My early-stage Rhinophyma please help, please

[YankeesRtheBest]

I'm 20 years old and have noticed from past pictures the clearly noticable difference in the size and shape of my nose. I have a ridiculous amount of oil that pours out of my nose like a river. (and the t-zone is extremely oily too. I have bad cystic acne and I swear to you...I literally have hundreds of blackheads in my nose and when I get them removed they are inches long. (Not sure if that is related to rhino) but I also have bad redness and broken capillaries & veins under my nose and two broken blood vessels on the nose. Pores are large, might be from extracting the blackheads though?

**I WANT TO SEND THIS INTO REMISSION IF I CAN BECAUSE IT'S EARLY. (accutane did not work for me) If NLITE is the best laser for rhinophyma, how do I exactly tell the doctor to treat the nose area as he or she will most likely be inexperienced. (settings, how to point it)
I THOUGHT TREATING THIS EARLY ON IS THE BEST. CAN ANYONE PLEASE TELL ME HOW TO DO IT WITH A LASER AS I BELIEVE IT'S THE NEXT BEST AFTER ACCUTANE.
-Accutane did not work for me, but that doesn't mean it can't work for others, it has helped many remember.

Thankyou so so much. -Chris Long Island, NY

[irishgenes]

I sympathize with you, as my nose tip dropped lower on one side last August. I posted "Dr. Naser--How Long Before Nose Swelling Becomes Permanent?" as a topic on this page, and although Dr, Nase didn't answer, someone did post a couple of links he had written previously on rhinophyma. You might want to read those. For some reason, people tend not to answer these posts about rhinophyma, maybe because it is more rare. (Aren't we the lucky ones?)

I haven't had IPL yet, but it can shrink pores and stop the progression of rhinophyma. I don't know if it can undo the excess growth that has already occured. I am as worried about that as you are.

(Spilled tea on keyboard--it's typing crazy with extra lerttersr!)

[irishgenes]

OK, this morning my keyboard seems to be typing OK, so I will finish my post. I am interested in what dose and for how long you took Accutane. It usually works for most everybody, at least in the short term. I took it 3 times and it worked, but the acne always came back in 12-18 months.

I have written this before, but I don't think anybody has tried it yet. I'd really like to see somebody try this and report success. If it works, you will know it by the second day. To reduce oil significantly, take 320 mg. standardized extract saw palmetto (sold over-the-counter and online by lef.org--I can't speak for other brands) twice daily, morning and night. There is a scientific reason that this might work, and that is because it decreases the conversion of testosterone to dihydrotestosterone, which is the bad type which causes oily skin & acne (in conjunction with genetic factors), prostate problems, hair loss, etc. Although I am female, women do have testosterone, so I used it for a year for my very oily face. It worked for me very well right away, and for my sister, too. You could up or lower the dose as needed. It is quite safe. It is actually used in place of the drug Proscar over in Europe. (Note--should not be used by women who might become pregnant.)

Now, about your desire to tell your IPL doctor what settings to use---is he/she really open to that? I have not met any derms who are willing to take a patient's suggestions on something like that, though I am sure there are some. It will be so great when Dr. Nase finally gets his Quarterly Update published. On his website, he says he is going to
"Supply rosacea sufferers with medical references to help their physicians treat rosacea with the same cutting-edge approaches as 'rosacea experts'." So hopefully that means he will give the settings. I have signed up on his website to be notified when it is available. Was supposed to be Spring 2005, but his illness interfered with that date.

Finally, from your ID, I guess you are a sports fan. Is there any possibility that you are a body builder and maybe taking steroids or some type of "muscle building" product that might be aggravating your acne?

[teresa]

Chris,

Regarding the early-stage rhinophyma and n-lite: I just had my first laser treatments with Dr. Darm and one of his assistants yesterday. Today I am just a little red and swollen - very similar to a sunburn. I am going to have another treantment in 2 weeks. I am going to print out all I can about using n-lite for rhinophyma, as I believe I am also in the early stages. My nose is very often swollen and always shiny with grease. I have no blackheads though. I have never tried accutane, but would prefer to treat it with laser if possible. I used to have a very oily t-zone, but due to my age (43), I believe my skin is dryer now. If Dr. Darm decides to try the n-lite for my nose, then I will post the results. I am sure it will take a few weeks for the final outcome to become apparent.


