Dr. I apologize that this is somewhat off topic but seemed a reasonable place to ask this question. I’m currently being seen in Haverford for poikioloderma. Propanolol has helped somewhat with flushing but I’m interested in taking a more aggressive step. In your experience would you recommend vbeam or IPL? I realize a consultation is necessary, but I’m interested in the overall success of this approach. Thank you

Hello- Your practice did a phenomenal job with my daughter’s adult acne. Thank you! Now it is my turn – I have rosacea and lots of sebaceous hyperplasia lesions and 2 dermatologists in the area said there was no treatment. I am worried particularly about the sebaceous hyperplasia – new lesions are popping up every month. Is there a way to 1) remove the ones I have, and 2) prevent new ones from popping up? Is this a virus or bacterial infection? Thanks so much for your consideration.

I am interested in receiving laser treatment for my rosacea. I understand the lasers are very effective. I’m had 3 laser treatments (in the past 9 months) from dermatologists in the area that cost me a lot of money. However, these lasers did little to improve my situation. I need a program of more treatments and I’m on a limited budget. How much would (4) V-beam laser treatments cost? While cosmetic in nature, I longgg for the doctor who realizes what we patients go through. Would you consider offering people who suffer from chronic long standing a discount on monthly/yearly treatments? I would hope that more patients would loyally follow a doctor who sympathizes with suffers who are forced to live with this horrible condition who need repeated treatments living on a fixed income. The insurance companies are horrible. I don’t know what it is like to go out without makeup. I have many girlfriends and family members who suffer as well. I won’t consider swimming because I am so ashamed of my face. I know about Carecredit, (pay on it all year long) but hope there is something more for the long term, meaning people who would be long-term patients at a more reasonable price. I certainly would. Please respond. I know that are many people who feel the same way. : ( Not living life at the fullest….

I have Facial Telangiectasia and rosacea. What would be the appropriate treatment to address the Telangiectasia. I’m not sure which type of laser treatment would be best to treat my conditions Thank you in advance,
Tina.

Hi Dr. Ringpfeil, Does your office offer Platelet Rich Plasma facial rejuvenation? And is that safe for people with rosacea? Thanks,
Claudia

If you have rosacea, will insurance cover the cost of the laser treatment? What treatments for rosacea are covered?

Hi, I was just diagnosed with possible rosacea from one of your dermatologists. I have a small amount of bumps, but mostly redness on my cheeks. I was prescribed Metrocream and Sumaxin wash. The dermatologist told me this should get rid of bumps, but I was wondering what will get rid of the redness. Also, if I do have rosacea, will it get worse? Is there any tips you recommend for someone experiencing mostly redness. Thanks

I have two questions regarding pulsed laser dye for rosacea: (1) I’ve seen photos on the Internet of red blotches/bruising on the skin. Does this indicate stronger and therefore more effective treatments? Or can treatments be just as effective without the bruising? (2) I am trying to become pregnant. Could I still have the laser procedure? Also, regarding Mirvosa, I’ve read that it can be extremely effective, but also read anecdotal stories from patients of terrible rebound effects. What is accurate regarding the drug? Thanks

Hello Dr. Ringpfeil, For the past few years I have suffered with Rosacea with mild acne on my cheeks (I do have some mild scars leftover from acne during my teenage years 15-20 years ago). I’m very interested in receiving pulse dye laser treatment and am curious if this is something that would work on this condition for my current rosacea and cheek redness.

I just started used Mirvaso for severe redness and it is working but I am not breaking out with the little pimple like imflamation on my cheeks. I also have used and still use at night the Metrogel which will work when used for a long period of time. I was wondering if I could use these 2 medications together or should I just use the metrogel at night and the mirvaso during the day? Thanks so much for your answer.

I know that mineral makeup is recommended for rosacea but powders make my skin dry and flaky. What is a good liquid foundation makeup to use that wont flare up my rosacea and a little less pricey ?

Nearly everyone using Mirvaso experiences aweful rebound lasting anywhere from a couple days to neverending misery. This is according hundreds of anecdotal reports on rosacea forums. Mine took 2 weeks to return to my normal miserable redness. My rebound was painful and with the embarrassing redness – I had suiicdal thoights. Aweful drug.

About 1 1/2 years ago I suddenly got rosacea along with spots of hairs missing on my beard at once. This condition is quite bothersome as I have used Metro Gel and cleanse my face everyday, but like most people with rosacea it only works so well. My question is on my forehead I have slowly got these little you might say white raised spots which don’t go away. Is there a procedure or medicine that can get rid of them. I went to a dermatologist a while back and said he could burn them off. I asked him what would happen if he did that, he said the spot would scab up and slowly heal to a pink color, then over time return to normal skin color. I did not have it done, I was wondering if you agree to this approach or is there something else that can be done and if so would it leave a scar. Also on 1 spot on top of my forehead I seemed to have developed this sort of raised lighter colored streak of skin that is quite noticeable. Would happen to know why this would develop and what if anything can be done to help correct its appearance.

Hello Dr. Ringpfeil, I believe I am experiencing the condition of rhinophyma. I am 47 years old and have had rosacea since my early 30’s. I have within the last few months noticed a difference in my nose. It seems larger and thicker and it is making me very anxious. My skin on my nose and the surrounding area is very oily. I went to see a dermatologist and he told me I do not have rhinophyma. He did however, prescribe me 50 mg 2x day of doxycycline for my rosacea. I believe his diagnosis is wrong. There are definite changes in my nose. Will the doxycycline help with my nose? Is rhinophyma a condition that you have a lot of experience diagnosing and treating? I don’t want to do nothing if there is medicine I should be using. I believe that I am in the early stages of rhinophyma and want to be proactive. Any guidance you could offer me would be appreciated.
Thanks!

Dr. Ringfeild, Thank you for answering my questions so quickly. I have 2 more questions about the photodynamic therapy. I am interested in photodynamic laser therapy but I only have 7 days off from work. Is there a method that could be used that would allow for a recovery within 7 days such as less time under the laser? If this is not an option is there another form of treatment that could help with light rosacea and acne discoloration that would help and fit into the 7 day recovery time frame? Thanks again, Mary

Hi Dr. Ringpfeil, I have rosacea and red discoloration from acne scars. I am interested in getting photodynamic laser treatment but I have heard that it is painful. Do you suggest/provide any pain medication for this procedure? Also is it possible to get a small area of my skin done to see how my skin will react prior to getting my full face done?
Thanks,
Mary

I turn 70 on Friday and my Rosecia was diagnosed by my dermatologist a couple of months ago. I was
given Mirvaso and it cleared it right up during the day. At night I used Metronidazole gel. In the past few weeks it has gotten worse every day! It stings when putting meds on, my face is bright red in the cheeks and a little on my nose. When I rinse my face with cool/cold water it feels wonderful but that won’t work for more than a few minutes at a time. I just don’t understand why or how this came on. I never had skin problems before and I have tried so many different creams and gels and Doxy twice a day. I am totally frustrated.

hello, I tried mirvosa about 10 days ago. I only used it once. It made my skin very pale and it seemed to work to take aways the background redness. I did not have severe redness, it was very mild, and has been the same for years. After using mirvosa once, my skin has not returned back to its normal redness. I am not taking anything for but keep it moisturized and drinking lots of water. Will my skin go back to normal? I have heard a lot about rebound redness from this product. I have not seen significant improvement since the rebound effect. I am getting worried this will be permanent.

