So confused! Please help me!

[JennaB]

Hi again,

I have been diagnosed with perioral derm and rosacea back in november. When I was diagnosed with PD I was not too concerned with it has I only had a few minor bumps along my nose that seemed to dissappear after a few weeks once I stopped using tissue paper to dry my face off with after cleansing (My derm said paper products can provoke it...but since reading stuff on the internet about it, I haven't come across any mention of this. Is he being crazy?) Anyways, I also got a flouride free tootpaste. But the last 2 weeks I have noticed an increase in my pd type bumps! So I started researching and I found out sls products can provoke it?! Ahh...my derm recommened ceptaphil gentle skin cleanser and I have been using that religiously for months now (since July when he recommened it). When these bump like things started taking over a week or so ago and I learned about this sls and how it was in my cleanser! I since have stopped using it and have just been using luke warm water to cleanse my face. I have looked up pictures of pd from the links that have been provided in some of the threads on this wonderful site and I do have it. It is just not has bad as some of the pictures. Mainly I have a few tiny red bumps, just under my eyes but on my cheeks, I also have these clear, fluid like bumps around my nose (like in the crease and sides of my nose) Then in my nasal labio folds? (I think that is right?) I have tiny little red and clear like water type blister like dots in there! I have no earthly idea why I have sooo many more of this pd bumps all of a sudden. I am extremely distressed about this. I mean it says to just wash with warm water until the rash subsides and do not use moisturizer. Ever since I started washing my face with just luke warm water and using no moisturizer my skin has gotten soooo dry! Like in my nose creases it is like dry, cracking, painful and my forehead gets super dry and itchy. My nose creases are itchy too if I don't moisturize. Like so itchy that if I wasn't has disaplined has I am I would seriously just scratch the crap out of that area. Also, the skin burns around nose and chin area. Is this symptoms of pd? My derm perscriped me Minocycline 100 mg a day when I was initally diagnosed (but I wanted to see if just cutting out the things he mentioned would clear it up without the antibiotics) but it is worse than ever right now! So I went to my doctors yesterday and explained to him what was going on, what my derm recommened and if it was ok to be on the antibiotic (I am just a bit concered with this med as I read the side effects but my doctor assured me they were rare). Wow, this is getting long winded! Sorry, I really never mean for it to be. I just do not understand how you can only wash your face with luke warm water! I just feel like my face isn't clean. Also, it was so dry today that I just had to use some form of moisturizer (I used my coconut oil). Is this bad? I know it says not to use moisturizer with pd but my skin is flipping out! I just am so lost all of a sudden. I have always had relatively flawless skin except for the stupid acne I get on my chin and the flushing. But now these pd bumps have decided to take over. I have always used cleansers (really gentle ones always because my skin has always been freakishly beyond sensitive) and moisturizers. So this pd has thrown me for a real loop. So I am starting the anti biotics tonight because I just can not get rid of it. I also heard that make up and stuff can provoke pd has well! I love using mascara and I have to use a concelor for my dark eye circles! But now since these stupid bumps started taking over I am afraid to even use my make up now in fear that it will make this worse I honestly feel sooo blah without emphasizing my eyes. I mean I just graduated from university and instead of worrying about finding a good job I have to deal with this crap.

I honestly am so confused. Do I use a cleanser do I not? Do I moisturize? If I do not my skin literally just gets so dry and I tend to flush more when my skin is dry it seems (I don't know if that even makes sense or is possible?) Will these anitbiotics help with these red tiny dots and fluid water filled like bumps? I am just desperate for some help or guidance. For those of you with pd and rosacea what do you do!? I know suncare is crucial for people with rosacea but ever since I started using suncare (back in the summer before I was diagnosed my derm recommened it) I started first noticing these fluid like bumps in summer (but there were only 1 or 2)! So I since have stopped using sunscreen because apparently that provokes this pd I am just so lost, I have no idea how to treat this! I am begining to think I should instead go into dermatology instead of pursuing a masters in social work. Could coconut oil be bad for the pd? Please, please if anybody could offer any advice, guidance (take me under their wing? lol) reassurance even Again so sorry for this retardedly long post again, I know it reeks of desperation. I am just seriously at my wits end.

