I have 'severe' ROSACEA & have had this for over 20 years. It is extremely debilitating! I cannot even go out to a restaurant to eat because the warm temperature brings on a lasting scarlet flush. I have tried 'everything' oral & topical - plus had the Pulsed Dye laser & Photoderm. I am sick to death of dermatologist's telling me to avoid the obvious triggers - instead of treating the trigger's, themselves! Has anyone, as a very, very last resort ever tried Endoscopic Transthoracic Sympathectomy: Sympathetic Nerve-Mediated Flushing Surgery? This, I know is a major surgery & should not be undertaken lightly & obviously one needs an excellent surgeon. This procedure (although can possibly have side effects) helps prevent flushing & perspiration.