People are Looking in -- We shall see what it brings?

[drnase]

Hi Group,

I just received a very surprising email asking for rosacea information -- a subscription to my quarterly report/book from Dr. Albert M. Kligman, MD. PhD. Dr. Kligman is probably one of the top three names in Dermatology across the world. He is well into his 80's now but still is active. I think this is good but I really dont know if I should send him information because it disputes his theory that rosacea is purely from photodamage (which is wrong) and his first line of treatment with rosacea sufferers is with retin A. He clears the papules and pustules at the expense of aggravating the underlying vascular and neural dysfunction. It is cool that he and others are looking in at our groups and my web site, but I dont know if anything constructive can come from information exchange as he is clearly tied into his position and honestly I'm a little intimidated to send a book that logically discusses all the cons of his treatment approach. Yikes.

Warren, should I invite him to the board for our first physician Q and A. We would have to set up another section as I could have many physicians step in and do this. I would probably lay a littlle bit low with Dr. Kligman and be very respectful, but it would have to probably take place over a two to three day period.

1. We gather the most commonly asked questions -- no more than 20.
2. We let him answer and post
3. We follow up with further questions for specifics and clarification
4. He then answers one final time.

What do you and this group think?

[tryingtogetoverit]

I think it's a great idea.
This is how things happen and change, you have nothing to lose and tons to gain. (So cliche, I know.)

Your book might be able to open his eyes or cause him to re-evaluate his previous notions, etc.
Regardless, I think it would be interesting, informative and might provide a stepping stone for other dr's to come and do a Q & A.

I vote yes!
Orion
PS, I'd have no problem calling a few derms myself and asking them to do this very thing. Dr. Diane Thaler is someone who seems to be concerned about rosacea. She seems eager to help/learn.

[Lycaon]

I think poss, its an ideal opportunity to show what the physician Q and A could do. Why so worried about sending the book, hes obviously taking an interest in something which most 'set in there way' phsicians' would not even consider reading. If hes so respected and then reads your work and sees worth in it, it could open up a phenomenol amount of research into the subject, from people aware of this guys reputation and standing

[Ghost]

Dr Nase,

Did Dr Klingman send you money to buy your book, or did he request it for free?

There are different implications with each.

[celticgirlie]

I am hoping that Dr. Kligman has resistant rosacea cases and is open to new approaches from other concerned and caring doctors.

I am hoping he has patients complaining of neural pain and burning and doesn't know how to treat it.

I am hoping that he has heard great things about this "Dr. Nase" and wants to learn more about him.

I am hoping information that disputes Dr. Kligman's theory is cause for him to re-think his ideas and, possibly, change his theory.

I say do it. Opportunity is pounding at our door......

[evy]

Historically, scientists and doctors have read, disputed, pooh poohed new ideas. That's just the way it is. If your theories are improving Rosacea patients lives, you just have to believe in that. I and many of us with Rosacea, knows whether or not we are seeing improvment with your methods. You need to believe in that as well. Send him the book, add a little note about how honored you are that a man of his stature is taking an interest in your work. THEN STAND YOUR GROUND. :D

[clsykes00]

Dr Nase,
I have to confess, I have actually been seen by Dr. Kligman (about a month ago) and brought your book with me to my visit. I tried to review the book with him (because he prescribed tazorac to me), and his first comment was "don't believe what you read because the guy (Dr. Nase in conversation) is a Phd, not an MD." By his response and the way he perused it, this was the first time he had seen the book. After he made his comments, I looked at him a little cross eyed, but knowing that I was in the presence of a derm god, I didn't push him on it. I walked away questioning, "this guy has seen thousands of rosacea patients and continues to prescribe tazorac (and dynacin). This guy is a derm god, what is he thinking? Am I on Pluto?" I asked if he has seen moderates become milds, and severes become moderates by using his methods. He said thousands have under his methods. This made me more confused, especially since he is generally the lead researcher on several new rosacea drugs/treatments.

That said, I have showed your book to quite a few UPenn derms. They have played down the book initially. But, I'm wondering if they recently had a gathering to discuss patients with rosacea, since I am a bit of a zealot when it comes to making them listen and hear my case.

All that said, I am planning to go see him again in about a months time. I can get another read on his thoughts about the book then. Anything to help the cause!!!

IMHO, I think providing him your information in a constructive way would be a huge step for rosacea. Any quote by him and written documentation by him echoing what you have done Dr. Nase and the thoughts you have put together in your book would go a long way and would resonate through the derm community.

