The treatment of persistent
erythema and
rosacea flushing is extremely challenging, especially for patients with anxiety. The aim of this study was to verify the efficacy of
carvedilol in
rosacea patients with persistent
erythema and
flushing. A total of 156 patients were randomized to use oral
carvedilol 5 mg bid (twice per day) (n = 105) or topical
brimonidine (n = 51) for a 10-week period with 6 weeks of follow-up. Both the efficacy of
carvedilol and the status of anxiety/depression were analyzed by patient self-assessment (PSA), clinician
erythema assessment (CEA), generalized
anxiety disorder (GAD-7), and patient health questionnaire-9 (PHQ-9). Our study found that
carvedilol exerted a dramatic reduction in CEA/PSA scores and
sting/burning sensation scores in comparison to topical
brimonidine. Additionally,
carvedilol treatment dramatically improved
telangiectasia,
erythema, and pigmentation with no obvious side effects. Patients with
carvedilol treatment showed an improvement of depression/anxiety, as reflected by lower GAD-7 and PHQ-9 scores than patients with topical
brimonidine. Notably, we found
carvedilol treatment had better outcomes among patients under 30 years of age with
rosacea younger than 30 years old. Conclusively, our findings reveal that
carvedilol could quickly and effectively improve facial
erythema, which might stem from the improved the status of anxiety/depression.