Irishgenes,

Your post about saw palmetto really got my attention. Your statement about testosterone and its conversion is quite interesting. I had hormone testing a month or so ago and found that I have a rather high level of testosterone for a woman. Maybe a good question would be "Is that part of the reason why men tend to suffer more often with rhinophyma than women?" Probably an oversimplification, but something to start with?

Anyway, I am going to try the saw palmetto from that website and see how it helps. Maybe coupled with the IPL, there will be a huge improvement! I'll let you know. Thank you for the info.

Teresa

[irishgenes]

Well, I don't know where Chris went, but I am glad you are going to try saw palmetto, Teresa. Let me know how it works. I have written about this herb on the thread "Does Accutane Permanently Destroy Sebaceous Glands?", too, and a few other threads as well. I just can't speak highly enough about this herb's instant results. I started taking it again yesterday because the oil started up on my face again. No more oil! The pimples that were starting just dried up right away. (Not to be confused with the p&p of rosacea--these were "grease pimples".) I am starting with 160 mg. twice a day. Formerly I took 320 mg. twice a day. It is important to take it twice a day, not just once.

I had not thought about the possibility of rhinophyma being affected by dihydrotestosterone. Great observation, Teresa!!! I am sure that is why rhinophyma is so much more common in men. I did not get the rhinophyma until some months after I had quit taking the saw palmetto that I had been taking for over a year. I don't know if the saw palmetto can undo the damage that has occured to my nose or not, but I am sure going to keep taking it in the hopes that it will prevent further growth. Also hoping it can improve my receding hairline. I don't know what my testosterone level is now. Back in my 40's, I had my testosterone tested because of my acne/greasy skin, and it was normal. However, I think it was still converting itself into the bad dihydrotestosterone.

You are lucky to live near Dr. Darm. Will be interested in hearing how your treatment with the N-light goes, if he decides to use it on you. I used to live in southern Oregon, but now I am on the east coast. I wish I didn't have this flying phobia!

[YankeesRtheBest]

Teresa,

Thankyou so much, that would be greatly appreciated if you could post about the NLITE and rhinophyma. It really means a lot, thanks so much.


Irishgenes,

I will absolutely try the saw palmetto. What is the best brand to get? That is very interesting to hear though. Do you really think it can help stop my cystic acne and prevent any rhinophyma from progressing? Just curious..how long do i take 320 mg twice daily for and do you know if it's safe to use long term? Also, is it ok to take while on doxycycline? I also just started a supplement called Triple Omega with omega 3-6-9 (flax, fish, and borage oils) for my ocular rosacea.
PS-No I don't take steroids, but I am a die-hard Yankee fan even though they're not doing so great right now.
Thanks again for the info :) -Chris

[irishgenes]

It is certainly worth a try, Chris, as you sound pretty desperate! The United States Pharmacopeia stated that this herb "has no significant side effects and only rarely causes mild stomach upset or diarrhea." You would have to take it twice a day for as long as you have acne. I noticed that if I skipped a dose, the oil immediately returned. I started to try it on my own just out of deductive reasoning before I ever had a computer and could research these things; there is not much on the internet about this use. The product I used was Super Saw Palmetto from Life Extension: http://www.lef.org/newshop/items/item00651.htm?source=ProductList

However, I have recently gone back to taking it and am using Spring Valley brand from Wal-Mart. It seems to be doing just as well, but I've only used it for a couple of days now. I know that not all brands of herbs actually contain what they state on the label, though, so you should stick to one of these brands first.

The fact that you failed to clear with Accutane worries me, because Accutane is strong stuff! Doctors have mostly ignored the important hormonal component of acne.

What are you using to extract your blackheads with? I would imagine vacuum devices can be pretty harsh on rosacea skin. I read an anecdotal report about a drug called "guaifenesin" helping rosacea. I bought some OTC "Mucinex" in the 600 mg. extended release dose hoping it might help my flushing. It didn't, but it unexpectedly seemed to flush the greasy gunk out of my pores. (This is before I started using saw palmetto again.) I hesitate to say this because I would need to repeat this several times to see if it wasn't just a figment of my imagination. Mucinex is in some cough syrups (at a lower dose) and thins mucous. I am not sure how or why this would work. There's a discussion of guaifenesin on the ESFB Channel, another online rosacea group. Have you ever visited that website?
http://www.esfbchannel.com/cgi-bin/yabb/YaBB.pl?board=Pictures&action=display&num=1115061362

Another great website is the Rosacea Blog: http://www.rosacea.co.uk/blog/

Oh, I forgot to say that I am also taking the doxycycline with the saw palmetto. I don't think there are any interactions.

