As I thought, he was concerned about my taking spiro for my acne. I showed him the pictures I took before I started taking spiro and he asked why it was prescribed to me. I told him I asked for the rx because my acne was getting worse and I'm in perimenopause. He examined my face and told me that I have rosacea (yes, I know this) and my acne has been caused by my rosacea being aggravated. He went on about spicy foods, coffee, alcohol, the weather, stress affecting rosacea. Perimenopause didn't seem to be a big thing with him. Yeesh!
He wrote a rx for a topical compound to help with the redness and also prescribed an antibiotic called Apprilon. This is the Canadian name for the antibiotic Oracea in the US and apparently people have had some positive results from this.
He gave me a low dose to take once a day. He did say to finish off my spiro (I have another week's supply) and the topical treatment and antibiotic should work. He also said that if I can control my acne within the 80% range, then he'd rather see me go this route instead of taking spiro continuously.
If this doesn't work, then I can get a rx for spiro renewed with my gp and to adjust the dose to a lower amount. He's obviously not a fan of taking oral drugs for skin conditions, at least not with spiro (and with good reason) and I'm glad he's not a pill pusher. He wrote the rx for the antiobiotic when I expressed concern about the acne coming back if I stopped taking spiro. Otherwise, I think the rx would have been just for the topical compound.
Of course I'm concerned my acne will come back once I stop taking spiro but I also gave some thought to what he said about stress. I have been under a tremendous amount of stress these past couple of years with work and personal stuff. Last year, I went on holidays and didn't think about work at all. My skin actually cleared up quite a bit. Hmm.... I do think there is a correlation with that. Stress can and does stimulate the hormones. I love spicy foods but I've cut that out of my diet and it looks like I'll have to continue doing so.
anyone taken oracea? did it help?
I'll be seeing my gp next week to discuss getting a rx for spiro, just in case.
I took Oracea before spironolactone, and it may have reduced the erythema (redness) a little bit, but it didn't help with the acne / papules / pustules component.
The whole point of Oracea is that 40mg is just below antimicrobial activity (50mg+). So it is an antibiotic at such a low dose that it just slightly reduces inflammation without killing bacteria. I know a lot of people who take it for rosacea, but typically it is people with just the redness, not papulopustular rosacea.
I did the whole rosacea gamut, avoiding triggers, using calming botanicals on my skin, using Oracea and Metrogel, and it didn't really get me anywhere. My redness would only subside a tiny bit, and the acne didn't go away either.
I've kind of given up on the constant facial redness, since I've had multiple laser treatments that didn't improve it by much either. But I do use Mirvaso (which is a new cream that constricts the facial blood vessels) in the morning so I have a normal skin tone for at least part of the day.
I hope this all works out for you, but he doesn't sound very informed about the hormonal component to skin AT ALL.
I agree with Green Gables, perimenopausal women go through hormonal changes that can lead to/aggravate acne and your derm didn't give a s... about it. He could lower your dosage to see how you respond and then decide what is best for you. I hope your gp will be more helpful. My experience with doctors is that they never give you what you need. They always seem to prescribe things too weak or too heavy for my condition and they never listen to what my opinion is - which is not random cause i am a health professional as well. Anyway being less stressed has many benefits and you should definitely try it, no doubt it will help with acne as well.
I took Oracea before spironolactone, and it may have reduced the erythema (redness) a little bit, but it didn't help with the acne / papules / pustules component.
The whole point of Oracea is that 40mg is just below antimicrobial activity (50mg+). So it is an antibiotic at such a low dose that it just slightly reduces inflammation without killing bacteria. I know a lot of people who take it for rosacea, but typically it is people with just the redness, not papulopustular rosacea.
I did the whole rosacea gamut, avoiding triggers, using calming botanicals on my skin, using Oracea and Metrogel, and it didn't really get me anywhere. My redness would only subside a tiny bit, and the acne didn't go away either.
I've kind of given up on the constant facial redness, since I've had multiple laser treatments that didn't improve it by much either. But I do use Mirvaso (which is a new cream that constricts the facial blood vessels) in the morning so I have a normal skin tone for at least part of the day.
I hope this all works out for you, but he doesn't sound very informed about the hormonal component to skin AT ALL.
I agree with Green Gables, perimenopausal women go through hormonal changes that can lead to/aggravate acne and your derm didn't give a s... about it. He could lower your dosage to see how you respond and then decide what is best for you. I hope your gp will be more helpful. My experience with doctors is that they never give you what you need. They always seem to prescribe things too weak or too heavy for my condition and they never listen to what my opinion is - which is not random cause i am a health professional as well. Anyway being less stressed has many benefits and you should definitely try it, no doubt it will help with acne as well.
Yeah, I know, that's what I thought. He didn't seem to pay much attention to the hormones and my age. Yeesh, you'd think these specialists would clue into this sort of thing. I've had to be my own doctor in all of this and it has been a tiring process and I'm grateful that the spiro has cleared up my acne.
Thanks Green Gables for your input on the Oracea. I'll talk to my gp to get his take.
I picked up the compound this morning and the ingredients are:
azelaic acid (15%)
erythromycin base powder (3%)
hydrocortisone powder (1%)
unibase (no % for quantity)
Apparently the azelaic acid is supposed to help with redness and according to drug.com, it has a good rate of success. I'm supposed to use this compound twice a day, applying a thin layer. The pharmacist said to spot test it first to make sure my skin doesn't get irritated. As for continual use, I would need to see the derm again and he did say that ideally, I should go down to one application a day. He gave me one refill for the compound and the Oracea so I don't think he wants me to do this long-term. I think the derm's whole point is to avoid rosacea triggers in order to prevent breakouts. Nice theory and I hope it works in practical reality.
I'll talk to my gp before filling out the Oracea rx and discuss going back on spiro if I need to but at a lower dose. At least the derm was okay with this option and I think it's because he was pleased with my blood test results. (all okay)
Fingers crossed this works for me. And yes, I do think stress is a factor for me. As mentioned in my original post, my skin cleared up quite a bit when I was on holidays last year as I was relaxed and didn't think about work or every day life. Something to consider for my overall health anyways.
Wish me luck!
He did say to take spiro if this doesn't work
If you're serious about the rosacea, there are two main rosacea forums you can look into.
The first one is UK-based, so if you're in Canada you may find more helpful info on that one, at least for products and doctors and such. Your health care systems seem similar.
I'm disappointed that they put hydrocortisone in your compound.
Hydrocortisone is to rosacea what strong antibiotics are to acne.
It may help in the short-term, but almost always has really bad long term effects.
If you're serious about the rosacea, there are two main rosacea forums you can look into.
The first one is UK-based, so if you're in Canada you may find more helpful info on that one, at least for products and doctors and such. Your health care systems seem similar.
I'm disappointed that they put hydrocortisone in your compound.
Hydrocortisone is to rosacea what strong antibiotics are to acne.
It may help in the short-term, but almost always has really bad long term effects.
Thanks for the link to the rosacea group. It seems very informative.
I've heard about hydrocortisone and of course it concerns me.
I've spoken to a doctor and a pharmacist about this and they said it's a 'baby' amount and for short term, it shouldn't be a problem.
I'm aware of the long term effects and I'll be speaking to my gp about this as well.