7 days ago, 2 tiny pimples appeared on my nose. Within 48 hours, my nose was under attack…it became swollen, red, and forming pustules with a yellow puss. It ached and was itchy. It was huge !
100 mg of doxycyclene prescribed by an acute care physician has managed to control it.
However, now I have the after-effects of some swelling as well as black scabs all over my nose.
I look like a freak-show ! I believe what I contracted was Rhinophyma…..and not surprisingly, my father had a mild case of it when he was my age.
What kind of topical treatments can be used at this stage ? Will this persist and tend to re-form ? Should I stay on the doxy for a prolonged period of time ?

I was diagnosed with type 2 rosacea last August. I immediately went on Metrogel for two months or so with no results. I have now been on Oracea for over four months and Finacea for about nine weeks. I have seen no improvement, and I have also been keeping a food diary for 10 weeks, and I have still not fully identified any food triggers. I don’t know what to do at this point, and I barely eat anything out of fear of a severe flareup. Are there any other options for the papules and pustules?

Hi – I was wondering if you could recommend a makeup brand for skin type with rosacea and acne with scars, also dry. Thank you

Dr. Ringpfeil, I am being treated for rosacea and I am using Oracea, MetroGel, and have had several PDL treatments with great success. What do you recommend to exfoliate dry/dead skin? When I go to put on my sunscreen it frequently clogs with the dead skin, and when I get out of the shower, my skin is very dry. I don’t want to use any product that will 1) irritate my skin and 2) make my face red. Any advice you could provide would be appreciated. Thanks,
Dan

I am 45 and I washaving no major skin problems then about 6 months ago my skin started getting a burning sensation on my face. Then I got a big red spot on my chin and slowly went to my cheeks and now my forhead. I went to see a dermatologist he did a biopsy and said i have Rosecia. Since then I have been using Metro gel and Oreca and its not woking very well as my cheeks are always red along with my forehead. Also I am starting to get a few little white pimples on my forhead which don’t get better or go away. Also I have noticed I have some spots on my skin which seem to have lost pigment and also some spots on my beard where little patches of hair are missing. I went to dermatologist and they said it is just rosecia with hypopigmented spots and they had no explanation for spots missing hair.
Anyway I wondering is their any special treatment or laser treatment for treating white pimples on my forehead along with my red cheeks. Also do know if its common to get Rosecia and then get hoypopigmented spots on your face along with having a few spots on the beard where hair is struggling to grow.

Hello Dr. Ringpfeil, I’m 34 years old, have oily skin, have had acne on/off since my teen years. Accutane really helped when I was in high school. I still use Retin-A and my face is pretty clear. I still get a pimple here and there. Currently, my issue is my face is always red. I’m tired of people asking me if I just got back from vacation. Redness under my cheekbones is very red. I do not use Retin-A in those areas. I use sunscreen almost everyday, elta md UV clear SPF 46. Last week I tried Mirvosa, it seemed to work for sometime, but I now seem even more red when I’m not using it. I don’t want to continue to use it and continue to make my skin worse. Will Mirvosa make my skin worse if I continue to use it? I feel like it’s just a temp fix. From what I’ve read I think PDL could be a better option. What percentage of patients do you feel are happy with the PDL treatment? and what are the risk? I’m highly considering making an appointment for consultation. Thanks!

Is there any laser or other procedure that you would recommend to help remove or shrink veins on the upper eyelids due to ocular rosacea? One dermatologist I consulted with said he could use the vbeam perfecta on this area after insertion of an intraocular eyeshield. Is using the vbeam on the upper eyelid generally considered safe, or could you recommend a better option?

Is there such a thing as too many vbeam treatments for rosacea? Are there any negative long-term side effects to having multiple vbeam treatments?

Dr. Ringpfeil, What’s the deal with Mirvaso, the new topical from Galderma aimed at reducing redness in rosacea? I was interested in trying it but it seems like people who have used it are very disappointed and are seeing significant rebound flushing. Reading some reviews online, it seems that some users feel that their condition and baseline level of redness may have worsened after using Mirvaso. Would you advise against using this topical until more is known about it, despite the drug receiving FDA approval? Thanks,
Dan

My Rosacea started a long term flare up when I was pregnant with my daughter, which also in turn triggered PCOS (poly cystic ovarian syndrome) or at least made it worse making it noticeable. What I have noticed is that being estrogen dominant now and when my hormones cycle thorough monthly my flare up will get worse till after ovulation then once hormones drop and the redness will lighten. I have a Mirena IUD now so the progesterone may help with the cysts. I have also heard that progesterone creams have helped with the inflammation. Is there any truth to it possibly being linked to hormones fluctuations? Mine is mostly on my forehead and really only noticeable after exercise or a shower probably due to open capillaries. I also have itchy patches from the corner of my mouth to about my chin and I must have those itchy patches as well on my scalp it can be terribly itchy in the same spots, is there anything that I can do for that? I have heard tea tree oil has been helpful with some people. I don’t want to try it though as I tried glycol acid and it chemically burned my face. How safe is something like tea tree? Thank you in advance for your response.

Hi
If the telangiectasia forms on the face, can it get smaller and go away on it’s own without laser intervention?

Dr. Ringpfeil, I have very low Vitamin D along with rosacea. My Vitamin D is 11ng/ml, well below the 30 and 74 ng/mL that is the acceptable range. My primary care recommended that I take 4000iu of Vitamin D3 a day to help raise it. I started taking this supplement daily, however, I flushed almost immediately upon taking it and the flush does not go away. I have read that taking Vitamin D and elevating my levels into the acceptable range will help my rosacea and reduce inflammation. Is this true? Is there a link between low vitamin D and rosacea? Lastly, should I continue to take the D3 supplement even if it is causing flushing at this time? Some additional information – I’ve been on Oracea 40mg and Metrogel 1% for a year now, and I have a mild-moderate case of type 1 and type 2 rosacea. I’ve also had four PDL sessions that have greatly reduced erythema in certain areas. Thanks,
Dan

Hello doc,
I am an asian skin and have had rosacea for over a year. I have
visited many derm and they alll prescribed me different kind
of antibiotics. I have redness and as well as pastules on my cheeks,
now its increasing to nose and forehead. i have done
two courses of antibiotics but the problem still continues,
as soon as i stop them my rosacea returns. My present derm
has also prescribed me met gel together with antibiotics, i used that
for three months.
i have stopped both of them and now using herbal methods
such as rosewater and turmeric, which helps the inflammation.
pls advise me on what i should continue with and will my
rosacea go away on its own?

