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SECOND OPINION | ROSACEA | BCBS | Full Episode

August 13, 2019


>>ANNOUNCER: “SECOND OPINION” IS BROUGHT
TO YOU BY BLUE CROSS BLUE SHIELD, ACCEPTED IN ALL 50 STATES. BLUE CROSS BLUE SHIELD. LIVE FEARLESS.>>ANNOUNCER: “SECOND OPINION” IS PRODUCED
IN CONJUNCTION WITH UR MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW
YORK.>>DR. PETER SALGO: THIS IS “SECOND OPINION,” AND
I’M YOUR HOST, DR. PETER SALGO. THIS WEEK — “MYTH OR MEDICINE”?>>SHERRIF IBRAHIM: IS YOUR MORNING CUP OF
JOE CAUSING YOU TO FLUSH? STAY TUNED FOR THIS WEEK’S “MYTH OR MEDICINE.”>>DR. PETER SALGO: AND SPECIAL GUEST BARBARA FICARRA. FOR MANY YEARS, SHE HAS BEEN DEALING WITH
A FRUSTRATING AND SOMETIMES EMBARRASSING CONDITION.>>BARBARA FICARRA: ONE OF THE FIRST THINGS
I DID WAS LOOK IT UP ONLINE AND SAW SOME REALLY SCARY PICTURES OF HOW THE DISEASE CAN PROGRESS,
AND IT CAN BE… NOT JUST DEBILITATING, BUT DISFIGURING.>>DR. PETER SALGO: SHE’S HERE FOR A SECOND OPINION.>>DR. PETER SALGO: THANKS FOR BEING HERE, BARBARA. I KNOW YOU’VE GOT A LOT TO TELL US, SO LET’S
GET RIGHT TO WORK, SHALL WE? LET ME INTRODUCE YOU TO YOUR “SECOND OPINION”
DOCTORS, AND THEY’LL BE HEARING YOUR STORY FOR THE FIRST TIME. WE HAVE DR. MARY GAIL MERCURIO FROM THE UNIVERSITY OF
ROCHESTER MEDICAL CENTER AND OUR “SECOND OPINION” PRIMARY CARE PHYSICIAN, DR. LISA HARRIS, FROM OUR LADY OF LOURDES MEMORIAL
HOSPITAL. BARBARA, YOU’RE AN ACTIVE PROFESSIONAL WOMAN,
BUT YOU’VE GOT AN ONGOING PROBLEM THAT CAUSES YOU GREAT DISCOMFORT AND SOME DISTRESS AT
TIMES. SO WHY DON’T YOU FILL US IN? WHEN DID ALL THIS START HAPPENING TO YOU?>>BARBARA FICARRA: I WAS ABOUT 40, AND I
STARTED NOTICING IN THE OFFICE THAT I WOULD SPONTANEOUSLY START TO TURN RED IN THE FACE
OR THE –>>DR. PETER SALGO: YOUR WHOLE FACE OR JUST –>>BARBARA FICARRA: I WOULD FEEL A FLUSHING,
AND I WOULD FEEL MY EARS GET HOT, WHICH, IF YOU’RE IN AN OFFICE SETTING, ISN’T ALWAYS
THE THING TO DO.>>DR. PETER SALGO: RIGHT.>>BARBARA FICARRA: BUT I STARTED TO NOTICE
CHANGES IN MY SKIN.>>DR. PETER SALGO: DID YOU NOTICE SOME THINGS THAT
WOULD BRING IT ON, OTHER THINGS THAT WOULD MAKE IT GO AWAY?>>BARBARA FICARRA: I THINK STRESS WAS ONE
OF THE FIRST THINGS THAT I NOTICED AS A TRIGGER.>>DR. PETER SALGO: RIGHT.>>BARBARA FICARRA: EXERTION, EXERCISE — I
NOTICED I WAS GETTING MORE RED THAN USUAL WHEN I WOULD EXERCISE.>>DR. PETER SALGO: OKAY.>>BARBARA FICARRA: IF I HAD A GLASS OF WINE.>>DR. PETER SALGO: PANEL — LISA, SINCE YOU’RE A
PRIMARY CARE PHYSICIAN, YOU’D BE OFTEN, IF YOU WILL, THE GATEKEEPER, A PHRASE I’M NOT
REALLY ALL THAT FOND OF. BUT HERE ARE THE SYMPTOMS. WHAT’S GOING THROUGH YOUR MIND? WHAT DO YOU WANT TO DO?>>DR. LISA HARRIS: THOSE ARE PRETTY NONSPECIFIC
AND VERY EARLY ON, SO A WOMAN IN HER 40S THAT’S REPORTING FLUSHING, THEN I’M GONNA START ASKING
HER QUESTIONS ABOUT HER MENSTRUAL CYCLE AND WHETHER OR NOT SHE’S STARTING TO DISPLAY SOME
MENOPAUSAL SYMPTOMS. SO, HAD YOUR PERIODS CHANGED AT ALL OR NOT
GETTING SHORTER OR LONGER OR HEAVIER BLEEDING OR ANYTHING LIKE THAT?>>BARBARA FICARRA: NO, NOTHING LIKE THAT. I WAS IN GREAT HEALTH.>>DR. PETER SALGO: AND THIS IS CLEARLY SOMETHING