By the way, he is a super nice man and full of energy despite being 80. He also has rosacea himself, with broken blood vessels on the front part of his cheeks (confusing me more about treatments).

I hope this doesn't alarm you!

Best,
Trey

[drnase]

Ghost,

He "requested" the information as most physicians do. I am not sure how this would indicate anything other than professional courtesy which we usually give to each other (to a certain extent).

[adyus]

Hello dr.Nase. I think inviting him here would be a very good idea. If you say he uses retin-A, than I say he has much to learn about this condition. Talking with people that have suffered many years from this, people who have tried almost everything out there might open his eyes a little.
If he's still active at his age, he must be quite a character....

Best wishes,


Adrian.

[drnase]

Trey,

Thanks for that input. That is always the first thing they say .... he is a PhD. Until they read the credentials and realize I went to medical school and am considered a medical doctor who can prescribe certain things and perform treatments; I am a medical Physiologist -- not a medical physician.

It is sort of a knee jerk reaction by derms, but not by primary care doctors.

Dr. Kligman is the king in acne. He is also the inventor of retin A, so he pushes it. I have so so many emails from past Kligman patients about him causing progression of the disorder due to his cement in the ground atttitude. I dont know if this is the right guy to start with on Physician Q and A, but it certainly would get around.

I would also humbly request that although this certainly is not my board that I would be allowed to put in some Dr. Nase thoughts on each physician Q and A. That may sound out of line, but each doctor swears by his own treatment methods and some that we interview will give dangerous advice. I certainly will respect any answer to that last bit of info.

[adyus]

IMHO, I think providing him your information in a constructive way would be a huge step for rosacea. Any quote by him and written documentation by him echoing what you have done Dr. Nase and the thoughts you have put together in your book would go a long way and would resonate through the derm community.

Very good point. I second this....


Adrian.

[Ghost]

Ghost,

He "requested" the information as most physicians do. I am not sure how this would indicate anything other than professional courtesy which we usually give to each other (to a certain extent).


Dr Nase,

My thinking is if he bought your book it's because word has reached him about it and he believes it's worth buying.

A book requested for free is generally understood to be for review; it's a business proposition.

[celticgirlie]

I just have to say I am so tired of doctors recommending retin-A and all forms of it. My last derm. swore that it was the number 1 recommended treatment and even when my skin was screaming out in pain, redness and dryness she STILL wanted me to use it. Also, I am shocked to learn that my current derm. has patients using it.

When will this end? Exactly how many rosaceans are successfully using it? I don't understand.

:arrow:

[drnase]

Hi Ghost,

I have given out hundreds of books for free to medical professionals (and rosacea sufferers who could not afford it). It has never been a business proposition for me. It has always come under "professional courtesy" like we do in academia. I can request his book on Acne and Rosacea and he should reciprocate. This is part of the fundamental collaborative effort.

That's been my take.

[clsykes00]

I would also humbly request that although this certainly is not my board that I would be allowed to put in some Dr. Nase thoughts on each physician Q and A. That may sound out of line, but each doctor swears by his own treatment methods and some that we interview will give dangerous advice. I certainly will respect any answer to that last bit of info.

Speaking for myself, I could not imagine a more constructive Q and A with Dr. Nase involved and other derms, especially those like Kligman and Guy Webster ( have seen both for my condition), both of whom get a ton of press coverage. Credibility is key, and that makes Dr. Nase critical in my opinion in "marketing" the true realities of Rosacea. And IMHO, the proper "marketing" of rosacea has created many structural barriers to treatments/cures, awareness, insurance reimbursements, etc.

I just fear putting to much pressure on you Dr. Nase.

Best,
Trey

[clsykes00]

Time for Ghostbusters (no just kidding),

It's a good idea to invite him - I would like to hear his experiences with low dose isotretinoin. I doubt he'll discuss Retin A much to be honest - frankly I'm not sure he uses this for rosaceans anylonger.

Marc, I have seen him recently, and he does prescribe low dose accutane for some patients with resistent, severe cases. He, like others, claim its the single best treatment option for rosacea. Just thought you would want to know. Best, Trey

[bethanne]

I say, invite him, on Dr. Nase!

The worst that could happen would be the good
Dr. continuing to believe in the approach he
already uses, but the best would perhaps be
a more open mind and who knows what
that could lead to.

