Experiences with rosacea and seborrheic dermatitis

[Guest guest]

I was a passive participant of this group for many months, mainly

during the most intense periods of my flare ups. Now that my rosacea

and associated phenomena have been brought under control (at least

temporarily), I wanted to share my experiences in case they might be

of use to others. I am a thirty-nine year old man.

First, since rosacea is not clearly understood and incurable, I have

come to realize that lending the condition a single name such as

" rosacea " could be harmful to treatment. It becomes too easy to label

it, seek the conventional (or unconventional!) treatment for it, and

stop pondering its many guises and manifestations. But I've seen that

it's nowhere near as simple a condition as the single one-word name

for it would lead you to believe.

In my case, for several years at least I've had mild erythema, with

some telengiactasia (one on my cheek to the side of my nose, several

on either side of the nose where it attaches to the face just above

the lips). My regular physician called the redness to my attention two

years ago and offered treatment, which I refused, since he told me it

would involve permanently taking antibiotics. A year later, he

mentioned it again, and after reading up on rosacea for the first time

and realizing its progressive nature, I decided that I probably did

have it and should treat it. I am fair skinned and an easy blusher,

and thus a prime candidate.

My physician's first prescription was for Sulfacet, which was tinted

and caused me some embarrassment as a man who looked like he was

wearing makeup. When the Sulfact appeared to be causing a reaction on

my skin, I consulted with my physician and we switched to Metrogel,

which I seemed to tolerate just fine. Trying to be a good patient, I

started using sunscreen and moisturizers and wearing a broad-brimmed

hat in the sun.

Everything went fine for two months, except that I was noticing a lot

of small bumps on my forehead (only slightly red, usually). I stopped

applying the Metrogel on my forehead since I had had no rosacea

symptoms there anyway. But the bumps didn't go away entirely, and

seemed to come and go in phases. In October of last year, the area of

my face with the erythema (nose and both sides of the nose) suddenly

broke out in lots of papules, and it became much more noticeably red.

The areas where I was applying Metrogel and sunscreen and moisturizer

began to feel hot and irritated. My regular physician told me to stop

the Metrogel, and he put me on oral minocycline (50 mg, once a day). I

stopped applying sunscreen and moisturizer. I also scheduled an

appointment with a dermatologist because the redness and bumps were

starting to get me down.

It was a month before I could get an appointment, and then the crusty

old dermatologist told me to stop the minocycline, switch to

tetracycline 250mg/twice a day, and he gave me a prescription for a

lotion containing Lidex (steroidal cream) and a moisturizer called (I

believe) Aquamed. Although his prescription called for me to apply the

lotion to my face twice a day, I used it very sparingly due to the

cautions posted on this site about the usage of steroids, and due to

my own research on rosacea. The dermatologist scheduled patients in

five minute increments, so he was utterly uninterested in my history,

my thoughts on the matter, or counseling me about how to apply the

lotion and about the exact nature of my rosacea.

After six weeks, the papules and pustules had subsided somewhat, and

the dermatologist told me on my follow up to simply keep up the

tetracycline. He gave me a prescription for a full year.

Complicating everything was my love of swimming and my sensitivity to

chlorine (I would sometimes get red spots on my face after swimming).

To shield my cheeks and nose from the chlorine, I would often apply a

layer of Vasoline to them just prior to swimming.

When another outbreak of very red and dry skin occurred a few weeks

after the last visit to the dermatologist, I decided to return to my

primary care physician because, unlike the dermatologist, he is always

willing to listen to me and let me suggest new approaches. We both

discussed the possibility that what I was actually seeing on my face

was not a more advanced stage of rosacea or a flare up, but actually

seborrheic dermatitis. He suggested using Nizoral shampoo as a facial

wash. He also agreed with me that it might be a good time to try

Noritate, which might be much more gentle on my skin than Metrogel had

been.

Reading on seborrheic dermatitis showed me that some important things

in its treatment run exactly counter to what I had been told about

rosacea. Thus I started exercising vigorously so as to sweat (for the

first time since the nasty flare up occurred last fall), and I

actually deliberately got out into the February sun for a little

while.

The results came after a couple of weeks, and after I realized I would

have to let Nizoral shampoo sit on my skin for five to ten minutes and

not simply wash it right off. The redness declined dramatically, the

flaking skin disappeared, and I was back to the stage (mild erythema

only) where I had been when I first started treatment seven months

ago. Whether it lasts, who can say.

But I feel I have learned something important. Namely, it's very easy

to confuse seborrheic dermatitis with rosacea, and that Vasoline, by

clogging my pores, was probably worsening the seborrheic dermatitis

much more than it was protecting me. I haven't been swimming for

several weeks, but when I go again I am going to lay off the Vasoline

and carry some unchlorinated water in a spray bottle to wash off my

face immediately every time I take a break, so that the chlorine

doesn't dry on my face.

I know from my reading of the messages here that my story will match

very few people's experiences, but there may be some who will benefit

from one or another aspect of it. I remain on tetracycline and

Noritate, but will visit my primary care physician after another month

or so to see about tapering off the oral antibiotics if everything

remains ok until then.

Dan

P.S. I strongly recommend the following basic article on rosacea,

written by the chair of the dermatology department at Tulane

University:

http://www.postgradmed.com/issues/1999/02_99/millikan.htm