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Steroid induced rosacea.

86 posts in this topic

SeattleJT: Thank you for adding to this thread. I did not have the experience of post-Accutane flushing and Hate&Love was asking for my support when I really have no experience in that side of it.

ComplexIssues: Thank you for the compliment. I take it this means you have forgiven me for doing the same to you? I want you to read what Wistar says in this thread. Is that what you are experiencing?

http://www.acne.org/messageboard/Mites-Rosacea-t237610.html

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Hi again everyone; once again I want to apologize for the really depressing mellow-dramatic post. I'm feeling better today; not 100% but much better. My skin seems less red, but we'll see what the rest of the day brings. Thank you everyone for the input btw.

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MrsZ- did you notice more redness upon starting your course or no??

I remember my skin got really hot and red at times during the first month of Accutane, like it was on fire. My skin would spaz out sporadically during the first 2-3 months. I had one last horrible steriod induced rosacea flare about 2 1/2 to 3 months into my course. My skin was on fire and I looked like I had the measles. Of course this had to happen during a meeting that included the CFO and CIO of the company I was working for at the time.

Also, after I stopped Accutane - my skin would get really red when I applied moisturizer. It was also incredibly dry, and still is and that comes with its own problems. But, all my life my skin was an oil slick - like you described. Oily skin can get really bad when a woman is in her 30's, it doesn't really stop till a woman is in her 40's. So, the Accutane should help in that regard.

You should thoroughly read the Accutane logs on this message board. Accutane will do weird things to your body and skin and it is comforting to know you are not alone and not imagining it.

I hope that helps.

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Hate&Love,

An increase in redness while on accutane is actually pretty common. Most people have this go away during treatment or shortly after, but there is the possibility that it could stay much longer.

If you feel that you have exhausted other possible solutions then I can understand going on accutane because it has the best chance to deal with both the steroid induced rosacea and acne. I would advise you to be careful about your dose though because the higher doses are usually where people begin to get side effects. 40mg could very well be fine (I wouldn't go higher), but if you started to develop any problems I wouldn't be afraid to go down to 20mg.

I am really not trying to be negative about accutane, but the problem with it is that everyone goes into it thinking that it is some miracle drug and nobody really understands the potential side effects. I do not have a problem with anyone taking accutane after thoroughly understanding the potential side effects which may not go away even after you stop the drug as well as understanding that accutane may not cure your acne. I guess what I am trying to say is that taking accutane should be an informed decision and I believe most people go into it very naive (myself included). I was completely blindsided by what happened to me and I truly would not wish that experience upon anyone else.

In regards to what MrsZ said you should go into accutane with the understanding that your body will be different once you are done. As she said the dry skin is different than what you are used to and the more you understand that your body will be different the less of a shock it will be once you are finished with your course.

I hope this works out well for you.

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MrsZ- Thankyou so much for the reply, during your course the first month was it constant redness or just when you would flush?? I don't think I realized the effect this would have rosacea wise; it wouldn't be such an issue normally, but I was hoping to start College this fall and also have some sort of life this summer so the additional redness, I don't know that I can deal with this. I honestly have no idea how you were able to take such a high dose!? Also, post-accutane when did your skin return to a normal skin tone even w/ moisturizer??

TJ- I really appreciate your comment; I did go into this understanding the side effects but I think the one thing I under-estimated is my own body and it's reaction. I'm realizing that 40 mgs is likely too much for me; I knew this upon instinct but just wanted a shorter course and also my Derm made it seem like the idea of low dose for myself would not be as good. He is one of those "really high dose, kill the acne as soon as possible" type derms and for me I can now see that style is really not going to work, so I'm going to have to call him Monday. I would much rather have a longer course then walk around with my face looking like a tomato 24/7, I do know that some redness is a normal side effect but I didn't know that it would come so soon and be this red, so again this is a sign to me that I will be lowering it and likely extending my course into the 10-11 month range. For now I'm waiting until Tuesday to take my next pill, as I've already taken 3 pills which makes 120 mgs or 6 days of 20mgs, so when Tuesday arrives I'll take a 40 mg every other day until I can get my correct script in a month.