GOING ON WITH HER SKIN – AT LEAST, IT’S AN OUTWARD MANIFESTATION. SO CHIME IN IF YOU’D LIKE. ANY OTHER QUESTIONS? WHAT’S YOUR DIFFERENTIAL?>>DR. MARY GAIL MERCURIO: ANY G.I. PROBLEMS WITH IT? ANY OUTBREAKS OTHER THAN THE REDNESS?>>BARBARA FICARRA: NO. NOTHING.>>DR. MARY GAIL MERCURIO: SO NEVER ANY SORT OF PIMPLES
OR OTHER SPOTS ON YOUR FACE? JUST THE REDNESS? AND WOULD IT STAY BEYOND — HOW LONG WOULD
THESE EPISODES LAST?>>BARBARA FICARRA: IT WOULD SUBSIDE AFTER
A PERIOD OF TIME. SO IT WASN’T LIKE I WAS PERMANENTLY RED, BUT
IT WOULD COME AND GO. AND THAT WAS FRUSTRATING, TOO, TO ALL OF A SUDDEN BE TURNING RED WITHOUT
KNOWING WHY.>>DR. LISA HARRIS: AND DID YOU ITCH AT ALL?>>BARBARA FICARRA: NO. THERE WASN’T ANY ITCHING.>>DR. PETER SALGO: I’M CURIOUS — WHY DID YOU ASK
HER ABOUT G.I. SYMPTOMS?>>DR. MARY GAIL MERCURIO: WELL, JUST THINKING OF
MORE SYSTEMIC REASONS FOR FLUSHING.>>DR. PETER SALGO: LIKE WHAT?>>DR. MARY GAIL MERCURIO: LIKE CANCER OF SOME SORT.>>DR. PETER SALGO: OKAY.>>DR. MARY GAIL MERCURIO: YEAH.>>DR. PETER SALGO: OR SOME SORT OF VASOACTIVE TUMOR.>>DR. MARY GAIL MERCURIO: RIGHT.>>DR. PETER SALGO: RIGHT. AND SHE ANSWERED “NO” IN DETAIL TO ALL OF
YOUR QUESTIONS, REALLY, SO WHAT’S IN YOUR DIFFERENTIAL, LISA? A DIFFERENTIAL DIAGNOSIS, BY THE WAY, IS A
LIST OF THINGS THAT DOCTORS WOULD CREATE THAT MIGHT POSSIBLY BE CAUSING THESE SYMPTOMS,
EACH ONE OF WHICH IS GONNA CHECK THEM OFF AND WE’LL TRY TO RULE SOME OUT, RULE SOME
IN. SO, WHAT’S IN YOUR DIFFERENTIAL?>>DR. LISA HARRIS: SO, STILL PRETTY LIMITED AND
THE SYMPTOMS ARE STILL PRETTY GENERIC, SO AT THIS POINT, I MIGHT STILL OBSERVE YOU AND
SEE WHAT’S HAPPENING. WE MAY CHECK A THYROID PANEL AND SEE WHAT’S
GOING ON. AND, CERTAINLY, THE PHYSICAL EXAM WOULD BE IMPORTANT TO SEE.>>DR. PETER SALGO: AND WHAT’S IN YOUR DIFFERENTIAL?>>DR. MARY GAIL MERCURIO: WELL, THE DEFAULTS, WHEN
ALL OF THAT — WHAT WE CALL REVIEW OF SYSTEMS — IS NEGATIVE, WHEN THERE APPEARS TO BE NOTHING
ELSE GOING ON, WE DO LAND ON ROSACEA OFTEN.>>DR. PETER SALGO: OKAY, ROSACEA’S ONE. ANYTHING ELSE?>>DR. MARY GAIL MERCURIO: WITHOUT A RASH THAT REMAINS
THERE, IT RULES OUT MOST OTHER SKIN CONDITIONS.>>DR. PETER SALGO: WHAT ABOUT ECZEMA?>>DR. MARY GAIL MERCURIO: ECZEMA WOULD NOT BE TRANSIENT,
AS SHE IS DESCRIBING.>>DR. PETER SALGO: AND PSORIASIS?>>DR. MARY GAIL MERCURIO: THERE WOULD BE A LONG-TERM
— THERE WOULD BE CHANGES OF THE SKIN THAT WOULD BE SUSTAINED, LIKE SCALING OR REDNESS.>>DR. LISA HARRIS: I KNOW YOU HAVE WEIRD THINGS,
LIKE HEAT-INDUCED URTICARIA, BUT SHE DOESN’T HAVE A RASH, AGAIN, SO THAT’S WHAT MAKES IT
DIFFICULT.>>DR. PETER SALGO: NOW, I KNOW THAT DERMATOLOGISTS
LOVE PICTURES, BECAUSE, OF ALL THE SPECIALTIES, YOU’RE THE ONES WHO CAN MAKE A DIAGNOSIS SOMETIMES
BY JUST LOOKING. SO WE GOT SOME PICTURES FOR YOU.>>DR. MARY GAIL MERCURIO: HERE, YOU CAN APPRECIATE
THE SYMMETRY — LOOKS EXACTLY THE SAME ON BOTH SIDES OF THE NOSE — SO WE WOULD SUSPECT
THIS WAS FROM A CONTACT DERMATITIS, PERHAPS SOME PART OF THE EYEGLASSES. AND YOU CAN SEE IT’S A LITTLE SCALY THERE. THIS WOULDN’T BE SOMETHING THAT WOULD DISAPPEAR
