Aspirin should be the first line of defense against flushing, an early sign of rosacea and persistent source of embarrassment to patients, says Joseph B. Bikowski, M.D., a dermatologist practicing in Sewickley, Pa., and a clinical associate professor of dermatology at Ohio State University in Columbus. Dr. Bikowski frequently takes this message to professional conferences, sharing his own experience.
"I have both migraines and rosacea," he begins. "Several years ago, I was talking to Dr. Albert Klingman. He mentioned that there was an increased incidence of rosacea in people who have migraines. I knew some neurologists give one baby aspirin a day to migraine sufferers to try and prevent the dilation of blood vessels in the brain."
Five years ago, Dr. Bikowski decided to do an informal study. He asked his rosacea patients to take a daily aspirin (81 mg) and maintain a log of flushing incidents, rating each day on a 1 to 10 scale. Within a month, many patients were experiencing less flushing and shorter episodes of erythema.
Flushing and triggers
Patients who present with flushing may have early-onset rosacea, or the cause may be unrelated; i.e., menopause, emotional issues. The National Rosacea Society (NRS) recommends keeping a diary in order to determine individual triggers and then modifying activities and behaviors to avoid the triggers. In one patient survey, NRS reported the most common triggers as sun exposure, stress, hot or cold weather, wind, heavy exercise, alcohol, hot baths and spicy foods.
NRS classifies rosacea triggers and their treatment into two major categories.
Substances like alcohol, certain drugs, niacin and the body's own production of histamine cause blood vessels to dilate. Patients who fall into this category may benefit from aspirin and/or antihistamines.
Warm temperatures, heavy exercise and hot beverages overstimulate the autonomic nerves. These triggers respond to cooling techniques, such as cold drinks, fans or a cold towel on the neck. In severe cases, physicians sometimes prescribe clonidine or beta blockers.
Aspirin, the miracle drug
Dr. Bikowski argues, "Aspirin therapy is safe. It's great for the heart. It's great for the colon. Why not the skin?" He further notes that there are few contraindications for aspirin use, it's inexpensive and it can be taken in combination with most drugs.
Dermatologists should advise patients of the standard warnings about the use of aspirin, even at low dosage. These include:
Look for enteric-coated tablets, which are more likely to dissolve in the intestines, avoiding stomach problems.
Take aspirin with a heavy meal.
People who consume a lot of alcohol, pregnant women or nursing mothers and people taking drugs for anticoagulation purposes, arthritis, asthma, ulcers, stomach problems, bleeding problems, gout or diabetes need to consult a physician before beginning an aspirin regimen.
When using aspirin, be alert to new symptoms, a worsening of pain, an allergic reaction, swelling or redness, ringing in the ears or loss of hearing, nausea or vomiting. If they occur, especially in children, a physician should be contacted.
Disclosure: Dr. Bilkowski reports no interest in any company associated with the manufacture or marketing of aspirin.