levels, but switches to npradrenaline above 30 mg a day. I think there were people on this forum who had some good success with Zoloft perhaps, there was another antidepressant that some here mentioned, perhaps do a search on it?

                          A few people I know mentioned some extra papulas while on mirtazapine, but most don't have this problem. I don't know about rosacea plaques though....
                          My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

                          Comment


                          • #14
                            Originally posted by nat007 View Post
                            I don't know of any other antidepressant that targets rosacea and mainly rosacea flushing to be honest.. Mirtazapine is one of the only ones as far as I know that is also an antihistamine. It does affect the serotonine levels, but switches to npradrenaline above 30 mg a day. I think there were people on this forum who had some good success with Zoloft perhaps, there was another antidepressant that some here mentioned, perhaps do a search on it?

                            A few people I know mentioned some extra papulas while on mirtazapine, but most don't have this problem. I don't know about rosacea plaques though....
                            The two spots on my skin turned out to be nothing, probably windburn or something.... As for my question about anti-anxiety plus antihistamine drugs, I wonder if anyone has tried Atarax (Hydroxyzine). It is a serotonin antagonist as well as an antihistamine.

                            Comment


                            • #15
                              Originally posted by nat007 View Post
                              Weirdly enough the remeron usually works best at 15 mg... Sorry..
                              At 30 it still works but it might work slightly less than and at 45 mg there is a very low probability that it will work for the rosacea.
                              The reason is probably that remeron has a dual action mode; at 15-30 mg it works on serotonin levels mostly and at 30 mg and above it works more on noradrenaline
                              receptors. Both work for depression but at 15 mg it has significant anti histamine actions. hence why you gain most weight at that dose and are more hungry at 15 mg than on 45 mg. I find that at 30 mg the remeron is not as effective as at 15 mg and wrincledclue noticed the same thing recently she wrote. I would stick to 15 mg for a bit longer personaly if I were you and see, because it does get more effective over time as it builds up. 30 mg is an option as well (youll feel even less depressed then) but be aware of a potential reduction of its effectiveness then.
                              I think you're right. Since upping my dosage to 30mg daily, I think it's less effective than at 15mg. As such, I thnk I need to try something else/extra.

                              Nat, I read the post on your blog (I think scarletnat is your blog?) thoroughly explaining how the anti-malarials are not the magic bullet for flushing that some people think they are. Have you received any responses from people you've reached out to or do you have any update or conclusions on plaquenil or mepacrine's efficacy?

                              Comment

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