New to rosacea - what next?

[SteveLondon]

Hi,
I'm a 36 year old guy. Started getting very dry facial skin on cheeks and bridge of nose about four months ago and tried various moisturizers. Was under a lot of stress and really down about cystic acne that had come back with a vengeance. GP told me to use aqueous cream but it had no real effect. I went to a dermatologist about the acne and he said the dry rash was probably seb derm, so prescribed me Elocon, which I used on and off for about a month or so - but after a few days the rash kept coming back. My GP now tells me it's probably rosacea - constant redness and burning over cheeks, bridge of nose, between eyes and lower part of forehead. I'm now getting small red bumps on my cheeks.
I've tried very plain moisturizers, Sudocrem seems to calm it a bit. Tried pure aloe vera last night and it was like my face was on fire - went bright red and burnt so much that I had to wash it off within five minutes.
I started a course of doxycycline two months ago for cystic acne and my GP said this should tackle the rosacea, but I haven't seen any improvement. Due to see my dermatologist next week - should I be asking for low dose accutane? Or is it possible that the rash is just a reaction to doxycycline/elocon? Stopped the elocon about five or six weeks ago, as soon as I read that it could make rosacea worse.
Very confused and upset - this has appeared out of nowhere, on top of severe cystic acne all my adult life - so it's great to see that people are out there who can offer some much needed advice. Any thoughts would be much appreciated!

[SteveLondon]

Sorry, forgot to attach pic - this was reaction to aloe vera!!

[CrabbyCathy]

Hello and welcome!

In my opinion, it would be best to try other types of medication for rosacea before jumping straight to accutane, unless your derm recommends it for the cystic acne. Doxycycline, depending on the dosage strength, can take up to 4 months to show effect.

Before I go on, were you trying very harsh products for the cystic acne before this all started? That possibly could have really irritated and compromised your skin barrier, leaving it vulnerable and very apt to react to everything, even your usual products.

Back to rosacea--if it is indeed rosacea, your doctor can try the most commonly prescribed medication, metronidazole, which comes in cream and gel form (I'm favoring the gel lately, even though my skin is dry). There are also antibiotic topicals, and some creams/face washes containing sulfur. Start with one thing at a time, and try to spot-test for a few days. I know it's hard, but it's better to have a localized negative reaction rather than one all over the skin/face. Trust me, we have all, at one point or another, gleefully spread a new product all over our face and had our skin then go .

Although cortisone is in no way intended for long-term use, and can thin the skin, along with other negative side effects, it can be helpful to calm things down initially if used very infrequently. It's not something you want to use every few weeks when you have a flare, for example. A few times a year is more like it! Ask your derm if he recommends this; my own derm recommended using it twice daily for one week only to calm down a very bad flare I had.

From looking at your picture, and reading your description, it could very well be rosacea, but of course I'm not a doctor and only he/she can confirm this. It looks like rosacea that is irritated and flaring--mine tends to look rashy when I'm having a flare.

If you find that your plain moisturizer works well, do continue using it, along with finding an equally gentle cleanser. It can take a few months, but rosacea can be calmed down and managed. Here is a link on a discussion of cleansers:

viewtopic.php?f=11&t=263

Here is a link for more information, including dietary triggers that some people have. And also be careful of the sun/heat. Please let us know what your derm says!

http://www.rosacea.org/patients/index.php

http://www.rosaceafacts.com/What-is-Rosacea

[Mike T]

Hi Steve,

Crabby Cathy has given you really good advice.

I also believe you should leave Accutane as the very last resort. If and when you do decide to take it please do some research on it before hand. I took it many years ago and wish i hadn't. It cured my acne but left me with a list of more serious problems. However back when i took it high dose/short duration was the norm, thesedays with greater awarness they are prescribing 1/4 of what i took which is still doing the job with far less side effects.

I am also lucky enough to have sebbhoriec dermatitis aswell. If your's wasn't out of control to begin with i dont think you should have been prescribed the steroid lotion (Elocon) as a first line treatment. You say you have used it for about a month. I would not use it anymore than this. Do some reasearch, steroid containing topicals are known to worsen and even cause Rosacea after prolonged use. Instead you should be trying out antifungal shampoo washes for your face and hair. I find the commercially available antifungal shampoos too harsh for my face so i get a compounded aqueous cream with 1% Zinc Pyrithione which works well for the facial seb derm. For the hair i use Nizoral and Head and shoulders. Most of the time a good moisturiser is enough to keep my facial seb derm at bay.

Steroid creams should really only be used in times were you need to calm down a reaction quick. Maybe once ore twice every few months. So for instance after your reaction to the aloe vera the steroid cream applied once in the morning and once at night should be able to control things pretty quickly. After your face gets back to normal let it rest a few weeks before trying something new. And always spot test, like Cathy suggested, so you can localise any potential reaction to one area rather than your whole face. Most Rosacea skin is very sensitive.

From your picture, what you have looks more like Rosacea rather than acne to me. But i can't be sure. I think a good place to start would be to try a Metronidazloe containing topical, as Cathy has suggested. This should hopefully reduce the pustules from Rosacea, which from your picture seem to be aggravated by your reaction to the Aloe Vera Gel.

I got the Metronidazole prescription from my local GP to save on the hefty consultation cost my derm charges.