Hi Doctor, Thanks for opening this forum to questions. I have had rosacea characterized by red apples and sometimes underlying redness for at least five years. The papules present when I eat certain foods or when I’m under a lot of stress. Recently I discovered by accident that a round of oral antibiotics (amoxicillin) completely cleared my skin to the point where it didn’t react even to trigger foods. Experimentation with a topic antibiotic produced the same results. I don’t want to be reliant on antibiotic treatments and was wondering if a v-beam laser would help my particular case of rosacea. I have heard wonderful things from people who have gotten this procedure but am not sure how a laser would keep me from reacting to foods (tomatoes, chocolate, caffeine, red wine, spicy foods) in the future. I’ve committed 2013 to trying to control my rosacea and would really appreciate your input. Thanks! Laryssa

I have type 1 rosacea, consisting of a red nose, background redness of face, and severe flushing of cheeks and sometimes ears. What laser/light treatment would be best for each of these? Also, can treatments be performed during the spring/summer, so long as a strong sunscreen is worn consistently?

Dr. Ringpfeil, I read an article about PyratineXR. I have rosacea and I see that there were some studies that showed this to be extremely effective in treating redness associated with rosacea. Reviews online also seem positive. Do you know anything about this and would you recommend it in conjunction with MetroGel and Oracea? Thank you. Bob R.

hello! is it okay to have the vbeam every 4 to 5 weeks for rosacea? I have been having the vbeam for this but normally have it done every 3 months so I thought if I were to have it done every 4 to 5 weeks it would show better results ( the vbeam has helped overtime) Also have you heard anything more on the new and upcoming topicals that are coming out to help with redness. I know that Galderma is doing some studies. Thanks! ashleigh

Hi, I’ve been suffering from acne for several years and it has progressively been getting worse. Im 21 years old and feel like I’m at the end of my rope. I recently looked up the symptoms of rosacea and I am convinced that this is what I am suffering from. My face is always red, I blush easily, and people often ask if I have a sunburn. I’ve been on everything from differin, accutane, fiancea, to microdermabrasions and light treatments but have had no success. This is a problem I suffer from constantly and it has truly crippled my self esteem. I feel uncomfortable talking to people or going out in public and I fear that there is no hope for my condition. I eat healthy (lots of water, lean meat, lots of fruits and vegetables) and take a multi-vitamin because I read that several vitamins (A, B, C, D, E, K) all help with the skin and inflammation but to no avail. Is there anything that can be done so that I can live a normal life again? Thanks,
Scott

Hello! at this time i have vbeam txs to help control my rosacea such as redness. i wanted to know if bruiseing would be more effective than just the tsx with no bruiseing. what are your thoughts on the pulse stacking tech? thanks,
ashleigh

Hello! at this time i have vbeam txs to help control my rosacea such as redness. i wanted to know if bruiseing would be more effective than just the tsx with no bruiseing. what are your throughts on the pulse stacking tech? thanks,
ashleigh

Dr. Ringpfeil, I have mild Rosacea that consists of flushing. It has been controlled very well through Vbeam treatments. Unfortunately, I also have acne. Is it safe to use Differin, AHAs (glycolic acid) and BHAs (salicylic acid) on my skin? Could any of these exacerbate the rosacea and facial flushing? Thanks!

I was diagnosed with rosacea about 8 years ago. I was on a perscribed medication for 3 years but my primary doctor advised me to discontinue it because it may cause cancer. I was told by a friend that she uses a product called Sea buckthorn (berry cream) for her face. I ordered it from Canada online and it made a dramatic difference! It shrunk my pimples after the first treatment! It is all natural and I will continue to use this product!

Dr. Ringpfeil, Can someone who has rosacea take PDE5 inhibitors (viagra, cialis)? If I get some flushing from these medications, will they cause permanent setbacks? Thanks!

Will it ever go away on it’s own or do you have it for life?

Is it true that rosacea is caused by demodex mite? I have recently acquired symptoms of rosacea, and I am confused by the different reasons given for it’s cause. Are natural remedies effective at all? I have read anything from sea salt facials and tea tree oil to borax – peroxide mixes. I would to anything to end the misery!

I recently developed rosacea and it has been a trying time. I am on metrogel and a face wash which helps some. I started a new birth control the same time it began, could the two be related? Also, can I use a self tanner? Thanks!

Dr. Ringpfeil, I was recently diagnosed with rosacea. I am taking oral and topical antibiotics and the redness and pimples are clearing up already. Most have seen their visible signs of rosacea clear up greatly or completely diminish when taking the antibiotics. If this is the case for me, my question is, do i still need to avoid rosacea triggers? I know enough to stay out of the sun, but do I need to be concerned about other things like spicy food if I am taking the medication, or are triggers only a concern for someone trying to manage the condition without seeking the help of a professional? Thanks,
Mike

I have a red face all day long. i don’t know what to do any more. i’ve done my research and think it may be rosacea, but since i am not a doctor i am not sure. What are your recommendations for reducing redness on my dry face. Also,do you accept Keystone health plan east?

I am a 27 year old male experiencing rednesson both my left and right cheekbones (upper corner close to my eyes). This appeared suddenly about 9 months ago. I was told by a few doctors that rosacea is extremely rare at my age. I have had one IPL treatment done. Prior to this I could see some small blood vessels on my right cheek but not my left cheek. Now, the redness is still there but I no longer see any signs of blood vessels. I am wary about having more IPL treatments done as they may not be helpful in my case. This condition is quite embarassing and troubling for me and I would like to get to the bottom of what’s causing it before being blindly treated and prescribed topical medicine. I’ve already tried Finacea and Metro Gel and both did not solve the problem. What I would like to know is whether you would be willing to do a skin biopsy on these patches in your office in order to get more information on the root cause? Please advise. Thank you.

Dr. Ringpfeil, I am a 27 year old male experiencing redness on both my left and right cheekbones (upper corner close to my eyes). This appeared suddenly about 9 months ago. I was told by a few doctors that rosacea is extremely rare at my age. I have had one IPL treatment done. Prior to this I could see some small blood vessels on my right cheek but not my left cheek. Now, the redness is still there but I no longer see any signs of blood vessels. I am wary about having more IPL treatments done as they may not be helpful in my case. This condition is quite embarassing and troubling for me and I would like to get to the bottom of what’s causing it before being blindly treated and prescribed topical medicine. I’ve already tried Finacea and Metro Gel and both did not solve the problem. What I would like to know is whether you would be willing to do a skin biopsy on these patches in your office in order to get more information on the root cause?

