Two Different Diagnoses - What Do I do?

Like to get some expert advice for IPL or Laser therapy for rosacea ? Post your question here and one of our helpful Laser and IPL Doctors will offer their thoughts on your query.

Two Different Diagnoses - What Do I do?

Postby circawdm » Wed Sep 17, 2008 6:49 pm

Hello,

Really hoping to get some expert or experienced opinions on this:

I was diagnosed as having garden variety stage 1-2 rosacea about a year ago by the best dermatologist in my town - Mayo trained etc. After a year of up and down flares and 8 Pulsed Dye laser treatments and trying some topicals, it still is not under good control. Some days, like with others I read on here, it is better than others. It is only on my nose - toward the end and on the sidewalls toward the end. None on my forehead or face, etc.

So recently he did a biopsy - to rule out discoid lupus he said. FINALLY today his office called and they said I had cells that were common with inflamation....no surprise. He sent it out for a biopsy to rule out discoid lupus.

I got to pathology reports: One showed just typical cells from inflamation basically. The other said the cells looked like it could be sun allergy, rosacea, or discoid lupus. Nothing for sure there either! I had an ANA test 6 mos ago and it was negative. I know that doesn't mean it is not discoid lupus. But now they want to treat it with some kind of topical steroid called Cyclocort/amcinonide along with sunblock 70 on my nose and sunblock 50 on the rest of my face!

I don't know WHO or what do believe! I seem to remember there are other blood tests for discoid lupus I believe. I really hate to treat my nose with expensive steroid cream and alot of goopy sunblock (I am rarely out in the sun anyhow) if I have (just) rosacea.

Suggestions please??? I am now more anxious than before, and stress makes all these symptoms worse as you know.

Thank you.

Dennis
circawdm/Dennis
circawdm
I'm new here
I'm new here
 
Posts: 16
Joined: Sat Sep 06, 2008 9:26 pm


Re: Two Different Diagnoses - What Do I do?

Postby drsoldo » Thu Sep 25, 2008 9:47 pm

Disclosure
This information does not constitute medical advice. Any individual who believes they are suffering from any medical condition, including, but not limited to rosacea, should seek treatment from a licensed medical physician who is qualified to diagnose and treat the particular condition. Nicholas Soldo, M. D.

It is impossible to make accurate comments from afar and I think it sounds like you have a reputable competent derm taking care of you and I suggest you follow his advice--With what little information presented I am not sure this sounds like rosacea--DR S
drsoldo
Apprentice Member
Apprentice Member
 
Posts: 49
Joined: Wed Jul 09, 2008 4:54 pm

Re: Two Different Diagnoses - What Do I do?

Postby circawdm » Thu Sep 25, 2008 10:08 pm

Hello Dr:

I had a second consult today with a well respected dermatologist (actually two), here who had my lab results, complete history on this, and also had recent lab tests I had done recently, - from C3-4, double stranded DNA, CRP, anti-Smith, and 4-5 other tests given to pts. who might have or do have lupus - including discoid lupus. All were negative. I realize discoid is not diagnosed with only blood tests, but they can be somewhat helpful. My nose has improved without anything on it since my last post, and today the dermatologist and her partner (also a dermatologist with 20+ years experience) said they thought from the very limited and inconclusive pathology testing done on the biopsy, and all the other very typical rosacea symptoms I have, plus how the skin LOOKED to them, they are thinking it is rosacea - just a stubborn case. They are putting me on doxycycline AND a topical called Clenia. They said if the Clenia burned or was not helping after a week or two, I could switch to metro lotion in combination with the oral doxycycline.

We will try this for 4-6 weeks. My one papule where the biopsy was taken is completely gone as is most of the erythema. If, at the end of 4-6 weeks, things have flared up again or do not look good, they are suggesting another punch biopsy, and sending it to a lab which has the sophisticated equipment and people trained to do the different "stain tests" and other types of tests on the tissue sample, which would give them a much more conclusive diagnosis of what I have. They feel I was hit with alot of laser and not much else, and it simply did not do much good in the long run, especially systemically.

Thank you for your reply. I will post when I have some more results or news.

Sincerely,

Dennis
circawdm/Dennis
circawdm
I'm new here
I'm new here
 
Posts: 16
Joined: Sat Sep 06, 2008 9:26 pm

Re: Two Different Diagnoses - What Do I do?

Postby drsoldo » Thu Sep 25, 2008 10:59 pm

Obviously we need to establish an accurate diagnosis--If in fact it is rosacea then IPL is still the treatment of choice(not PDL) and might also be adjuncted with oral(I never use more than 40mg of Doxy per day)and a nonsteroidal topical antiinflammatory--Keep me apprised--DR S
drsoldo
Apprentice Member
Apprentice Member
 
Posts: 49
Joined: Wed Jul 09, 2008 4:54 pm

Re: Two Different Diagnoses - What Do I do?

Postby circawdm » Thu Sep 25, 2008 11:39 pm

Thanks Dr.

I did not think the Pulsed Dye Laser was the best frankly from what I read. And the tech who does it for the doctor zapped me the last time on full power she said, and made two passes, and my nose was black and purple and blue for 4 weeks! After that, it was worse than before it seemed.

Anyhow, while I cannot afford the 40 mg stuff, 50 mg. of doxycycline and the other non steroidals I am hoping will work well, even if it takes a little fine tuning. As for the laser, I am on SSDI, so depending on whether they will "gift" me the 3-4 minute treatment of their IPL, I will do the other, and we'll see what happens. I read two places where DLE is diagnosed if a person has a positive double stranded DNA with the other skin symptoms. Mine was negative.

As I said, if no change or worse in 4-6 months, we'll do another punch biopsy and send it off to a lab that has the equipment and techs to do a definitive dx of discoid or not.

Thanks for your time and input,

Dennis
circawdm/Dennis
circawdm
I'm new here
I'm new here
 
Posts: 16
Joined: Sat Sep 06, 2008 9:26 pm


Return to Ask a Doctor

cron