Oral steroids ( prednisone , [ Medrol ]) can help severe cases of hives in the short term, but their usefulness is limited by the fact that many cases of hives last too long for steroid use to be continued safely. Other treatments have been used for urticaria as well, including montelukast ( Singulair ), ultraviolet radiation , antifungal antibiotics, agents that suppress the immune system, and tricyclic antidepressants ( amitriptyline [ Elavil , Endep ], nortriptyline [ Pamelor , Aventyl], doxepin [Sinequan, Adapin]). Evidence to support the benefit of such treatments is sparse. In ordinary cases, they are rarely needed. A new treatment recently available for chronic urticaria is the monthly subcutaneous injection of a monoclonal antibody, omalizumab ( Xolair ), directed against the IgE receptor on human mast cells.
Oral and topical antibiotics are often ineffective in the treatment of erythema and flushing. The most effective way to prevent the occurrence of flushing episodes and the progression of the disease is to avoid the associated trigger factors. Low-dose clonidine (Catapres; mg twice daily) may be effective in controlling flushing, especially in women who are postmenopausal. 18 A nonselective beta blocker (such as long-acting propranolol [Inderal], 80 to 240 mg daily, and nadolol [Corgard], 40 to 80 mg daily) may also be used to treat erythema and flushing. 18
Finding proper treatment can be difficult - while a dermatologist may understand the complexities of treating the facial skin of rosacea, they lack the training and expertise required to address the symptoms of rosacea involving the eyes. To address the symptoms of eye rosacea, an ophthalmologist would be recommended. Keep in mind though that while they specialize in the treatment of ocular conditions including those involving rosacea, they may not always be aware of the skin symptoms of rosacea and therefore may not link the involvement of ocular and skin in the same condition making it challenging to co-ordinate a treatment plan.