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Thread: Painful burning- possible hormone connection?

  1. #51
    Senior Member laser_cat's Avatar
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    Quote Originally Posted by Chai View Post
    Hmmm. I didnít know lighting sensitivity could be autoimmune. Iím pretty sure thereís an autoimmune element. Hopefully my Dr next month can answer some questions about that.

    Iím not sure what she meant about calcium channel blockers. She said it kind of in passing and I thought I had read somewhere that some people try them for rosacea.

    Iím not taking mirtazapine- it was one that I tried and failed with. A beta blocker might be a good call though. I know a lot of my flushing is triggered by anxiety.

    I have taken the Trintellix for a few days- so far, just sick today my stomach and I feel kind of more red but that could be due to something else (stress, hormones, etc).
    Oops sorry re: mirtazapine - got you confused with rich good luck!

  2. #52
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    Iíve been on the Trintellix for anout 5 days and felt nauseated the whole time. But last night I woke up with my skin hurting and when I got up this morning, I had a dark red flush. It hasnít gone away since then (even with Clonidine and benzo) and it hurts a lot. Does this sound like a SSRI thing or something else? I havenít had anything this bad in a long time (at least thatís seemingly without a trigger, like stress or heat).

  3. #53
    Senior Member laser_cat's Avatar
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    Quote Originally Posted by Chai View Post
    I’ve been on the Trintellix for anout 5 days and felt nauseated the whole time. But last night I woke up with my skin hurting and when I got up this morning, I had a dark red flush. It hasn’t gone away since then (even with Clonidine and benzo) and it hurts a lot. Does this sound like a SSRI thing or something else? I haven’t had anything this bad in a long time (at least that’s seemingly without a trigger, like stress or heat).
    Chai - sorry to read ... I don't know. I do know SSRI's can help Raynaud's and cause a feeling of warmth for some people. Maybe if you are on clonidine, the warmth feeling might be more pronounced (since blood vessels might want to "spring back" from being constricted by clonidine)? I hope you eventually felt better. If I were you though -- I'd try to get a couple more data points before you stop the drug, if you stop the drug. Or maybe halve the dose for a while?

    Not sure if you are taking it for pain -- but I think there are other drugs known to work better for (neuropathic) pain. I thought

    https://myelitis.org/resources/medic...ropathic-pain/

    is a nice overview (second half, really). They seem to suggest:

    1) sodium channel blockers (mexiletine, topomax, etc) - sodium channels are hyper-excitable in sensory nerves
    2) gabapentin, lyrica to block calcium channels in CNS - these become upregulated as well
    3) antidepressants (tricyclics, SNRI's, NDRI's ... something about the serotonin and norepinephrine together ... possibly with dopamine .. not so much SSRI's)

    "The results from studies of the SSRIs in the treatment of painful diabetic neuropathy suggest that these agents are less effective than agents that affect both serotonin and norepinephrine. These drugs are great for the treatment of depression, but are not very effective for neuropathic pain."

    Not mentioned that might be worthwhile - botox, low dose naltrexone

    Good luck

  4. #54
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    Quote Originally Posted by Chai View Post
    I have extremely painful burning that occurs both with and without redness. Nothing seems to put a dent in the pain. It sometimes seems connected to hormonal fluctuations. Iím trying Yaz (second month) and Spiro (3 days, low dose) to see if I could control the hormonal fluctuations but so far the pain might be even worse (although the breakouts have diminished). Anyone with a similar experience? Anything work for you? I asked my dermatologist and she said she had never heard of it for rosacea and any topical thing she would normally prescribe would just make my rosacea worse. So basically she said- live with the fact that it feeeps like someone poured acid on your face sometimes. :P
    A big fat yes, is the answer to this question. Had my first flare up back in 2003 when I changed birth control, I stopped BCP and it eventually went, Rosacea free until I hit menapause, the burning came back bit time, worse than ever. So hormones are my trigger, the only thing that put a dent in my painful flushing and burning is celexa/citropram and an antihistamine everyday. I still flush, but not as bad, and the hideous burn has gone. Good luck

