Pronounced facial flushing and persistent erythema of rosacea effectively treated by carvedilol, a nonselective β-adrenergic blocker

Abstract

To the Editor: Rosacea is a common facial disorder characterized by centrofacial erythema, flushing, telangiectasia, edema, papules, and pustules.1,2 Treatment of erythematotelangiectatic rosacea (ETR) with severe facial flushing and persistent erythema remains challenging despite some successes with β-adrenergic blockers,3 clonidine (α-adrenergic agonist), naloxone (opiate antagonist), ondansetron (serotonin antagonist), and endoscopic thoracic sympathectomy. Traditional β-blockers nadolol and propranolol (20-40 mg, 2-3 times a day)3 can suppress flushing reactions, but the side effects of hypotension and bradycardia may pose problems because most patients are normotensive.