DEAR DR. GOTT:
When I was 19, I had my acne burned off with X-rays. Twenty years later, it came back so I took tetracycline for thirty years. My acne didn’t disappear but started to change so my primary care physician sent me to a dermatologist. I was told that the acne was being replaced by rosacea.

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.