Ruddiness face and HCV

[JackABCD]

During the last 2-3 years I have developed some sort of ruddiness  face. Does anyone familiar with that ? Is there anything to do with that ? Once I asked my hep doc and he told that is somehow common with HCV and that it is not something that should worried me.

Thanks.

[jmjm530]

Google "rosacea" and spend some time reading. Depending on your specifics, there may be some lifestyle changes, topical medications, and/or laser or other light treatments you may want to look into. I never heard of rosacea being associated with Hepatitis C, although the treatment for Hepatitis C (interferon/ribavirin) flared whatever little rosacea I may have had into a full-blown case -- which while much better now, I'm still dealing with one year post treatment. Also, be careful with your eyes -- have them checked, wear sunglasses, and artificial tears if dry -- as rosacea can often manifest itself in and around the eyes (ocular rosacea). Lastly, see a good dermatologist for an accurate diagnosis, because if it's rosacea, the condition tends to get worse as you get older if ignored or untreated. Just a tip on your internet search -- you may run across writings, posts, or forums by someone (I think he's a doctor by not a medical doctor) with the initials J.N. Be aware that he is quite controversial.

All the best,

-- Jim

[JackABCD]

Thank you Jim.

Acctually last Jan I have seen a Dermatologist when it was much worse and she told me that she thinks it is Seborrhea, She also recommended me a cream that helped at that time, but at that time my face skin was dry which doesn't look like now.  

I am not sure if it is OK to use that cream for a long time, I should talk with her about that.

Do you think Seborrhea has anything to do with HCV ?

Thank you,
Jack

[Andiamo1]

Seborrhea is caused by an alergic (allergic) reaction to a fungus.  It is usually treated with Nizoral cream sometimes along with a steroid cream.

I have HCV as well as Seborrhea, but that is too small a sample to establish a relationship between the two.  My rash has gotton much worse since I started treatment in the Prove 3 trial.  I assume that is caused by the immune stimulus and dry skin sx from the treatment.

[jmjm530]

Seborrhoeic dermatitis (eczema)is quite common in the general population but possibly even more so in those with HCV. Not sure.

Treatment however oftenflares seb derm, as it did with me. In fact, I had seb derm, psoriasis and rosacea layered on various parts of my body (including face) which made diagnosis more difficult, even with a dermatologist.

Based on what you said, it's quite possible that you only have seb derm, or you may have seb derm layered as in my case. Seb derm often presents itself with some sort of scaling/flaking, but then again so does psoriasis. Here are some pics of seb derm but then again, the redness you see is also very similar to that with rosacea.

I've found it not uncommon for different dermatologists to differ in their diagnosis, as sometimes it's more of an art than science when more than one condition presents. For this reason, you may want to get a second consult (I saw 3-5 derms eventually). Did they do a biopsy? Scrape and check for fungus? Does the sun aggravate, help, or is neutral for your condition? (Rosacea often flares from the sun.)

As to treatment, as stated, Elidel is often prescribed for all three conditions. Be VERY careful if your doctor prescribed anything with cortisone in it for your face except for maybe a very short period like two weeks, and even then, only very occasionally. Some doctors will NEVER prescribe cortisone for the face, even the 1% hydrocortisone you can get at the drug store. Definitely find out what is in the cream you've been prescribed and see another derm before using it, especially since your symptons seem to have changed some.

All the best,

-- Jim

[jmjm530]

Here's the seb derm pics. Meant to say "topical steroids" instead of cortisone, which is a steroid.

http://dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html

[JackABCD]

Thank you, I looked at the pics, it is not as in the pics, it is acctually much less severe then seen in the upper row pics.

My dermatologist didn't take any a biopsy or scraped.

The sun does aggravate it significantly therefore I am trying to avoid sun exposure.

I would say it is more noticeable where there is a white light on my face (like a neon light).

Does Elidel  considered as the best medication for that ?

[JackABCD]

Dear Andiamo,
Dod the Nizoral cream help ?
Thank you
Jack

[WillPower]

Until I was treating my HCV, I have never, ever in my 67 years had either rosacea or seborrhea .  No major life style changes, just HCV and tx.  It is gradually causing my face to loose its smooth texture of the past.  I am now ten months post tx.  It comes and goes about every three weeks.  It clearly began with HCV/tx.  Nobody in my family has ever had this problem.  If I stay svr, I accept the substitute, but it is interesting that this is totally new to me.  Odds are that it is caused by HCV drugs messing with my immune system!

