seb derm or rosacea

I'm confused by the differential diagnosis between seb derm and rosacea.  I have persistant red areas on the end of my nose with flaking on the bridge and sides.  I also have flaking on the forehead, and cheeks, but only redness on the nose.  I was first diagnosed with seborrheic dermatitis (my father has it) and treated with Nizoral and Aclovate.  They helped with the redness but the flaking persisted.  Now the dermatologist has changed the diagnosis to rosacea or an early stage of rhinophyma and prescribed a couple of days on erthromycin and Metrogel, which I've been using for about a week with some resolution of the redness, but it still persists.  I have never experienced flushing but I have had on occasion a nodular inflamation (inflammation) on my nose, but I'm not sure if that was a result of roscaea of a plugged pore (I have always had enlarged plugged pore on my nose)and never really noticed any papules.  I'm not confident in the rosacea diagnosis.  Are there any other distinguishing features between seb derm and rosacea.

[Alan Rockoff, MD]

They can indeed be hard to distiguish, because both affect the same part of the face--the middle third--and each can be associated with redness and scaling.  The fact that seborrhea treatment didn't get rid of the scaling does suggest rosacea.  Rosacea treatment takes several weeks to assess, however, so I wouldn't quit just yet.  Also, your doctor may need to shift the topoical and/or oral treatment (to a tetracycline derivative, for instance) if this regimen doesn't work.  I'd wait a while before bailing out.

Best.

Dr. Rockoff

[ttiki]

Please keep posting your results on your current treatment, I'm very interested..