AFTER A FEW MINUTES.>>DR. PETER SALGO: AND PSORIASIS? WE’VE GOT A PICTURE OF THAT.>>DR. MARY GAIL MERCURIO: SO, THERE’S THAT SCALY
RASH. WE CALL IT A SILVERY SCALE.>>DR. PETER SALGO: OKAY. AND LAST, WE HAVE ROSACEA. YOU MENTIONED ROSACEA.>>DR. MARY GAIL MERCURIO: AND THIS IS TYPICAL ROSACEA. BUT BEYOND JUST THE REDNESS THAT WE SEE IN
THIS PICTURE, YOU CAN SEE THOSE LUMPS AND BUMPS, THE PIMPLE-LIKE RASH. SO THE COMBINATION OF THESE ACNE-LIKE LESIONS
WITH THE REDNESS IS ROSACEA — QUITE CLASSIC.>>DR. PETER SALGO: SO, THOSE ARE THREE PLAYERS,
ANYWAY, ALTHOUGH YOU WERE FOCUSING IN ON ROSACEA RIGHT AWAY.>>DR. LISA HARRIS: AND CERTAINLY, FROM PRIMARY CARE,
WE’D WANT TO KNOW, HAD YOU CHANGED ANY TOPICAL AGENTS THAT YOU’D BEEN USING? HAD YOU BEEN EXPOSED TO ANYTHING DIFFERENT? WAS THERE ANYTHING IN THE ENVIRONMENT AT WORK
THAT HAD CHANGED? AND IF ALL THAT IS NEGATIVE…>>BARBARA FICARRA: THAT’S ALL NEGATIVE, YEAH.>>DR. MARY GAIL MERCURIO: AND MANY PATIENTS WHO
HAVE ROSACEA COME IN THINKING THEY HAVE LUPUS. EVERYONE’S HEARD OF THAT BUTTERFLY RASH OF
LUPUS, WHICH ACTUALLY WOULD BE EXTREMELY UNUSUAL TO HAVE IN ISOLATION. THERE WOULD BE OTHER SYMPTOMS GOING ON.>>DR. PETER SALGO: WELL, YOU WEREN’T GETTING ANYWHERE
WITH A DIAGNOSIS. OR WERE YOU?>>BARBARA FICARRA: I SORT OF FOUND OUT BY
ACCIDENT.>>DR. PETER SALGO: WHAT HAPPENED?>>BARBARA FICARRA: I WAS AT MY OPHTHALMOLOGIST,
GETTING AN EYE EXAM, AND I NOTICED THAT THE INSIDE OF MY EYELIDS LOOKED UNUSUALLY RED,
AND I ASKED HIM ABOUT IT, AND HE SAID, “WHAT’S YOUR NATIONALITY?” — WHICH I THOUGHT WAS AN ODD QUESTION. AND I TOLD HIM, AND HE SAID, “OH. THAT’S IT.”>>DR. PETER SALGO: YOUR OPHTHALMOLOGIST DIAGNOSED
ROSACEA. IS THAT COMMON?>>DR. MARY GAIL MERCURIO: THAT IS NOT UNCOMMON.>>DR. PETER SALGO: THAT’S SUCH A DOCTOR RESPONSE. “IT’S NOT UNCOMMON.” [ LAUGHTER ] “WE SEE THIS” IS ANOTHER ONE. BUT OPHTHALMOLOGISTS SEE IT BECAUSE WHY?>>DR. MARY GAIL MERCURIO: BECAUSE THERE IS AN OCULAR
VARIANT OF ROSACEA THAT CAN OCCUR IN ISOLATION OR ALONG WITH THE MORE TYPICAL SKIN MANIFESTATIONS.>>DR. PETER SALGO: SO, NOW THAT WE MADE THE DIAGNOSIS,
MY QUESTION IS, WHAT CAUSES ROSACEA?>>DR. MARY GAIL MERCURIO: THE MILLION-DOLLAR QUESTION. WE DON’T KNOW A PRECISE CAUSE. IT’S PROBABLY MULTIFACTORIAL, AND WE KNOW
IT HAS TO DO WITH SOME ABNORMAL REGULATION OF THE IMMUNE SYSTEM THAT CAUSES INFLAMMATION
OF THE FACE.>>DR. PETER SALGO: AND WHY THE NATIONALITY QUESTION? WHY DID THAT NAIL IT FOR THE OPHTHALMOLOGIST?>>DR. MARY GAIL MERCURIO: IT’S MUCH MORE COMMON
IN INDIVIDUALS OF CELTIC OR NORTHERN EUROPEAN ANCESTRY, BUT IT CAN IMPACT ALL SKIN TYPES.>>DR. PETER SALGO: MM-HMM. WERE HER SYMPTOMS TYPICAL IN RETROSPECT, LISA?>>DR. LISA HARRIS: WELL, NO. AGAIN, YOU TYPICALLY WILL SEE THE ACNEIFORM
TYPE OF RASH ALONG WITH THE REDNESS OF THE CHEEKS, AND IT LASTS. SO TO HAVE A TRANSIENT REDNESS THAT GOES AWAY
IS NOT VERY TYPICAL. BUT I THINK, OVER TIME, IF SHE’D BEEN SEEING
HER PRIMARY CARE PHYSICIAN OVER TIME, THEY PROBABLY WOULD HAVE NAILED IT.>>DR. PETER SALGO: ALL RIGHT, SO, NOW YOU’VE GOT
A DIAGNOSIS. SOUNDS GOOD. I GUESS NEXT THING YOU DO, YOU GO TO YOUR