Idk though; maybe I'm making a mistake by lowering my dose when this could be just a temporary effect and the redness will fade within the next month or so?? Ugh, I really wish this didn't have to be so damn stressful and confusing!! I read most of the logs MrsZ but the problem is none of them have steroid induced rosacea so I don't really know what to expect in that aspect, nor if things will improve redness wise and when?? I have nothing to go off of for the most part and that just really makes this all the more mind boggling.

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Honestly, I do not remember the specifics of my Accutane side effects. I just know that from the point I used steriod creams to a year after Accutane my skin was unpredictable. One thing I can say is that if you cannot tolerate topicals now, I would avoid them post-Accutane, especially since you may be predisposed to rosacea. I stupidly took my derms advice to use topicals to maintain my clear skin. My instincts told me not to. I suffered a lot because of that and it wasn't necessary.

How your skin behaves on Accutane during treatment is not always an indication of how it will behave permanently. Even at the 6th month of treatment and at 120mg dosage - my skin was NOT dry and flakey and my dermatologist was baffled. However, now my skin is very dry.

The cumulative dosage of Accutane is the important key to remission. You can reach that cumulative dosage slowly with a low dose or quickly with a high dose. That my dear is up to you and don't be afraid to confront your derm with your concerns. You need to listen to your instincts.

SeattleJT and I are on the extreme opposite ends of the Accutane experience spectrum and this is naturally going to confuse you. No one can predict how your body will handle Accutane and if it will clear your skin at all. I was willing to suffer through Accutane treatment because I had exhausted all the other treatment options, I felt ugly, depressed and my skin problems became the single focus point of my life and the barometer of my emotional state. It was a nightmare. I was willing to end that nightmare at all costs.

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Honestly, I do not remember the specifics of my Accutane side effects. I just know that from the point I used steriod creams to a year after Accutane my skin was unpredictable. One thing I can say is that if you cannot tolerate topicals now, I would avoid them post-Accutane, especially since you may be predisposed to rosacea. I stupidly took my derms advice to use topicals to maintain my clear skin. My instincts told me not to. I suffered a lot because of that and it wasn't necessary.

How your skin behaves on Accutane during treatment is not always an indication of how it will behave permanently. Even at the 6th month of treatment and at 120mg dosage - my skin was NOT dry and flakey and my dermatologist was baffled. However, now my skin is very dry.

The cumulative dosage of Accutane is the important key to remission. You can reach that cumulative dosage slowly with a low dose or quickly with a high dose. That my dear is up to you and don't be afraid to confront your derm with your concerns. You need to listen to your instincts.

SeattleJT and I are on the extreme opposite ends of the Accutane experience spectrum and this is naturally going to confuse you. No one can predict how your body will handle Accutane and if it will clear your skin at all. I was willing to suffer through Accutane treatment because I had exhausted all the other treatment options, I felt ugly, depressed and my skin problems became the single focus point of my life and the barometer of my emotional state. It was a nightmare. I was willing to end that nightmare at all costs.

Hate&Love,

I wholeheartedly agree with MrsZ's 2nd paragraph.

In regards to topicals I agree with MrsZ as well. I can only speak from my own experience, but I have found that my skin responds very well to klaron (sodium sulfacetamide) post accutane. I had been on it before my accutane course, but it basically had no effect on my oily skin. With the combination of flushing and dry skin post accutane I have found that most topicals seem to only make things worse so you really want to be careful in that regard. I actually have been surprised with how effective the klaron has been at treating my acne. I do not know if it will work for you post accutane, but as far as topicals go it is very mild and doesn't increase my dryness so if you needed some sort of maintenance it would be my recommendation. Once again though I have no experience with steroid induced rosacea so I don't know if klaron will make that worse. MrsZ, have you tried klaron?

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I have had great success with something similar to Klaron - it is called Plexion. This is Sodium Sulfacetamide 10% and Sulfar 5% and I use it in the form of cleansing cloths after I work out. It is the only prescription "topical" I will use now. Sulfar is great for both acne and rosacea. It is anti-inflammatory and anti-bacterial and it is supposed to kill demodex mites (these are found in high amounts on those with rosacea). It does not however have the harsh exfoliating action found in BP, AHA, BHA and retinoids.