[YankeesRtheBest]

Irishgenes,

hey, no the accutane appeared to be working beautifully on my acne, but even at as low of a dose as 10 mg twice a week, it dried out my already terrible dry eye from my ocular rosacea. I'm been on every dry eye treatment in the book, restasis, plugs, natural tears, fish oils, eye scrubs, compresses, etc., but accutane is just too drying, even my lips were so chapped, I put tons of vaseline on every night.
Anyways, I'm trying not to get my hopes up too much, but the saw palmetto thing is pretty exciting. And if it can prevent me from going bald ..o man! I couldn't put into words how cool that would be since it runs in my family. No, I'll try not to get too excited. It's just hey... not bragging, but I can be a good looking guy, this whole acne/rosacea thing has turned my world upside down to where I've been depressed for the past few years. I have to look foward to a future with a huge rhinophyma nose, pimples, rosacea, and no hair. What attractive features, huh? I'm sure all the girls in my college will be looking for these. Well thanks again, I appreciate it. -Chris

[fut]

Yankees,

You should take a visit to acne.org community boards - there are some very intelligent posts in regards to sebum production and what has worked for them.

Regards,
George

[irishgenes]

Be sure you get the standardized extract and not just ground-up berry powder. I believe the Spring Valley brand only comes as high as 160 mg. so you'd need 2 caps twice a day at first and then adjust as needed. I am going to feel so bad if this doesn't work for you after getting your hopes up! I take a lot of dietary supplements in the hopes of preventing aging, cancer, ....death! However, with all the rest, I don't really see or feel any difference. The saw palmetto is the only herb I have ever used that I saw immediate results with, and I know it is the herb because the oil comes and goes depending on whether I am taking it. But nothing works for everybody.

[YankeesRtheBest]

Teresa,

I was hoping you could update all of us on your laser treatments with Dr. Darm. Thanks, it's greatly appreciated. -Chris

[YankeesRtheBest]

Hey irishgenes,

I just wanted to update you on my saw palmetto experience. I was on and off it because I wasn't sure if it was contributing to my dry eye problem, but now I'm pretty sure it wasn't. I've been on it for almost 2 weeks now, but I'm still getting cystic out breaks here and there, but hopefully with continued use it will work. I think my sebum production has gone down some what so that has to be good. I'm using the brand tru nature that says standardized concentrated extract on it twice a day, 320 mg like you said. I had a couple questions I was curious about though that maybe you could help me with, I have an unusual amount of blackheads, will this help that too maybe? How long do you think I should give this to see if it really will help my cystic acne? With long-term use, can this have any damaging effects in fertility or my reproductive system? Also, it seems for a while now I have to go to the bathroom often even when I don't drinka lot of water. Today I think I went 8 times, and I don't know if it's a coincidence, but since saw plametto helps the prostate, it just occured to me that maybe I may have a prostate problem? I just hope it's not cancer or something, but then again, I worry about everything. I don't know, I guess I should see a doctor about it. Thanks for your time, I appreciate it. -Chris

[irishgenes]

I'm sorry to be slow in answering this, but I haven't been getting my emails from the Forum for some reason. Anyway, it is very unlikely that you would have prostate cancer at your age! "The fatty acids in saw palmetto... are now known to tone and strengthen the male reproductive system by counteracting the effects of oestrogen and progesterone and controlling testosterone levels." And, "...saw palmetto is rich in sterols... which have been shown in rats to have anti-inflammatory properties similar to cortisone. This explains the herb's traditional use for treating inflammation of the airways, excessive discharge of mucus from the sinuses, and genito-urinary problems." From this website: http://education.guardian.co.uk/higher/medicalscience/story/0,9837,576381,00.html

I don't know about that brand. Consumer Labs didn't rate it. Is it standardized to 85%? The brands they rated "not acceptable" were CVS Pharmacy, Gaia Herbs, Herbalife, NaturalCare, & Safeway.

