Interesting article by Dr. Kligman

[tryingtogetoverit]

I came across this:

"A Personal Critique on the State of Knowledge of Rosacea"
http://www.cunliffe-awards.org/pages/awards/lectureship2003_manuscript.html
I thought it was great. It's a little old, but I still really liked it.

Orion

[Kelli]

I've read about half of it, and it is very interesting. But, isn't this the same guy that still prescribes topical Metrocream and antibiotics for everyone and said nothing of laser treatments?

But, I do call BS on the "no women get rhynophima or P&P." Look at me and Smudge (sorry sweetie... just know you're dealing with it.)

Gonna finish reading it later.

[irishgenes]

I REALLY disagree with him that only 10% of women have p&p with rosacea! And he says the lesions are self-healing in 3-10 days. Well, most are, but I have had a few stick around for over 4 months. At least he gets that the vehicles of topicals are too irritating for our skin and he questions the studies where lesions are counted as a method of telling if a treatment works. He also gets how psychologically disturbing this disease is, especially for women, because our appearance is constantly being judged.

[Kelli]

I'm with you Irish... I agree and disagree with him.

I see that he's taking 2 steps forward, then one step back. Making slight progress, but because even HE'S not open to everything, he's giving false information.

[Malay]

In the article A Personal Critique on the State of Knowledge of Rosacea A. M. Kligman claims (on page 4):

"I will soon publish evidence that the response to vasodilating and irritant stimuli generally increases just prior to menstruation, for unknown reasons."

Does anyone know if this has been published?

[irishgenes]

I don't know if he has published that, but I DO know the "unknown reason". It is because estrogen drops dramatically at menstruation. (I have been cured of my rosacea with estrogen.) I have basically quit reading the Rosacea Forum, but got an email on this thread because I had made a post to it back in August.

[KHM]

What is shocking is he is citing an unknown reason for this problem.

Sheesh - I thought 1/2 of the population at least understood the side effects from estrogen dropping like that. Plus any male MDs actually paying attention.

[flareface]

Estrogen did not cure my Rosacea by any means, but it did make a huge difference to the overall quality of my life. And it ended my hot flashes which were making my flares worse and more unbearable. I'm 50, had been hot flashing for more than a year, but resisted the HRT. When the Rosacea kicked in last April it made everything worse, I couldn't tell the difference between a hot flash and a face flare, one made the other worse and I was a mess! So I gave in and went on a low dose Estrodoil and it has been a miracle drug for me. I started on the pills in June, and in September my doc put me on a low dose Estrodoil vaginal ring. This has been a life saver for me, as it gives me a constant stream of medication and my liver doesn't have to process it. Even though it has not cured my Rosacea as I hoped when I started taking it, I am getting a long list of other benefits. I have lost weight, it eliminated the fuzzy thinking, most of my menopausal symptoms are gone, and most important my anxiety level has decreased dramaticly which as everyone knows is a huge flare trigger. So I guess I'm on Estrodoil for life.
Roxanne

[lakan]

He says that every rosacea patient he have met have had a history of flushing before getting the actual disease. I find that crazy cuz i had completely pale skin and did never flush before using harsh acne meds, then it suddenly started and progressed quickly..

[irishgenes]

Hi, flareface! I only check the Forum about once a month now that estrogen has cured me of rosacea, but I did happen to read a couple of your posts. The one above about how you weren't cured by estrogen, but it helped you, and another about how you flush at 3 PM. I just wanted to tell you that I strongly believe that the reason you flush at 3 PM is because your estrogen dips low at that time of day. See my posts on the 3 PM problem here:
http://forum.rosaceagroup.org/viewtopic.php?t=2774&highlight=

You are taking a low-dose estrogen through the ring, but that is probably the reason that estrogen hasn't cured you. (Now, this is assuming that you didn't show rosacea before your late 30's, when estrogen decline sets in. Women who get it early in life probably have two genes for it or something!) For one thing, your ring is probably ethinyl estradiol, right?, which is not bioidentical. For another, it has no estrone. And last, you are not getting enough. Every body organ seems to have a different minimum requirement level of estrogen, and temperature regulation seems to be the most susceptible to minor estrogen fluctuations.

The ONLY way you can increase the dose to the level that is "just right" for you to get rid of ALL your symptoms is to use an estrogen cream or gel, because with no other form can the patient make small changes in dose. Only you will know how much to use by your symptoms, and you will have to use trial and error and keep a record. Your doctor sitting in his office can't tell you your correct dose, although he will certainly act like he knows that a standard dose is just fine for all his patients. If doctors tried to prescribe the same dose of insulin to every diabetic, diabetics would be dropping like flies. Diabetics have a glucometer to judge how much insulin they need each day. Too bad we menopausal women don't have estrogen meters. The creams and gels that doctors like to prescribe because they are made by drug companies and available at the local pharmacy are in pre-measured pumps and don't include estrone. You can't use a one-size fits all dose because each individual woman needs a different dose, and the difference between bad symptoms and no symptoms can be as little as .05 mg. estradiol per dose!

[lafittevillage]

Do you think woken in their 20s can benefit by taking estrogen?

[irishgenes]

I would hope that women in their 20's still have enough estrogen, but if you are taking a birth control pill, the wrong one might be having an effect on your rosacea. When young women have hormone problems resulting in papules and pustules, it may be due to polycystic ovary disease, which causes an increase in testosterone. Kelli knows about this.