PRIMARY CARE PHYSICIAN WITH THE DIAGNOSIS AND YOU GET CURED. SO WHAT HAPPENED?>>BARBARA FICARRA: I WISH. I WENT TO A DERMATOLOGIST TO CONFIRM WHAT
MY OPHTHALMOLOGIST FIGURED WAS HAPPENING, AND SHE LOOKED AT ME AND SAID, “YEP, YOU’VE
GOT IT.” SHE ALSO HAPPENS TO HAVE ROSACEA, SO SHE COMMISERATED
WITH ME ON ALL THE THINGS THAT WERE SETTING OFF MY SKIN. AND I TRIED A NUMBER OF DIFFERENT TOPICAL
PREPARATIONS. I TRIED –>>DR. PETER SALGO: “TOPICAL” MEANS YOU PUT IT ON
YOUR SKIN, LIKE A CREAM.>>BARBARA FICARRA: YES.>>DR. PETER SALGO: AND?>>BARBARA FICARRA: AND I REALLY DIDN’T SEE
ANY IMPROVEMENT, AND IT SEEMED THAT MY SKIN WAS SO SENSITIVE THAT KIND OF MANIPULATING
IT WITH ALL THESE CREAMS WASN’T HELPING. IT WAS ONLY MAKING THINGS WORSE, AND THAT
WAS REALLY FRUSTRATING FOR ME.>>DR. PETER SALGO: DID YOU ASK IF THERE WAS A CURE?>>BARBARA FICARRA: OH, SURE. YEAH.>>DR. PETER SALGO: AND YOU WERE TOLD…?>>BARBARA FICARRA: THERE’S NO CURE. IT CAN ONLY BE MANAGED, AND ONLY TO AN EXTENT,
SO…>>DR. PETER SALGO: SO, WHAT DO YOU TELL PATIENTS
WITH ROSACEA? NO CURE, THE TOPICALS AREN’T WORKING. “WHOOPS”?>>DR. MARY GAIL MERCURIO: YEAH, IT’S A CHALLENGE. IT’S A CHRONIC CONDITION CHARACTERIZED BY
EXACERBATIONS AND REMISSIONS, SO YOU REALLY HAVE TO TREAT CHRONICALLY TO KEEP THINGS AT
BAY. YOU HAVE THE MOST DIFFICULT VARIANT OF ROSACEA
TO TREAT IN THAT IT’S JUST THIS INTERMITTENT REDNESS, SO MOST OF THE TOPICALS AND THE PILLS
ARE NOT VERY EFFECTIVE.>>DR. PETER SALGO: SO, WHAT ELSE WERE YOU TOLD TO
DO? WERE YOU TOLD TO TRY TO FIGURE OUT WHAT BRINGS
IT ON OR WHAT MAKES IT BETTER?>>BARBARA FICARRA: YEAH, WHAT THE TRIGGERS
WERE TO TRY TO IDENTIFY THOSE.>>DR. PETER SALGO: TRIGGERS BEING THOSE THINGS THAT
MIGHT BRING ON AN ATTACK.>>BARBARA FICARRA: AND AT THAT POINT, I WAS
— YOU KNOW, THEY ASKED WHAT I WAS USING TO CLEANSE MY SKIN, AND I REALLY WAS TRYING NOT
TO USE A LOT OF PRODUCTS ON MY SKIN. BUT, AGAIN, THEY HAD ME TRY A LOT OF DIFFERENT
CLEANSERS, YOU KNOW, AND IT JUST SEEMED THAT TRYING A LOT OF DIFFERENT THINGS ON MY SKIN
WAS MAKING THINGS WORSE. IT WAS JUST, YOU KNOW –>>DR. PETER SALGO: AND YOU’RE NODDING — “YES, WE
SEE THIS.”>>DR. MARY GAIL MERCURIO: ‘CAUSE ONE OF THE KEY
FACTORS IN MANAGING ROSACEA IS EDUCATING PATIENTS, AND YOU HAVE TO WORK TOGETHER WITH YOUR PROVIDER
TO IDENTIFY — YOU KEEP USING THE WORD “TRIGGERS,” WHICH IS A KEY WORD IN ROSACEA. BASICALLY, THOSE ARE ENVIRONMENTAL FACTORS
THAT BRING OUT YOUR ROSACEA. THE DIFFICULT PART IS THAT IT VARIES FROM
PERSON TO PERSON, SO YOU CAN’T JUST BE HANDED A LIST OF WHAT TO AVOID. YOU HAVE TO LEARN WHAT MAKES YOUR ROSACEA
WORSE.>>DR. PETER SALGO: SO, WE’RE GONNA PAUSE FOR A MINUTE. I JUST WANT TO POINT OUT WHERE WE ARE. YOU’VE GOT AN INCURABLE DISEASE THAT’S CAUSING
YOU DISTRESS, IT’S NOT GETTING BETTER WITH TREATMENT, AND YOU CAN’T IDENTIFY TRIGGERS
— AT LEAST, NOT IMMEDIATELY.>>BARBARA FICARRA: RIGHT.>>DR. PETER SALGO: SOUNDS JUST GREAT.>>BARBARA FICARRA: YEAH. AND IT’S YOUR FACE. IT’S WHAT YOU PRESENT TO THE WORLD, SO THAT
MADE IT THAT MUCH WORSE, YEAH.>>DR. PETER SALGO: EVERYBODY, STAY WHERE YOU ARE,
BECAUSE WE’LL BE RIGHT BACK TO HEAR YOUR SECOND OPINION, BY THE WAY. BUT FIRST, HERE’S THIS WEEK’S “MYTH OR MEDICINE.”>>ANNOUNCER: IF YOU HAVE ROSACEA, YOU MAY
