Rosacea Treatment

[SME800]

I went to dermatologist #1 as a follow-up to a previous visit about a month prior related to a bacterial infection.  He had advised me at that previous visit to stop using a cleanser (which contained 2% salicylic acid) and instead use an anti-bacterial soap.  However, I have long had easily irritated skin and found the cleanser made it feel a lot better, especially along the jaw line where I shave.  By contrast, the anti-bacterial soap had caused my cheeks to become bright red, develop what impressed me as lesions, and even seemed to cause some wrinkling and brown spots around the eyes.  

For whatever reason, dermatologist #1 was very busy and kept talking over me, discussing our previous case.  I didn't even have time to tell him about the effect of the anti-bacterial soap.  All that I got out was, "My skin gets red and irritated."  He said I have rosacea and prescribed me MetroGel.

I decided to get the diagnosis confirmed.  Dermatologist #2 immediately said I have rosacea, before really even talking to me (though he did subsequently take a history and look at my skin closely).  He dismissed the antibacterial soap connection as "pure coincidence."  He then prescribed me Solodyn and Elidel cream.

Because the two courses of treatment were so different, I decided to see a family physician who has background in dermatology.  To my surprise, he didn't think I had rosacea at all.  He recommended that I simply use the MetroGel if I ever felt the need due to any flushing.

I'd appreciate any advise on where I should go from here.  I should note that most people who look at me say I don't look like I'm all that red, but I definitely have pinkish cheeks.  Also, my sister has also been diagnosed as having rosacea.  I'm thinking maybe I should use a Cetaphil Cleanser to wash and apply the MetroGel for a bit.

[Alan Rockoff, MD]

I can't really negotiate without seeing you between three other opinions.  I suspect from your description that you just have red cheeks that flush, not actual rosacea.  Some doctors classify lain redness as a form of rosacea, but even if you call it that, rosacea treatments like creams and pills don't help.  Lasers and similar devices can help reduce redness.  No treatment I know of helps flushing, other than avoiding whatever triggers it (wine, spices, etc.)  You seem skeptical of the doctors you've seen.  I guess that's your prerogative, but you'll need to find a skin doctor you actually trust to examine you in person for a definitive diagnosis.

Best.

Dr. Rockoff

[SME800]

Thanks.  I appreciate the insight.  I should note that I do have a couple of little red bumps leftover from when my cheeks flared up after using the anti-bacterial soap.  It's the only time I believe I have ever developed such bumps.  They seem to be fading somewhat without treatment.

There was also something that I forgot to mention to the two dermatologists that I saw:  As soon as I washed my cheeks with a cleanser, the redness and pain in my cheeks immediately disappeared.  I wish I had mentioned that, as I'm not sure whether it would have impacted the diagnosis or not.  I'd be a lot more confident in the diagnosis if I had mentioned it.

Anyway, I do appreciate your help.  You are right that I need to find a dermatologist that I trust.  I'm not ordinarily so skeptical, but things just developed in a way that became confusing for me.

[sally504]

hi, i'm just repling to Rosacea Treatment i was just wondering how long did it take for the redness to disappear?

[SME800]

The cheeks immediately stopped swelling and blistering when I used the cleanser.  Some redness persisted for a few days after, I think.  It's now more of a pink rash.  I've been going with dermatologist #2's recommendations and treating with the Elidel, but I remain confused.  

I should note that my recollection, as posted above, about dermatologist #2 was off.  I typed this post up in haste.  In fact, dermatologist #2 said I have "atopy," and only later said I have rosacea when I directly asked him.  I was remembering it wrong--sorry.  But, I admit all these skin conditions seem to run together to some extent, and maybe a single diagnosis isn't easy to make.