1415174 tn?1453243103

Trouble with Rosacea

Hi, I have had Rosacea for a number of years. I don't know what Type it is but it is red pimples on my cheeks, occasional white heads but these are rare,and nose and  Telangiectasia on my chin.  I have been treated with Topical Finacea 15%. It has helped for a long time. But lately I am getting a lot more small pimples and peeling skin. I put Cetaphil Eczema calming cream on my face before putting on the Finacea and that has helped with the redness. But my skin still has been peeling. My triggers are hot temperature and not sure what else. I am allergic to Metrogel. I have Metrocream.  I tested it on my arm and then face on the chin and didn't blow up like I did with Metrogel. But I also don't like the idea of having to use a low dose antibiotic and the side effects are not so good at least in the package insert. Is there anything else I can do? I don't really put much cream on my face except when I use the Finacea. I don't like the feeling of goo on my face. But I will if I have to. The other related problem is that I got a corneal ulcer that was possibly due to rosacea or the possible mites that can be associated with rosacea. I don't really believe that theory too much yet. But the Corneal specialist did. So I have to put a hot rag on my eyes twice and day and clean them with eye lid wipes. I am frustrated with not ever having good skin. But the Finacea does work especially on my nose. Any ideas?
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Sorry you've had to deal with rosacea. The Finacea has worked well, it seems. Perhaps it's losing its efficacy, don't know.

You've also tried Metrogel and Metrocream. Those are the same meds in different form.

As you know, rosacea tends to be chronic and recurrent. It is often difficult to treat.

Sadly, there is nothing that is uniformly effective...

except for being on low-dose antibiotics when you believe a flare-up is coming. Some people need to stay on these for much of their lives.  Your ought to consider having antibiotics on hand for when you see or sense a flare-up. They are the quickest and best way to try to avoid a bad flare-up.

There is a panoply of antibiotics that work. They really work nicely in the correct dosages. That's a discussion for you to perhaps have with your dermatologist.

You might want to try using Metrocream one day and Finacea. They are different products and perhaps one would complement the other. Worth a try.

There are exacerbating factors, affecting different people different ways.

In general, rosacea patients should avoid physically cold (e.g., iced tea), as well as physically hot (e.g. coffee, tea).

In general, patients may notice foods or spices, ketchup, etc., that tends to cause redness and general worsening.

In general, you should avoid the use of any and all moisturizers, oily stuff, and creams on the affected areas.  Wash with either plain tepid water or a gentle soap and water. Don't use hot or cold water. Rosacea skin is sensitive to temperature changes.

Good luck. I know you'll do well.

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Thanks! Don't use cream. What do I do for the peeling skin curad petroleum jelly? Its ok when i am home but when i go out i look hideous.  LOL
Thanks! Don't use cream? What do I do for the peeling skin curad petroleum jelly? Its ok when i am home but when i go out i look hideous.  LOL. Also, Do low dose antibiotics "cause" resistance since they are not at the clinical level. Also, i tend to develop a lot of allergies.  That is why I am reluctant to use more antibiotics.
Certainly I understand your reluctance to try oral antibiotics. They are the most effective way to help; no doubt about it.

I doubt you'd have any trouble with low dose tetracycline, minocyline, even erythromycin, doxycyline. You will be amazed at their efficacy. They should not "cause resistance." There may be what I refer to as an eventual "hardening" effect, which means that the particular antibiotic you're on doesn't work so great any more. Then you and your derm decide to switch it to another, or adjust your dosage.

Petroleum jellies in any form are murder for your rosacea.

Get ahold of some Wibi Lotion. It's a moisturizing preparation that may not be as cosmetically elegant as others available...but it is oil-free/greaseless and very important to try to ameliorate your rosacea.

I know you will do well.
Thanks so much. I don't have a dermatologist right now. My insurance is reluctant to send people to specialists. But I probably could pay for a few visits.  So will  low dose antibiotics still work on infections when used in the regular clinical dose if they stop working or are "hardened"? Can exposure to low dose antibiotics create allergies over time as do larger doses? That is a big problem for me.

Thanks again.
Hi again,

The doc of choice should be a derm, but you perhaps could mention what you think to your pcp.

As an aside, if your ins plan doesn't like to refer (and you really can't blame them), keep in mind that rosacea is a bonafide, real disorder. It is totally warranted to see a derm.

Low-dose antibiotics, as far as I know, would continue to work for other problems. And I know you know that rosacea is not an infection. It is a skin condition or ailment, not an infection.

Yes, antibiotics can aggravate allergic diathases in anyone.

You have such good questions. But they are difficult to specifically answer.

In my days, I treated hundreds of rosacea patients. I learned early and repeatedly that proper antibiotics were the best treatment.

One of my own daughters takes them when she needs them, a few times a year for a few weeks or months. Most of the time she is controlled by Metrogel.

As you know, there are millions of permutations and combinations regarding how an individual might react to a certain condition and its treatment.

As you now know I've experienced myself, docs are not correct all the time.  I'm as smart as the next guy, but overall probably not smarter.  "Luck and G-d." And methinks G-d comes first.

Experience matters. I'll tell you a little (irrelevant) story:

Within a year or two after I opened my derm practice, a patient came in with his interpreter. They were carrying probably 35-40 charts. The patient had seen doctors literally all over the world and no one knew what he had. The very second he came into my consultation room, I knew exactly what he had.

He had leprosy. During my residency, I had lectured other residents and staff about, you guessed it, leprosy. Certain lepers had a facial characteristic which, to the experienced, was pathognomonic. It's pretty unusual, but not really rare.

I proved my diagnosis with a little skin biopsy from his belly. The trick (which I'm sure you're familiar with) was to tell my pathologist to do an acid-fast stain so he could see the causative organisms. He did and I was right.

Obviously leprosy is a distasteful diagnosis, but I broke it to him gently and told him how we were going to treat it. I referred him to a friend, a Cuban dermatologist, who could speak his language and who had a small group of lepers he treated.

So many potentially deadly mistakes. Scary stuff.

Almost midnight here. I'm going to watch some TV, snuggle with my beautiful wife, and get a good night's sleep.
Interesting story. We had one case of Leprosy when I worked at a county hospital. A patient, from Mexico, was sent to us that had a wound that had  been treated with steroid and it got worse. The doctor at county took a specimen and lo it was acid fast. We then found it was Leprosy. So the patient recovered but like you said I am sure it was a surprising diagnosis for the patient.
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