Blackheads are just oxidized sebum. When I took Accutane, I developed blackheads for the first time in my life after about 3 weeks. That is because the sebum had slowed down enough to sit there and oxidize. Usually, it was flowing too fast to do that.

I wouldn't expect miracles with saw palmetto since your problem seems to be severe. Have you ever had your testosterone level checked?

[YankeesRtheBest]

No I never had my testosterone levels checked, but I swear to you, I am an oil producing machine since 14. The amount and size of the blackheads I have is so vast that upsetting does not begin to describe it. My cystic pimples literally feel like rocks embedded in my skin. I wish my eyes could tolerate accutane, but they simply can't, even at the lowest dosage. I'm looking into photodynamic therapy in order to treat my cystic acne, prevent rhinophyma, and hopefully treat rosacea. I'm just very nervous about getting it though because it supposedly irritates the skin and causes it to get red, I just don't want to worsen my rosacea and send it into the next stage. What do you think about that?
PS I've started a supplement, chelated zinc, which says zinc gluconate in parenthesis from vitamin world, to hopefully help with the acne.

[irishgenes]

Testosterone is necessary to have acne in men and women. That's why you don't see it in pre-pubertal children. Your level is probably normal, and it's just that your skin is reacting badly to normal levels. That is usually the case: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2430399&dopt=Abstract

But you seem to have tried so many things, and I know you are getting near the end of your rope. Here is an article on using Danazol for intractible acne in men: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6448129&dopt=Abstract
I don't know much about the drug, just giving you an idea. You might print out the abstract and take it to your dermatologist.

[drnase]

Hello Irish Genes and Chris,

Its interesting that you bring up the DHT for rhinophyma or stimulation of sebaceous glands. More blood flow brings more DHT to these areas. There was a an acne review article by a dermatologist who recommended that propecia, a DHT inhibitor may have some use down the road for acne patients over 30. I believe there are two enzymes and two receptors that you need to block though and thus they upgraded it to the new avodart which addresses both, but it is so new (this is not medical advice).

They also talked about herbs like you guys with Saw Palmetto coming up first, followed by Pumpkin Seed and Pygneum africum for DHT blockade.

Scientists have found that the single most active ingredient in all three herbs for DHT blockade is Beta-Sisterol and they are using 300 to 600 mgs of Pharmaceutical grade Beta Sisterol for prostate problems and acne. If you look through the web, to get this amount of pure Beta Sisterol from these sources would be impossible.

IrishGenes, did you ever come across this or have any thoughts on this? I think it would be a nice complimentary herb extract to take.

Interesting point is that many acne sufferers dont have abnormal levels of testosterone, they have more active enzymes that convert testosterone into DHT and/or more DHT receptors on the sebaceous glands.

[irishgenes]

The pumpkin seed and pygmeum africanum are often added to saw palmetto formulations, though I never used those. I had pretty good results in lowering sebum levels with plain saw palmetto, but I think Chris needs something stronger, so this is a great tip, Dr. Nase. I had not heard of the beta-sitosterol before. Just looking on the internet, here is one site which is selling 300 mg. caps that they say is 3000 tiimes more powerful than saw palmetto. http://www.prostate-miracle.com/ Now, I don't know if it is pharmaceutical grade. I'll have to do some research on whose formulation is best.

I don't understand why the researchers say it may be useful in men over 30--why an arbitrary age limit? And why wait until "down the road"? We need help now, and if it is available over the counter, I'm going to try it! I have read at least one study which says saw palmetto is as good as Proscar for prostate trouble without the side effects. Of course, that is not my problem! I've had pretty good results with decreasing sebum just with saw palmetto, but now I have a new problem, and that is thinning hair. Here is a study which used botanics (saw palmetto and beta-sitosterol) for hair thinning with good results. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12006122&dopt=Citation Since both the hair follicles and the sebaceous glands are affected by DHT, I think it is worth a try for both problems.

Do you think my hair could be thinning from the heat of rosacea flushing instead of DHT, Dr. Nase? Like some people lose hair after a high fever? Do you know how many degrees the skin increases during a flush? (When I was having menopausal "hot flashes" before going on estrogen, I actually ran a 2 degree fever most of the time! My doctors were so perplexed, and I went through the agony of a spinal tap before I finally figured it out myself.) Also, what do you think about Chris trying Danazol for his acne if the beta-sitosterol doesn't work?

