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Thread: Worst flare up of flushing

  1. #11
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    Quote Originally Posted by laser_cat View Post
    Thanks, and thanks for the dosage references (will see my derm soon). It's interesting that plaquenil (anti-inflammatory - but don't know precise MOA) can correct this ... at least partially.

    I've never taken accutane but for ~10 yrs prior to flushing/burning onset, my lips would peel off / fall off each day. A recent lip biopsy showed some inflammation but nothing alarming. Clonidine I believe dried out my nose (a couple nose bleeds / wk) and seemed to accelerate nose flushing/burning symptoms. Got better after I went off, but never back to baseline on its own. I would understand I guess how severe drying out could set a cycle of hyper-reactivity in motion.
    From the erythromelalgia recommendations, I am trying Periactin, have you tried this yet? I am finding it quite helpful so far and much lower risk than accutane. Also, how is mexiletine going? Clonidine is not a very effective medicine I don't think from my experience - I still think it's worth trying moxonodine before accutane, though I know it's hard to get in the US (but it's far more effective). Similarly mexiletine is really hard to get in the UK, and I'm still trying to get it!

  2. #12
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    Quote Originally Posted by antwantsclear View Post
    I've found moxonodine works a lot better than clonidine - they both play a similar function, but moxonodine does not give rebound flushing just before you need the next dose and its effect does not wear off the longer you take it. Hydroxychloroquine (plaquenil) has also been very helpful for me.

    The other thing that can help is Zhongzhou cream because it controls the demodex mites, which nearly everyone has and has been shown to play a part in the rosacea process (both flushing and pustules).
    Sorry the question but if Plaquenil helps you are you sure it's not Lupus related? I heard it can be quite harsh on the eye.

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    Quote Originally Posted by opare View Post
    Sorry the question but if Plaquenil helps you are you sure it's not Lupus related? I heard it can be quite harsh on the eye.
    Yes you do have to have eye tests if you take hydroxychloroquine (plaquenil). The side effects are less severe compared to those recorded for accutane, however. Hydroxychloroquine can help with lots of conditions such as arthritis, type 1 rosacea flushing, lupus etc.

  4. #14
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    Quote Originally Posted by antwantsclear View Post
    From the erythromelalgia recommendations, I am trying Periactin, have you tried this yet? I am finding it quite helpful so far and much lower risk than accutane. Also, how is mexiletine going? Clonidine is not a very effective medicine I don't think from my experience - I still think it's worth trying moxonodine before accutane, though I know it's hard to get in the US (but it's far more effective). Similarly mexiletine is really hard to get in the UK, and I'm still trying to get it!
    I have not tried periactin - one derm brought it up but we put a pin in it for some reason. I'll bring it up next time. I don't hear of it much in EM communities but every now and then I hear it works very well for someone, even bringing them into remission, so my sense is it might be an underused medication.

    I recently tapered off the mexiletine, just due to side effects at 600 mg. For whatever reason it gave me brain fog that snuck up on me. I have not heard of anyone else actually having brain fog from it. Some people have GI upset which I oddly did not have. The night flaring came back when I got back down to 300 mg.

    I'll perhaps revisit the moxonidine with my PCP - she might have some ideas on how to get it (in US).

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    Thanks for all the replies!

    I saw the derm last week and he suggested upping my mirtzapine dose and eventually trying Plaquenil. He also suggested I perhaps try Montelukast first. I do get a lot of allergies all year round so perhaps it may help although after searching through these boards it seems other people's experiences haven't been great. Evening flushing especially after food and lying down is my main problem. Plus a lot of pain in my cheeks which is there all the time.

    I'm really wanting to lower my clonidine dose as I've developed some bad Raynaud's in my hands and feet so another beta blocker would be a no go for me. Although now I'm thinking maybe atenolol might work as it's selective. Never had Raynaud's before being on Clonidine. My GP actually thought the ear flushing that I've been having is a type of Raynaud's. I'm reluctant to stop the clonidine though as it makes me so pale and I'm scared about potential rebound but I'm getting this weird cold burning feeling where I think I'm about to flush and actually my cheeks are icy cold. Not good. I'm also getting weird itching sensations and pin pricks in my hands and feet with the cold weather.

    Would moxonidine be a better alternative? Might ask to switch.

    Laser_cat I took accutane at low dose, 10mg a week for many years as a maintenance dose for acne. It oddly made my baseline a lot paler however the flushing I eventually got on it was a lot deeper, my cheeks would swell up as well. The clonidine really helped take away the swelling for me. I was on multiple courses of accutane full strength and low dose throughout my life and it was only after so many years that I developed the flushing so don't let that put you off. It definitely made my allergies a lot better while I was on it and I never got any of the nose flushing that I get now plus the red hands and feet. But I guess it's very hit and miss. Your lips will definitely take a hit if you try the accutane. Even on low dose I still have really dry peeling lips and I stopped taking it about 9 months ago.

    I'd definitely like to try an SNRI. The mirtzapine really knocked out the flushing for me first time round but somehow that mechanism stopped working and was switched back recently with the change to cold weather.

    antwantsclear does Zhongzhou cream help with just the flushing type of rosacea? I don't get any p&ps, my skin's quite smooth. Just lots of damaged blood vessels that come and go. Also did you get any side effects from the Plaquenil?

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    Quote Originally Posted by owldog View Post
    Thanks for all the replies!

    I saw the derm last week and he suggested upping my mirtzapine dose and eventually trying Plaquenil. He also suggested I perhaps try Montelukast first. I do get a lot of allergies all year round so perhaps it may help although after searching through these boards it seems other people's experiences haven't been great. Evening flushing especially after food and lying down is my main problem. Plus a lot of pain in my cheeks which is there all the time.