Dr. Ringpfeil, I’m considering having IPL treatments for rosacea. Down the line I would like to have fillers done (under my eyes for deep tear trough) such as Restylane. What I’d like to know is whether the needles (inserted for the filler) could cause damage to the blood vessels treated for the rosacea? Perhaps the blood vessels would already be closed off and “dead” then and it would not matter. However, this would all be in the same general area of the face so that’s why I’m curious. Thank you.

Hello. I have rosacea for about 7 years now. I would like to advice keeping a diary for yourself. Write down everything you eat and drink and when you flare up. This will help you finding patterns. When you avoid the foods that trigger redness it will help you sooo much! I learned this on the website of the national rosacea society. I have read many comments about how food and identifying food related triggers have helped people to fight rosacea. I only have mild flare ups occasionally, but I think my rosacea has cleared about 85% with my personal diet.

I have an ocular rosacea blepherits under my left eyelid. I am on doxycycline daily, treating it as a skin condition. Do you have a cure or better treatment for this. This condition is very disruptive in my life as I, like everyone, need to use their eyes. I am left feeling like I have sand in my eye constantly and sometime it gets worse when flaring up. Please respond soon so I can get help if there is something I am not aware of to do. Thanks

I heard that rosacea could be directly related to the mind, does anyone in your practice use psychodermatology?

How do you feel about medications such at erythromycin (antibiotic) to reduce itching and burning sensation due to rosacea. When I have a flare-up, I am itchy all over my body.Thanks

The questions are very specific and must be directed at your treating physician. Without evaluation of your skin and hair and knowing with certainty the name of the method used, I am unqualified to render any judgment.
Franziska Ringpfeil, MD

Hi Dr.,
I have had rosacea for a number of years. It wasn’t a severe case, but approx. 5 years ago I went to a Plastic Surgeon and after consultation, I agreed to IPL. If memory serves me correctly I had about 6 or 7 sessions and it was effective. I was very pleased with the results. The Dr. had advised me in order to maintain the results I should come back once a year and have one session of IPL. So, for the past few years I went back for the session. Again, I was pleased with the results. About 2 weeks ago, I went in for my yearly session, and the Dr. advised he had a newer and better procedure. I think it was called Limelight, but I’m not 100% sure. The procedure was similiar. They applied a gel on my face which was on for an hour. Then, he came in with some type of heat wand and went around my face. The last application was the laser which stung alot more than previous years. The previous sessions the laser felt as though someone was hitting my face with a rubberband. This session it really really stung. After the session was complete, I noticed two bruises/swelling. One was on my forehead, and the other was on the right side of my face and it was in my hair line. I remember looking at the bruise/swelling around my hairline, and I remember thinking that doesnt look good, and I wonder if my hair will fall out in that place. About a week later the swelling/bruises went away. I cut my hair and I cut it somewhat close on the sides. The next morning, when I awoke, I noticed an oval shaped bald spot on my hairline exactly where the laser struck it and caused the bruise. It looks very unussual. I’ve had it now for about 5 days and I dont believe I have grown any hair back in that spot, at least not yet. I guess I have a few questions and I’m not sure if your going to be able to answer them. The 1st one, is in describing that the laser struck the hairline causing a bruise is it normal that the hair in that location fell out. Did the laser damage the hair follicle. Is the hair ever going to grow back there.
Thank-You

I would like to know the cost per treatment and how many treatments are needed .. I only need it done on a portion of my forehead. Thanks Mike

Hello! Ive had rosacea for years and have tried several drs and every treatment. I have constant redness and have itchy bumps/blotchiness during flare ups. During our visit last year you suggested PDL or IPL. My symptoms have gotten progressively worse and I think Im finally ready to go to this extreme. (A) Is one treatment better than the other (PDL v IPL)? (B) In your experience does insurance ever cover these treatments? Thanks so much 🙂

PDL and IPL both work for most types of poikiloderma. Occasionally, an alexandrite laser might have to be added for best results. If poikiloderma does not improve after 2-3 treatments, we do not continue treatments. Most people who are responders gradually clear in 4-5 treatments.

The only effective treatment for sebaceous gland hyperplasia is the Smoothbeam laser. It targets oil glands and destroys them. The treatment causes a small blister of the enlarged oil gland that then scabs and resolves in about 6 days. One to 3 treatments will effectively and permanently destroy the sebaceous hyperplasia in fair skinned individuals. Unfortunately, there is no preventative treatment yet for sebaceous gland hyperplasia. The ability to develop these over time appears to be a genetic trait. It is unclear if reduction of oil glands, for example with photo-dynamic therapy, can reduce the rate of new sebaceous gland enlargement.
You may schedule your treatment.
Rosacea cannot yet be cured. If skin is predominantly red, laser and IPL treatment is available to subdue this. In inflammatory rosacea that goes along with small red bumps and pustules, anti-inflammatory treatment is available. In all types of rosacea, hydration of skin is key and I strongly recommend Neutrogena Hydroboost gel for oily skin or gel cream for dry skin as a baseline moisturizer.

I agree that many people suffer from the noticeable redness of rosacea and find it extremely bothersome. Pulsed dye laser treatment is the gold standard for fair skinned individuals and most people need 3-5 treatments to achieve significant reduction in their redness. The results after this series of pulsed dye laser treatments should last about 7 years. Rarely, redness associated with rosacea is stubborn and does not respond to 3-5 treatments. I have cared for individuals who needed up to 10 PDL or any combination of laser and IPL treatment to get to these results. We do make financial adjustment in those who do not respond like the average and we do not exceed a certain fee while continuing treatment. Without knowing your skin type and the types of laser you have been treated with, I am unable to provide a fair assessment of your case. I urge you to make an appointment for medical evaluation with one of our dermatologist so that we can decipher the shortcomings and develop an appropriate treatment plan.

The best laser for facial telangiectases and redness from rosacea is the V-beam perfecta, a pulsed dye laser. You are a candidate for treatment if your skin is light and if you do not have a tan. If your skin tone is Mediterranean, light Asian or darker than that, an Nd:YAG laser is the best treatment. Please schedule an appointment for consultation.

At this time, we do not offer platelet rich plasma treatment.

Laser treatment for rosacea is highly effective for reduction of background redness and enlarged capillaries. While it can temporarily improve breakouts in some with inflammatory rosacea, it is not a standard treatment. Unfortunately, laser treatment is not covered by insurances for either indication. Insurances cover prescription medicines for inflammatory rosacea such as topical and oral antibiotics and ant-inflammatory agents. Some insurances may even cover a topical prescription medicine (Mirvaso) that reduces redness for 8-10 hours during the day.