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Thank You both once again for offering your advice and opinions. In regards to my treatment, I think you are very right MrsZ, I'm going to go with my instinct, I knew anything more than 20 mgs would be too high but I just wanted to "get this over with" because just as you said I feel extremely ugly, and my emotional barometer is also in regards to the condition of my skin. Right now I'm looking just as I was pre-intervention, worse than the picture I posted. I'd been able to get things somewhat under control lately, but all of this is from extreme measures. I.e avoiding any and all triggers, extremely anti-inflammatory diet, keeping the house very cool, etc. So then when I show up at my derm office and my skin is not as red as normal suddenly he seems to forget I even have rosacea or something and starts talking about all this 60 mgs etc. Um, hello?? Right now my skin is dark pink, so I'm not happy to say the least as my state of mind is dependent on the condition of my skin. I know my Dermatologist is a Dr. and while I do think he knows what he's doing, I know my body far better than he ever will, so I can tell you right now that this 40 mgs is way way too much, I look like I've been our baking in the sun for a few days straight with no sunscreen, which I avoid the sun at all costs, sunscreen or not, as its a MAJOR trigger and makes me extremely red, so that certainly isn't the case. While yes I want this gone I cannot suffer through my course like this. I'm going to start taking my 40mgs every other day or every 2 days in order to get 13 mgs a day, I think this would be a more appropriate starting place and was what I felt would be best originally, 10 mgs a day. So, I will likely implement that for now and then possibly go up to 20 mgs next month, either that or remain at 10 mgs depending how things go. My course will be longer yes, but I cannot suffer like this for the months to come. I've been feeling bad enough already, extremely ugly, unhuman most of the time, and that's without this additional redness, so right now, I'm not feeling too good to say the least. Once my course comes to an end I really don't think I'll be using any kind of topicals, thankyou for the warning MrsZ, but when the time comes though for maintnence I'll look into the Klaron especially if its proven to be non-irritating or drying for both of you. Well, sorry for this being so long as always. Oh, and I want to again thank you both from the bottom of my heart, in a time and situation like this it's easy to feel completely alone so I really cannot tell you how much it's helped having the support.

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ComplexIssues: Thank you for the compliment. I take it this means you have forgiven me for doing the same to you? I want you to read what Wistar says in this thread. Is that what you are experiencing?

http://www.acne.org/messageboard/Mites-Rosacea-t237610.html

Mrs. Z, yes I didn't take your comments too harshly, as I have thick skin, pun intended.

Given the history of my bizarre skin, I don't blame you for thinking it's mental.

The update is: It's been about a week and a half of me stopping any application of any

topicals like moisturizers, etc..and the good news is that the redness is about 80% gone.

The bad news is that the skin still feels a bit like sandpaper...With that said, I think

the skin looks more healthy and less atrophied...I'm going to see if the dry rough texture

goes away in time...but the fact the redness has really lessened is encouraging news.

I checked out the link. I don't think the symptoms match up, but if my condition deteriorates, I may need to get another skin sample test.


Personal Regimen:

Morning and Night:

- Purpose Gentle Cleanser,

- followed by Neutrogena Moisturizer for Sensitive Skin.

Every other day:

- Shampoo/cleanse face with Ketoconazole shampoo, 2%

- followed by Neutrogena Moisturizer for Sensitive Skin.

Supplements:

- Multi Vitamin 1-2 times daily.

- Up to 6 capsules of Flaxseed Oil/Fish Oil daily.

- Probiotic capsules, usually once a day.


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ComplexIssues - I am very happy to hear that the redness is going away.

I want to clarify something though.

Yes, I did indeed suggest that your skin problems might be "in your head". However, I was also trying to say that it is best to stay with one derm. When you stay with one derm you build a treatment history with them, they learn what works for your skin and what doesn't. Unfortunately, this is through trial and error and the process of elimination. That is often how it works in dermatology. Doing it this way should eventually lead to a proper understanding of the condition you are suffering from.

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Mrs. Z,

Fortunately, I am not mental and for the last 3 months I did stay with one derm, in which I saw her 3-4 times before she pawned me off to an associate. Their conclusion was I just have eczema, here are some creams, and good luck. Not satisfied, I then went to see another doctor who made the most recent diagnosis that it wasn't eczema and prescribed Epiduo a differin/bp combo.


Personal Regimen:

Morning and Night:

- Purpose Gentle Cleanser,

- followed by Neutrogena Moisturizer for Sensitive Skin.