[drnase]

The pumpkin seed and pygmeum africanum are often added to saw palmetto formulations, though I never used those. I had pretty good results in lowering sebum levels with plain saw palmetto, but I think Chris needs something stronger, so this is a great tip, Dr. Nase. I had not heard of the beta-sitosterol before. Just looking on the internet, here is one site which is selling 300 mg. caps that they say is 3000 tiimes more powerful than saw palmetto. http://www.prostate-miracle.com/ Now, I don't know if it is pharmaceutical grade. I'll have to do some research on whose formulation is best.

I don't understand why the researchers say it may be useful in men over 30--why an arbitrary age limit? And why wait until "down the road"? We need help now, and if it is available over the counter, I'm going to try it! I have read at least one study which says saw palmetto is as good as Proscar for prostate trouble without the side effects. Of course, that is not my problem! I've had pretty good results with decreasing sebum just with saw palmetto, but now I have a new problem, and that is thinning hair. Here is a study which used botanics (saw palmetto and beta-sitosterol) for hair thinning with good results. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12006122&dopt=Citation Since both the hair follicles and the sebaceous glands are affected by DHT, I think it is worth a try for both problems.

Do you think my hair could be thinning from the heat of rosacea flushing instead of DHT, Dr. Nase? Like some people lose hair after a high fever? And what do you think about Chris trying Danazol for his acne if the beta-sitosterol doesn't work?


Hi IrishGenes,

1. BetaProstate is pharmaceutical grade I believe

2. I believe the dermatologist was being conservative and just put the acne together with the hair loss for propecia; but you are absolutely right, why not treat it while its happening during adolescence.

3. I honestly dont know if the heat of rosacea would affect the hair follicles, but I doubt it. Males have 3 main factors with hair loss, DHT, inflammation and fibrosis. Secondary are nutrient supply and ATP production in the hair follicle. Females have many more unknown with their diffuse hair thinning. DHT is a small player, but estrogen also plays a role and inflammation. Ketoconzaole shampoo is very good for both sexes for the inflammation and removal of DHT. Oral spironolactone is probably the number one treatment for female hairloss (had to do a lot of research on this for my ex). Using the wrong birth control pills as you so wisely mentioned is a very big player. I would get the 2% ketoconazole shampoo online. There are many hormones at play with females as compared with primarily DHT for males, thats why the spironolactone works -- it works on several hormones. I believe some dermatologists have also developed a topical spironolactone lotion or spray that is comparable to the oral form.

4. I dont know anything about danazole. Ill have to look that up.

[irishgenes]

I dont know anything about danazole. Ill have to look that up. Here is the link again to the Danazol study I found for Chris. He seems to have tried so many things without success that I was just trying to come up with something new, and I believe hormones are the main culprit in acne. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6448129&dopt=Abstract

I will definitely give the ketoconazole shampoo a try. I've always been afraid to try spironolactone because of the tumors it causes in lab animals. I'm on bio-identical estrogen. If I wasn't, I'd probably be totally bald by now.

[drnase]

I dont know anything about danazole. Ill have to look that up. Here is the link again to the Danazol study I found for Chris. He seems to have tried so many things without success that I was just trying to come up with something new, and I believe hormones are the main culprit in acne. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6448129&dopt=Abstract

I will definitely give the ketoconazole shampoo a try. I've always been afraid to try spironolactone because of the tumors it causes in lab animals. I'm on bio-identical estrogen. If I wasn't, I'd probably be totally bald by now.


Interesting link thanks. Hormones are definitely involved in acne as well as an inherent stickiness of epidermal cells. Those seem to be the first two primary problems. Then after clogging you get the bacteria, inflammation and cytokines.

Below is a link to one of the best female hairloss experts in the world. He compounds a topical spironolactone lotion and has rigorously tested it clinically to look for systemic absorption -- none. Worth a look and possibly email the doctor.

https://www.xandrox.com/topical.htm

I hope it helps some. Ketoconazole shampoo definitely halts the shedding in most people used three or four times a week.

[drnase]

In case link does not work:


TOPICAL SPIRONOLACTONE IN THE TREATMENT OF ALOPECIA
AND INSTRUCTIONS FOR USE


ODORLESS 5% SPIRONOLACTONE LOTION NOW AVAILABLE



It’s been firmly established that alopecia. androgenetica, more commonly known as male pattern baldness or just pattern baldness, is initiated by dihydrotestosterone (DHT) attaching to the receptor sites on the hair follicles [1.2.3.4.].

