Guest guest Posted April 11, 2002 Report Share Posted April 11, 2002 > > > Ok, I've heard this twice now in the last day or so. What is the > difference > > between flushing/blushing predisposition + acne vulgaris vs having > cea? > > Isnt cea just the predisposition to flushing/blushing that > eventually if > > left untreated long enough will lead to other problems such as > > papules/telengiectasia/swelling etc? I don't see a difference. > The difference between flushing/blushing + acne vulgaris and rosacea is location and comededones or not. Practially, treatment wise not much difference. > There's a big difference, Adam. > > Here's how I see it: the predisposition to develop rosacea is called > pre-rosacea, which isn't a condition but only an increased > disposition to developing the condition of rosacea. That is, we can > say that if a person flushes easily, they are at increased risk for > developing rosacea in later life. But at that stage it's not > appropriate to diagnose them as rosacean. That's because rosacea is > not just easy flushing -- easy flushing is not a condition, it's > normal. Most young people who flush easily will either outgrow it, or > just flush as they always do for the rest of their lives. > > But in a sizable number of people who flush easily, the recovery from > flushing becomes prolonged, it becomes easier and easier to trigger a > flush, and in some eye problems develop even before any more obvious > skin changes...all are indications that pre-rosace is turning into > rosacea (assuming other disorders have been ruled out). No one knows > why. > > How do we treat pre-rosacea to prevent it from developing into > rosacea? There's no way I know. But rosaceans can possibly slow down > the progression of the early stages to the later, more cosmetically > disfiguring stages, with good skin care and attention to triggering > events. > Interestingly, you can treat pre-acne with topical retinoids to prevent real acne. Could differin prevent pre rosacea??? > cea is a clinical diagnosis, which means there's no test to > perform, it's all based on signs/symptoms. Classically, rosacea > manifests in one or a combination of four ways: inflammation (papules > with surrounding erythema), vascular abnormalities (prolonged > flushing, spiders), edema (physma), and ocular manifestations. > Interesting, that the ocular rosacea can occur while the skin is > still in pre-rosacea, but there's a lot that's not clear about this > condition. One of the biggest mysteries is the connection between > easy flushing and the signs/symptoms of rosacea. There are plenty of > theories, but no one theory seems to explain everything about the > condition. > > > > Dr. Nase says in his book on page 182 under the heading > MISCONCEPTION #3: > > ROSACEA DOES NOT AFFECT PEOPLE UNTIL THEY ARE IN THEIR 40's OR 50'S: > > > > " This is an extremely common misconception. Most general medical > articles > > report that rosacea is a disorder of the middle-aged. This is > Absolutely > > Wrong! It is Very common for teenagers and young adults to have > classic > > cea. This disorder Usually starts to rear its ugly head in the > late > > teens and early 20's. " > younger ages and rosacea is correlated with type I or II skin, (pale, white folk) (irish types, english types, etc.) and sun exposure, lower lattitudes, high altitudes, etc, and harsh skin products. > I can't know what Dr. Nase is referring to. What evidence does he > offer to support those statments? I can't know if he's confusing pre- > rosacea with rosacea, which is what the last sentence seems to allude > to. But I don't know. > > To say that rosacea during the teenage years is rare doesn't mean > it's impossible, it just means it's rare. That it's far more common > for teenagers to suffer from acne vulgaris doesn't mean every > teenager suffers from acne vulgaris. > > And many teenagers blush/flush easily, some will outgrow the > tendency, others will continue to flush easily through life but > nothing more -- but, a sizable group will progress to signs/symptoms > of rosacea. This is key: just because someone blushes/flushes easily > does NOT mean they have rosacea or are absolutely destined to develop > rosacea. Nor does it mean that everyone with rosacea has a history of > easy blushing/flushing. cea is just not that straightforward. > > Hope that helps. How are things going with the U of Rochester > referral? > > Marjorie > > Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2002 Report Share Posted April 11, 2002 Once and for all. Shine a brigh light on your face. Strech your skin, if you see comedones, you have acne. For good pictures of what a comedone looks like, get a dermatology textbook. You can have rosacea and acne concurrently. Just because you have acne does not exempt you from rosacea. If you have comedones, and inflammatory lesions, the odds are that the inflammatory lesions got that way by maturing comedones, the primary