Skin & Allergy News Article

[Guest guest]

Here's an article I saw on Skin and Allergy News - May 2001.

Take care,

Matija

cea and Other Red Faces: Tips for Diagnosis and Treatment

Norra Macready

Los Angeles Bureau

MAUI, HAWAII — When determining the cause of a patient's red face,

always to consider the most obvious culprit first.

By itself, rosacea is one of the most common causes of a red face,

but it may coexist with other dermatoses, such as Demodex

infestation, seborrheic dermatitis, or steroid-dependent dermatitis,

Dr. Junkins-Hopkins said at the annual Hawaii dermatology

seminar sponsored by the Skin Disease Education Foundation.

cea may occur in darker skin and sometimes appears in areas other

than the face. It has also been reported with high-dose vitamin B12

therapy and can signal systemic disorders associated with flushing,

such as carcinoids or mastocytosis, said Dr. Junkins-Hopkins of the

University of Pennsylvania in Philadelphia.

Pursue treatment of rosacea in a stepwise fashion, starting with

therapy that has the fewest complications or least cost. Low-dose

isotretinoin may be helpful in difficult-to-treat cases.

Sulfacetamide or other sulfur preparations may also be helpful, she

said.

Sometimes the very products intended to treat rosacea may exacerbate

it, said Dr. S. Manjula Jegasothy of the Miami Skin Institute. Since

rosacea is associated with sensitive skin and contact dermatitis,

patients could be predisposed to react to ingredients found in skin

care products: preservatives such as formaldehyde, paraben, or benzyl

alcohol; or vehicles, including lanolin, polyethylene glycol, or

propylene glycol.

When diagnosing stubborn contact dermatitis, go beyond the standard

patch test and consider testing for allergic reaction to steroids,

sesquiterpene, sunscreens, personal toiletry items, and even

household plants, Dr. Junkins-Hopkins said. In certain populations,

test for latex allergy and dust mites too.

A good history is especially important when a patient comes in

complaining of a rash that comes back when he or she stops using

topical steroids. That is the tip-off that the patient could have

dermatitis induced by steroid use or abuse. Even low-dose

hydrocortisone in over-the-counter ointments or facial creams may be

the source of the problem.

Dr. Junkins-Hopkins advised weaning the patient off the steroid,

calming flare-ups with tetracycline, and treating the initial

condition appropriately once weaning is complete.

Demodex mites, found in almost all adult humans, may cause bright

erythema, often with well-defined edges, and follicular spines or

pustules.

A biopsy or scraping may be helpful, especially in people with

rosacea. The prevalence of Demodex organisms is higher in pus samples

from rosacea patients. Documenting their presence can help guide a

more directed, antimite-related therapy. Treatment may be with

sulfur, sulfacetamide, or metronidazole.

Dr. Junkins-Hopkins also advised doctors to consider prescribing

topical permethrin, 10% crotamiton, 10% benzyl benzoate, or oral

ivermectin for Demodex infestation.

When it comes to flushing, there are two types, Dr. Junkins-Hopkins

said. The autonomic nervous system mediates the " wet flush, " which is

associated with heat; menopause; drugs such as nicotinic acid,

calcium channel blockers, and quinidine; epilepsy; and emotional

arousal, she said.

The " dry flush " is a direct result of vasodilation related to

disorders such as cluster headaches, certain types of migraines,

Parkinson's disease, or diabetes. It may also be a side effect of

vasodilating agents taken for cardiovascular disease.

Dr. Junkins-Hopkins also advised clinicians about " weekend flushing, "

caused by abrupt caffeine withdrawal. If flushing is severe, she

warned her listeners to rule out carcinoid syndrome and mastocytosis,

especially if the patient has a history of wheezing, diarrhea, or

hypotension.

Analysis of the plasma or urine for histamine or its metabolites in

cases of suspected mastocytosis is often not helpful, Dr. Junkins-

Hopkins said. Assessment of serum tryptase, a bone scan, or bone

marrow evaluation could yield more useful information.

[Guest guest]

Matija,

Thanks for sharing the article!

This kind of thing sometimes makes me mad, however.

Information distributed to doctors never suggests

asking the patient diet or lifestyle questions, or

anything similar. All of the suggested treatments are

drugs.

We had an old family friend who was a physician in our

community for many years (now deceased). I can

remember what he said about the eventual demise of

" house calls " .

He said he could learn more about a patient in one

home visit that he could ever learn in 20 office

visits.

In one home visit he could potentially learn about his

patient's socio-economic background, the cleanliness

of his/her environment, family relationships, life

stressors, religion, diet, smoking and drinking

habits, and exposure to household allergens and toxins

(for example cats, or lead-based paint), all of which

could affect health.

He considered all of those factors crucial, but

doctors rarely do anymore. Insurance companies and

time/money factors (and their education) won't allow

it.

Refuse to be just a " slab of skin " to your doctor!

Make him/her discuss the details!

(I'm really on a soapbox now!)

Suzi

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