Genetically, only the follicles on the top of the scalp are encoded with the receptor sites [5.6.24.], which explains why hair follicles along the side of the head and in the back of the head do not atrophy. The attached DHT on the receptor sites is perceived as a foreign body and the immune system begins to destroy the hair follicle, shortening the growth phase and causing the hair shaft to become progressively finer in texture [6]. In extreme cases, only a microscopic vellus hair remains. The good news is that these follicles have the inherent capacity to mature to their former size and thickness.

Encouraged with the success of finasteride to reduce the amount of DHT in the scalp of patients with male pattern baldness (MPB), doctors and scientific researchers took another look at existing medications that are known to act as anti-androgens.

There have to be stringent criteria for an anti-androgen that can be used to combat or even reverse pattern alopecia.

The ideal anti-androgen should have the following properties:

(1) It must have potent anti-androgen activity; (2) It should selectively prevent or successfully compete with DHT without changing testosterone levels; (3) It should be effective topically, so it can be conveniently applied with minoxidil solutions or lotions and (4), It should be easily absorbed into the skin, but should have no systemic effects where it is not applied.

That’s a tall order. Surprisingly, there is such a medication: spironolactone. And it’s not a new medication [7.8.]. For over thirty years spironolactone has been used for its anti-androgenic effects in both males and females [14.15.]. Taken orally, it is such a potent anti-androgen that, although it is an effective anti-hypertensive drug, it is rarely used to treat men with hypertension because of its feminizing properties which can include painful gynecomastia [16.17.].

Applied topically, however, spironolactone does not have systemic side effects [12.18.19.20.]. Clinical evaluators of topical applications of spironolactone concluded, "as far as the topical use is concerned, spironolactone seems to be highly effective with absence of systemic effects"[19]. Physicians have been treating patients for MPB for well over fifteen years and there have not been any reports of systemic side effects. In my own research, the use of topical 5% spironolactone along with Xandrox 5% solution yielded improved results as compared to the use of Xandrox 5% alone. Likewise, the combination of 5% spironolactone with Regrowth's 5% minoxidil yielded improved results as compared to the use of 5% minoxidil used with daily 1 mg doses of finasteride (with the added advantage of zero side effects).

Among its other properties as an anti-androgen, spironolactone is a potent competitive inhibitor of DHT at its receptor sites [21]. Therefore, spironolactone effectively prevents DHT from attaching to the receptor sites on the hair follicles [22].

As a result, the follicles no longer atrophy and can mature again to their normal size. And it does so without decreasing the circulating levels of DHT in the body. By comparison, finasteride inhibits the formation of DHT, causing troublesome side effects in many patients.

Multiple studies in various medical centers document that spironolactone is effective when applied topically [22].

In studying the anti-androgenic effects of topical spironolactone at the Department of Dermatology at New York University School of Medicine, researchers established that spironolactone concentrations of 0.01% to 5% produced a dose responsive decrease [23]. When both topical 5% spironolactone and topical 5% minoxidil are used daily in the treatment of MPB, the effects of the medications are synergistic. Whereas neither medication alone is particularly effective for the majority of patients, the success of the combination has been experimentally proven. Our own success rate with this formulation has been approximately 75-80%.

Our extensive R&D have finally produced a spironolactone lotion which almost totally eliminates the inherent disagreeable smell of spironolactone. In addition to the 5% concentration of spironolactone in the lotion, there are small (1 to 3 mm) vesicular pockets of pure, unsuspended micronized spironolactone powder. This should be spread onto the scalp with one's fingertips to optimize the effects of the application.

Do not combine medications containing spironolactone and minoxidil in the same container. The medications slowly react with each other, resulting in a compromise of their pharmacological activities. However, since it requires many hours for spironolactone and minoxidil to chemically react with each other, they can be consecutively applied to the scalp without compromising each other.

Regrowth's 5% Spironolactone Lotion has a shelf life of more than 18 months when kept at normal room temperatures.



