I am going for laser Tuesday

[Twickle Purple]

Hello and thank you for this site.

This is my first post, I found this because I was looking for info on Green Laser side effects. I have used high potency steroids for over 40 years full-time all over, including my face. I have chronic, active atopic dermatitis head to toe. I keep it well controlled with ointments and vaseline. I am fair skinned and blush easily. Until my mid-30s I had a really healthy looking face, the capillaries were swollen in a pattern that made me look robust and out-doorsy. My first experience with Rosacea (I just didn't know this til 10 years later) was what I thought was a new manifestation of my atopic derm -- a good and nasty case of perioral dermatitis. I've been to many many MDs and Derms over my years and for this I went to a new teaching Derm and he was smart and inspired my trust. He put me on a 4 step regime of gradually reduced steroid ointments mixed with 2% Clindamycin. Two weeks per stage, applied twice a day with the last being hydro-cortisone in aquaphor with 2% Clindamycin. Worked like a charm.

Forward almost a decade and I have full blown Rosacea: head, neck, ears, chest even. My pores are getting large, my face is always swollen and very red and I have blister/pus bumps or very red and painful mystery bumps, the tip of my nose is changing. I have moved to a new province and had to go through finding a new doctor. The majority of MDs I’ve experienced don’t know what to do with my skin (or sadly, a lot of skin conditions). My new MD says it's the worst case of Eczema she's seen, I have her sympathy but she doesn't know what to do with the active flare on my face,neck and chest. At this point I'm not aware it's Rosacea and think that my eczema is entering a new and nasty stage. After almost a year I can't take it, it's getting worse and is so painful. She sends me to a Derm who says I'm taking everything there is: Elidel, Protopic, Betnovate, Elecom (ointment and liquid) and Doxipen. “Try higher dosages.” I feel very frustrated by this lazy response. Higher doses are not the answer. I had suppressed adrenals in my 20s from higher doses of steriods. So, I upped the Doxepin thinking it would help the flushing. Two months later I made a new appointment, my face was unbearably painful. A locum Derm (the other one had gone on maternity leave) said there was nothing to do for me but "wow, quite the widespread Telangiectasia", the most she's ever seen. She was insensitive and incredibly immature (actually said “ew” at my pustules) I was ticked. On my way out of the appointment I saw a sign for another Derm (that exhausted our list of Derms out where I live). He was one of those 'beauty' specialist-type Derms. I thought it could be worth a try -- anything was better than the two young and extremely unhelpful women I'd seen. I made an appointment for a consult for a 'red face'. In the meantime I called up the Derms office where I used to live and asked them to fax me my records. I then went to my MD and asked for RX of 450g of each course so I could wean myself off steroids once and for all. I know that only the steroids will penetrate deep enough to really treat my Atopic Dermatitis but I was willing to give the Protopic and Elidel another serious try for as long as I could.

I went to the Beauty Derm and he also added an oral antibiotic, Doxycycline. My whole body is doing very well. My face, while still a brilliant red, is much improved. It’s no longer a blue red and the swelling is greatly reduced, the skin doesn't scream in pain with the mildest touch and my eyes are feeling better too.

Sorry for the really long post! Here is what I have recently learned:
I have Rosacea – not steroid Rosacea. A recent article I found on the Web (I didn't bookmark it sorry so cannot support this with a link) stated that there is no Steroid Rosacea -- there is Steroid aggravated Rosacea. That if you get Steroid Rosacea you are a person with who is prone to Rosacea anyway. Some folks can use steroids on the face and do not have a problem.

I am going for Gemini (green light) laser treatment on Tuesday and am quite frightened. My husband is worried because I have such tissue-thin skin but I have reassured him that I will be fine. I hope so. I don't want any pain, swelling, crusting, scabbing or scarring. *sigh* We have stocked up on non-flushing foods (I flush from water sometimes so I know this may be futile). I have taken some before pix and will post some afters.

A plus to all this: I have a terrific collection of hats.

Thanks for ‘listening’

Sincerely,
Twickle Purple

[Twickle Purple]

Hi again,

After doing a lot of reading on this forum and other sites I decided to approach this with tempered enthusiasm. I asked a lot of questions and learned that 1) they had not treated anyone who had my skin type (very thin due to many years of steroid application) and 2) they had not treated anyone with the amount of redness that I had. This was enough to give me pause but not enough to bail out completely. I really want help and there is nothing else right now...

Realizing the interest was more in my pocket book than my face I took charge. Since they didn't know how my skin would respond I asked if we could try some sample sites. I have read in the posts that this was very beneficial. They had not done this before! I was told that they would charge me $150 for the sampling (well worth it), my full treatment will be $600 for a 1 hour treatment of full face and neck.

