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Thread: Weighing options from small to drastic: any advice?

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    Default Weighing options from small to drastic: any advice?

    The question:

    I have time now where I could do something with more recovery time or more drastic and trying to weigh options. Things Iím considering: PDL (bruising or not), micro ETS (I know, I know about mixed experiences with this and have read scientific studies and personal reports. About half my flushing is anxiety/stress and I have a very public facing job that requires hours of talking/presenting, which is the only reason Iím considering it at all, plus my social phobia re blushing has seriously curtailed my social life.), changing medication or increasing dose (higher dose of mirtazapine? Trying Effexor again, although it caused flushing responses when I tried in past. Other?). Any suggestions on these options or on things Iím not thinking of? I have tried beta blockers and many different antidepressants.)

    Background:

    1.5 years since first diagnosed with Type 1 & 2. Have tried virtually all medication and creams plus laser genesis (4) and IPL (2) and havenít noticed big differences from the latter.

    Baseline redness isnít too bad, but this is when Iím cool, seated, relaxed, etc. Flush every day, multiple times a day, to varying degrees. Can flush to scarlet, with major triggers being heat and anxiety. Lately, nose flushing has returned for some reason. Type 2 is pretty under control.

    Diet: I eat about 4 foods because most else causes issues (I probably splurge on a few others sometimes but staple diet is just a few foods.)

    For flushing: on .2mg Clonidine patch, 2mg klonopin, 15 mg mirtazapine. I also use a cream that is a blend of metrogel, Soolantra, and finacea- not sure if that helps redness or just Type 2.

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    Senior Member laser_cat's Avatar
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    Quote Originally Posted by Chai View Post
    The question:

    I have time now where I could do something with more recovery time or more drastic and trying to weigh options. Things I’m considering: PDL (bruising or not), micro ETS (I know, I know about mixed experiences with this and have read scientific studies and personal reports. About half my flushing is anxiety/stress and I have a very public facing job that requires hours of talking/presenting, which is the only reason I’m considering it at all, plus my social phobia re blushing has seriously curtailed my social life.), changing medication or increasing dose (higher dose of mirtazapine? Trying Effexor again, although it caused flushing responses when I tried in past. Other?). Any suggestions on these options or on things I’m not thinking of? I have tried beta blockers and many different antidepressants.)

    Background:

    1.5 years since first diagnosed with Type 1 & 2. Have tried virtually all medication and creams plus laser genesis (4) and IPL (2) and haven’t noticed big differences from the latter.

    Baseline redness isn’t too bad, but this is when I’m cool, seated, relaxed, etc. Flush every day, multiple times a day, to varying degrees. Can flush to scarlet, with major triggers being heat and anxiety. Lately, nose flushing has returned for some reason. Type 2 is pretty under control.

    Diet: I eat about 4 foods because most else causes issues (I probably splurge on a few others sometimes but staple diet is just a few foods.)

    For flushing: on .2mg Clonidine patch, 2mg klonopin, 15 mg mirtazapine. I also use a cream that is a blend of metrogel, Soolantra, and finacea- not sure if that helps redness or just Type 2.
    I personally found 60 mg propranolol ER / day or higher to specifically help with social / anxiety flushing/burning for me, maybe 90%+. Unfortunately that wasn't one of my goals really ("time of day", heat, etc are the disabling guys for me ... I do flush every time I talk to non-family but I'm happy working at home / being a hermit and so just take propranolol as needed.) I've tried clonidine pills and patch and + personally neither form helped me for social/anxiety flushing, which was surprising bc that's what I thought it was supposed to be good for. Propranolol or nadolol (nadolol is the more extreme vasoconstrictor) was oddly superior (also better than clonazepam). I know you tried propranolol before but not sure about the higher dose / ER. I think it might take ~2 wks to start to see effects but a reasonable trial according to my derm would be 1 month (I tapered off super slowly by opening the capsules to limit rebound). Low dose propranolol (which I think you tried) might decrease the natural sympathetic vasoconstriction (by blocking beta 1 receptors on presynaptic terminals, possibly increasing flushing) without enough to block the Beta 2 receptors to facilitate some peripheral vasoconstriction. As I increased the dose, I noticed I was paler + the effect was stronger, eg.

    Nose flushing for me was triggered by all vasoactive meds unfortunately - clonidine being the worst. Nerve pain meds and anti-inflammatories seemed to be the way to go for me on that. Buprenorphine/ and other opioids were oddly great at getting rid of it, as well as NSAID's. At low dose, suboxone would actually be less sedating to me than your doses of clonidine + clonazepam, but understand everyone's different. My derm said at one point I could pulse indomethacin on/off for a couple wks if I wanted but I didn't pursue that. Zonisamide (an anti-seizure) helps my nose + swelling, as well as cymbalta and nuva ring to keep hormones low and constant (nose flushing was always worse around ovulation). It's not a cure but at least it's no longer daily.
    I think several ppl on here notice NSAID's like ibuprofen to help their nose. An earlier member "Barbara" noticed Paxil helped her nose - so i think SSRI's might also be helpful. Effexor made my bp jumpy and worsened my nose flushing for me personally.
    I vaguely remember someone saying LDN helped their nose.

    It must be so tough having a people-oriented job on top of flushing issues and phobia about it. hope this maybe gives you some ideas
    Last edited by laser_cat; 16th June 2019 at 03:10 AM.