[jmjm530]

Jack: The sun does aggravate it significantly therefore I am trying to avoid sun exposure.
-------------------
The sun is a very common rosacea trigger, but often helps seb derm, so my guess is rosacea. Just remember, I'm not a dermatologist -- only play one on the internet :) -- so do see a derm for proper diagnosis.

Rosacea is treated several ways, depending on type and severity. First is to identify triggers and avoid -- or  compromise -- in terms of exposure. For the sun, best to avoid as much as possible and always use a sunscreen, with some products better for rosacea skin (often very sensitive) than others. Do you ever flush after exercise, being in a hot environment, or drinking red wine, for example? Some more common rosacea triggers.

Currently I use the Elidel more for spots of psoriasis and seb derm than rosacea, although I sometimes use it for that as well. Current rosacea regimen is Metrogel 1% gel (anti-inflammatory) and (Sodium Sulfacetamide 1% and Sulfur 5% Lotion) applied on alternate evenings, mostly on nose and upper cheek areas. I also use a Clindamycin (antibiotic) preparation most mornings. Then I use Elidel wherever I see flaking (seb derm). This seems to work pretty well BUT it's based on what I need after consulting with several dermatologists. Your condition may be different and require different meds. Laser and IPL (intense pulse light) treatments are also available for the redness. In more advanced cases -- when you see postules -- courses of oral antibiotics are often used. Never got that far but very close.

Rosacea doesn't have a cure but it can be controlled very well if you make the effort. Keep on top of it and you should be OK.

Forgot to ask if your'e on treatment or just recently completed treatment. Treatment made everything skin-wise like 1000% worse and it took close to a year post tx for things to calm down significantly.

-- Jim

[jmjm530]

Whatever rosacea or seb derm I may have had prior to treatment, I hardly noticed. I had significant seb derm during treatment and the rosacea started near the end of treatment and continued after per my last post. Definitely the treatment drugs, most probably the interferon, and no doubt my UVB Narrow Band light treatments for psoriasis didn't help either. As mentioned, I've got things under control for now and will probably do IPL (intense pulsed light) and/or laser treatments in the future to help clear the rosacea skin up. And yeah, no more sun bathing.

-- Jim

[JackABCD]

Thank Jim, This is a very helpfull information, I will go and meet a very good dermatologist.

About Tx - I am supposed to start at the end of Aug.

Recently I started with Milk Thistle and that looks good so far, my feelings are much better and ALT went down from 300 onto around 150 (it is 1 month since I have started Milk Thistle), I am waiting for VL test (last VL test was 2 milion).

[JackABCD]

You asked: " Do you ever flush after exercise, being in a hot environment, or drinking red wine, for example? Some more common rosacea triggers. "

I forgot to answer, but the question is - Yes.

[JackABCD]

You asked: " Do you ever flush after exercise, being in a hot environment, or drinking red wine, for example? Some more common rosacea triggers. "

I forgot to answer, but the answer is - Yes.

[jmjm530]

Definitely discuss the flushing, sun sensitivity, etc, in terms of rosacea when you find your new dermatologist. As mentioned, often multiple skin conditions are layered on each other, as the skin itself isn't as smart as the doctors who give names to its conditions :) Treatment very often will present additional challenges in terms of your skin, so getting a good derm in place now is a good idea. As to milk thistle, some doctors don't want you to take it during treatment and some allow it. I assume you've discussed it with your doctor.

All the best,

-- Jim

[Andiamo1]

Yes the Nizoral cream helped very much.  Using Cortisone on the face can thin the skin and make some capilaries vissible and that is permanent if it happens.  Dermatologists are careful when they prescribe the combo cream.

I used only the Nizoral and it worked like a charm.

[jmjm530]

I was prescribed Nizoral (KETOCONAZOLE)and similar for my seb derm but it flared my facial rosacea to the extent that I had to revert to a steroid (Cutivate) for two weeks to calm things down. Rosacea skin (if that is what Jack has) can be extremely sensitive and that's why I suggest he see a good dermatologist before trying anything. Happy to hear Nizoral worked for you. I did have some success with Nizoral on parts of my body other than the face. Did you use Nizoral on your face? I couldn't even tolerate OTC tar oil shampoos while on treatment.

-- Jim

[Andiamo1]

I did use it on my face and most of the time it worked.  Once I had the same reaction as you and had to use steroids briefly. It does seem to me that the problem became much worse during the tmes I was on treatment and is the worst it has ever been now that I am in prove 3.

[JackABCD]

Just want to tell you that eventually Bifonazole solved my problem (until the next time as said by the my dermatologist).
Thanx, Jack