Every other day:

- Shampoo/cleanse face with Ketoconazole shampoo, 2%

- followed by Neutrogena Moisturizer for Sensitive Skin.

Supplements:

- Multi Vitamin 1-2 times daily.

- Up to 6 capsules of Flaxseed Oil/Fish Oil daily.

- Probiotic capsules, usually once a day.


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Mrs. Z,

does alcohol consumption affect mites on the skin?


Personal Regimen:

Morning and Night:

- Purpose Gentle Cleanser,

- followed by Neutrogena Moisturizer for Sensitive Skin.

Every other day:

- Shampoo/cleanse face with Ketoconazole shampoo, 2%

- followed by Neutrogena Moisturizer for Sensitive Skin.

Supplements:

- Multi Vitamin 1-2 times daily.

- Up to 6 capsules of Flaxseed Oil/Fish Oil daily.

- Probiotic capsules, usually once a day.


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Mrs. Z,

does alcohol consumption affect mites on the skin?

No, not that I am aware of.

But, alcohol can cause flushing, flares and inflammation that leads to breakouts. Although in my experience, the breakouts are only temporary.

When I had steriod induced rosacea - they took a biopsy of my skin and there was a huge population of them found in my skin graph. I had a biopsy done when I was in the middle of a horrible flare up. I am not sure if it was the steriod induced rosacea that caused the demodex to overpopulate or the Elidel which the derm had given me right before I had the horrible flare. Elidel is a topical that is prescribed for eczema. It is great at reducing redness. It suppresses the auto-immune system. My theory is that if your auto-immune system is suppressed it is very easy for the mites to populate on your skin. That is just my own theory - but I have tried Elidel three times and I always ended up with screwed up skin.

Nobody knows for sure what the demodex mites role is in skin inflammation, acne and rosacea - but I do believe they play a role and cause problems and as I mentioned, they found them on my skin in a biopsy.

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Mrs. Z,

I read an article about demodex mites....And it said something about these over populated infestations occurring mainly in women and it's due to lack of cleansing and over use of products on the skin such as moisturizer -- it feeds off that. So when you put on Elidel, that makes sense why it would get worse...I'm starting to think I might have this condition because that would explain why my face would get red after putting on any moisturizer and how it would never seem to really get better...Now that I've stopped any topical application, the skin tone is nearly back to normal. The only problem is that the skin still feels dry and has sandpaper texture...I'm on my third week of getting off all moisturizing creams so I hope at some point my skin will return to its natural texture..Next time I see my derm im going to request a skin biopsy.


Personal Regimen:

Morning and Night:

- Purpose Gentle Cleanser,

- followed by Neutrogena Moisturizer for Sensitive Skin.

Every other day:

- Shampoo/cleanse face with Ketoconazole shampoo, 2%

- followed by Neutrogena Moisturizer for Sensitive Skin.

Supplements:

- Multi Vitamin 1-2 times daily.

- Up to 6 capsules of Flaxseed Oil/Fish Oil daily.

- Probiotic capsules, usually once a day.


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Hello Complex Issues!

Demodex mites are also found in steriod induced rosacea. It would make sense that all those steriod creams you were prescribed led to an overpopulation of them. Also, the rash and bumps they cause tend to reoccur in the same place each time, which explains your left cheek.

Please let me know what the skin biopsy shows.

I hope you finally find the answer to your skin issues.

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MrsZ, it has been almost 2 weeks sense my last accutane pill, sense then the extreme redness has reduced but I still look much redder than I was looking pre-accutane consumption.

I've been giving this alot of thought recently and I'm becoming fearful that perhaps as I've been dealing with this for almost 11 months now that its become permanent and my skin is permanently damaged and will never look normal again. What is your perspective on this?

At the moment I don't know that I can handle accutane, aside from maybe the 10 mgs but do you really think that will make this go away?? I just want it to go away, have a normal skin tone again, at this point I've gladly accepted the acne in itself, it's just all this redness and flushing. I guess you really don't appreciate what you have until it's gone as they say!

I've also been thinking maybe I should start on spirolactane and doxycycline again but the thing is I don't quite understand the effects antibiotics has on steroid induced rosacea, does it clear it totally or just make it look not as present yet it's still there? I just really don't understand how one goes about actually making this whole process stop as it seems to be never-ending not to mention hopeless.