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    Quote Originally Posted by laser_cat View Post
    I personally found 60 mg propranolol ER / day or higher to specifically help with social / anxiety flushing/burning for me, maybe 90%+. Unfortunately that wasn't one of my goals really ("time of day", heat, etc are the disabling guys for me ... I do flush every time I talk to non-family but I'm happy working at home / being a hermit and so just take propranolol as needed.) I've tried clonidine pills and patch and + personally neither form helped me for social/anxiety flushing, which was surprising bc that's what I thought it was supposed to be good for. Propranolol or nadolol (nadolol is the more extreme vasoconstrictor) was oddly superior (also better than clonazepam). I know you tried propranolol before but not sure about the higher dose / ER. I think it might take ~2 wks to start to see effects but a reasonable trial according to my derm would be 1 month (I tapered off super slowly by opening the capsules to limit rebound). Low dose propranolol (which I think you tried) might decrease the natural sympathetic vasoconstriction (by blocking beta 1 receptors on presynaptic terminals, possibly increasing flushing) without enough to block the Beta 2 receptors to facilitate some peripheral vasoconstriction. As I increased the dose, I noticed I was paler + the effect was stronger, eg.

    Nose flushing for me was triggered by all vasoactive meds unfortunately - clonidine being the worst. Nerve pain meds and anti-inflammatories seemed to be the way to go for me on that. Buprenorphine/ and other opioids were oddly great at getting rid of it, as well as NSAID's. At low dose, suboxone would actually be less sedating to me than your doses of clonidine + clonazepam, but understand everyone's different. My derm said at one point I could pulse indomethacin on/off for a couple wks if I wanted but I didn't pursue that. Zonisamide (an anti-seizure) helps my nose + swelling, as well as cymbalta and nuva ring to keep hormones low and constant (nose flushing was always worse around ovulation). It's not a cure but at least it's no longer daily.
    I think several ppl on here notice NSAID's like ibuprofen to help their nose. An earlier member "Barbara" noticed Paxil helped her nose - so i think SSRI's might also be helpful. Effexor made my bp jumpy and worsened my nose flushing for me personally.
    I vaguely remember someone saying LDN helped their nose.

    It must be so tough having a people-oriented job on top of flushing issues and phobia about it. hope this maybe gives you some ideas
    Thanks for all the feedback! Youíve given me a lot to think about. I talked to a new dermatologist today and she recommended PDL and Botox. You tried Botox, right, with some success? Is there a reason you didnít keep doing it? I never found a dr who had done it for rosacea until today.

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    I still do botox and find it specifically (partially) helpful for "time of day" flushing. Not at all helpful for anxiety flaring unfortunately.

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    Quote Originally Posted by laser_cat View Post
    I still do botox and find it specifically (partially) helpful for "time of day" flushing. Not at all helpful for anxiety flaring unfortunately.
    Ah, thatís unfortunate because thatís scout half of mine... Iím going to give it a try though.

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    Quote Originally Posted by Chai View Post
    Diet: I eat about 4 foods because most else causes issues (I probably splurge on a few others sometimes but staple diet is just a few foods.)
    What four foods are you ingesting. What fluids are your drinking?
    Brady Barrows
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    Quote Originally Posted by Brady Barrows View Post
    What four foods are you ingesting. What fluids are your drinking?
    Oatmeal, blueberries, peas, and eggs (although I donít eat eggs as often). I sometimes have a little cheese or chocolate with seeming no adverse effects. Liquids: water.

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    Quote Originally Posted by laser_cat View Post
    I still do botox and find it specifically (partially) helpful for "time of day" flushing. Not at all helpful for anxiety flaring unfortunately.
    Do you have any thoughts about doing PDL and then Botox shortly after, or whether it would be better to try Botox first by itself? I have mixed feelings- I could get rid of some underlying redness potentially with PDL but it might interfere with assessing the Botox.

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    Quote Originally Posted by Chai View Post
    Do you have any thoughts about doing PDL and then Botox shortly after, or whether it would be better to try Botox first by itself? I have mixed feelings- I could get rid of some underlying redness potentially with PDL but it might interfere with assessing the Botox.
    Of the medications you've not tried, hydroxychloroquine is the one that helped me most with flushing. This was far more helpful for me compared to mirtazapine. Gabapentin is also an option.

    Moxonodine does not seem to be prescribed very often but worked far better for me than clonidine, as the blood pressure does not rise just before it's time to take the next dose. You would just take one or the other as they are both alpha blockers, but moxonodine is a newer, more effective hypertension drug.

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    Quote Originally Posted by antwantsclear View Post
    Of the medications you've not tried, hydroxychloroquine is the one that helped me most with flushing. This was far more helpful for me compared to mirtazapine. Gabapentin is also an option.

    Moxonodine does not seem to be prescribed very often but worked far better for me than clonidine, as the blood pressure does not rise just before it's time to take the next dose. You would just take one or the other as they are both alpha blockers, but moxonodine is a newer, more effective hypertension drug.
    I would like to try moxonodine because I usevthe clonidine patch to avoid rebound but my skin has a terrible reaction to the patch (gets all red and itchy for awhile). But my gynecologist is the only one who prescribed clonidine and I havenít seen studies if moxonodine and hot flashes so Iím not sure who would give it to me. I guess I can ask the new derm. The ones I have seen before never want to prescribe oral antiflushing meds - one even said she never treats flushing because it just looks like a flattering blush. :P

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