Bibliography



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2. Rattner H: Ordinary baldness. Arch Dermatol Syph 44:201-213, 1941

3. Rook A, Dawber R: Diseases of the Hair and Scalp. Oxford, Blackwell Scientific Publications, 1982

4. Baden HP: Diseases of the Hair and Nails. Chicago, Year Book Medical Publishers, 1987

5. Lattanand A, Johnson WC: Male pattern alopecia: A histopathologic and histochemical study. J Cutan Pathol 2:58-70, 1975

6. Blauer M, Vaalasti A, Pauli SL, Ylikomi T, Joensuu T, Tuohimaa P: Location of androgen receptor in human skin. J Invest Dermatol 97:264-268, 1991

7. Menard RH, Stripp B, Gillette JR: Spironolactone and testicular cytochrome P-450: Decreased testosterone formation in several species and changes in hepatic drug metabolism. Endocrinology 1974;94:1628-1636

8. Menard RH, Martin HF, Stripp B, et al: Spironolactone and cytochrome P-450: Impairment of steroid hydroxylation in the adrenal cortex. Life Sci 1975;15:1639-1648

9. Schapiro G and Evron S. A novel use of Spironolactone:treatment of hirsutism. J Clin Endocrinol Metab. 1988;51:429-432

10. Cumming D, Yang J, Rebar R, Yen S.: Treatment of hirsutism with Spironolactone. JAMA. 1982;247:1295-8.

11. Boiselle A, Tremblay RR: Clinical usefulness of spironolactone in the treatment of acne and hirsutism, abstracted. Clin Res 1978;26:840A

12. Yamamoto A, Ito M. Topical spironolactone reduces sebum secretion rates in young adults. J Dermatol, 1996 Apr,23:4,243-6

13. Berardesca E, Gabba P, Ucci G, Borroni G, Rabbiosi G: Topical spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands: an autoradiographic study in subjects with acne vulgaris. Int J Tissue React 10:115-119, 1988

14. Burke BM, Cunliffe WJ: Oral spironolactone therapy for female patients with acne, hirsutism or androgenetic alopecia. Br J Dermatol 112:124-125, 1985

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[YankeesRtheBest]

Thanks for all of your info irishgenes. A big dilemma that I have now is that I know I'm 20 years old and completely understand that PREVENTION is the key to fighting this thing. But i still do not know how to go about preventing my early stage rhinophyma. Photodynamic therapy may not even work because it takes so many treatments to maybe get results, that's not promising. I see that I produce an abnormal amount of oil w/ painful cysts, hundreds of blackheads. I seem to have a good chance of developing advanced rhinophyma. There has to be something I can do to def put a hault to this besides accutane.
I am very depressed about this. I just want to help my situation. Any suggestions guys?? Would a pulsed dye laser close the sebacious glands pemanently?
**What are the ways/best way to FIBROSIS the glands shut??? Thanks.

[YankeesRtheBest]

I'm stupid, I didn't even see the last couple posts because I didn't go to the second page. Thankyou Dr. Nase for the info, I appreciate it. Thankyou again irishgenes. -Chris

[YankeesRtheBest]

Hey, ok I just read the entire passage on the Beta-Sitosterol. Do you really think this would work for my acne? And so I don't have a testosterone problem..I have a DHT problem and this will be 3000 times stronger than the saw plametto I'm currently on in order to stop sebum production and the conversion of testosterone to DHT?? I wonder if it can truly help rhinophyma too? I'm going to purchase the Beta-Sitosterol, do you think it's safe? The thing I always worry about with everything is infertility. Whenever hormones and medications are mentioned I worry about that the most for some reason.

Thanks so much Dr. Nase and Irishgenes, I am very grateful for your care and concern. -Chris

[irishgenes]

Beta-Sitosterol is not going to cause infertility, Chris! There's no way to know if you have too much tetosterone without doing a blood test, but usually men (and women) with acne and hair loss problems either convert too much testosterone into the bad DHT or their sebaceous glands and hair follicles just react badly to DHT. Beta-sitosterol should be much more effective at lowering DHT and thus sebum than saw palmetto, though I'm not sure if 3000X is hype or not. I went out and bought some Source Naturals Beta-Sitosterol at my local health food store a couple of days ago. It was $12 for 60 pills, and I guess I'll start off with one AM & PM. The Beta-Sitosterol is 375 mg., but it also has 187 mg. campesterol and 131 mg. stigmasterol included. The label says "Phytosterols are natural components of many vegetables and grains. Preliminary scientific evidence suggests that plant phytosterols may help to support cholesterol wellness.." That's an added benefit I hadn't known about. Says it is "natural, safe, derived entirely from plant sources", but women who are pregnant or nursing should consult a physician before taking. It's worth trying, Chris, and if it doesn't work and you get really desperate, there's always the Danazol.

