seb derm vs rosacea

I am white male, 42 yrs. since my early twenties, history with scalp seb, brought under control with daily neutrogina shampoo, havent had any probs with this in about 7 yrs, and continue daily shampoo. In mid twenties had occassional probs w/ seb derm on cheeks used cortaid w/ fair results, eventually more often, until mid thirties, when desonide was perscribed to treat varying degrees of occassional raised red patches at temples, hair line, cheeks,side burns area, and sometimes nose, usually with a symmetry to it. Have often noticed that it seems just the right amount of sunshine (about an hours worth now and then) also helped. I would use a very small amount of the desonide nearly every night (amounting to about 2 oz. per year) and this kept the problem well under control and I was happy.
Six months ago my dermatologist said I probably have rosacea and discontinued giving me desonide and put me on metrolotion which I used twice daily for four months. This seemed to make a moderate and tolerable situation much worse. with the metrolotion my face was totally red most of the time with an unusual hue. I finally stopped it and now have the same old symptoms and have been using the last of an old (1998) desonide. My question is if I have rosacea, what about the IPL therapy I have heard about, or other meds, and why shouldn't I go back to the desonide? Especially because I used only very small amounts? This is driving me crazy.

[Alan Rockoff, MD]

I think your dermatologist should reconsider your situation.  If you had steroid-induced rosacea, it would have gone away after 6 months.  Your doctor might want to consider a non-steroid cream like Protopic or Elidel as well.  But desonide is indeed mild enough for regular use, if that's the only thing that works for keeping your skin calm.

Take care.

Dr. Rockoff

[rosaceaguy]

Here is some more info about rosacea and a link to find more info

Rosacea (ro-ZAY-shah) is a chronic disorder that develops gradually and is characterized by flushing, blushing, redness, pimples, red gritty eyes, burning or stinging and, in some advanced cases, a bulbous nose (called rhinophyma). The disorder can be confused with and co-exist with acne vulgaris and/or seborrhoeic dermatitis. Men and women of all ages can be affected but middle-aged women are more susceptible because of hot flashes caused by menopause. Anyone that is fair-skinned of European or Celtic ancestry are more likely to be affected.

Patients have one or more of the following symptoms:

    * Flushing and blushing easily with the redness persisting
    * Small red bumps (papules), some pus-filled (pustules)
    * Redness and inflammation
    * Small blood vessels visible on the face
    * Red eyes and eyelids
    * Sensitive skin

Rosacea can cause low self esteem which can lead to clinical depression.

Triggers:

Rosacea can easily progress to more advanced stages by irritating topical products and other triggers causing flare ups. People with rosacea should try to minimise triggers such as alcohol, spicy foods and stress. Gentle skincare products should be used that are designed for sensitive skin and a sunblock containing zinc oxide or titanium dioxide used while in the sun.

Many anti-acne and anti-wrinkle treatments are too harsh for rosacea skin and will progress the disease. Treatments like microdermabrasion, chemical peels, high dosages of isotretinoin (Accutane