I had read on Dr. Crouch's Web site that he does not recommend laser for Steroid skin. He also has a video showing an actual treatment, which went a long way to taking the fear of the unknown away.

I said go for it. The technician and the Derm consulted and were going to go low strength and single pass. No way, I said I wanted to get some results and if we were going to test we were going to make it count. They chose 3 spots, 2 discreet (right temple and below my right ear lobe) and one unavoidably front and centre at the base of my neck, which would be good test runs for the areas to be treated.

We started on the temple at a #5 and I found it quite tolerable. She eventually took it to #10 and did two passes. By the end of the second pass it was uncomfortable. The area behind my jaw, below my ear is naturally tender but the discomfort was less there. The area above my collarbone was the most uncomfortable and my tummy and pec muscles jumped with each zap. Eventually that reaction lessened but it was the most painful. What I learned was areas with bone hurt more than areas of meaty tissue.

I ended the session feeling very optimistic and encouraged. I made another appointment in two weeks for the full head and neck treatment. I have welts and mild blanching where the zaps occurred but nothing else.

I hope someone finds this helpful.

Very sincerely,
Twickle Purple

[fut]

Hi,

I wish the best of luck to you. Half of this battle will be informing yourself, it seems like you are on the right track!

My experience has been that the Doctor doing the procedure means a lot in results. Make sure you found the right one before you dip into your pockets.

[vesna]

Twicle Purple,
I also had my consult and test patches yesterday! I am not sure of the results yet - the two spots they tested are redder now than they used to be. But I'll give it a week to subside. I've also made the next appntmt, being hopeful. Who are you using? (You can PM me if you don't want to make it public.)
Good luck to you,
Tanya

[Twickle Purple]

Thank you for the wishes fut. I must admit my optimism-meter goes down the more I read the posts of what many folks here have gone through. My doctor is a 5 minutes per type, I don't hold great hope for him. He professed disbelief that Protopic gives me a Rosacea-type reaction as "it does not do that." This lack of awareness would typically send me to the door but I have no one else here and I need RXs regularly.

Hi vesna/Tanya, What locations did you get your patches done? My skin is just horrible right now, very 'alive' and irritated... and itchy itchy itchy! I don't know if my areas are itchy because of allergy/atopic derm or if the treatments activated something. Any area exposed to UV is extremely itchy. I don't go out in the day if I can help it (I work from home) and I wear huge hats and coverup when I go out to water a plant or let my dog out. I stopped my Doxepin because it altered my state of mind to much. I need something else very soon. I feel quite desperate today.

About the test areas: The area treated on my collar bone has remained blanched and looks promising, the area behind my jaw/below my right ear is red and puffy/lumpy, the area on my right temple just at my cheek bones is still just as red as the untreated side but is solid swollen about 1 inch diameter with defined edges. It doesn't hurt to touch it at all, it's just very hard (no itch on that). My right ear is puffed. It's too soon to tell how long this will last.

I regret that I am hesitant to say who I am seeing. I have no options here for treatment and I need what I can get. I believe that anyone suffering a skin condition is more or less at the mercy of the medical profession. Just like any profession -- only a small percentage are exceptional, most are adequate and too many are incompetent. I'm amazed at what folks here have endured and I am strengthened by their sharing.

Very sincerely,
Twickle Purple

[vesna]

Twicle Purple,

I had two test spots - one in the right sideburn area and another one on the opposite, symmetrical. Four pulses on each side (two at 570 and two at 590 nm, no overlapping) w/Vasculight.

The right side spot was already plenty red before the test and it remains the same. The left side spot used to be fairly pale when not flushing but it's kinda red now too. I have not experienced any burning sensations, no swelling but no blanching either. I am on PMS at this point which always exacerbates my redness any way, so I have to wait and see till next week, which sounds like what you'll have to do.

I am thinking that next time it'll be wise to do test patches during the second week of my cycle, as opposed to 1 week before the period, as it was the case this time... I am talking about the next set of test patches b/c I've learned of a good doc in Boston area (from this board and I'm thankful beyond words to the person who'd shared it, as it does not seem to happen very often). So I want to try him as opposed to starting the Txs in NYC.

I also avoid walking in the daylight lately and I almost always wear a wide-brimmed hat w/SPF (save for a quick in-and-out-of-the-car trip to a post office).

I do not have very high IPL hopes for myself at this point for some reason (probably b/c I am on PMS I try to think positive though. We've both just started on this Tx-type road, so you have to be optimistic, right?

Keep me posted about how your test spots look like next week!
Tanya