lesion. Also, if you flush and blush, your pustules have the added benefit of being rosacea caused. Does this matter for treatment. Does the pustule care when you apply clindagel to it how it got that way? No, if the clinagel is going to work, it will work on acne pustules and rosacea pustules. Now, when you have a microcomedone, different treatment, retinoinds, are required to expel that microcomedone and normalize follicular keratinization to prevent that comedone from growing up to beceme a pustule or, better, to prevent the microcomedone from forming in the first place. If you have rosacea, do not use retin a or tazorac, use differin gel. If you have rosacea, do not use full dose accutane, use low dose. These are the main treatment differences. > > > > , acne rosacea in a 20 year old is possible but very rare -- > > far, far more common is acne vulgaris. Also far more common is > > chronic flushing/blushing that doesn't have a disorder associated > > with it, is just a characteristic of the person, perhaps an > inherited > > tendency or trait. > > > > Both acne and easy blushing/flushing occur so commonly in the young > > that there's no compelling reason to link them together. Having all > > the symptoms of a condition doesn't mean you have that condition, > not > > by a long shot. > > > > Plus, if there's any question on a diagnosis, the better medical > > management would favor the conditon that is more amenable to > > treatment (in your case, acne vulgaris), then to jump immediately > to > > the condition that has no great treatment -- especially when the > > first is so common in the patient population, and the second is so > > rare. Does that logic make sense to you? > > > > Clindagel is a topical antibiotic, like Metrogel commonly > prescribed > > for rosacea, just a different antibiotic (clindamycin rather than > > metronidazole). Why are you sure it will irritate you -- have you > had > > bad experiences with topical clindamycin in the past? Topical > > antibiotics are anti-inflammatory, but only clindamycin will kill > off > > the bacteria that commonly causes acne vulgaris. (cea isn't > > thought to be caused by bacteria). > > > > I know nothing about photoderm treatments. Why is he recommending > > them for you? > > > > Marjorie > > > > Marjorie Lazoff, MD > > > > > > > Hello y'all: > > > > > > I just went to the top rated dermatologist in Nashville and > > he > > > said that at my age(20) rosacea is almost impossible to have and > > that > > > what I have is some acne and a flushing/blushing predisposition > > that > > > can be helped by Zyrtec. He prescribed me the Zyrtec and > Clindagel > > for > > > the acne. I'm worried. So many people say that people my age can > > get > > > it, and I do have all the characteristic symptoms of > rosacea....is > > this > > > another clueless derm? He also advised getting photoderm at his > > clinic, > > > likely at a 550 wavelength. I'm sure the clindagel will irritate > > > me...I'm confused. Any advice would be appreciated. > > > > > > - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2002 Report Share Posted April 11, 2002 Once and for all. Shine a brigh light on your face. Strech your skin, if you see comedones, you have acne. For good pictures of what a comedone looks like, get a dermatology textbook. You can have rosacea and acne concurrently. Just because you have acne does not exempt you from rosacea. If you have comedones, and inflammatory lesions, the odds are that the inflammatory lesions got that way by maturing comedones, the primary lesion. Also, if you flush and blush, your pustules have the added benefit of being rosacea caused. Does this matter for treatment. Does the pustule care when you apply clindagel to it how it got that way? No, if the clinagel is going to work, it will work on acne pustules and rosacea pustules. Now, when you have a microcomedone, different treatment, retinoinds, are required to expel that microcomedone and normalize follicular keratinization to prevent that comedone from growing up to beceme a pustule or, better, to prevent the microcomedone from forming in the first place. If you have rosacea, do not use retin a or tazorac, use differin gel. If you have rosacea, do not use full dose accutane, use low dose. These are the main treatment differences. > > > > , acne rosacea in a 20 year old is possible but very rare -- > > far, far more common is acne vulgaris. Also far more common is > > chronic flushing/blushing that doesn't have a disorder associated > > with it, is just a characteristic of the person, perhaps an > inherited > > tendency or trait. > > > > Both acne and easy blushing/flushing occur so commonly in the young > > that there's no compelling reason to link them together. Having all > > the symptoms of a condition doesn't mean you have that condition, > not > > by a long shot. > > > > Plus, if there's any question on a diagnosis, the better medical > > management would