Rosacea, Dermatitis, or Something Else?

[SME800]

I've actually posted on this matter previously, but--each time I see a doctor--I have lingering questions and your answers help in alleviating some of the stress I experience.  After a bacterial infection, I began using anti-bacterial soap at the advise of dermatologist #1.  When I subsequently had a very bad reaction, dermatologist #1 said I had rosacea and prescribed MetroGel.  I began researching rosacea and didn't feel like I had the sort of prolonged flushing discussed on rosacea web sites.  

So, I got an appointment with dermatologist #2, with my stated reason for the appointment being, "Confirm diagnosis of rosacea."  Dermatologist #2 asked if I get red after drinking alcohol or eating certain foods.  I said "no."  He then asked many questions about allergies and checked if I had little bumps on the back of my arms.  He told me I had "atopy."  As the appointment was wrapping up, I asked him, "Do I have rosacea?"  He said "yes," then prescribed Elidel cream and Solodyn tablets.  

When I did reseach on Elidel, I was surprised to find it's generally prescribed for atopic dermatitis.  I then began to believe that was closer to the real diagnosis and began using the Elidel and Solodyn.

I just had a follow-up visit with dermatologist #2.  When I mentioned that I had a "flare up" (by which I meant a feeling of heat and stinging)  twice since last time I saw him, both times occuring when I stepped in-and-out of a cold air conditioned car and the sun, he replied, "Rosacea is a permanent condition. I can only help treat the symptoms but can't cure it."  We also talked about the appearance of my face, and he mentioned that the "rash" should get better.

So, I am back to being confused.  How can I tell whether its rosacea, atopic dermatitis, or some combination?  And, any advise on how can I better communicate with my dermatologist about my concerns when I return for a scheduled follow-up in three weeks?

[Alan Rockoff, MD]

It sounds like rosacea, which can cause a dry and sensitive feel.  Your dermatologist preferred Elidel to steroids, because steroids can aggravate rosacea.  There are many factors that can aggravate the sensitive feeling.  If you notice a specific one (like stepping out of an air-conditioned car into the sun), then you can do your best to avoid the trigger, though of course this may not always be possible.  But there isn't much to say about these triggers other than to identify them and avoid them if you can.  They can't be explained or treated specifically, and no medical treatment can eliminate them.

Best.

Dr. Rockoff