As far as your work contradicting what he has
professed, it is never disrespectful to have a
dignified intellectual debate among reasonable
people. At least not in my world. Perhaps I
do not understand something about medicine
and academia, but in my job, I interview people
on a daily basis--some well respected--many
well known. It is my job to question and
respectfully play devil's advocate, and I have yet
to meet anyone who was offended by that sort
of lively exchange. In fact, I've found the opposite.
Those who are most confident in their beliefs
welcome the opportunity.

And I'm sure the moderators here would ensure
the tone of the discussion.

Beth

[AmandainAtlanta]

I definitely say bring him on- I think it is a great idea... get more people involved one at a time!

Amanda

[allstar]

Dr. Nase,

What about asking Dr. Darm to contribute to this Q&A forum also? It would be a great intro to the institute, and a time with an experienced laser physician who you are working directly with.

Please keep us updated - and take care of your health - thank you for putting the needs of rosacea sufferers in the forefront of your life and recovery. Your tenacity is amazing.

Allstar

[Warren]

I think we could wait a bit before we get Klingman and see how he responds to and information Dr Nase sends him. Having him would be a big boost for the site if we hope to attract other dermatologists as Dr Klingman is very well known.

My currect thinking of how we should set up the Q&A section is to put it in a separate section of the site from the forum say http://rosaceagroup.org/physicionQandA/klingman.html

and set up that page as a professional media article with a little bio, photo, Q&A and any extra info they want to add, with comments by Dr Nase.

We could have a thread of suggested questions and when the article is posted announce it in the "Research and new medical journal articles" forum.

[JonathanGamache]

I would also humbly request that although this certainly is not my board that I would be allowed to put in some Dr. Nase thoughts on each physician Q and A. That may sound out of line, but each doctor swears by his own treatment methods and some that we interview will give dangerous advice. I certainly will respect any answer to that last bit of info.

Dr. Nase.

I would be disapointed if you didn't add your own comments to these Q and A's. After all, the main reason everyone is at this board is because of you.

Jonathan.

[Strive]

I certainly would be interested in a Q&A forum with a variety of experienced, respected physicians in the field. Respectful, open-minded dialogue is what this is all about.

Oh, and add another vote for the contribution from Dr. Darm.

[Ajay]

I am so new to this but any interest can only be goos surely. Dr Nase it would in my oppionion be unthinkable for you not to be involved with this as you are to so many the best. Can I just add I find it very sad that people seem so suspicious of others motives, I must be nieve I would have thought word has got through to him about how good both the book and you are and he wants to see for himself.

[IowaDavid]

I say, invite him, on Dr. Nase!

The worst that could happen would be the good
Dr. continuing to believe in the approach he
already uses, but the best would perhaps be
a more open mind and who knows what
that could lead to.

As far as your work contradicting what he has
professed, it is never disrespectful to have a
dignified intellectual debate among reasonable
people. At least not in my world. Perhaps I
do not understand something about medicine
and academia, but in my job, I interview people
on a daily basis--some well respected--many
well known. It is my job to question and
respectfully play devil's advocate, and I have yet
to meet anyone who was offended by that sort
of lively exchange. In fact, I've found the opposite.
Those who are most confident in their beliefs
welcome the opportunity.

And I'm sure the moderators here would ensure
the tone of the discussion.

Beth


Seems like a good rationale to me. A courteously-toned exchange of ideas. If things get too hot, then the moderators can step in and say, "let's move along." I don't see why Dr. Kligman would take it personally and go on a mission disparaging Dr. Nase's theories to every derm or doctor he talks to. It seems only good can come out of it--even if Dr. Kligman doesn't change his beliefs. Perhaps it will give this community a little exposure. It seems like, as has been said before, derms don't pay attention because they consider this disease as checked off in the "cured" column. Maybe a little back-to-back mentions of Dr. Nase--the Dermatology Times article and, maybe, this--would wake the doctors up.

It's funny. You'd think if you kept seeing your patients showing up in your office with scorching red, irritated, inflamed faces, and they kept saying, "This isn't working," you'd eventually start to question why your approach wasn't helping people get back to normal.