All the best,

Mike

[SteveLondon]

Thank you both very much for your replies - that's a real help. (Not sure whether I reply to you directly, or here?)
I forgot to mention that I've already been on two high strength courses of accutane for cystic acne - so I was thinking of a low dose here, which I've read can have good results with rosacea. As you say, it might be a bit early for that, but if there's any way I can stop if deteriorating then that's my top priority!
Also lucky enough to have seb derm, which is why I was prescribed the elocon. I have used it sparingly in the past, but it's always seemed to deal with what I thought was seb derm. This time the burning just didn't go away and has stayed like that for the past few months. I haven't used any harsh topical acne products though, so this has really come like a bolt out of the blue.
It's funny that it seemed to coincide with the worst bout of cystic acne I'd had in years - whether the two are related, or whether it's just triggered by the stress of getting acne back, I've no idea.

Thanks once again for taking the trouble to reply and I'll let you know how my visit to the derm goes!

All the best,

Steve

[CrabbyCathy]

Thank you both very much for your replies - that's a real help. (Not sure whether I reply to you directly, or here?)
I forgot to mention that I've already been on two high strength courses of accutane for cystic acne - so I was thinking of a low dose here, which I've read can have good results with rosacea. As you say, it might be a bit early for that, but if there's any way I can stop if deteriorating then that's my top priority!
Also lucky enough to have seb derm, which is why I was prescribed the elocon. I have used it sparingly in the past, but it's always seemed to deal with what I thought was seb derm. This time the burning just didn't go away and has stayed like that for the past few months. I haven't used any harsh topical acne products though, so this has really come like a bolt out of the blue.
It's funny that it seemed to coincide with the worst bout of cystic acne I'd had in years - whether the two are related, or whether it's just triggered by the stress of getting acne back, I've no idea.

Thanks once again for taking the trouble to reply and I'll let you know how my visit to the derm goes!

All the best,

Steve

You can reply here! That way any info can possibly benefit others also

OH my. Elocon wasn't familiar to me, so I assumed it was something specifically for seb derm. I just googled it on a whim--it's a topical steroid. It sounds like you just used it for a month, not longer, correct?

Seb derm presents as waxy scales on the skin, not just general dryness--do you have that also? I'm sure you know that the Accutane can cause severe dryness of the skin, lips, etc. (not sure how long ago you stopped)

[SteveLondon]

Thanks Cathy.

I used it for a month - I'd apply it for a couple of days and it would clear things up, but then the dryness and rash would come back after another few days, so I'd try again. I have tried a different, lighter steroid cream - very rarely and sparingly, over a longer period, so perhaps it's coming back to haunt me?
I finished the second accutane course a good seven or eight years ago and my skin has been drier since, though this burning has only been for the past three months or so. As for the seb derm, I do have the flakes on my scalp and chest sometimes, though not really on my face. Confusing or what?
I've been aware over the past few years that a heavy drinking session results in very blotchy skin for a few days afterwards, including a type of rash on my cheeks - maybe this was a precursor to what I'm now experiencing.
Thanks again for taking the trouble to answer me - it all seems a bit self-obsessed on my part, but it's a worrying thing to have developed, as I'm sure everyone on here knows.
A quick question - I've been told milk thistle is very good for rosacea. Does anyone know whether this is true?

Steve

[CrabbyCathy]

Thanks Cathy.

I used it for a month - I'd apply it for a couple of days and it would clear things up, but then the dryness and rash would come back after another few days, so I'd try again. I have tried a different, lighter steroid cream - very rarely and sparingly, over a longer period, so perhaps it's coming back to haunt me?
I finished the second accutane course a good seven or eight years ago and my skin has been drier since, though this burning has only been for the past three months or so. As for the seb derm, I do have the flakes on my scalp and chest sometimes, though not really on my face. Confusing or what?
I've been aware over the past few years that a heavy drinking session results in very blotchy skin for a few days afterwards, including a type of rash on my cheeks - maybe this was a precursor to what I'm now experiencing.
Thanks again for taking the trouble to answer me - it all seems a bit self-obsessed on my part, but it's a worrying thing to have developed, as I'm sure everyone on here knows.
A quick question - I've been told milk thistle is very good for rosacea. Does anyone know whether this is true?

Steve

I think you'd have to use the steroid a long time to get steroid-induced rosacea; I'm looking but can't find an actual "time". Just this little blurb

http://rosacea-support.org/over-counter ... cause.html

Confusing! Although a lot of times, seb derm and rosacea go hand-in-hand. And the drinking+blotchy skin sounds like rosacea.

We're not self-obsessed I mean, it's our face that it's affecting. Why can't we have rosacea of the knee or elbow?

It's supposed to be the silymarin in milk thistle that is good; let me search. So internally it cleanses the liver and topically it acts as an anti-inflammatory. Hmmm! Sorry for all the links, I found them interesting!

http://www.ausci.com/resources6.htm

viewtopic.php?f=4&t=1195&p=8861&hilit=milk+thistle#p8861

http://rosacea-research.org/wiki/index. ... _Silibinin

http://www.treatment-skincare.com/Rosac ... roves.html

http://www.ncbi.nlm.nih.gov/pubmed/18254805

[mbird21]

Seb Derm, i would almost be 100% positive looking at that pic even from a distance, some visible flaking around nose and patchy dry pink/red patches, i too have severe seb derm affecting, basically everywhere that has a hair or oil and it burns due to the widespread condition.

If you have rosacea, its a complication of the seb derm, calm the seb down and the rosacea will calm if there is any.

Thats what i think it is anyway, but certainly look for a clear diagnoses good luck!.

[CrabbyCathy]

So.....what happened? Very curious!