Background redness is a very common trait in rosacea. It is not known whether it worsens over time. Several factors influence facial redness, specifically heat, sun exposure, stress and certain foods. Long term reduction of facial or chest redness associated with rosacea can be achieved with a series of 3-5 laser treatments. Intense pulsed light provides excellent short term results when you do not have a lot of time before an important event. Periodic maintenance is needed to sustain results. A topical cream “Mirvaso” provides immediate results that last 8-12 hours. Please note that reduction of facial redness by any of these means does not influence your inflammatory rosacea (small bumps). They are best corrected with stress reduction techniques as well as anti-inflammatoiry topical peels, gels lotions or creams or oral probiotics, oral niacin/mineral combinations supplements and anti-inflammatory medication.

Bruising with PDL can be avoided since the V-beam perfecta was created in 2005. However, some people may still develop red blotches can last for several weeks (not bruises).
In general, we discourage any elective treatment during a pregnancy. PDL can safely be performed before you get pregnant.
Mirvaso is indeed very effective as an anti-redness medication. The “rebound phenomenon” described by several who have used it might be true in very few cases. Most of the time, Mirvaso was used at the onset of an inflammatory flare to reduce concomitant redness. The flare progressed because it was not adequately treated by anti-inflammatory agents and the anti-redness treatment cannot treat inflammation.

Pulsed dye laser is exactly for the cheek redness with rosacea. After several treatments 4-6 weeks apart, this background redness is much improved and results stay for several years. Pulsed dye laser treats the inflammatory component of rosacea, which are small red bumps with or without pus, only temporarily. Inflammatory rosacea requires proper hydration of your body and skin, proper sun protection and might even require topical oral anti-inflammatory treatments.

Tiny little pimples or pustules on the cheeks in individuals with rosacea are the hallmark of inflammatory rosacea. Common topical treatments for inflammatory rosacea are Soolantra and Metro-Cream in people with dry skin, and benzoylperoxide, Finacea or Metro-Gel in people with normal or oily skin.
Mirvaso or pulsed dye laser treat only the widened blood vessels that show as the red background skin in rosacea. Treatments for the red background as well as for inflammation can usually be used at the same time.

Almay makes products for sensitive skin. You might also consider the tinted sunscreens such as Anthelios tinted mineral available at our office. other participating physicians and CVS.

I am sorry to hear about your experience. However, I would like to thank you for sharing this experience.

If the white bumps on your forehead are sebaceous gland hyperplasia, they could be treated by electrofulguration (burned off). This procedure leaves a small scar that often becomes skin colored over time. The most effective treatment, however, is treatment with a diode laser called Smoothbeam by Candela. It is not associated with scarring in fair skinned individuals. Please note that this blog cannot provide a diagnosis nor customized treatment. Please consult with your dermatologist on the light streak on the forehead.

Rhinophyma is a rare condition that is often associated with rosacea. It occurs as a result of overgrowth of oil glands. It affects predominantly men. Benzoylperoxide in form of daily cleansers and topical leave on products are often preferred if oily skin accompanies rosacea as this topical medicine keeps oil glands at a minimum. However, it may not prevent the development of rhinophyma in a predisposed person. Shrinkage of oil glands can be achieved with photodynamic therapy, Smoothbeam Laser by Candela and low dose isotretinoin treatment. When rhinophyma has already developed, surgical treatment by CO2 laser ablation or dermabrasion are usually the only treatment options. Doxycycline treats inflammation in rosacea but its role in treatment of rhinophyma is unknown.

If your concerns are rosacea and acne discoloration, photodynamic therapy is generally not the first choice. I strongly recommend evaluation in the office because I do not feel qualified to suggest a specific treatment plan without knowing all the details.

PDT is indeed uncomfortable at times. We use cold air to help with this. Ibuprofen can be taken one hour prior to the procedure. Topical numbing does not work well with PDT as it would hinder the activation. A test spot can be performed. The cost for a test spot is however the same as for the treatment as the medicine ampule must be used or discarded after mixing.

The scientific community cannot yet explain why rosacea occurs but there is some suggestion that the trait runs in families. Once rosacea has developed, stress can exacerbate the inflammatory component while there are many triggers that exacerbate the redness of the skin, such as anything that generates heat (sun exposure, exercise, hot soups or beverages).
Irritation on the face is often experienced during a flare. I suggest that you return to your dermatologist for modification in the management to better tackle the very irritated skin. While Mirvaso does not per se cause an inflammatory flare it should be stopped until your skin no longer feels ultra sensitive.

I am aware that a few people experience rebound redness after Mirvaso. It does not usually stay lfor more than a few days. Drinking lots of water is helpful. If your skin has not gone back to baseline, I suggest you return to the dermatologist who prescribed Mirvaso for evaluation and to rule out an inflammatory flare of your rosacea that can be treated medically.

Rhinophyma is a slowly progressive swelling of the nose induced by overproducing oil glands. It affects almost only men. It does not present with acute pimple like inflammation but pimples can occasionally occur on top of rhinophyma as an expression of inflammatory rosacea. I believe that you should be evaluated for best treatment options. While a blog serves to provide general information to a community of readers, it cannot provide individual medical advice. Consultation with a dermatologist is strongly recommended and in addition to in-office consultation, our office provides online consultation with a one day turn around. Just follow the instructions on the home page if you are too far from our office, your work schedule does not permit you to take time off or you are very eager for an answer.

The best course of action is a return to your dermatologist to let him/her know about the treatment difficulties. Sometimes temporary dose adjustments are needed. Food dependencies in rosacea can be difficult to establish although many with rosacea do better off dairy. Excellent hydration of the body is key (coffee, black and green tea do not count for hydration because they are diuretic) as is meticulous sun protection on your face. Vitamin D, which is produced when UVB rays shine on our skin, increases inflammation in already inflamed areas. High does oral vitamin D, which is used to treat osteoporosis, can also keep rosacea longer. Not eating anything is not the answer.

The best product for acne scars is Anthelios primer with SPF 50 by LaRochePosay, which is used before make up. It is available at CVS. However, rosacea prone skin can be very sensitive and I recommend that you exercise caution with any new product that you put on your face. Should the primer not agree with your roasacea, please use mineral based make up. Jane Iredale is the most famous brand but there are now many much less pricey options available.

Sensitive skin in rosacea does not like to be challenged with physical exfoliation but usually does very well with a daily glycolic acid product. Whether you chose cream, lotion or gel formulation depends on the dryness of your skin. Low percentage glycolic acid products are available in many drugstores and I most often recommend Aqua glycolic products.

