Wednesday, 1 August 2012

Not every red facial rash is Rosacea!

The other day I met a man who came in requesting treatment of his "rosacea" with laser...he'd already been to a well known laser clinic and been diagnosed with the rosacea by the nurse/laser therapist.

Here's his baseline pic:



He was therefore quite surprised to hear that I completely disagreed with the 'diagnosis'..and that the treatment for his condition isn't with laser rejuvenation, but that it would actually respond to topical antifungal preparations.

So, what's the problem?

This is actually a quite severe case of seborrhoeic dermatitis..one of the most common skin and scalp complaints around.
Seborrhoeic dermatitis typically causes a scaly scalp..also known as common dandruff.  But if left untreated for years, as in this case, it will spread onto other areas..usually the eyebrows, central face and sometimes into the outer ear canals.
This patient actually had seborrhoeic dermatitis so badly that it had extended throughout his entire beard area too.

How do I know that this is seborrhoeic dermatitis rather than rosacea?
Well, the two conditions really don't look alike...
Seborrhoeic dermatitis causes a scaly rash, rosacea doesn't.  The rash of rosacea is typically pustular and telangectactic, without any involvement of the scalp for example.

Because this patient has such a chronic case of seborrhoeic dermatitis, the chronic inflammation has caused moderately severe redness of the central face, which dramatically improved following treatment only with antifungal cream and shampoo..within just 3 weeks!  Here's the 'after' pic (though I haven't quite finished with him yet!):




Funnily enough, he had only applied the antifungal cream to the cheeks, missing the upper lip scaly areas, so is going to apply to those areas before he returns next!  To help resolve the residual redness on the cheeks a little quicker, I also performed one session of laser rejuvenation (Medicare rebatable too..another win for the patient!) onto those areas that are now clear of fungus at the follow up session.
Needless to say, he is a very happy patient!  Will update this post once I have the updated image from the next review visit.

Lessons from this experience:
If you have a skin complaint, have your rash properly diagnosed by a trained MEDICAL doctor.  Nurses and laser therapists are NOT MEDICALLY QUALIFIED to diagnose, even though they may have been trained to administer treatments!
Laser treatment can be expensive..and a waste of time and money if it is done inappropriately.
We all (unless you're 'lucky' enough to be a 3rd gen family trust baby!) work hard for our income..but having a conflict of interest and performing unnecessary treatments doesn't do your clients or your business reputation any favours!