HAVE NOTICED THAT A WARM CUP OF COFFEE OR TEA CAUSES YOU TO FLUSH. IT’S IMPORTANT TO KNOW YOUR TRIGGERS. DOES THIS MEAN YOU’LL HAVE TO GIVE UP THAT
MORNING CUP OF COFFEE OR SWITCH TO DECAF? DOES CAFFEINE CAUSE ROSACEA FLARE-UPS? IS THIS MYTH OR MEDICINE?>>SHERRIF IBRAHIM: “CAFFEINE CAN CAUSE ROSACEA
FLARE-UPS” — THAT’S A MYTH, AND I’LL TELL YOU WHY. I’M SHERRIF IBRAHIM. I’M AN ASSISTANT PROFESSOR OF DERMATOLOGY
AT THE UNIVERSITY OF ROCHESTER. THE EXACT CAUSE OF ROSACEA IS UNKNOWN. WE DO KNOW THAT PATIENTS WITH ROSACEA HAVE
AN INCREASED NUMBER OF SMALL BLOOD VESSELS LOCATED SUPERFICIALLY IN THE SKIN. THESE VESSELS ARE PRONE TO DILATION FROM A
VARIETY OF SOURCES. CAFFEINE, ONCE THOUGHT TO BE A STRONG TRIGGER
OF ROSACEA, MAY OR MAY NOT NECESSARILY BE SO. ONE INTERESTING STUDY FOUND THAT PATIENTS
WHO WERE GIVEN A BEVERAGE AT ROOM TEMPERATURE THAT WAS CAFFEINATED DID NOT HAVE ANY KIND
OF FLUSHING RESPONSE. HOWEVER, IF THEY RAISED THE TEMPERATURE OF
THE BEVERAGE TO 140 DEGREES, WHETHER THIS WAS COFFEE OR JUST PLAIN WATER, THESE PATIENTS
ALL HAD A FLUSHING REACTION OF SIMILAR TYPE AND INTENSITY. SO, IN REALITY, IT MAY NOT BE THE TEA OR THE
COFFEE THAT YOU’RE DRINKING, BUT THE TEMPERATURE OF THE HEATED BEVERAGE THAT YOU’RE INGESTING. AND THAT’S MEDICINE.>>ANNOUNCER: NOT SURE IF IT’S MYTH OR MEDICINE? CONNECT WITH US ONLINE. WE’LL GET TO WORK AND GET YOU A SECOND OPINION.>>DR. PETER SALGO: AND WE’RE BACK WITH BARBARA. BARBARA, THANK YOU FOR SHARING YOUR STORY
WITH US. JUST TO RECAP, YOU’VE HAD A FEW YEARS OF FRUSTRATION
WITH A RASH THAT WOULD COME AND GO OR, IF YOU WILL, FLUSHING THAT WOULD COME AND GO,
AND NOBODY COULD SEEM TO TELL YOU WHAT WAS WRONG, SO YOUR OPHTHALMOLOGIST SAID, “CONGRATULATIONS. YOU’VE GOT ROSACEA.” AND AT THAT POINT, YOU HEARD THERE WAS NO
CURE. HOW DID THAT MAKE YOU FEEL?>>BARBARA FICARRA: IT WAS TOUGH. THAT WAS A LITTLE FRUSTRATING. BUT I HAD TO PUT IT IN PERSPECTIVE THAT IT
WASN’T THREATENING MY HEALTH. IT WAS JUST GONNA BE AN ANNOYANCE. IT WAS GONNA BE SOMETHING THAT I HAD TO MANAGE
AND LEARN TO LIVE WITH.>>DR. PETER SALGO: NOW, WE WERE DISCUSSING TRIGGERS
BEFORE WE WENT AWAY TO BREAK. THERE ARE THINGS THAT CAN TRIGGER AN OUTBREAK
OR A RASH OR A FLUSHING EPISODE. AND DID YOUR DOCTORS TELL YOU TO TRY TO IDENTIFY
THOSE?>>BARBARA FICARRA: THEY GAVE ME A LIST OF
LIKELY TRIGGERS, AND AS I LOOKED AT THE LIST, I REALIZED THERE WAS A CORRELATION BETWEEN
THE LIST AND WHAT I WAS EXPERIENCING, SO THAT WAS HELPFUL.>>DR. PETER SALGO: WHAT’S ON THE LIST, GENERICALLY?>>DR. MARY GAIL MERCURIO: STRESS. WE ALL KNOW HOW EASY IT IS –>>DR. PETER SALGO: LIKE THE STRESS OF HAVING ROSACEA? I MEAN, COME ON.>>DR. MARY GAIL MERCURIO: AND HOW EASY TO ELIMINATE
STRESS IN YOUR LIFE, RIGHT?>>DR. PETER SALGO: [ CHUCKLING ] RIGHT.>>DR. MARY GAIL MERCURIO: TEMPERATURE FLUCTUATIONS,
SPICY FOODS, WIND.>>DR. PETER SALGO: YOU SAID THAT THERE WERE SOME
ITEMS ON THE LIST THAT YOU IDENTIFIED. WHAT WERE THEY?>>BARBARA FICARRA: YEAH. WELL, ALL OF THOSE, AS WELL AS EXERCISE — IF
I WORKED OUT, I WOULD GET UNUSUALLY RED. IF I WENT CROSS-COUNTRY SKIING, I TURNED THE
