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Seriously depressed for Rosacea for 15 years
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Seriously depressed for Rosacea for 15 years

Dear Doctor,

I am a 31 years old Asian male. Ever since I hit puberty, my nose has been oily and red and big. When taking a close look in a mirror under white light, I could see a lot of small dilated vessels.

Every since that puberty, I have been thinking about it every day every second. I could not concentrate for one minute without thinking about my nose. It has been a nightmare and is so torturous for me to sustain such tremendous amount of psychological pressure.

The major reason of my depression is that when I google the word "rosacea" ,  I saw so many disfigured nose that I could not bear to think that one day my nose would look like one of those.

My nose has not yet shown any major deformations. However, there are many small dilated vessels on my nose and the pores are quite big along with uncountable blackheads. It results in a very unsightly fat nose.

I have seen a few dermatologists and the pills they prescribed did not help any of the symptoms. So the only option I have is to avoid triggers and wait for the Rosacea to get worse. But waiting for it to get worse is so difficult for me.

Having said that, I am not really much concerned about the red part. I am very very very very concerned about the potential disfigurements of the nose.

I understand that the extra growth tissue can be removed by laser. However, I see some people with rosacea, they often have thickened skin with large pore and the nose is enlarged as a whole, not just bumps. So I am extremely worried and horrified if I've got to that stage, I would never have a chance to have a normal looking nose again.

I really hope to hear that in case my nose skin is thicken and deformed in the next 10 years , there are options for me to restore the nose to a normal looking before Rosacea.
Thanks for posting your query.

I can understand your concern for rosacea but the disfigured nose that you have seen in pictures is rhinophyma which typically occurs in very severe cases of rosacea.

Your worry about rosacea is natural but unless the diagnosis is confirmed there is no point in stressing yourself. You should first of all consult a dermatologist and get a physical examination and biopsy of the skin done to confirm the diagnosis.  

Now regarding rhinophyma, it may respond to medication if diagnosed in its early stages. These medicines are isotretinoin and tretinoin, benzoyl peroxide, or azelaic acid and topical antibiotics. Other than that, surgery can be opted for. Surgery can be performed using a scalpel, laser, cryosurgery, electrosurgery, or dermabrasion. But the problem may recur after treatment.

Rhinophyma is considered an advanced stage of rosacea and even if diagnosis of rosacea is confirmed by your dermatologist, there are treatment options to limit rosacea. It has been seen that home care of washing with a prescription sulfa wash twice a day, applying an antibacterial cream morning and night, and taking an oral antibiotic for flares are quite effective. You can get the topical metronidaole and azelaic acid prescribed from your dermatologist. Other treatment options include lasers, pulsed-light therapies, photodynamic therapy, and isotretinoin.

Also try to limit exposure to rosacea triggers which include smoking, spicy foods, hot drinks, alcohol, dairy products like yogurt, sour cream, cheese, soy sauce, yeast extract, chocolate, beans and pods and citrus fruits, ingredients used in cosmetics like peppermint, eucalyptus oil, witch hazel, clove oil, menthol and fragrance and exposure to sunlight and to extreme hot and cold temperatures. Use mild soaps and cosmetics and apply sun screen with a minimum spf of 30 atleast half an hour before going out in the sun.

With these lifestyle treatment options you should benefit but if the symptoms persist then you can discuss the treatment options mentioned above with your dermatologist.

Hope that this information helps and hope that you get better soon.

Wishing you good health.

Dear Doctor,

Can the thicken skin on top of the nose be removed in the same manner like the overgrowth bumps due to rosacea? or can it be removed at all?

It will be my last.

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