Lighter colored areas of skin can occur after an inflammatory process, including rosacea, or they can be due to an overgrowth of certain types of yeast that physiologically reside on our skin. Hair loss in the beard area is not associated with rosacea but could occur with stress and with infections. The inflammation in rosacea is usually treated with anti-inflammatory agents such as topical metronidazole, azelaic acid (peel or gel), sulfur, sodium sulfacetamide and oral doxycyline. If white and red bumps do no go away, the treatment plan should be modified. I recommend that you work with your dermatologist on finding the right combination for you. It is not always trivial in rosacea.
Background redness from widened blood vessels can be treated with pulsed dye laser if you are fair-skinned. Other lasers may be used if you have a darker skin tone. These lasers also treat inflammation (red bumps) but they have no preventative effects on the inflammation. They work really well to reduce background redness for a long time.

Your description is that of the telangiectatic phase of rosacea, where background redness may occur on mid cheeks, and perhaps, lower forehead, chin and nose. Mirvaso is indeed only a temporary treatment. Its effects last for 8-12 hours and then wear off. It has no lasting effect nor does it claim to. It does not worsen redness. However, redness can worsen with heat exposure, alcohol, hot beverages and others. Stress and dehydration also induce small red bumps on the skin that can last for several days.
Pulsed dye laser treatment addresses the redness of rosacea. Most people have great reduction of background redness and flushing response after 4 treatments every 4 weeks. Results typically last for 7-10 years.
The reduction of background redness by pulsed dye laser does not prevent inflammatory flares of rosacea that may go along with small red bumps and sometimes even pustules. This variant of roascea is not as common but may require other types of treatment. Always stay hydrated, reduce alcohol and caffeine intake, eat a balanced diet rich in anti-oxidants and keep using sun protection.

Widening of blood vessels on upper eyelids due to rosacea is rare and may be difficult to tackle. In our office, we do not treat the upper eyelids with a pulsed dye laser because of possible risks, although we use intra-ocular shields routinely for other procedures. It may be best to consider camouflage by eyeshadow.

There is no scientific or anecdotal evidence that the number of Vbeam (pulsed dye laser) treatments must be limited. In more than 16 years of operating a pulsed dye laser (Vbeam perfecta and its predecessor) I have not observed any long-term side effects after repeated treatments for redness or blood vessels in any of my patients as long as the laser was used appropriately.

I have prescribed topical brimonidine for several years and was happy when Mirvaso was finally FDA cleared. For most people, brimonidine seems to work well to reduce redness temporarily. I also heard about disappointment. The most common is the ghostly look but we had one incidence where rosacea worsened after Mirvaso use. However, many factors play a role in rosacea and in this one case, a number of trigger factors were at play (sunlight, alcohol).
Mirvaso is a temporary treatment that gets you through a social event. Pulsed dye laser treatment has a much more profound and lasting effect on redness and is the better option if you had a flare after Mirvaso or if you are hesitant because of what you read.

What you describe could be an overlap of rosacea and seborrheic dermatitis (rosacea mostly on the forehead and the itchy areas on the chin and scalp could be predominantly seborrheic dermatitis). The coexistence of both is not rare and requires delicate care. Tea tree oil may work well for seborrheic dermatitis but can upset rosacea. If you are set on trying of tea tree oil, use it in a small area first to see how your skin reacts. There are number of other options available, including Quelage peels (not based on glycolic acid, which is rarely tolerated beyond 50% anyone who has rosacea), Bionect cream, Elidel cream etc.
Hormonal changes can aggravate rosacea in some women. The redness of rosacea can be capped for years by a series of laser treatments with a pulsed dye laser. A topical precription product that constricts blood vessels for many hours was just released to the market yesterday.

Most data suggest that bruising settings are no more effective than
non-bruising settings when using a pulsed dye laser. The V beam perfecta
offers the opportunity not to have to deal with downtime because of dark
purple marks for about one week. Pulse stacking may be used when laser
energy is limited. This is not necessary with the Vbeam perfecta as it
offers and energy range.

Unless angiomas or telangiectases on the face occur during pregnancy, they are not expected to go away on their own. Laser treatment is simple and does not leave any scar behind. Most of the time, a single treatment dissolves the spot and the initial bruise from the laser lasts only a few days.

Recent research shows that vitamin D appears to stimulate pro-inflammatory events in the skin in some of the well-known inflammatory disorders such as psoriasis and rosacea. It is therefore not surprising that the sudden addition of vitamin D3 caused flushing of your rosacea prone skin. While it is very important to replenish your vitamin D levels, please discuss with your dermatologist if you could add other anti-inflammatory agents to your current regimen while you need to take high dose vitamin D3.
Anti-inflammatory agents include doxycycline and metronidazole (which you are already taking), azelaic acid, Quelage peel, topical sulfur or oral combinations that contain nicotinamide, zinc, folic acid, copper and azelaic acid.

Rosacea is a trait that manifests at a certain point of time. It can have multiple triggers. Cure is not yet available. Background redness stays controlled for several years after a series of laser treatments. The pustules often need a radical change in life style, and occasionally topical and oral anti-inflammatory supplements, topical or oral antibiotics to seize. A treatment plan can be tailored to your specific needs during a consultation.

The underlying redness in rosacea as well the degree of flushing with any triggers can significantly be reduced with laser treatments. However, if you develop red papules in response to food and stress, these will continue to occur despite reduction of background redness. The tendency to form papules can be controlled with dietary modifications, stress controlling techniques (Yoga, meditation etc), Quelage peels, topical azelaic acid (Finacea), oral anti-inflammatory supplements (e.g Nicazel), topical (metronidazole) and oral antibiotics.

The widened capillaries in rosacea can be treated. Lasting reduction of background redness in type 1 rosacea can be achieved with laser treatment.
In a fair skinned individual, pulsed dye laser treatments are appropriate while in someone with Mediterranean or darker pigment is limited to Nd:YAG laser. If using PDL, between 3-4 treatments 4-6 weeks apart are needed. With Nd:YAG, on average 4-6 treatments are needed spaced 6 weeks apart. Redness typically lasts for up to 24 hours after each treatment but swelling can last for up to one week. Bruising is rare. Sun protection is paramount for 4 weeks after each treatment but must be continued to maintain results.
Intense pulsed light (IPL) is a temporary option in a light skinned person.

It appears to be safe to use and the 2 studies from 2009 and 2010 are positive. The critics of the two studies suggest that they were sponsored by the pharma industry but I was unable to verify this yet. It can be safely used in conjunction with MetroGel and Oracea.

V-beam treatments are most efficient when performed every 4-6 weeks until redness is sufficiently reduced. Should redness return several years down the road, a series of V-beam laser treatment can be repeated. There are 2 topical formulations in the pipeline that reduce redness for several hours during a day. Both are currently available for other purposes and not indicated for use on the skin. Galderma will launch one of these agents very shortly as it has passed FDA mandated trials.

Evaluation by dermatology is recommended to determine the underlying cause.
While both rosacea and acne are chronic conditions and no cure has been developed, it should be possible to tailor a treatment regimen to your needs. It will include some of the lifestyle changes you have already made as well as other options.

