How to manage a rosacea flare-up after peritoneal dialysis?

Question

Hello doctor,

I am a 44-year-old female. My rosacea has worsened significantly since starting peritoneal dialysis. My face burns with every exchange, could this be a reaction to the dialysis fluid? My eyes are becoming extremely dry while using the cycler, is this related? I tried azelaic acid, but I am concerned about the risk of peritonitis. Are there any safer alternatives? My flushing worsens when using high-glucose dialysis bags, is this normal? How can both treatments be balanced effectively?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Causes and considerations:

Fluid reaction: PD (peritoneal dialysis) fluid components, such as pH, glucose, or lactate, may trigger rosacea flares. Consider switching to a lower-glucose or bicarbonate-based solution.
Dry eyes with cycler: Nighttime dehydration is common. If permitted, increase daytime fluid intake or use artificial tears before bed to maintain eye moisture.
Azelaic acid alternatives: Metronidazole cream (lower risk of peritonitis) or oral Doxycycline (anti-inflammatory and safe for PD patients) may be suitable options.
Flushing with high-glucose bags: This is a normal response due to osmotic stress, causing vasodilation. If appropriate for your dialysis plan, consider using Icodextrin for long dwells.
Balancing both conditions: Work closely with your nephrologist and dermatologist to adjust PD solutions while maintaining gentle skincare, using non-irritating topicals, and implementing hydration strategies.

Take care, and I hope this information is helpful to you!

Thank you.