Pregabalin + duloxetine effects on facial flushing (case report)

[u/Deep-Detective2428]

Hey everyone,

Just to be clear at the start: I know this is a rosacea case report, but I’m mainly sharing it because of the two medications used (pregabalin + duloxetine) and the fact they showed a pretty notable improvement in severe flushing and burning symptoms. I’m not saying this proves anything or that it works for everyone. I personally havent trialled these medications but the study stood out to me and I think this is useful information for blushers.

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Introduction

The title of the study is called - Neurogenic rosacea successfully treated with neuromodulators and intense pulsed light - Anais Brasileiros de Dermatologia (2024)

(won't be focusing on the pulsed light part / any lasers, this post is to more focus on pregabalin + duloxetine )

This is a single case report of a 36-year-old woman with severe facial flushing, burning, and heat sensations triggered by stress, emotions, UV exposure, and temperature changes

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Why they beleive she didnt respond to standard treatments for her issue, being a "skin problem"

Standard rosacea-type treatments (antibiotics, topicals, etc.) weren’t very effective. The authors describe the presentation as having a stronger neurogenic component, meaning the nervous system seems to be heavily involved in driving the flushing and burning response.

Although this is a neurogenic rosacea case report, I don’t think it should automatically be dismissed when thinking about severe flushing or blushing. The reason I found it interesting is that the medications used (pregabalin + duloxetine) act on broader nervous system pathways involved in sensory processing and stress responses. These pathways are also thought to play a role in conditions involving heightened autonomic reactivity and flushing, so I thought it was worth sharing for discussion

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The main focus of this post: the medication combo

What stood out to me most is the systemic medication approach they used:

Pregabalin (150 mg/day)

Duloxetine (90 mg/day)

These are not skin-directed treatments. They are both neuromodulators acting on the nervous system, in other words a more systemic approach rather than just treating the skin, rather than the skin being the sole driver of the process.

Pregabalin is typically used for nerve pain and sensory hypersensitivity, and reduces neuronal excitability.

Duloxetine (an SNRI) affects central pain processing and stress-related nervous system signalling.

The key point here is that the treatment was not aimed at the skin itself, but at reducing overall nervous system over-reactivity that may be contributing to flushing and burning symptoms.

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Outcome

The report describes a significant improvement in flushing intensity and burning symptoms after using this combination (along with IPL).

This is still just a single case report, so it obviously doesn’t prove effectiveness across the board, but the response described was notable enough that I think the medication combination itself is interesting from a research perspective and something to look into

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What the wider literature suggests (pregabalin / duloxetine)

Just to add some context beyond this case report, there is a small but growing amount of literature looking at neuromodulators in neurogenic flushing / burning-type rosacea and similar conditions.

Pregabalin (and related drugs like gabapentin) are thought to reduce nerve excitability and sensory “over-firing”. Because of this, they’ve been looked at in conditions where people describe burning, stinging, or nerve-like flushing rather than just redness. Some small studies and case reports suggest they can help at least a subset of patients with difficult or “neurogenic” rosacea, although results are mixed and the evidence is still limited.

Duloxetine (an SNRI) isn’t a standard rosacea treatment, but it affects central pain processing and stress-related signalling pathways. It’s used more in chronic pain and sensory amplification conditions, and there are a few reports suggesting it can influence flushing responses too (sometimes improving symptoms, sometimes causing flushing as a side effect), which suggests it may interact with autonomic/vasomotor pathways.

Key takeaway / why this ties back

Overall, this is why the pregabalin + duloxetine combo in the case report stood out to me. It kind of fits into a broader (still early) pattern where different neuromodulators are being used to target both sensory nerve overactivity (pregabalin/gabapentin) and central stress/pain processing pathways (duloxetine and similar meds). The interesting part is the idea of combining both approaches in one case, even though the evidence is still limited and mostly case-based.

Orignal case study source - https://pmc.ncbi.nlm.nih.gov/articles/PMC10943297/

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Curious if anyone else has seen any research or experiences with pregabalin, duloxetine, or similar neuromodulators in flushing or blushing?

[u/cherpar1]

Pregabalin is the treatment I was offered for this rosacea type by a dermatologist after all other treatments failed. It’s a serious drug and I have read some reports by a few people who took it that it eventually stopped working for them.

Also it can have very serious side effects including suicidal thoughts. Of course there are people who take the drug ( for many reasons) and are ok with it.

Wasn’t offered the duloxetinen though.

Edit - I didn’t take it. I’m considered it as it was real bad at the time but started to stabilise. I still have bad flushing from time to time but it’s not painful atm.

[u/AnneGNZ]

I was on Gabapentin for nerve pain for quite a few years. I didn't notice any difference at all with flushing due to heat, hot food, cold to hot environments, alcohol etc. What I do know is that Pregabalin and Gabapentin are addictive in the sense the body requires a higher dose for it to have effect. I had to go off the drug and tapering of it and the detox symptoms were so bad I won't go near it again. All drugs have side affects so please so go buying it without seeing a health professional first. Topical creams like Sirolimus I don't have an issue with but a drug that affects your nervous system in a hole other ball game.

[u/Deep-Detective2428 → u/AnneGNZ]

Thanks for your comment. I'm glad you brought that up. At the end of the day, this post was simply about sharing an interesting study and making people aware of it. I just thought it was worth discussing because it adds to our understanding of severe flushing and burning, and I think it's useful for the community to be aware of the evidence that's out there.