Most data suggest that bruising settings are no more effective than non-bruising settings when using a pulsed dye laser. The V beam perfecta offers the opportunity not to have to deal with downtime because of dark purple marks for about one week. Pulse stacking may be used when laser energy is limited. This is not necessary with the Vbeam perfecta as it offers and energy range.

Adapalene(Differin) does not typically worsen rosacea or contribute to flushing, yet hydroxy-acids could do that in a subset of individuals with rosacea. You indicate that your flushing has been well controlled with pulsed dye laser treatments through V-beam perfecta. The lack of flushing suggests that you should continue your alpha and beta hydroxy acids to control your acne.

Thank you for your input. Sea buckthorn appears safe to use internally and topically and it has many health and medicinal uses. Unfortunately, clinical studies are still missing. Please continue to use if it helps your skin.

Phosphodiesterase inhibitors (Viagra, Cialis) widen all blood vessels including those that are already widened when you have rosacea. Apart from prolonged flushing, they could in theory increase the diameter of blood vessels permanently. However, as roascea and its progression is somewhat unpredictable, this statement cannot uniformly be supported. There is no peer reviewed study yet that has looked into any data.

Rosacea is not known to go away once it has developed. However, its most common expression, redness of the face due to enlarged blood vessels, can be treated with laser to a degree that rosacea is not seen. Laser treatment does not prevent inflammatory flares that present in form of red bumps or tiny pus bumps on the skin. Regular Quelage peel every 2-3 months helps those with rosacea and dry skin to maintain a beautiful complexion as it soothes the skin and reduces inflammation. Benzoyl peroxide based cleansers help best in those with rosacea and oily skin (be sure to use a white towel when using benzoyl peroxide based cleansers). Daily application of application of glycolic acid followed by sunscreen in the morning helps all types of rosacea (dry, normal or oily skin). The base formulation must be adjusted to the skin type.

The causes of rosacea are not entirely understood yet. Organisms on the skin (Demodex mite) as well as bacterial colonization of the stomach H.pylori) have been blamed to cause rosacea by some scientists and refuted by others.
A genetic pro-inflammatory predisposition may be underlying rosacea and triggers are often known to a person who has rosacea. Complete avoidance of triggers is not always possible but sun protection is crucial. Water intake should be adequate or ample. Natural remedies include a diet rich in alakaline or poor in pro-inflammatory foods as well as supplementation of vitamin B3/zinc/copper/folic acid/azelaic acid. Redness can be treated with laser whereas inflammation of the skin (red bumps us pus bumps) requires medical treatment. Local treatments include natural substances that reduce inflammation (e.g. Quelage peel/quesia), azelaic acid and antibiotics. Oral antibiotics are used in severe flares or when eyes are involved. While cure is not available at this time, treatment is tailored to the skin – whether oily or very dry.

Although not very likely, the start of your birth control may have triggered the rosacea to come out at that time. However, rosacea is believed to be a trait within that can respond to many triggers, the most common being exercise and heat, sunlight, spicy foods, hot beverages or soup, alcohol etc. Self tanners or bronzers as well as other camouflage make up may be used to cover the redness. However, rosacea skin may be sensitive to chemicals and you should try the self tanner on a small area first.

Triggers are a concern regardless whether you are managing rosacea with medication, holistic methods or not managing it all. There are triggers for flushing and there are triggers for inflammation. While there is often overlap, you may be able to discern over time what trigger causes which response in your skin. For instance you may get flushing for several hours with spicy food. If this does not bother you, you can continue eating spicy food. You may get inflammation with stress and may decide to seek stress reducing techniques such as yoga or meditation to lessen this trigger.
Flushing can only be minimized through reduction of the widened facial capillaries e.g. by laser treatments. The inflammation is treated by topical or oral antibiotics or anti-inflammatory agents. Those medicines cannot prevent a flushing response.

The questions are very specific and must be directed at your treating physician. Without evaluation of your skin and hair and knowing with certainty the name of the method used, I am unqualified to render any judgment.
Franziska Ringpfeil, MD

An evaluation by a dermatologist will be able to confirm if in fact you have rosacea. Facial redness is common in rosacea, a chronic condition in which additional flushing can be triggered by sun exposure, heat, exercise, red wine etc. Facial redness occurs because of widened superficial blood vessels. A series of laser treatment can reduce the number of blood vessels for many years. We do take Keystone health plan east.

A skin biopsy is certainly possible especially if there is any doubt in the diagnosis of rosacea or if the confirmation of the diagnosis would reduce any anxiety on your part considerably. The benefit of the outcome of the biopsy must be weighed against the permanent small scar that a biopsy will cause.
Once a diagnosis is confirmed, a treatment plan can be designed.
Rosacea most commonly develops between 30-60 years of age, however, it can begin in childhood. My youngest patient with rosacea was 7 years at the age of onset. If in fact you have rosacea, I do not expect topical anti-inflammatory medications such as metronidazole (Metro Gel)or azelaic acid (Finacea) to reduce redness dramatically. These medications as well as oral anti-inflammatory agents work well when you are in an inflammatory flare where the skin forms little red bumps or even pus bumps in the affected areas. The background redness with or without visible blood vessels that is observed in about 85% of all people with rosacea is most effectively treated with a series of pulsed dye laser treatments (usually between 2-4) although ongoing intense pulsed light (IPL) treatments may achieve control eventually, too. There are medications that are currently in trial for topical control of the redness. They will work temporarily to provide relief from the redness for several hours.

A skin biopsy is certainly possible especially if there is any doubt in the diagnosis of rosacea or if the confirmation of the diagnosis would reduce any anxiety on your part considerably. The benefit of the outcome of the biopsy must be weighed against the permanent small scar that a biopsy will cause.
Once a diagnosis is confirmed, a treatment plan can be designed.
Rosacea most commonly develops between 30-60 years of age, however, it can begin in childhood. My youngest patient with rosacea was 7 years at the age of onset. If in fact you have rosacea, I do not expect topical anti-inflammatory medications such as metronidazole (Metro Gel)or azelaic acid (Finacea) to reduce redness dramatically. These medications as well as oral anti-inflammatory agents work well when you are in an inflammatory flare where the skin forms little red bumps or even pus bumps in the affected areas. The background redness with or without visible blood vessels that is observed in about 85% of all people with rosacea is most effectively treated with a series of pulsed dye laser treatments (usually between 2-4) although ongoing intense pulsed light (IPL) treatments may achieve control eventually, too. There are medications that are currently in trial for topical control of the redness. They will work temporarily to provide relief from the redness for several hours.

Fillers do not interfere with any blood vessels, not even those that may have become widened by rosacea. If the needle stick during filler placement scratches an intact blood vessel bruising can occur and may last 8-10 days on average. There is no long lasting effect form bruising, i.e. no widening of blood vessels. Therefore, the sequence in which you want to enhance your face is also interchangeable.

