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Treat Dermatitis first, then V beam reduces rosacea flares

Rosacea is only apparent on my left cheek and a...

Rosacea is only apparent on my left cheek and a tiny bit on my nose. Both appear to be caused by sun damage because I've had bad sunburns in those locations because I didn't reapply sunscreen enough.

I also slept on my left side for 7 years.  Once the rosacea started flaring up in 2010 due to stress, hot coffee and red wine, sleeping on that side made it worse.  So I now sleep on the other side and only drink iced coffee.

I've tried taking doxycycline (20mg twice a daily) and Metrogel and Finacea, and it controlled the acne portion of rosacea but the redness was always there and flares still happened too easily.  I'm hoping that V Beam will reduce the redness and the flares.

The treatment itself was a lot like lower power version of hair removal.  (Dr. R used 7.5 joules versus the 25+ joules for past Laser Hair Removal sessions.)  It's less painful than hair removal, and the strangest part is seeing green flashes with my eyes closed and the metal goggles on. 

A few hours after treatment, I look like I got in a fist fight.  I'll post an updated photo with the same camera as the before in a few days.

My whole cheek was swollen and bruised for 5 days....

My whole cheek was swollen and bruised for 5 days. After 1 week, the bruising is completely gone and my cheek no longer seems to flare. I feel normal again for the first time in a year. I still plan on going in for another treatment in a month to treat the remaining redness.

If you have persistent dandruff, one factor in...

If you have persistent dandruff, one factor in your rosacea is probably Seborrheic Dermatitis.  After the redness got worse after a rainy 4 day hike in Hawaii (perfect conditions for a fungus), I was researching dandruff treatments and learned people with Rosacea often also have Seborrheic Dermatitis, which is caused my a fungus.  I bought some Nizoral shampoo and some Lotramin Ultra cream, and those two have cleared up the persistent redness that remained even after 5 V Beam treatments.  So please, make certain you have your Dermatologist check for any signs of Seborrheic Dermatitis before you start V Beam.  V beam did fix the rosacea flare ups but not the persistent redness, since that was a rash.  I probably could have only had 3 V beam treatments if I had been treating the Seborrheic Dermatitis from the beginning.

Products I recommend for Seborrheic Dermatitis:

Nizoral 1% Ketoconazole shampoo (use daily for 2 weeks, then once per week)

Neutrogenia T/Sal - 3% Salicylic acid shampoo (alternate with Nizoral)

Lotramin Ultra - use on worst areas of redness


Seattle Dermatologic Surgeon

Dr. R is an expert Dermatologist with just the right amount of humor to make having your face lasered a less stressful experience.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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Do NOT go and see Kelly the PA at Jennifer Reichel's office for a Vbeam. I am a very experienced vbeamer and she used the wrong settings (way too strong) and it's been two weeks and my skin still looks red and burned. Absolutely horrible experience. I've been to many of the best rosacea doctors and this was by far the worst treatment I have ever received.
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Nizoral is in my Amazon cart now! I have had SebDer since I was a kid. It is so embarrassing, but just one Rx practically cured it. I'll try the Niz on my face for a while. How long did it take you to see results with the Niz?
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It would be better to get an Rx for Ketoconazole cream (2%) since the shampoo has some foaming agents that can irritate sensitive skin. In retrospect, the redness on my face was exacerbated by a face cleanser that was marketed for people with sensitive skin (SebaMed) but has Sodium Laureth Sulfate as its primary ingredient. After rereading "Skin Type Solutions" by Leslie Baumann MD, I follow her advice to avoid using any shampoo on my face (it's too irritating for reactive skin) and use only La Roche Posay Toleraine Dermo-Cleanser.
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Thank you, Eric. Nizoral is out of my cart now! I have used the Rx strength in the past, so I might ask for another Rx the next time I visit my derm. I actually tried VBeam out last year and initially, the redness around my nose (where I had the procedure performed) disappeared like magic. But it came back and it about the same as it was before. Do you feel that the multiple treatments with vbeam were worth it in the long run? Also, many people state that the excess heat from lasers is absorbed by the surrounding skin and causes fat atrophy because it destroys the cellular structure. What are your thoughts on that, if you have any? I certainly dont want to trade one issue for another.
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A decent over-the-counter anti-fungal cream is Lotramin Ultra (Butenafine Hydrochloride). My rosacea outbreaks started after I switched to only using natural skin care products made from food grade oils. I've always had minor dandruff and spots of tinea versicolor on my legs (which I just thought were ezcema), and I think using so much food oil-based lotions on my face allowed the Malassezia yeast (formerly called Pityrosprum ovale) to grow rapidly because it feeds off any oil with 11+ carbon atoms. See the 1968 "Study of the Fatty Acid Metabolism of the Yeast Pityrosporum ovale" by Peter F. Wilde and Patrick S. Stewart. The only oils used in skin care products with 10 or fewer carbon atoms are Medium-chain triglycerides: caprylic acid (c8) and capric acid (c10). CeraVe products have caprylic/capric triglycerides as the 3rd ingredient after water and glycerin. You can buy MCT oil at Whole Foods, but note that it should be kept refrigerated so it doesn't go rancid. I'm going to buy some and throw out all moisturizers with any other oils in them. Most doctors who offer V Beam have a discounted rate after 4 or so treatments. The challenge for people who have surface blood vessels is that they tend to come back easily, so a maintenance treatment every year or so is probably inevitable. Since a laser is a single wavelength of light that targets redness, it should be much more selective than a broad spectrum light beam like IPL. So I doubt that it would cause fat loss. I've had a lot of V Beam treatments (6 over 3 years) and I haven't noticed any fat loss on my cheeks.
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Thanks for the reply, Eric. I currently use CeraVe products and I am just crazy about their facial moisturizer. Thanks for your thoughts on the V beam. It is hard to get a straight answer when you are researching this stuff. What you said about annual maintenance sounds about right. Thanks, Eric. Rock on! \m/
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Wow- I have mild persistent rosacea and persistent dandruff (nothing has worked)- thanks so much for your post. I've had Vbeam with so-so results. My skin looks similar to yours. I'm going to try your dandruff remedies. Thanks!
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How did the dandruff remedies work for you, Nessie76?
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Pardon my spelling errors! Yikes :)
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Hey Eric K, I just wanted to thank you for your insighet about Sep. Derm and rosacea. So helpful...THANK YOU!!!
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Thanks for the post, Eric.
In fact I scheduled an appt for vbeam with the same doctor. :)