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MrsZ, it has been almost 2 weeks sense my last accutane pill, sense then the extreme redness has reduced but I still look much redder than I was looking pre-accutane consumption.

Are you saying that you stopped the Accutane treatment all together?

I have always endorsed high dose Doxyclycline (100mg, 150mg, 200mg) as a treatment for steriod induced rosacea and rosacea. It is effective, it reduces redness, pimples it does not induce flushing and when you are done all you need to do is continue on a topical antibiotic.

Accutane takes a long time to work, it will get worse before it gets better. It takes a good 2 months to a year for your skin to adjust to the changes if you have been on a moderate to high dose.

But, I have already explained this multiple times in this and other threads. And all of that information can be found restated throughout this forum.

If you want your skin to get better again you are going to have to commit to a treatment program of some sort and you are going to have to give it time to work. Whether it is high dose doxyclycline or Accutane, which are the standard treatments. It seems to me that your derm is advocating 60mg of Accutane so that it knocks out your problem quickly and has a good chance of permanently eradicating the acne. But, if you are afraid of Accutane because of the negative effects it has had on people on this forum - that is your choice. I refuse to get in the middle of that debate AGAIN. There is nothing I can say to eliminate your fear and indecision that I haven't already said before.

I know your doctor said that antibiotics do not eliminate the redness - but it is a common treatment for rosacea because it is anti-inflammatory and kills the bacteria. At the bottom of this page I am placing a link that contains a video that explains this.

http://rosacea-support.org/how-collagenex-...ing-oracea.html

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Can any pharmacy make sodium sulfacetamide 10%/sulfar 5% cleansing clothes

like they compound it right?

do you just ask your doctor for this is clothe form?

Theres no brand name behind it right

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Can any pharmacy make sodium sulfacetamide 10%/sulfar 5% cleansing clothes

like they compound it right?

do you just ask your doctor for this is clothe form?

Theres no brand name behind it right

Exactly, that is the compound.

The brand name of the cleansing cloths I use is Plexion.

Sulfacetamide 10%/Sulfar 5% is also marketed in the US as a cleanserunder the names Rosanil Cleanser and Rosula Aqueous Cleanser. It comes in lotion and gel forms under the brand names Avar, Nicosyn, Nocacet, Plexion SCT cream and Sulfacet-R.

Honestly this stuff is great and is the only acne/rosacea product I can tolerate. In my opinion if you have flare up - wash your skin with the cloth and then finish off with cold water - it can help calm the inflammation and reduce the acne that may result. Obviously YMMV. If you are allergic to sytemic sulfa antibiotics it can cause problems (i.e. Bactrim).

It calms red skin - not immediately, but over time - and kills bacteria. It is helps combatting demodex mites and after using it for awhile it will stop the itching associated with them.

On another topic I read one of your posts in the Post Accutane thread about and I wanted to comment. You mentioned that you were considering going to a moisturizer only regimen. If you think you have demodex mites, that is a bad idea as it will encourage them. If your skin just cannot tolerate topicals, which I totally understand - then yes that would be something to try if you don't have mites.

Good luck. It is a total ongong battle to find the right products for our skin, especially post-Accutane.

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Mrs. Z,

I read an article about demodex mites....And it said something about these over populated infestations occurring mainly in women and it's due to lack of cleansing and over use of products on the skin such as moisturizer -- it feeds off that. So when you put on Elidel, that makes sense why it would get worse...I'm starting to think I might have this condition because that would explain why my face would get red after putting on any moisturizer and how it would never seem to really get better...Now that I've stopped any topical application, the skin tone is nearly back to normal. The only problem is that the skin still feels dry and has sandpaper texture...I'm on my third week of getting off all moisturizing creams so I hope at some point my skin will return to its natural texture..Next time I see my derm im going to request a skin biopsy.

Are you talking about the following article?

http://dermatology.cdlib.org/134/case_pres...emodex/lee.html

If so, what the author actually said was that demodex mites can lead to different three types of skin problems, "Demodicidosis has been classified into pityriasis folliculitis, rosacea-like demodicidosis and granulomatous rosacea-like demodiciosis gravis."