Dr. Nase, I also bought the ketoconazole shampoo, but am concerned about the spironolactone shampoo you mentioned having 50% alcohol. I wouldn't think that would be good for rosacea skin. I wonder if I could just get a spironolactone pill and grind it up, then put it in regular shampoo or the ketoconazole shampoo.

[YankeesRtheBest]

Thanks irishgenes, I'll look for it in my drug store and let you know what brand. Maybe I also didn't give teh saw plametto enough time, I was on it for about 3 weeks. I guess I just thought it should instantly work but maybe it takes months like zinc gluconate does?? Do you know ifit's ok to take this, being an herb, with my doxycycline. Or can I at least take it with my zinc gluconate and omega 3,6, 9 supplement, and I also have started to take acidophilus to grow good bacteria cause of the antibiotics. I seem to try to take everything apart so they don't cancel each other out, but it's too many pills to do that.

And back to rhinophyma, I just wnated to know if you anything about using teh lumenis one for thsi and what it can potentially do. How do I help direct my laser physician in the technique for doing this? Thanks irishgenes, it's always appreciated. -Chris

[irishgenes]

You gave the saw palmetto long enough. I'd give up on it now and try the beta sitosterol, which is stronger. I don't know if it will be in drugstores, as I don't think it is well-known yet. If you can't find it there, it will be in health food stores. Yes, it is OK to take it with doxycycline and the other supplements you are taking. I am taking doxycycline, too, but only 25 mg. AM & PM. Taken at that level, it does not act as an antibiotic, just as an anti-inflammatory, and thus I don't have to worry about adding probiotics like acidophilus. Maybe you are taking a higher dose for some reason?

I don't know much about IPL, so you'll have to ask others about that. I looked into getting IPL locally and could find no one who seemed knowledgeable, so I am holding off on that for now until I can find a good doctor on my side of the country.

[fanta]

Irish are you taking doxycycline??? you told us you were taking accutane last week, you cannot mix doxycycline and accutane, so you have to wait 1-2 months before you start on doxy

[irishgenes]

No, I took Accutane for only two days a month ago, and it was just a drop out of a 40 mg. capsule. I then remembered that mixing doxycycline with Accutane was a big no-no and quit taking the Accutane. I am still alive a month later, so no harm done. I may go back to ultra low dose Accutane someday, but right now I'm just going to try the beta sitosterol to control sebum. Reading the list of side effects for Accutane makes me nervous.

[drnase]

Beta-Sitosterol is not going to cause infertility, Chris! There's no way to know if you have too much tetosterone without doing a blood test, but usually men (and women) with acne and hair loss problems either convert too much testosterone into the bad DHT or their sebaceous glands and hair follicles just react badly to DHT. Beta-sitosterol should be much more effective at lowering DHT and thus sebum than saw palmetto, though I'm not sure if 3000X is hype or not. I went out and bought some Source Naturals Beta-Sitosterol at my local health food store a couple of days ago. It was $12 for 60 pills, and I guess I'll start off with one AM & PM. The Beta-Sitosterol is 375 mg., but it also has 187 mg. campesterol and 131 mg. stigmasterol included. The label says "Phytosterols are natural components of many vegetables and grains. Preliminary scientific evidence suggests that plant phytosterols may help to support cholesterol wellness.." That's an added benefit I hadn't known about. Says it is "natural, safe, derived entirely from plant sources", but women who are pregnant or nursing should consult a physician before taking. It's worth trying, Chris, and if it doesn't work and you get really desperate, there's always the Danazol.

Dr. Nase, I also bought the ketoconazole shampoo, but am concerned about the spironolactone shampoo you mentioned having 50% alcohol. I wouldn't think that would be good for rosacea skin. I wonder if I could just get a spironolactone pill and grind it up, then put it in regular shampoo or the ketoconazole shampoo.


IrishGenes,

This type of cosmetic alcohol will be applied directly to your scalp and most will evaporate. Some will enter the blood stream, but it should not cause an "alcohol-induced flush" or irritate the facial skin.