Thank you for this very valid comment. There are indeed many who have learned to keep their rosacea controlled by identifying and avoiding their dietary flare triggers or simply by increasing the percentage of anti-inflammatory nutrients in their diet. There are others whose rosacea does not seem to correspond to diet and in whom anti-inflammatory treatments will help.

Unfortunately, there is not yet a cure for ocular rosacea or other variants of rosacea. However, treatment should resolve inflammation enough to not experience the sandpapery feel in your eyes anymore. It appears that your daily doxycycline does not work for you, although it is extremely effective in most people with ocular rosacea and will stop symptoms entirely. Please discuss treatment alternatives with your dermatologist or ophthalmologist.

I agree that proper balance of our body influences rosacea as well as many other conditions of the skin. Most of our patients hear during their consultation with us that they can use Biofeedback, Yoga, Meditation and certain diets to influence their chronic conditions. Most will have better control when they incorporate these techniques but some certainly benefit from psychodermatology. There are two trained and very experienced psychodermatologist in the greater Philadelphia area: Dr Caroline Koblenzer in Center City and Dr Richard Fried in Yardley.

Personal feelings aside, erythromycin may work for your symptoms but there is currently not enough scientific evidence to support erythromycin as an anti-itch medication for rosacea. Other antibiotics, especially those in the tetracycline family, are commonly used to treat rosacea flares and often help with the systemic effects of a flare. Franziska Ringpfeil, MD

The removal of showy redness from enlarged blood vessels is most efficient with a pulsed dye laser. Widened blood vessels in rosacea typically affect almost the entire face including central cheeks, nose, chin and lower forehead. Typically, up to 4 treatments are needed spaced 4-6 weeks apart.
Cost per treatment is $400. It is unusual to have rosacea localized only on the forehead. Not all widened blood vessels (telangiectasias) suggest rosacea. Telangiectasias can occur independent of rosacea. They often require less than 4 treatments and the charge is $105 for the first spot and $20 for each additional spot per treatment. Complimentary consultation with our aesthetician is available and exact diagnosis, treatment plan and pricing will be discussed.

Redness due to widened blood vessels in rosacea is a very common problem.
About 85% of all people with rosacea have variable degrees of baseline redness that only becomes more showy with triggers like sun exposure, caffeine, spicy food, hot beverages or red wine.
The most efficient treatment for this redness is the pulsed dye laser (PDL).
Between 2-4 treatments 4-6 weeks apart are needed. Additional laser induced redness typically lasts for up to 24 hours after each treatment but swelling can last for up to one week. Bruising is rare. Sun protection is paramount for 4 weeks after each treatment but should be continued to maintain results. These usually last 5-10 years. PDL treatments can be repeated.
In contrast, intense pulsed light (IPL) is a non-laser light source that quickly reduces redness with rosacea. It is a nice choice when you quickly need to look better. The effects last for several weeks and IPL can then be repeated as needed or every 2 months to maintain results. It is not my preferred choice because most people with rosacea are looking for long term results. Considering that the cost per treatment is the same, PDL is much more cost effective. Franziska Ringpfeil, MD

I found that my problem, which we discussed last fall, is Eczema, an allergic reaction. I found that the best treatment is to buy Fine grain sea salt from the supermarket, mix a few tablespoons of salt with an equal amount of water, put it on a washrag, and let the affected skin soak for an hour or maybe, possibly overnight. This eliminates the redness very well. I believe that this is partly because water with salt is a good way to treat allergies. For example, to treat summer nose allergies, pharmacies sell saline (ie salt) solutions to put in one’s nose. Sea salt is especially healthy, because of the minerals in the salt. By a similar logic, by soaking skin that is undergoing allergic inflammation in sea salt, the salt extracts and pulls out or “diffuses” the chemicals that the skin is allergic to. I do appreciate very much how you spent time talking with me about this, and I hope that this may also be useful for you as an extra “tool” in your kit. Thanks!

Thank you for sharing your experience.

I was glad to see you consider Chris Devon’s question above (August 2012) about Demodex mites as a possible explanation for skin rashes, as well as keeping an open mind on the topic. You may find it interesting that ABC News aired a report on how the mites build up bacteria inside them and treating the mites has helped with treating the skin: https://vimeo.com/28740321 I also read that Rosacea patients were found to have 12 times the normal number of these mites, which are actually common. If a patient presented with the symptom of eczema around the eyes, might you consider testing for mites in the skin and/or for a bacterial infection? Thank you

Eczema (atopic dermatitis) may go along with an altered bacterial colonization or even infection due to missing defense proteins known as cathelicidins. If eczema appears infected, a bacterial culture is sometimes taken. I am unaware of a significant role of mites in atopic dermatitis. Eczema often spares the oily areas of our face where a large number of mites reside physiologically. As you have pointed out, mites may be implicated in rosacea. The scientific community can still not determine the significance of these mites. In practice, only very few people with rosacea improve with anti-mite treatment. Viruses in the gut of bacteria on our skin may also play a role in rosacea and other inflammatory conditions of the face. The vote is still out on treatment for these.

Thank you, Dr.!

What i found is that if I swim in the ocean, use sulfur soap, or treat with steroids over night, then the next day the redness and inflamation from the eczema is gone, but after a few days it comes back, even if I try those treatments for a week at a time. The second issue that appears to arise in many adult cases of eczema is wrinkling of the skin. Even if the redness is cleared away with steroids, the wrinkles caused by the redness appears to remain. Would you recommend simply wrinkle cream that can be purchased from CVS when such wrinkles result? Regards.

Wrinkling of the skin occurs in children and adults with atopic dermatitis (eczema) alike. The skin is extremely dry after an atopic dermatitis flare and most definitely benefits form extra hydration. Most people get excellent results by applying a moist wash cloth to the affected area x 10 minutes, followed by a thin coating with Vaseline or Aquaphor. After 5-10 days, the skin’s hydration is typically restored. Most of the currently available anti-wrinkle creams are based on providing moisture. Some may also contain agents such as retinol or botanical substances. Please stay away from those with retinol as they could further dry your skin. Please also stay away from those that contain many botanical agents as they can serve as sensitizers on atopic skin. If you want to go the fancy rout, you may find the moisturizers that contain peptides most useful, e.g. Neocutis Biocream. In general. it is very important to constantly work on keeping your skin barrier intact. About 70% of people with atopic dermatitis have a defect in filaggrin. Those who do, usually respond well to daily moisturizing with Cetaphil Restoraderm. The other 30% do very well with glycerin based hydration in the old fashioned Neutrogena body lotion that you can order online. Weekly use of sulfur soap or bleach bath (one quarter cup of bleach in an entire bath tub) keeps bacterial colonization to a minimum.