What kind of doctor do I go to next? I hope you can help me.

DEAR READER: I am confused why you experience symptoms now unless you have been exposed to an allergen, are on a new medication, herb or other supplement, or have had an unidentified occurrence in your life. Could you have undiagnosed rosacea or seborrheic dermatitis? Have you changed jobs and are exposed to central air conditioning or different cleaning agents? Did you get a new pet?

Pramosone is a hydrocortisone steroid, Doxycycline is an antibiotic and Prascion is an antibacterial agent. Your skin specialist appeared to cover all the bases but failed to alleviate your symptoms. Therefore, you should request referral to another dermatologist who can either correctly diagnose your condition or determine what is causing it and prescribe accordingly. Check with your local hospital to find someone who can make recommendations for a proper referral.

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.

For many years I was embarrassed by problems with dandruff and flaking on my clothes. I would also have facial skin problems related to rosacea. My dermatologist gave me several different prescriptions but none ever seemed to give me any long lasting relief.

Somehow or another, I found a very simple solution that has helped me tremendously. I use a product called Brass, ZP-11 Anti-Dandruff Hairgroom. I rub it into my scalp after shampooing and then rub a light application onto my face and eyebrows. Something in the formulation works for me. It is a very inexpensive product at about $6 a bottle. Perhaps some of your readers will benefit from it as I have.

DEAR READER:
I have not heard of this product before. However, if it works for you, congratulations.

Readers, if any of you have had experience with this product please let me know your results, either pro or con. Also let me know where it can be purchased (for the future barrage of letters I am sure to receive asking where it can be bought).

To give you 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I couldn’t tell the difference in the early stages of the transition. About a year later, however, the change was very apparent. At this point I was put on minocycline twice a day and have taken it for over six years.

My skin has always been very oily and I have inordinate amounts of seborrheic keratoses, some too big to freeze off. Now, if I stop my minocycline for three weeks, what looks like pus drips off my nose. Once I start the medication again, it takes another four months to get back to normal.

Is there any way off this treadmill? Like me, it’s old.

DEAR READER:
Rosacea is an increasingly common, chronic condition with about 14 million sufferers. It primarily affects the face but can also appear on the chest, scalp, ears and neck. It is generally characterized by redness on the checks, nose, chin or forehead. There are four types of rosacea, subtype 1 (flushing and persistent redness), subtype 2 (persistent redness with red bumps and pus-filled pimples), subtype 3 (thickened skin usually with enlargement of the nose) and subtype 4 (affects the eye, usually dry eye, tearing/burning, swollen eyelids, recurrent styes and more).

Rosacea has no known cause but it is believed that those with fair skin who blush/flush easily are at higher risk than others. It occurs in women more frequently. However, affected men tend to have severe or advanced cases. There is no cure but, with early treatment, it can be controlled.

Treatment generally starts with oral antibiotics and topical creams. These usually bring the condition under immediate control and is then maintained with long-term use of topical therapy. Some individuals may receive treatment with intense pulsed lights or lasers. Some may have visible blood vessels removed, nasal deformities from excess tissue corrected or doctors may attempt to reduce extensive redness.

If you would like more information, I recommend you visit the National Rosacea Society’s website, www.rosacea.org.

You also mentioned seborrheic keratoses. These are benign, non-invasive skin growths that usually develop around midlife or after. They generally appear as sharply margined, raised, yellow/light tan to black waxy or scaly oval lesions on the face, chest, shoulders and back. Because they are benign and harmless, you do not need to worry about them. They can be a nuisance if they are irritated or rubbed by clothing or are cosmetically unsightly. Your dermatologist may be able to remove or reduce the appearance of the larger lesions with other procedures, such as curettage (scraping) or electrocautery if they truly bother you. In some instances, two of the procedures will be used in conjunction (usually cryosurgery and curettage or electrocautery and curettage). Seborrheic keratoses have no known cause but may be related to sun exposure. Normally only one or two will appear over many years. See your dermatologist if the lesions start to bleed or if they appear rapidly because this may be a sign of skin cancer.

A dermatologist is your best bet. Ask him or her about possible treatment options and express your concerns about the current treatments you are receiving for your skin disorders. You may choose to go to another dermatologist for a second opinion. Your dermatologist appears to be handling your care very well. Good luck and let me know how this turns out.