favor the conditon that is more amenable to > > treatment (in your case, acne vulgaris), then to jump immediately > to > > the condition that has no great treatment -- especially when the > > first is so common in the patient population, and the second is so > > rare. Does that logic make sense to you? > > > > Clindagel is a topical antibiotic, like Metrogel commonly > prescribed > > for rosacea, just a different antibiotic (clindamycin rather than > > metronidazole). Why are you sure it will irritate you -- have you > had > > bad experiences with topical clindamycin in the past? Topical > > antibiotics are anti-inflammatory, but only clindamycin will kill > off > > the bacteria that commonly causes acne vulgaris. (cea isn't > > thought to be caused by bacteria). > > > > I know nothing about photoderm treatments. Why is he recommending > > them for you? > > > > Marjorie > > > > Marjorie Lazoff, MD > > > > > > > Hello y'all: > > > > > > I just went to the top rated dermatologist in Nashville and > > he > > > said that at my age(20) rosacea is almost impossible to have and > > that > > > what I have is some acne and a flushing/blushing predisposition > > that > > > can be helped by Zyrtec. He prescribed me the Zyrtec and > Clindagel > > for > > > the acne. I'm worried. So many people say that people my age can > > get > > > it, and I do have all the characteristic symptoms of > rosacea....is > > this > > > another clueless derm? He also advised getting photoderm at his > > clinic, > > > likely at a 550 wavelength. I'm sure the clindagel will irritate > > > me...I'm confused. Any advice would be appreciated. > > > > > > - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2002 Report Share Posted April 11, 2002 Once and for all. Shine a brigh light on your face. Strech your skin, if you see comedones, you have acne. For good pictures of what a comedone looks like, get a dermatology textbook. You can have rosacea and acne concurrently. Just because you have acne does not exempt you from rosacea. If you have comedones, and inflammatory lesions, the odds are that the inflammatory lesions got that way by maturing comedones, the primary lesion. Also, if you flush and blush, your pustules have the added benefit of being rosacea caused. Does this matter for treatment. Does the pustule care when you apply clindagel to it how it got that way? No, if the clinagel is going to work, it will work on acne pustules and rosacea pustules. Now, when you have a microcomedone, different treatment, retinoinds, are required to expel that microcomedone and normalize follicular keratinization to prevent that comedone from growing up to beceme a pustule or, better, to prevent the microcomedone from forming in the first place. If you have rosacea, do not use retin a or tazorac, use differin gel. If you have rosacea, do not use full dose accutane, use low dose. These are the main treatment differences. > > > > , acne rosacea in a 20 year old is possible but very rare -- > > far, far more common is acne vulgaris. Also far more common is > > chronic flushing/blushing that doesn't have a disorder associated > > with it, is just a characteristic of the person, perhaps an > inherited > > tendency or trait. > > > > Both acne and easy blushing/flushing occur so commonly in the young > > that there's no compelling reason to link them together. Having all > > the symptoms of a condition doesn't mean you have that condition, > not > > by a long shot. > > > > Plus, if there's any question on a diagnosis, the better medical > > management would favor the conditon that is more amenable to > > treatment (in your case, acne vulgaris), then to jump immediately > to > > the condition that has no great treatment -- especially when the > > first is so common in the patient population, and the second is so > > rare. Does that logic make sense to you? > > > > Clindagel is a topical antibiotic, like Metrogel commonly > prescribed > > for rosacea, just a different antibiotic (clindamycin rather than > > metronidazole). Why are you sure it will irritate you -- have you > had > > bad experiences with topical clindamycin in the past? Topical > > antibiotics are anti-inflammatory, but only clindamycin will kill > off > > the bacteria that commonly causes acne vulgaris. (cea isn't > > thought to be caused by bacteria). > > > > I know nothing about photoderm treatments. Why is he recommending > > them for you? > > > > Marjorie > > > > Marjorie Lazoff, MD > > > > > > > Hello y'all: > > > > > > I just went to the top rated dermatologist in Nashville and > > he > > > said that at my age(20) rosacea is almost impossible to have and > > that > > > what I have is some acne and a flushing/blushing predisposition > > that > > > can be helped by Zyrtec. He prescribed me the Zyrtec and > Clindagel > > for > > > the acne. I'm worried. So many people say that people my age can > > get > > > it, and I do have all the characteristic symptoms of > rosacea....is > > this > > > another clueless derm? He also advised getting photoderm at his > > clinic, > > > likely at a 550 wavelength. I'm sure the clindagel will irritate > > > me...I'm confused. Any advice would be appreciated. > > > > > > - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2002 Report Share Posted April 11, 2002 > Even more > unfortunately, the U of R referral went down the toilet. I called the derm > department at Strong Memorial Hospital and they cant see me until late July. > Also, the rather rude lady who answered the phone said I wouldn't be able to > see a resident or anything, and made me feel like a retard for even asking, > according to her there are 5 doctors there to see, thats it, and they're all > booked until mid-summer Adam, when I recommended Strong Memorial to you, I assumed you were unconflicted about finding the best medical facility in your area to help you manage your skin problem. ly, the age of the doctor, the social skills of the receptionist, or needing to wait a few months to help manage a lifelong condition are side issues. I wouldn't have expected you to bring them to the forefront. > Plewig, G. " cea: epidemiology and pathogenesis " J Cutan Med Surg 2 Suppl > 4: S4-10, 1998. > Donshik, P.C., " Inflammatory and papulosquamous disorders of the skin and > eye " Dermatol Clin 10: 533-547, 1992. > Shear, N.H. " Needs Survey of Canadian cea Patients " J Cutan Med Surg 3: > 178-181, 1999. > National cea Society " cea Review " Summer 1997. Drake, L. > Wiemer, D.R. " Rhinophyma. " Clin Plast Surg 14: 357-365, 1987. > Brinnel, H. " cea: disturbed defense against brain overheating. " Arch > Dermatol Res 281: 66-72, 1989. (<-- Interesting title, I'm surprised > something with this name was published in 1989!!) > Klaber, R " The Pathogenesis of cea: a review with special reference to > emotional factors " . Br J Dermatol Syp 51: 5011939 Thanks for this. Are these references at the back of the chapter? If so, they're references he found valuable and/or those he recommends to others for further information, not references that support a specific assertion. After making an unusual statement like his " Misconception #3 " , I would expect Dr. Nase would provide specific data supporting what he's saying. Maybe it's some place else in the book? Marjorie Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 2002 Report Share Posted April 12, 2002 > and,in my experience, in almost any line of > business, quite often, if the receptionist (or > the first line of contact in the place) is rude, > dismissive, abrupt or whatever, it is a very good > indication of the general tone and attitude of > the offce in general. usually this tone is > established from the " upper " management. in other > words, if the boss has an attitude than it > filters down and becomes an acceptable attitude > for the rest of the employees. , in clinics located or affilated with academic centers like Strong Memorial, the attending physicians are under contract and/or employed by the hospital. The hospital staffs the clinic, not the doctors. (Large group practices and medical organizations are run similarly.) Marjorie Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 2002 Report Share Posted April 12, 2002 > and,in my experience, in almost any line of > business, quite often, if the receptionist (or > the first line of contact in the place) is rude, > dismissive, abrupt or whatever, it is a very good > indication of the general tone and attitude of > the offce in general. usually this tone is > established from the " upper " management. in other > words, if the boss has an attitude than it > filters down and becomes an acceptable attitude > for the rest of the employees. , in clinics located or affilated with academic centers like Strong Memorial, the attending physicians are under contract and/or employed by the hospital. The hospital staffs the clinic, not the doctors. (Large group practices and medical organizations are run similarly.) Marjorie Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 2002 Report Share Posted April 12, 2002 > and,in my experience, in almost any line of > business, quite often, if the receptionist (or > the first line of contact in the place) is rude, > dismissive, abrupt or whatever, it is a very good > indication of the general tone and attitude of > the offce in general. usually this tone is > established from the " upper " management. in other > words, if the boss has an attitude than it > filters down and becomes an acceptable attitude > for the rest of the employees. , in clinics located or affilated with academic centers like Strong Memorial, the attending physicians are under contract and/or employed by the hospital. The hospital staffs the clinic, not the doctors. (Large group practices and medical organizations are run similarly.) Marjorie Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
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