Why doesn't it respond to treatment?

[HRJ412]

BACKGROUND

I am a Caucasian male 57 years old with a long history of acne since age 14.  During the past 5 to 7 years my skin has been relatively clear, with only minor breakout that was controlled by Benoxyl 10.  This past August I started to experience an increased level of breakout (two to three papules at the same time).  I went to a dermatologist who diagnosed me with moderate rosacea.  I have some redness in both cheeks only (the forehead, nose, and chin look normal flesh colored) and some "suntan" tan colored skin in parts of the neck and upper body.  There is no family history of rosacea. My ethnic background is English/Welsh/Irish/Polish.  



Treatment during the past two months has been an oral antibiotic (Doryx), Rosanil cleanser, and Metrogel.  I have also eliminated spicy foods, caffeine, chocolate, and hot liquids from my diet.  I drink a lot of cold water.  I have never consumed more than a couple drinks of alcohol per year. I work in an indoor office and thus my exposure to the sun is minimal (cutting my lawn).  I currently have three papules on the jawline on one side of the face. The other side of the face, forehead, nose, chin, and neck are clear.  My dermatologist says that he does not have many patients with breakout who have been taking as much medication as I have.  He has recently switched me to Finacea and a different oral antibiotic that is currently on order.



QUESTIONS:

(1)  If I do have rosacea, how did I go so quickly to the moderate stage?  I don't remember experiencing any of the symptoms of the minor stage!

(2) Why isn't the rosacea responding to the antibiotic treatment and diet change during the past two months?

(3) What other diagnosis might be possible for my symptoms? Is it worth getting a second opinion?

(4) A Chinese herbal product called AcnEase claims great results in treating both acne and rosacea.  Have you had any experience or knowledge of this remedy that is advertised on the Internet?

(5) Is there any way of predicting how worse my rosacea will eventually get? How long does it take to progress from moderate rosacea to severe rosacea?



Thank you for your consideration!

[Alan Rockoff, MD]

1 and 5:  Rosacea does not by any means necessarily progress through stages.  I have seen, for instance, severe rosacea disappear altogether for years.

2.  I think you may indeed be responding, if all you have at the moment are two or three pimples.  In fact, I'm not sure that I would call that level of breakout moderate in the first place.  In my experience, by the way, diet change makes little difference.  I suggest you eat what you like.

3.  You may have acne, which takes longer to heal, but I think your current dermatologist should be able to handle this.  

4.  Chinese herbals don't tell you what's in them, so I can't comment.



I'm not sure why your dermatologist said that "he does not have many patients with breakout who have been taking as much medication as I have."  Your course and treatment sound typical enough.



You need a bit more patience, I think.  Your doctor should be able to take care of this.



Best.



Dr. Rockoff