Mirvaso Rebound Flushing
Brimonidine (Mirvaso) can be effective for temporarily reducing the redness seen with rosacea, however for a significant proporiton of patients it can cause rebound flushing which results in greater redness than previously as it wears off.
Why it happens
Brimonidine works by constricting the small blood vessels in the face. When it wears off after several hours, these vessels don't just return to their normal dilated state; they can overcompensate and dilate even more widely than before. This results in a sudden, intense, and often burning flush that can be significantly worse than the original baseline redness.
How to taper or switch safely
If you are experiencing rebound flushing from Mirvaso, do not stop it abruptly, as this can worsen the rebound. The best approach is a very slow taper. Reduce the amount you use and apply it less frequently over several weeks. This allows your blood vessels to gradually readjust. During this time use gentle skincare. This can be combined with medical treatments for rosacea. Switching to oxymetazoline (Rhofade) may also be an option for some patients.
How can I help
I see patients in person in central London. An in person consultation allows me to examine the skin directly including features that are difficult to capture in a photograph such as 3-dimensional changes and textural change. This is the better option where the diagnosis is uncertain, where previous treatment has not been effective, or where a procedure is being considered. For more straightforward conditions such as acne and rosacea a remote consultation with clear photographs can be a good option.
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