    I'm really wanting to lower my clonidine dose as I've developed some bad Raynaud's in my hands and feet so another beta blocker would be a no go for me. Although now I'm thinking maybe atenolol might work as it's selective. Never had Raynaud's before being on Clonidine. My GP actually thought the ear flushing that I've been having is a type of Raynaud's. I'm reluctant to stop the clonidine though as it makes me so pale and I'm scared about potential rebound but I'm getting this weird cold burning feeling where I think I'm about to flush and actually my cheeks are icy cold. Not good. I'm also getting weird itching sensations and pin pricks in my hands and feet with the cold weather.

    Would moxonidine be a better alternative? Might ask to switch.

    Laser_cat I took accutane at low dose, 10mg a week for many years as a maintenance dose for acne. It oddly made my baseline a lot paler however the flushing I eventually got on it was a lot deeper, my cheeks would swell up as well. The clonidine really helped take away the swelling for me. I was on multiple courses of accutane full strength and low dose throughout my life and it was only after so many years that I developed the flushing so don't let that put you off. It definitely made my allergies a lot better while I was on it and I never got any of the nose flushing that I get now plus the red hands and feet. But I guess it's very hit and miss. Your lips will definitely take a hit if you try the accutane. Even on low dose I still have really dry peeling lips and I stopped taking it about 9 months ago.

    I'd definitely like to try an SNRI. The mirtzapine really knocked out the flushing for me first time round but somehow that mechanism stopped working and was switched back recently with the change to cold weather.

    antwantsclear does Zhongzhou cream help with just the flushing type of rosacea? I don't get any p&ps, my skin's quite smooth. Just lots of damaged blood vessels that come and go. Also did you get any side effects from the Plaquenil?
    Yes Zhongzhou cream does help quite a lot with the flushing of rosacea, especially when combined with medicines. Montelukast can be quite helpful but it caused anxiety side effects for me, and for many other people I know who've tried it for rosacea (it seems to cause side effects quite commonly even if they are not that severe, but enough to stop people continue taking it) - so I would try hydroxychloroquine, as it is more useful for accutane-induced flushing than montelukast.

    Yes, I found moxonodine a much better replacement for clonidine (both are alpha blockers), but moxonodine does not stop working over time, and does not cause Raynaud's syndrome in the same way.

    For ear rosacea, I definitely recommend wearing a hat in the winter - otherwise your ears will go very cold outside, then they will burn like crazy when you go inside... It's called the hot room syndrome, and seems to effect ears the worst of all face parts.

    I think Periactin is worth considering given your allergies as well - it's a anti-histamine with a particular benefit to (ear) flushing - others can help but for some reason this one seems to be particularly useful for flushing. It's available over the counter in the UK, so easy to get without a doctor visit.
    Last edited by antwantsclear; 8th November 2019 at 06:16 PM.

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    Quote Originally Posted by antwantsclear View Post
    Yes Zhongzhou cream does help quite a lot with the flushing of rosacea, especially when combined with medicines. Montelukast can be quite helpful but it caused anxiety side effects for me, and for many other people I know who've tried it for rosacea (it seems to cause side effects quite commonly even if they are not that severe, but enough to stop people continue taking it) - so I would try hydroxychloroquine, as it is more useful for accutane-induced flushing than montelukast.

    Yes, I found moxonodine a much better replacement for clonidine (both are alpha blockers), but moxonodine does not stop working over time, and does not cause Raynaud's syndrome in the same way.

    For ear rosacea, I definitely recommend wearing a hat in the winter - otherwise your ears will go very cold outside, then they will burn like crazy when you go inside... It's called the hot room syndrome, and seems to effect ears the worst of all face parts.

    I think Periactin is worth considering given your allergies as well - it's a anti-histamine with a particular benefit to (ear) flushing - others can help but for some reason this one seems to be particularly useful for flushing. It's available over the counter in the UK, so easy to get without a doctor visit.
    Zhongthou cream helps with the flushing? Can Soolantra do that too? Or what is the ingredient in Z. that helps with that

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    Quote Originally Posted by opare View Post
    Zhongthou cream helps with the flushing? Can Soolantra do that too? Or what is the ingredient in Z. that helps with that
    How does Zhongthou compare to soolantra or horse paste? I was reading that Zhongthou has high concentrations of zinc oxide and sulphur that's only labeled in Chinese and hasn't really been studied at all. Is this safe? Does it help with subtype 1?

    I tried soolantra in the past without any improvement. Should I try this instead or will it not work as well?

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    Quote Originally Posted by beherenow View Post
    How does Zhongthou compare to soolantra or horse paste? I was reading that Zhongthou has high concentrations of zinc oxide and sulphur that's only labeled in Chinese and hasn't really been studied at all. Is this safe? Does it help with subtype 1?

    I tried soolantra in the past without any improvement. Should I try this instead or will it not work as well?
    I have taken Zhongzhou cream for about three years and never had a problem with it, and you will find many other threads where members of this forum have taken it without problem. It really combines several treatments that have been used individually in the past for treating rosacea - e.g. sulphur cream, zinc oxide cream, and puts them altogether.

    I found Zhongzhou cream much more effective than Soolantra (I'm sure it's because it has several ingredients that kill demodex mites, whereas Soolantra only has one - ivermectin). Also, I found Soolantra stopped working after about 6 months - you can become immune to ivermectin.

    In the end, though, if you have bad flushing you will need to combine medicine, diet, topical, dietary and psychological approaches. There is no quick solution - it takes effort and perseverance, but Zhongzhou can be a very important part of reducing flushing and redness.

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