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Facial Flushing (Topicals)

Facial flushing is one of the most annoying aspects of Rosacea. This can be managed with a number of ingredients on topical skin care creams.

Facial Flushing (Topicals)

Topical ingredients for facial flushing 

These provide temporary relief of redness only.

• Brimonidine (Mirvaso) FDA approved 

• Oxymetazoline (Rhofade) FDA approved 

• Synchrorose.

Topical treatments take 2-6 weeks to have an effect.

Brimonidine 0.33% gel (Mirvaso)

Brimonidine tartrate gel is an aqueous gel that is applied to the face once daily. Brimondidone is a highly selective alpha‑2 adrenergic receptor agonist with vasoconstrictive and vasostabilising activity. It has anti-inflammatory effects by constricting very small subcutaneous vessels that results in oedema inhibition. It effects last for only 4 hours.

Treatment should be initiated with a small amount of gel (less than the maximum dose) for at least 1 week, then increased gradually, based on tolerability and response. The maximum daily dose (1g of gel per day) should not be exceeded.


Facial erythema without telangiectasia. It has no effect on pustules and papules

Topical oxymetazoline (Rhofade)

Oxymetazoline hydrochloride (1% cream), is a potent α- 1 agonist, has been approved by the FDA in 2017 for the treatment of persistent erythema of rosacea. The onset of action usually occurs within 1-3 h after application, with the effect lasting up to 8-10 h. It is not available in the UK.


Synchrorose targets skin and blood vessel reactivity and contains four ingredients:

1. 4-t-butylcyclohexanol = Tryp2 receptor antagonist - stops nerve stimulated peptide production irritating the skin by triggering stinging and burning by activating receptors on skin cells).

2. Dimethyl sulfone and silymarin (active ingredient in milk thistle) - suppress the activity of key skin inflammatory agents including interleukin 1 alpha which triggers erythema and swelling.

3. MSM - reduces the activity of VEGF and TNF-1 alpha.

4. Polyglutamic acid - creates a smooth, elastic, self-moisturising and soft film for improved sensory perception and protection of the outer layer of the skin.

It reinforces the skin’s support structure and stimulates the production of skin lipids improving skin sensitivity and stimulates epidermal renewal.

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