COLOR OF A YAM. I NOTICED THAT IF I DRANK EVEN A GLASS OF
WINE OR EVEN JUST A FEW SIPS THAT THAT WAS THE BIGGEST TRIGGER OF ALL, SO IT WAS A BIG
TRIGGER.>>DR. PETER SALGO: NO WINE, AVOID COLD, COLD AIR.>>BARBARA FICARRA: COLD AND HEAT.>>DR. PETER SALGO: AND SO NO CROSS-COUNTRY SKIING. THIS IS BEGINNING TO SOUND PRETTY LIMITING.>>BARBARA FICARRA: YEAH.>>DR. PETER SALGO: AND, BY THE SAME TOKEN, YOU HAVE
A CAREER IN THE PUBLIC EYE, SO A RED FACE WOULDN’T NECESSARILY BE IN YOUR BEST INTEREST.>>BARBARA FICARRA: RIGHT.>>DR. PETER SALGO: SO, WHAT DO YOU TELL PEOPLE WITH
ALL OF THIS? HOW DO THEY GO THROUGH THEIR LIVES AVOIDING
EVERYTHING?>>DR. MARY GAIL MERCURIO: YOU CAN’T. IT DOES SIGNIFICANTLY
IMPACT QUALITY OF LIFE AND PSYCHOLOGICAL WELL-BEING, AND THAT’S A LOT OF HELPING PATIENTS — TO
UNDERSTAND AND DEAL ACCORDINGLY. BEYOND AVOIDING THE TRIGGERS, WE TALK ABOUT
JUST ROUTINE SKIN CARE. AS YOU MENTIONED, CERTAIN PRODUCTS MAKE IT
WORSE, SO YOU REALLY HAVE TO BECOME KNOWLEDGEABLE OF WHAT WORKS BEST TO KEEP YOUR SKIN FROM
FLUSHING.>>DR. LISA HARRIS: AND I WANTED TO GET BACK TO SOMETHING
YOU SAID EARLIER, THAT YOU FELT THAT IT WAS JUST AN ANNOYANCE THAT YOU WOULD HAVE TO LIVE
WITH. AND THAT CAN BE A VERY HEALTHY APPROACH, BUT
WE ALSO DON’T WANT TO MINIMIZE THE IMPACT THAT IT’S HAD ON YOUR LIFE. AND FOR MANY PATIENTS, IT’S MORE THAN JUST
THE REDNESS THAT OCCURS. IT’S OTHER THINGS THAT CAN BE DISFIGURING.>>BARBARA FICARRA: RIGHT. I’M THANKFUL THAT IT HASN’T BEEN WORSE, BECAUSE
ONE OF THE FIRST THINGS I DID WAS LOOK IT UP ONLINE AND SAW SOME REALLY SCARY PICTURES
OF HOW THE DISEASE CAN PROGRESS, AND IT CAN BE… NOT JUST DEBILITATING, BUT DISFIGURING.>>DR. PETER SALGO: BEFORE ALL OF OUR VIEWERS TURN
OFF THE SET AND HEAD FOR THE INTERNET — BAD IDEA, BY THE WAY — WHAT IS SHE TALKING ABOUT? WHAT CAN ROSACEA DO PROGNOSTICALLY GOING FORWARD
THAT YOU REALLY DON’T WANT TO SEE?>>DR. MARY GAIL MERCURIO: SO, THIS IS WHAT WE CALL
THE VASCULAR FORM OF ROSACEA, WHAT BARBARA HAS, WHERE SHE FLUSHES. YOU CAN GET A MORE ACNEIFORM PICTURE, WHERE
YOU HAVE PIMPLES AND PUSTULES, SO IT LOOKS LIKE AN ADULT FORM OF ACNE ON A BACKGROUND
OF REDNESS. AND THEN THE MOST SEVERE, WHICH TENDS TO HAPPEN
MORE OFTEN IN MEN, IS WHERE YOU ACTUALLY DEVELOP, LIKE, FIBROUS THICKENING OR THE SKIN ON THE
NOSE ENLARGES LIKE A BULBOUS NOSE, AND THAT’S QUITE RARE. SO MOST COMMON IS THE ACNE-LIKE PICTURE ALONG
WITH THE FLUSHING. AND IF FLUSHING OCCURS FREQUENTLY ENOUGH,
YOU’RE LEFT WITH LITTLE BLOOD VESSELS CALLED TELANGIECTASIAS ON THE FACE THAT DON’T REMIT
BETWEEN THE FLARES.>>DR. PETER SALGO: AND WHAT DO YOU DO FOR THEM?>>DR. MARY GAIL MERCURIO: THERE’S ONLY ONE WAY TO
TREAT THE BLOOD VESSELS THAT PERSIST, AND THAT’S WITH LASER THERAPY. SO A LASER IS USED TO BASICALLY DESTROY OR
DISINTEGRATE THAT SMALL BLOOD VESSEL.>>DR. LISA HARRIS: OR HEAVY-DUTY MAKEUP.>>DR. PETER SALGO: OR HEAVY-DUTY MAKEUP. BUT, AGAIN, IT OCCURS TO ME, THE QUESTION
YOU WERE ASKING IS “IS THERE A CURE?” DID YOU EVER GET TOLD THAT THERE WAS ANYTHING
ON THE HORIZON? ANYTHING?>>BARBARA FICARRA: NO.>>DR. PETER SALGO: IS THERE?>>DR. MARY GAIL MERCURIO: FOR THIS — IT DEPENDS