"Pityriasis folliculorum primarily affects women and manifests a diffuse, faint facial erythema with itching and burning sensations as well as fine follicular plugs and scales imparting a nutmeg-grater, sandpaper-like or frosted appearance. A history of infrequent washing and application of heavy creams and make-up helps to confirm the diagnosis. Rosacea-like demodicidosis manifests erythema, scaling, and papulopustules mimicking common rosacea. However, the scaling in demodicidosis is follicular and the lesions are superficial with small papulovesicles or vesiculopustules. In demodicidosis gravis, the clinical features are similar to granulomatous rosacea with dermal granulomas containing mite remnants phagocytized by foreign-body giant cells and showing central necrosis."

The author also made a very important point about mites and rosacea: "Demodex mites are more frequently found in rosacea (51%) compared to 28 percent in eczema and 31 percent in discoid lupus erythematosus [13]. Differentiation from rosacea may be difficult when high densities of Demodex mites are present [12, 14]. However, the differential diagnosis will not pose a problem if Demodex mites could be detected in the perifollicular infiltrate, as illustrated in the present case. Hoekzema et al. reported a case of fulminant rosacea-like eruption and reviewed 22 other reported cases of rosacea-like demodicidosis [15]. Intradermal mites have been documented in 15 out of these 23 cases."

When I had a skin biopsy performed that led to a diagnosis of steriod induced rosacea - the biopsy stated there were demodex mites in the perifollicular infiltrate. In hindsight I know I had steriod induced rosacea AND demodex mites. Whether they are all a part of rosacea - I don't know, but they do require different treatments. Accutane probably helped with the mites as it stopped to sebum production. And the month before I went on Accutane I used the topical Metrogel which is metronidazole. I am also starting to believe that Elidel, which I have been given three times and led to horrible rosacea like flares - gave me problems with demodex mites. Elidel as I have previously mentioned, suppresses the auto-immune system and it is believed that demodex mites which naturally live on human skin are kept in check by our auto-immune systems.

It is important to note that this article is a small one, and cites what is only a very small amount of very small studies and articles on the subject. It should not be taken as medical fact. However, as you can see the problems I had with rosacea and the my biopsy supports what this article states.

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Mrs. Z,

Interesting information. A few questions if you don't mind:

1.) Did your skin have this itchy tingling sensation from time to time?

2.) Did your skin have some bumps and red dots here and there?

3.) Are there any signs of flakiness?

The last few days here have been hot and humid, and I noticed my skin seems to be a little

more red but I'm not sure if there's a connection...

I've been on doxy going into my 5th month...and it's been about 3 weeks of me not putting any moisturizers on my skin. It's made good progress, but my derm told me to use Epiduo (differin/bp combo topical), which I haven't yet cause I wanted to test out my skin to see if it would heal on its on. If I go back to him and ask for a skin biopsy to look for mites, it's going to seem like I'm just out of my damn mind! But I wonder, would a retinoid like the differin found in epiduo be effective in treating mites? I still don't know exacty what I have, but if it is mites, won't continued use on doxy, and good washing habits cure the situation?


Personal Regimen:

Morning and Night:

- Purpose Gentle Cleanser,

- followed by Neutrogena Moisturizer for Sensitive Skin.

Every other day:

- Shampoo/cleanse face with Ketoconazole shampoo, 2%

- followed by Neutrogena Moisturizer for Sensitive Skin.

Supplements:

- Multi Vitamin 1-2 times daily.

- Up to 6 capsules of Flaxseed Oil/Fish Oil daily.

- Probiotic capsules, usually once a day.


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Mrs. Z, can you enable the PM function, I'd like to send you a message.


Personal Regimen:

Morning and Night:

- Purpose Gentle Cleanser,

- followed by Neutrogena Moisturizer for Sensitive Skin.

Every other day:

- Shampoo/cleanse face with Ketoconazole shampoo, 2%

- followed by Neutrogena Moisturizer for Sensitive Skin.

Supplements:

- Multi Vitamin 1-2 times daily.

- Up to 6 capsules of Flaxseed Oil/Fish Oil daily.

- Probiotic capsules, usually once a day.


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Sorry, I do not want to turn my PM function on.

If you have a question, please post it to the board so that everyone can participate and benefit from the exchange of information.

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