Jenna

[solutionquest]

Hey, your post is nothing to apologize for!!!

My face freaked out recently...

Now keeping it simple, avoiding the extremely cold winds when possible, the sun as well....

It sounds like we have different problems, as I don't get my spots where you do.... but, if that coconut oil helped I don't think it would be harmful in the long run.

[JennaB]

Thanks for replying to my post solutionquest

I am always that one somebody with a different problem than everybody else! I am looking through old threads and not a lot about PD, lots on SD though.

Your skin even freaked out on the honey treatment you have been going with? I am so sorry to hear that. I know how frustrating it is. The weather were I am right now is just terrible. Cold and dry air. Hate winter. My diva skin apparently does too. I have been comforting myself by buying clothes and shoes!

I am not sure if the coconut is helping or not. Maybe I will just use it once or twice a week from now on.

How goes your battle with not fearing the flush?

Best wishes, Jenna

[Brady Barrows]

Confusion with Rosacea Part 1

One of the confusing things about rosacea is that its definition is sometimes vague and this adds to the confusion not only among sufferers but also with physicians. It is not uncommon to hear reports in this group and in all the online rosacea support groups of misdiagnosing rosacea for one of the rosacea mimics or vice versa. You say that your dermatologist initially diagnosed you with PD/Rosacea. To show you how confusing this is all one needs to do is look at the following photos provided by different sources. First off lets look at what is rosacea and compare that with Perioral Dermatitis:

Rosacea Subtype 1


Rosacea Subtype 2

[Brady Barrows]

Confusion with Rosacea Part 2

Perioral Dermatitis [PD]


Generally PD is around the mouth and chin, but as this this source explains, it can also be found on other parts of the body rarely.

From comparing the rosacea photos with the PD photo, it could be difficult to differentiate PD from rosacea, hence, your physician diagnosed you with PD/rosacea which covers it all. However, your description of the "tiny little red and clear like water type blister like dots" seems odd, as you point out. You might want to ask your dermatologist about some of the other rosacea mimics below:

Keratosis pilaris rubra faceii


Keratosis pilaris rubra faceii is described by this source as "characterized by redness (erythema) and the presence of rough bumpiness (follicular spines) which may begin at birth or during childhood or adolescence."

Keratosis pilaris


This same source says:

"Keratosis pilaris is seen most commonly during childhood and presents as small, rough, raised lesions (papules). These papules are described as "spiny and keratotic" and are typically skin colored. The papules are usually found on the outer surface of the upper arms and thighs, although it may occur elsewhere on the body. The roughness is accentuated by dry skin and the condition is often worse in the winter. It tends to be inherited and may be associated with atopic dermatitis."

Demodicosis (Demodectic Rosacea)


The above image http://www.consultantlive.com/photoc...84670?verify=0 says under the photo:

"The rash had overlying scale and minimal papules (A). No pustules were noted. Skin scrapings stained with chlorazol black E revealed transparent mites, 0.3 to 0.4 mm in length, with 8 segmented legs (B). Some areas of colonization had as many as 13 mites per visual field. Demodicidosis was diagnosed on the basis of the clinical presentation and microscopic evaluation."

As you can see, demodectic rosacea looks so much like rosacea that the only way to rule it out is to get a demodex mite density count with a skin scraping and microscopic examination. Has your physician ruled out demodex mites? If so, then you have a very up to date physician since in the past, most 'experts' in rosacea ruled out demodex as a minor player in rosacea so that most physicians don't bother to exam for demodex. If more rosaceans demanded demodex density counts we could gather more information on what percentage of rosaceans are suffering with demodectic rosacea, but for now it is rare that a physician considers examining with a skin biopsy and microscopic examination.