Or is this just me? Am I just unlucky finding these deaf derms that are still practicing alchemy in their offices? :wink:

[recluse]

it would be interesting to observe dr. nase engage this famous derm in a dialogue on rosacea. leading acne expert meets leading rosacea expert.

but in case you need a pep talk before you go up against this bad greasy character (for all derm's fall under the classification of "bad greasy character" until they stop their counter productive rhetoric about rosacea), then you should be reminded that you're something of a celebraty yourself.

i think most of the people on this board who suffer from acne have never heard of this acne dude's name, (it must be a thing only whispered amongst the elite!) but you can't do any research over the net on rosacea without hearing about dr. nase from hundreds of different sources. this is no exaggeration. not to mention that youre a freakin neurovascular scientist while this guy is just a dermatologist. 9 times out of 10, doesn't this mean that the neurovascular scientist is the one to invent the treatment while the derm mearly implements it (ie. perscribes the drug to patients)?

[irishgenes]

It will be so great, Dr. Nase, when you start interviewing derms on this website. If they disagree with you, we will know those are the ones to avoid. I can't wait to hear from a derm who agrees with you and appears to know how to use his IPL machine who has a practice on the EAST COAST so I don't have to fly to Oregon. I have a phobia about flying.

[ian]

Wow. This is excellent news. If he didn't request the book or email you, he obviously wouldn't care about it.

Plus, Dr. Kligman being 80 years old already - I would think he would want to be as open minded about Acne and Rosacea as possible. And, I think he knows he doesn't have much time left. I would much rather spend that time working on curing a condition - instead of spending my last days defending old ideals which I refuse to let go of simply because they're mine.

If you really think about it... no matter how much he's done for both fields, both conditions are still quite lacking in treatments (the same could be said for lots of dermatological conditions). Hell, the number one treatment for acne is one that's been in use for over a hundred years? (Benzoyl Peroxide) Now that's progress, people!

Not to mean any disrespect to Dr. Kligman, but I'd take a Dr. Nase over him any day of the week. And I'm sure there's thousands of other rosacea sufferers all around the world that will say the same. I hope you do give him a copy of your works, and I hope he's open minded enough to realize that some of his studies and theories need re-evaluation. And I think he may find that if he is open minded enough, he'll realize there's a whole bunch of sufferers who will grow to respect him even more.

[NoMoreRed!]

Thumbs up! :)

[Kathleen Tartar]

Dr Nase, you accomplish more while recovering than any other human being could do in the best of health and going full speed!
YOU ARE AMAZING!
My thoughts and prayers are with you

[bettina]

I think it's interesting; correct me if I am wrong, but Trey you said Kligman prescribes accutane for resistant cases, right?

He believes it's the "single best treatment"?

Wow, that is some endorsement for accutane! I'm glad I'm on it...

[clsykes00]

Bettina,
He does, but didn't in my case, likely because he wanted to try his "go to" option first, tazorac and anti-biotics (minocycline).

However, I think a strong, resounding endorsement of using low dose accutane comes from Dr Nase himself. For a very long time, he has said this is the best defense against rosacea.

Hope the treatment is working for you. I'm trying to get one low dose accutane myself in about 3 months.

Best,
Trey

[Winnie M]

Yes, please bring Dr. Klingman and Dr. Darm on!

Thanks a lot, Winnie


Dr. Nase,

What about asking Dr. Darm to contribute to this Q&A forum also? It would be a great intro to the institute, and a time with an experienced laser physician who you are working directly with.

Please keep us updated - and take care of your health - thank you for putting the needs of rosacea sufferers in the forefront of your life and recovery. Your tenacity is amazing.

Allstar

[Colleen]

I think any collaboration between professionals is a good thing - it can't hurt and gives both sides insight into various treatments. Even if no obvious changes are made at first it broadens the knowledge base of everyone concerned. Please consider though that in discussing different people and their viewpoints that they may also be reading those entries - you don't want to disrespect someone in discussion when you are trying to get more people involved in the forum. Just a thought as it is easy to ask a question in a way that can be very insulting even if it wasn't meant that way.

[drnase]

Yes guys and gals,

Kligman and Plewig (Germany) are strong supporters of long term (12 month) low dose (10 mg treatment) for many rosacea sufferers.

The main reason is that when you finally see rosacea on your face, you have had inflammatory dermal events occuring several years or a decade prior to the rosacea outburst. The single best medication to reverse these years of inflammatory damage, cell adhesion molecules (gates on blood vessels that let neutrophils into the skin) and neutophil induced oxidation and damage of blood vessels is accutane. Nothing else is capable of doing this currently.