DEAR DR. GOTT: For about two years, I had constant facial pain in my cheeks, jaw and behind my eyes with a feeling of constant pressure in my upper palate, sinuses, jaw and cheek, in addition to the pain and pressure in my front teeth. I also had redness on my cheeks, nose and down the left side of my neck. I consulted with my dentist who fitted me with upper and lower mouth guards, which I wear at night. He told me that I grind my teeth with a side-to-side motion and push my upper front teeth forward with my bottom front teeth. After a year and a half, the guards still had not relieved any of the pain.
Recently, I consulted with my primary-care physician regarding flushing and the redness on my cheeks and nose. I was diagnosed with rosacea and prescribed metronidazole gel to be applied twice a day. I was advised that it would only help reduce the redness and not the pain. However, after three days of using the gel, my facial pain was reduced by half and after 10 days, it was all but gone. I missed using it one day, and the pain returned. Just a couple of days after restarting, the pain went away again.
Because I haven’t made any other changes, I believe the gel is responsible but don’t know why since my doctor clearly stated that it was not a pain reliever. Can you tell me why this happened?
DEAR READER: Rosacea is a disorder of the skin that causes redness, inflammation, swelling, small pus-filled bumps and a host of other symptoms. It most commonly occurs on the face, but may develop on other areas of the body.
According to the National Rosacea Society, many sufferers report burning, stinging, itching or a feeling of tightness across the affected areas. I could not find documentation of facial pain or pressure as known symptoms. However, this is not to say that it is unrelated because inflammation and swelling can cause pain.
It is my theory that your facial pain was probably due to inflammation caused by the rosacea and by using the metronidazole gel, you effectively reduced or eliminated this source of the pain.
Because you do not mention having seen a dermatologist, I recommend that you make an appointment with one to confirm the diagnosis and undergo regular monitoring. Rosacea rarely gets better on its own and often worsens over time if not treated. While I do not doubt your primary-care physician’s diagnosis, I do believe you should get a second opinion from a specialist to ensure that you do, in fact, have rosacea and are being correctly treated. He or she will also be able to offer other treatment suggestions and helpful home-care tips.
In the meantime, stick with the prescription gel. You should also be gentle when washing your face and avoid or sparingly use lotions, creams and cosmetics because they may aggravate your symptoms. Avoid touching your face. Use sunscreen and oil-free moisturizers and cosmetics once the topical medication has dried. Extreme temperature changes, alcohol, sun exposure, stress and spicy foods may trigger symptoms.
To provide related information, I am sending you a copy of my Health Report “Dermatitis, Eczema and Psoriasis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