How many total treatments have you received so far? And does the rosacea come back at all?
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hey again eric,
i just wanted to share with you that after some experimentation i've found that coffee ( i most always drink iced ) is a huge contributor to my rosacea.. i don't know whether its the caffeine or what but i'm much better on days when i don't have any. i miss the energy but my face certainly feels better for it.. have you had a similar reaction? hope all is well.

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Yes!  My rosacea first appeared when I was drinking a lot of coffee and under a lot of stress when we switched the software that runs RealSelf.com from Drupal to the Yii PHP framework.  That was when I first noticed a burning feeling on my cheek and started having acne there.

I've found that matcha green tea doesn't produce the same reaction, even when I have it warm as a green tea latte at Starbucks.  (I do wait for a green tea lattee to cool, and typical make matcha green tea with lukewarm tap water.)  Matcha green tea is powdered tea leaves, so it has more caffeine than typical bags of green tea, yet only 25% as much caffeine as coffee. And there's another chemical, L-Theanine, that has a calming influence.  Green tea also tends to cause the body to prune excess blood vessels, although it's not as strong an effect as garlic or barries.  Watch this TED talk about foods that moderate blood vessel creation for more info.

Read my story about switching from coffee to matcha green tea and let me know if matcha gives you the energy to get through winter days while helping your face.

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Eric, after making the switch to Matcha tea I've found my skin to be of more favorable condition with all the flareups I've managed to avoid! Thanks a bunch! How are your results after the third V-Beam? I am having mine done in a few weeks- I will post a thorough review for the community. Wish me luck!:)
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Loved the video on anti-androgenesis!
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Yes, it has improved the texture -- my cheek is now smooth where it was bumpy.  I'm also using Finacea, and that really helps exfoliate the skin.  I previously used a salicylic acid toner that had an alcohol base, but that was too drying once I hit 30.  Even with Finacea, I have to first apply a moisturizer, then apply a tiny bit of Finacea, then apply more moisturizer to avoid irritating my skin.  I found that out the hard way when I applied Finacea undiluted and had acid burns. 

Also, I had to stop using Metrocream after the last V Beam treatment as it stung when I applied it.  If I'm diligent about using Finacea, it should keep my pores clear so I won't need the Metrocream.

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I am so glad you have seen improvement with your flushing! Has it improved your texture as well? A couple of doctors on here say it improves texture by stimulating collagen. Also have you looked into the laser genesis? Best wishes!!
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Great!  I've been using La Roche Posay Toleraine as a moisturizer and Vanicream Sunscreen daily my skin is really clearing up.  Toleraine really seems to help with the redness that can develop overnight if I sleep on that cheek.

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how are your results holding up?
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I am trying to reduce the amount of sugar in my diet so I only eat whole carbs. 

I'll probably have one more treatment in the fall since I had the last treatment right before a really stressful period at work.  I should have postponed the treatment until after that...

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also, in regard to the acne part, i've found that the best thing to do was eat a healthy diet full of vegetables and fruits. avoiding carbs made me acne clear in less than a week, it has worked for others as well. perhaps you should try if you haven't already? carbs are hard to avoid, and when i do eat them i will usually get a zit or two!
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i've tried finacea, but i only struggle with the redness and not the acne component of rosacea. i don't think there is currently anything topical that can address rosacea redness- sadly. your skin does look quite good, will you be having another appointment or are you satisfied at this point? thank you for the photos eric.
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Yes, the painful flares are gone and using Azelaic acid cream (Finacea) has helped keep my skin clear.  I previously used Salicyclic Acid on my cheeks but the alcohol base became too irritating when my roscea started a year ago.  I read that Finacea helps with the superficial redness and acne and that has been my experience.  Just make certain to mix it with a moisturizer because the 15% strength is too much by itself even in the cream version.

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hi eric. are things still good? i have an appointment next week... quite nervous!
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that's wonderful, very good to hear! so the downtime wasn't as bad the second time around? thanks again for providing pics+info, kind regards!
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