[Brady Barrows]

Confusion with Rosacea Part 3

Tinea Faciale


Frank Powell, M.D., one of the foremost experts on rosacea suggests that every physician rule out Tinea Faciale before diagnosing rosacea since it mimics rosacea and requires a different treatment. The source of the above three images says:

"Tinea faciale is a common infection of the skin on the face caused by a fungus. The infection usually starts out as a red or pink patch, and the patch gradually becomes raised and itchy with the center of the patch appearing as normal skin. This ring-like appearance explains the nickname for tinea infections, ringworm, though this is a misnomer as there is no worm involved. The same fungus that causes tinea corporis (a body infection) causes tinea faciale. All tinea infections are spread from contact with infected people (children commonly spread tinea from one to another), infected animals, or contaminated personal objects such as towels. Tinea infections are relatively easy to treat with prescription creams or pills from your doctor. Because tinea infections are contagious, it is best to avoid intimate contact or sharing of towels or pillowcases with someone with a tinea infection."

Pityrosporum Folliculitis

Source of the above image

Powell writes in his new book about this rosacea mimic:

“Pityriasis folliculorum is an often over-looked clinical entity” and cases are ‘mostly female.’ He explains that there is ‘usually a history of rarely using soap or water to cleanse the facial skin but instead using cleansing creams.’ These individuals often apply moisturizers and complain of a burning or itchy sensation. He states that the diagnosis of PF is ‘facilitated by use of dermatoscopy, which shows a distinctive picture of the presence of multiple white keratotic material consisting of keratin encrusted demodex mites protruding upwards from the follicular orifices.’ This condition ’seems to be caused by an over population of mites facilitated by the frequent use of creams and the lack of face washing with soap and water.’

Seborrheic Dermatitis


This source explains that "Seborrheic dermatitis is marked by flaking (overproduction of skin cells) and sometimes redness and itching (inflammation) of the skin, and it varies in severity from mild dandruff of the scalp to scaly, red patches on the skin." SD can occur with rosacea at the same time.

As you can see from the above photos, it is difficult to differentiate rosacea from just the few common rosacea mimics described above, not to mention there are many other skin conditions that mimic rosacea not listed above. It may be wise to get a second opinion from another dermatologist to confirm your PD/rosacea diagnosis or you might find that a more thorough physical exam and history of your condition, including what treatments you have tried may result in a different diagnosis.

[Brady Barrows]

Confusion with Rosacea Part 4

Last, but not least, one more skin condition you might want to consider is Atopic Dermatitis since many rosaceans report a dual diagnosis of rosacea with eczema (atopic dermatitis):


Atopic Dermatitis


According to this source:

Atopic dermatitis is a long-term skin disease. "Atopic" refers to a tendency to develop allergy conditions. "Dermatitis" means swelling of the skin.

The most common symptoms of atopic dermatitis are:

Dry and itchy skin
Rashes on the face, inside the elbows, behind the knees, and on the hands and feet.
Scratching the skin can cause:

Redness
Swelling
Cracking
"Weeping" clear fluid
Crusting
Thick skin
Scaling.
Often, the skin gets worse (flares), then it improves or clears up (remissions).

[Brady Barrows]

To show you just one of the rosacea mimics that makes this so confusing is this photo:


What would you diagnose the above patient with based on the photo?

Now read what this patient's problem was diagnosed as by clicking here.

[Wistar]

Originally Posted by Brady Barrows

To show you just one of the rosacea mimics that makes this so confusing is this photo:

What would you diagnose the above patient with based on the photo? .

Unfair that last one. The black bits over the eyes hides the edema. His eyes are swollen and almost closed, but you can't see it. Good pics though.

[Brady Barrows]

Originally Posted by Wistar

Unfair that last one. The black bits over the eyes hides the edema. His eyes are swollen and almost closed, but you can't see it. Good pics though.

Ok Wistar,

To be fair, I have started a new thread on this subject. If you would like to try to guess, please do by clicking here and let the games begin!