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Ask Dr. S. Attili Your Own Question
Dr. S. Attili
Dr. S. Attili, Dermatologist & Dermatopathologist
Category: Dermatology
Satisfied Customers: 5175
Experience:  MRCP (Dermatology), Int. Board Certification in Dermatopathology
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My skin is a puzzle! I have my nose always red, inflamed

Customer Question

Hello dr
My skin is a puzzle! I have my nose always red, inflamed with large pores and a located constantly feeling of dryness and swollen. It has been diagnosed with seborrheic dermatitis( i scale very little in moustashe and eyebrow area) and rosacea ( i blush in my ears and face) .No treatment works .
For rosacea i have done;
I blush in my nose and ears( but a diferent kind of blush)... Not always at the same time! I have used, minocicline, Azeleic acid, metrocream or other rosacea cream and they dont work and make me redder. The minocycline was the best with the redness at the mornings BUT in the afternoons i would sweat more and the redness would return worse!
For Seb Derm i have done;
Salicylic acid, that was amazing at first with the redness but with time made my skin more sensitive and red!
I also used ketoconazole cream for seb derm and did not work.
Oral antimicotics did very little with redness.
The sun sometimes does not worsen my skin , but sometimes let her angrier and redder!
The wind is very very bad for my nose skin.
I dont know what to do... please help...
Submitted: 6 months ago.
Category: Dermatology
Expert:  Dr. S. Attili replied 6 months ago.

Hello. I am Dr. Venkat Attili, Dermatologist and Dermatopathologist with over 10 years of experience in this field. I am here to assist you and will answer your questions to your complete satisfaction.
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Customer: replied 6 months ago.
ok... in attach
Expert:  Dr. S. Attili replied 6 months ago.

Thank you. Just to confirm- your main problem now is your rosacea (redness) rather than seborrhoeic dermatitis. Correct?

Customer: replied 6 months ago.
My main problem is the redness and my skin is very itchy, dry and very very sensitive... i only flake in my moustashe and eyebrow a little bit...
Expert:  Dr. S. Attili replied 6 months ago.

ok. Have you tried either of Brimonidine gel of Tacrolimus ointment?

Customer: replied 6 months ago.
sorry doctor i cant skype right now! i tried protopic but i think it burned my face... it was on fire de day after...the probelm sometimes is that i see the redness the day after and i stop the treament because i´m to afraid to continue! What do you think it looks like ? I can start again with anykind of treatment just guide me please.
Expert:  Dr. S. Attili replied 6 months ago.

Ok. Your history and picture is consistent with rosacea. The mild seborrhoeic dermatitis can be tackled later if needed, after your rosacea is under control. Since you have tried all other possible treatments for rosacea, I would suggest trying Brimonidine gel 3-4 times/ day. This is one of the newest treatments in the market and works quite well articularly for your type of rosacea. You can read all about it here: http://www.dermnetnz.org/treatments/brimonidine.html

The only problem is that I do not know if it is available in Portugal. Please try and let me know. Obviously it is still important to use a SpF30+ sunscreen and avoid exposing yourself to any potential triggers that might make you flush.

Expert:  Dr. S. Attili replied 6 months ago.

Hope this helps. Do keep me posted & get back if you have any further questions or feel that I have missed out anything. I will be here to provide ongoing advise as required. Best wishes.

Customer: replied 6 months ago.
what sunsreen do you recomend? Is there any one that can takle redness without affecting possible seb derm? do you think it can be early rinophyma?
Expert:  Dr. S. Attili replied 6 months ago.

Any sunscreen of SpF 30+ that is available at your chemists would do. Neutragena make good ones. Sunsense Sunsensitive is also a good brand (if available) Sunscreens would not affect seborrhoeic dermatitis. Do not worry.

Expert:  Dr. S. Attili replied 6 months ago.

This is not rhinophyma

Customer: replied 6 months ago.
Thank you ver much... I will try to find mirvaso... Just one last question; If i dont find mirvaso here in Portugal, what can i do ? do you recomend oracea? or something else? Thanks a lot and have a nice day...
Expert:  Dr. S. Attili replied 6 months ago.

If you do not find it, maybe you will need to find some friends in the USA or UK to post it out to you. Oracea is the same as minocycline. It would be worth giving it a try though, since you found minocycline somewhat helpful. Good day to you too. :)

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