Rosacea is a chronic (meaning longstanding) condition that affects the skin of the face. People with rosacea get acne-like bumps, flushing, redness, noticeably visible blood vessels in their skin, nodular or bumpy changes on their nose, forehead, or chin, exquisite sensitivity to sunlight, irritable skin that people with rosacea describe as feeling like stinging or burning, and last but not least, pink-eye symptoms. It’s quite a slew of changes on the facial skin, and most people with rosacea really suffer from it in terms of their reported quality of life.
I think the hardest part about seeing people with rosacea as their provider is that it can be so hard to treat and for people to actually get better. We treat it with a number of different meds including antibiotics like doxycycline, minocycline, and metronidazole, but also meds like azelaic acid which is an anti-inflammatory med, ivermectin which is an antiparasitic med, and brimonidine gel, which works to cause constriction of blood vessels in the face. There’s so many options because no one treatment is universally effective.
One of the most challenging aspects of rosacea to treat is the redness and irritable skin that accompanies the disorder. In fact, my patients with the redness-predominant type of rosacea are some of the most disappointing to treat because of their lack of response to treatments.
The study I’m going to introduce is one that gives me some hope because it demonstrates that an old drug actually works wonders to treat the redness of rosacea.
This study was just published a summer ago. It was published by a group of scientists based in China. Here’s what they did. They took a group of rosacea volunteers, 97 in total, and gave half of them this new drug for rosacea (but actually an old medication), and the other half, they gave a sugar pill also called a placebo. Now, these weren’t just any rosacea patients by the way. These were rosacea patients who had failed 3 months of standard rosacea treatments including tetracycline antibiotics, intense pulse light (a laser that closes enlarged blood vessels in the skin), and brimonidine gel, which again is a blood vessel constrictor. In other words, these were really hard to treat rosacea patients.
So, what was the med that the treatment group got? It was paroxetine. Paroxetine 25 mg daily for 12 weeks.
Paroxetine is technically an antidepressant. It’s an SSRI that works to treat not only depression but also OCD, and it does so by increasing the availability of serotonin in the brain (and possibly the skin based on this study).
The group of people with rosacea that got paroxetine had significant reductions in facial redness—many actually saw complete clearance of their facial redness. They also had significant reductions in flushing and the sensation of skin burning. It’s remarkable.
Plus, after 12 weeks, the paroxetine group had very little in the way of side effects when compared to placebo takers.
I won’t bore you with the actual numbers but here’s a rough idea: almost half of the paroxetine takers had improvement or clearance of redness or flushing. Not only that, but they also had improved mood and lower depression scores. And, that could’ve been from the drug itself being an antidepressant or from patients being so happy because their rosacea finally got better.
Rosacea itself is linked to depression. Studies have shown that inflammation in the skin actually correlates with inflammation in brain tissue, which may explain why paroxetine was able to reduce depression and treat rosacea at the same time—it may exert anti inflammatory effects in both the brain and skin. Not only that, but the doctors who performed this trial speculated that increased availability of serotonin helps to regulate blood vessel constriction in the skin, which in turn reduces facial redness.
Alright. I hope you, my rosacea suffering friends, got some value from this blog. Talk to your dermatologist about paroxetine if you have stubborn facial redness.
Reference: J Am Acad Dermatol 2023;88:1300-7