  5. #55
    Senior Member laser_cat's Avatar
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    btw - i think *sometimes* treating the nerve element can help to resolve the flushing/redness. Eg:

    https://entokey.com/refractory-eryth...to-mexiletine/ Mexiletine quiets the sensory nerves (may therefore reduce dilation by neurogenic inflammation) "An increase in the dose to 200 mg 3 times a day was attempted resulting in a dramatic improvement in pain and redness of his ears."

    https://www.jaad.org/article/S0190-9...347-3/fulltext neurogenic rosacea symptoms including swelling and redness responding to lyrica

    https://www.jaad.org/article/S0190-9...347-3/fulltext

    "This suggests that BoNT/A inhibits the release of these neurotransmitters from primary sensory neurons [8]. These neurotransmitters can act on blood vessels and induce vasodilatation. This can cause flares of weals to appear on the skin around lesions. By inhibiting the release of these neurotransmitters, BoNT/A can decrease tenderness and pain in areas where sensitized nociceptors are pathologically altered..."

    https://www.hindawi.com/journals/crim/2015/592170/ (This is a severe case of red, painful feet treated by an invasive procedure, but still interesting I thought, even if it might not necessarily apply to you)

    "In this frame Ziconotide could interfere with the neuroinflammatory circuit leading to inhibition of the vasoactive response, as this drug through its selective and potent action on N-type voltage-sensitive calcium channels is able to control neurotransmission at many synapses ... the unexpected improvement of leg and feet swelling and oedema after the treatment with the drug is a matter that deserves more attention for the use of Ziconotide also in other vasculopathies"

    best,
    Last edited by laser_cat; 3rd October 2018 at 10:45 PM.

  6. #56
    Senior Member nat007's Avatar
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    Quote Originally Posted by RichC View Post
    Hey Laser Cat,

    Im currently on 45mg of Mirtazipine, do you think this too high dosage to have an effect on blood vessels?

    And you mention Cymbalta, thats a new one to me, is that an SNRI like that of Effoxer?

    Also you mention Atenolol, thats a beta blocker if I am correct? How come you prefer this to over the common ones like Propranolol? Side effects etc etc?

    And what jappened to you taking Nadolol as im sure I have seen you talk about before?

    I am new to all this so feedback is very welcome as I am wanting to get on top of the burning cheeks and red skin episodes that come with rosacea and try to get it under control
    Hi Rich

    just chiming in also. My experience with mirtazapine was that at 15 mg it worked probably best for my flushing (against them I mean). But at that dose the antidepressant effect wasn't big enough, and the drowsiness related side effects were pretty noticeable. Derms I know prescribe mirtazapine however at 15 mg per day for flushing patients, exactly because at this dose the anti flushing effects are said to be highest. Mirtazapine works twofold, based on the dosing. Below 30 mg it has a stronger antihistamine effect, which is beneficial for us flushers. Above 30 mg it has a stronger noradrenaline effect, which is less interesting for anti-flushing effects, but at that higher dose it is more effective as an antidepressant. Hence why 15 mg a day is the official start up dose of mirtazapine for depressed patients, and not a stall dose.

    I experimented with different doses over the years and at 30 mg I found mirtazapine already less effective at controlling flushing. 45 mg might just be too high to get the full benefit from this med, as you will not have the highest antihistamine effects from it at that dose. I also stalled at 22,5 mg like Lizzy, because at that dose I find it good enough for flushing and also beneficial for cutting out (down) anxiety and depression....

    Maybe you can taper it (slowly!) off to a lower dose and notice what happens to your flushing? Mirtazapine can give quite strong cold turkey symptoms, including nausea, dizziness, brain zaps and restlessness (and as you already noticed terrible insomnia) if you go down quickly.
    Last edited by nat007; 6th October 2018 at 12:20 PM.
    Uses: 22,5 mg mirtazapine, clonidine and propranolol, Xyzal at times.
    Diet: trying low sugar, no gluten and dairy, high protein diet.
    Link to my rosacea blog:http://scarletnat.blogspot.com

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