How to Remedy Rosacea
I have severe rosacea that won't go away. I have seen two dermatologists but have not made much headway in controlling the problem. What should I do?
By Dr. Jessica Wu, MD
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If your rosacea seems especially stubborn and resistant to treatment, the first step is to make sure you have the correct diagnosis. There are several rosacea "impostors" that can mimic the signs and symptoms of rosacea, but don't respond to the usual rosacea treatments.
Many patients who are referred to my office for "rosacea" actually have seborrheic dermatitis (also known as seborrhea). Both conditions are associated with red patches on the cheeks and nose. However, seborrheic dermatitis produces dry, flaky skin, whereas those with rosacea tend to have oily skin with pimples and whiteheads. Also, unlike rosacea, seborrhea tends to affect the eyebrows, ears, and scalp, where it produces dandruff. Treatments for seborrhea include antifungal creams and mild cortisone creams.
Eczema (atopic dermatitis) and allergic reactions can also produce red patches on the face that look like rosacea. However, these conditions typically itch, and there is often a history of previous rashes or allergies elsewhere on the body. Lupus is a systemic autoimmune condition that can produce a red "butterfly" rash on the nose and cheeks, especially after sun exposure. This can be diagnosed with a blood test and skin biopsy.
If these other skin conditions are ruled out, and conventional rosacea treatments aren't working, it's possible that something in your environment is aggravating your skin. Rosacea is often worsened by environmental factors, so try to avoid known triggers such as heat, sun, hot and spicy food and drinks, and alcohol. It helps to keep a diary of what you eat and do throughout the day. One of my patients was frustrated by a sudden flare- up of her rosacea that wasn't responding to her usual medications. I asked her to keep a diary for two weeks, and when we reviewed it at her next visit, I noticed that her symptoms coincided with using the new steam shower she installed in her bathroom, which she used for an hour every night. When she cut back to 10 minutes three times a week, her rosacea subsided without my having to change her medications.
As a last resort, some cases of severe rosacea can be controlled with Accutane. This is an oral medication that was originally developed to treat severe acne. In low doses, it can help some patients who have rosacea that is unresponsive to topical creams and antibiotic pills. Accutane has serious potential side effects including liver damage, elevated blood triglycerides, and severe birth defects, so it should only be prescribed by a doctor who is experienced with the drug and can monitor you closely with regular office visits and blood tests. Since some private dermatologists do not prescribe Accutane, you may want to consider making an appointment at the dermatology clinic associated with your local medical school. Also, university physicians may be able to recommend new or experimental rosacea treatments that your previous doctors have not prescribed.
Video: Rosacea, blepharitis, eye irritation, symptoms & treatment - A State of Sight #63
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