ON THE TYPE OF ROSACEA. YOU ALSO TAILOR THE THERAPY TO WHAT THE MANIFESTATIONS
ARE. THERE ACTUALLY IS A NEW DRUG OUT FOR THE FLUSHING
TYPE OF ROSACEA THAT WORKS IN SOME BUT NOT ALL PATIENTS. IT WAS A GLAUCOMA DRUG, AND IT WAS NOTED THAT
PATIENTS WHO USED IT FOR GLAUCOMA, THEIR ROSACEA IMPROVED. SO NOW IT’S AVAILABLE TOPICALLY FOR ROSACEA. AND, LIKE I SAID, IT DOES NOT WORK FOR ALL
PATIENTS.>>DR. PETER SALGO: NOW, YOU’RE — WHAT? YOU’RE 15 YEARS INTO YOUR ROSACEA. HAVE YOU COME TO TERMS WITH YOUR ROSACEA,
ACCEPTANCE OF IT, OR ARE YOU STILL JUST TICKED OFF?>>BARBARA FICARRA: I HAVE COME TO TERMS WITH
IT A LOT. YOU KNOW, I DON’T LET IT KEEP ME FROM DOING
THE THINGS I WANT TO DO, ESPECIALLY EXERCISE AND BEING OUTDOORS. I STILL CROSS-COUNTRY SKI, AND I JUST LEARN
TO LIVE WITH THE REDNESS. I HAVE LEARNED THE PRODUCTS THAT WORK FOR
MY SKIN. WHEN I FIRST PUT MOISTURIZER ON, IT MAKES
MY FACE TURN RED BECAUSE I’M TOUCHING MY SKIN, BUT I HAVE TO MOISTURIZE MY SKIN. SO I HAVE BECOME KIND OF RESIGNED TO IT AND
JUST LIVE MY LIFE AND DEAL.>>DR. PETER SALGO: WELL, IF TRADITIONAL MEDICINE
HAS NOT MUCH TO OFFER — IS THAT FAIR — WE DON’T HAVE THAT MUCH TO OFFER?>>DR. MARY GAIL MERCURIO: FOR THIS TYPE. FOR THE ACNE-TYPE OF ROSACEA, THERE ARE MORE
OPTIONS, INCLUDING ANTIBIOTICS.>>DR. PETER SALGO: BUT HERS?>>DR. MARY GAIL MERCURIO: FOR HERS, MORE DIFFICULT. BUT ONE OTHER TRIGGER WE DIDN’T MENTION IS
THE SUN. IS THAT A PROBLEM FOR YOU?>>BARBARA FICARRA: I MOSTLY STAY OUT OF THE
SUN.>>DR. PETER SALGO: OKAY. WHAT ABOUT, NOW, ALTERNATIVE THERAPIES? WE’VE GOT SOME ANTIBIOTICS FOR SOME KINDS
OF ROSACEA. THIS GLAUCOMA THERAPY MAY OR MAY NOT HELP. BUT THEN THERE’S A WHOLE COTTAGE INDUSTRY
OUT THERE OF PEOPLE SUGGESTING ALTERNATIVE THERAPIES FOR ROSACEA. HAVE YOU TRIED THEM?>>BARBARA FICARRA: I THOUGHT ABOUT ACUPUNCTURE. I DON’T KNOW IF THAT HAS BEEN SHOWN TO DO
ANYTHING. BIOFEEDBACK TO DEAL WITH STRESS, ALTHOUGH
STRESS HASN’T BEEN AN ISSUE LATELY. I DON’T KNOW.>>DR. PETER SALGO: I MEAN, I READ ONE COMMENT YOU
MADE IS THAT YOU CAN’T PLAY POKER ANYMORE.>>BARBARA FICARRA: NO, I DON’T HAVE A FACE
FOR POKER, NO.>>DR. PETER SALGO: DID YOU PLAY POKER BEFORE?>>BARBARA FICARRA: NO. NO.>>DR. PETER SALGO: WELL, NO LOSS.>>BARBARA FICARRA: NO, RIGHT.>>DR. PETER SALGO: BUT THIS IS THE POINT IN THE
BROADCAST THAT I REALLY LIKE, BECAUSE WE HAVE WONDERFUL EXPERTS FOR YOU. IT’S YOUR CHANCE TO GET A SECOND OPINION ON
WHAT’S GOING ON WITH YOU. GOT A FEW MINUTES HERE. PLEASE — AVAIL YOURSELF OF THE OPPORTUNITY.>>BARBARA FICARRA: ONE OF THE THINGS THAT
I READ IS THAT THIS CAN PROGRESS. DO I HAVE THE TYPE OF ROSACEA THAT IF IT’S
LEFT UNTREATED, IT WILL GET WORSE?>>DR. MARY GAIL MERCURIO: IT’S UNPREDICTABLE. THERE’S NO TYPE THAT PROGRESSES TO WORSE. SOME REMAIN IN A VERY MILD STATE, WHICH IS
HOW I WOULD DESCRIBE YOUR ROSACEA. I WOULD JUST REMAIN COGNIZANT AND WATCH FOR
THE DEVELOPMENT OF THOSE BLOOD VESSELS. THAT’S A REASON TO TRY TO AVOID YOUR TRIGGERS. IF YOU HAVE TOO MUCH OF THE FLUSHING, THAT’S
