Rosacea Diagnosed - Now Dermatologist Wants to Check For Discoid Lupus

I am a 58 yo white male. I have medium skin, and no family history of skin cancer or lupus or anything like that. I don't burn easily and am out in the sun very little. I DO have a history of high stress, anxiety disorder, and flushing however. My father flushed in his 50-60s when he drank alcohol, but other than that he never had any skin disorders.  

A year ago the local Mayo clinic trained and well respected dermatologist saw me because I had been having redness off and on on the end of both sides of my nose - which was off and on. Small areas, and it would come and go. He said I had rosacea, irritated probably by abit of mild seborrhea in my scalp. He gave me Metrogel which did not help - it burned. They are specialists at his clinic in laser treatments, so he ordered a series of "Pulsed Dye Laser" treatments for my nose every 8 weeks apart, which helped some but did not last. They DID reduce the inflammation and occasional papule which I would get, which always went away on its own anyhow.

The erythema and off and on swelling has continued, and it is not worse in sunlight really (without sunscreen because I am out in it so infrequently and for such short periods of time) and foods don't seem to trigger flares. I am aware that if I am highly stressed I get the flushed hot face feeling out of the blue, and then usually my ears and my nose both feel warm-hot and my nose area is worse for a day or few days after. I do work on stress control.  

Last visit he said he wanted to do a biopsy to "rule out discoid lupus."  Well, I was there, and even though I wasn't keen to have it, I allowed it. Still waiting for the results. In the meantime, my GP of 21 years said to me he would be [b]very[/b] surprised if I had DLE, because sunlight exposure doesn't make my nose worse, and if I had discoid lupus, the LAST thing they would want to do is use a hot laser on it which would make it flare up alot. They would use topical steroids and sunscreen instead. He said the dermatologist is probably just frustrated by my lack of getting better symptom resolution, so he is wanting to rule out the DLE. I have seen photos of people with it, and what I have looks nothing like it. I also don't fit the age or gender profile for it among other things.

I was just getting ready to start doxycycline 50 mg. because I cannot afford the $140. a month for thirty 40mg Oracea pills, and his nurse practitioner said she thought the 50 mg dose ($25. cost for 30 pills) was on the edge where it could very well help, but it often takes a month or so to see real results.

Any comments greatly appreciated. I have no other place where the redness shows - not on face, scalp, or other places. I also drink NO alcohol and eat no sugar except what is naturally in foods. I avoid bananas because I was told that they have an enzyme that can trigger flares. I have had RAST blood testing from an allergist for foods, and also for purposes of checking my immune system due to the fibromyalgia I have mildly for the past 10 years, my doctor did an ANA, sed rate and complete blood work up on me in the past 6 months and all was completely normal-negative, as they always have been. I see my GP monthly because he is close and also to just have him check my back and fibromyalgia stuff. He also checks my CBC and electrolytes off and on since I have had a little problem with imbalance on sodium and potassium over time. Nothing serious, but he is very conscientious. He has also tracked my inflamed nose over the past year or so along with me. He sees as a GP alot of young and senior age patients with rosacea and eczema and other things. And he is also very familiar with malar rashes and SLE in women and the few men who get it also.

It would seem to me if I had anything systemic or even possibly discoid lupus, that something abnormal would have shown up on those tests. Perhaps not. I just know all the professional medical photos I see online for discoid lupus look nothing like the mild to medium inflamed end of my nose which also has off and on mild peeling in small areas. Nothing cornified or hard, and even pigmentation on any papule or other areas that are inflamed, even if abit swollen when they are at their worst.

Thanks for any comments, especially from the doctor.