Every day, patients come into the pharmacy with questions about specific medications or disease states.

Usually, I am able to discuss the specific situation with some level of confidence. But now and again, a question comes along that requires a bit of research. Today, I had one of those questions.
 
Rosacea affects approximately 15 million individuals in the United States and is considered a fairly common inflammatory skin disease.  Clinically, the characteristic flushing, papules, and pustules differentiate rosacea from other diseases of the face, such as acne or lupus.
 
Rosacea has traditionally been categorized into 4 distinct subtypes with variations in each. However, a 2011 study clearly presented a fifth distinct subtype described as neurogenic rosacea.
 
This particular subtype was identified by systematically questioning rosacea patients about their symptoms during routine visits to the clinic. Those identified with neurogenic rosacea all had a significant stinging pain, prominent erythema, and facial flushing in common.
 
Notably, an overwhelming majority of these patients identified triggers that caused a worsening of their symptoms, including heat, sunlight, hot showers, stress, exercise, and alcohol consumption.
 
Nearly 50% of these patients also experienced some type of neuropsychiatric condition such as a complex pain syndrome, essential tremor, depression, and obsessive-compulsive disorder. In addition, nearly three-quarters of patients with neurogenic rosacea experienced headaches.
 
This group of patients showed limited response to traditional treatments for rosacea, which include topical antibiotics and steroids, as well as oral antibiotics. Some patients responded well to medications that focus on nerve pain, such as gabapentin, pregabalin, tricicyclic antidepressants, and duloxetine. 
 
Interestingly, hydroxychloroquine, an antimalarial medication and disease-modifying antirheumatic drug (DMARD), demonstrated effectiveness in treating symptoms in a subgroup of the neurogenic rosacea patients.
 
The study authors proposed that the vasculature symptoms of rosacea may be responsible for some level of neuronal injury through one of many different proposed mechanisms. This process is variable and most likely a little different for each patient. 
 
Although neurogenic rosacea is not well understood, the authors of this particular study felt that identifying common nerve-related symptoms associated with rosacea and grouping them into a specific category may increase awareness of the condition within the field of dermatology.

Reference
Scharschmidt TC, et al. Neurogenic Rosacea: A Distinct Clinical Subtype Requiring a Modified Approach to Treatment. Arch Dermatol. 2011 Jan;147(1):123–126.