WHEN THOSE TINY BLOOD VESSELS DEVELOP.>>BARBARA FICARRA: I HAVE THOSE. THEY’RE JUST COVERED. BUT I HAVE TALKED TO A DOCTOR –>>DR. PETER SALGO: YOU USE THE LISA TRICK. IS THAT IT?>>BARBARA FICARRA: [ LAUGHING ] YEAH. I’VE TALKED TO A DOCTOR ABOUT THE LASER THERAPY,
BUT MY QUESTION TO HIM WAS, WON’T THEY RECUR, YOU KNOW, ONCE I ELIMINATE THE BLOOD VESSELS
THAT HAVE BEEN DESTROYED BY THIS? WON’T I JUST BE, YOU KNOW, PLAYING A GAME
OF CATCH-UP?>>DR. MARY GAIL MERCURIO: GENERALLY, YOU DO NEED
TO TREAT SERIALLY, AND SOMETIMES THEY’LL STAY AWAY FOR SIX MONTHS, A YEAR. SOMETIMES YOU’LL NEED TOUCH-UPS PERIODICALLY. THAT IS NOT A PERMANENT TREATMENT, EITHER,
UNFORTUNATELY.>>DR. PETER SALGO: BUT WHAT I’VE HEARD — AND IF
YOU’LL PERMIT ME TO ASK A QUESTION ON YOUR BEHALF — IS, IF I GET THE LASER, THE NEXT
TIME THEY COME BACK, WILL THEY BE WORSE? DOES THE LASER DO SOMETHING TO MY SKIN OR
THE BLOOD VESSELS?>>DR. MARY GAIL MERCURIO: NO, THE LASER DOES NOTHING
TO MAKE IT WORSE. AND PATIENTS WHO ARE VERY BOTHERED BY THE
REDNESS, THAT IS THE MOST DEFINITIVE TREATMENT OPTION WE HAVE.>>DR. PETER SALGO: SO, WHAT ELSE DO YOU WANT TO
ASK?>>BARBARA FICARRA: ONE OF THE THEORIES ABOUT
WHAT CAUSES ROSACEA IS THAT IT’S MICROSCOPIC MITES. HAS THAT BEEN RULED OUT?>>DR. MARY GAIL MERCURIO: WELL, IT HASN’T BEEN RULED
OUT. SO, EVERYONE — MOST PEOPLE HAVE SMALL MITES
CALLED DEMODEX ON THEIR SKIN AT A CERTAIN LEVEL. AND IT’S KNOWN THAT PATIENTS WITH ROSACEA
HAVE MORE OF THOSE MITES, AND WE DON’T KNOW WHY. WHICH CAME FIRST — THE MITES OR THE INFLAMMATION
THAT ALLOWED THE MITES TO PROSPER THERE? SO, ONE OF THE MANY TOPICAL TREATMENTS FOR
ROSACEA IS AN ANTI-MITE TREATMENT CALLED — AND IT’S USED TOPICALLY — CALLED PERMETHRIN.>>DR. LISA HARRIS: AND THAT WOULD MAKE SENSE FOR
THE ACNEIFORM OR THE –>>DR. MARY GAIL MERCURIO: PRECISELY.>>DR. LISA HARRIS: BUT NOT FOR THE VASCULAR FLUSHING,
BECAUSE THAT’S REALLY MORE OF AN INTERNAL SYSTEMIC PROBLEM.>>DR. PETER SALGO: AND AS WE WERE DISCUSSING MITES,
I HEARD A GREAT BIG “EW!” ALL OVER AMERICA. BUT THESE ARE MICROSCOPIC THINGS THAT WE ALL
HAVE.>>DR. MARY GAIL MERCURIO: VERY SMALL.>>DR. LISA HARRIS: YOU WOULDN’T WANT TO SEE WHAT
LIVES ON YOUR SKIN.>>DR. PETER SALGO: OH, I HAVE, AND I’VE CHOSEN NOT
TO THINK ABOUT IT.>>DR. MARY GAIL MERCURIO: BUT WE DO, IN OUR OFFICE,
SCRAPE THE SKIN WITH A TINY BLADE AND LOOK UNDER THE MICROSCOPE FOR THOSE MITES, AND
THEN WE DETERMINE IF THIS WOULD BE A GOOD TREATMENT FOR INDIVIDUAL PATIENTS. SO, AGAIN, EVERYONE IS DIFFERENT, AND THAT’S
WHY THERE IS SUCH A VARIETY OF TREATMENT OPTIONS.>>BARBARA FICARRA: WOULD I BENEFIT FROM PURSUING
TREATMENT AT THIS POINT OR LOOKING AT OPTIONS?>>DR. MARY GAIL MERCURIO: YEAH, I WOULD CONSIDER
THE TOPICAL PRODUCT I MENTIONED THAT HELPS TO PREVENT THE BLOOD VESSELS FROM DILATING,
AND THE LASER IS ALWAYS AN OPTION.>>DR. PETER SALGO: SO, WHAT ABOUT THESE ALTERNATIVE
THERAPIES? DO ANY OF THEM WORK?>>DR. MARY GAIL MERCURIO: THEY WORK IN SOME PATIENTS. I DO HAVE PATIENTS WHO HAVE COME IN SAYING
THEY TRIED SOMETHING, SOMETHING THAT’S NOT FDA-APPROVED FOR THIS CONDITION, AND IT MAKES
THEIR SKIN FEEL BETTER. AND I’M ALL FOR SOMETHING THAT ISN’T HARMFUL
AND WILL WORK FOR ROSACEA.>>DR. LISA HARRIS: I THINK THAT’S THE ISSUE. YOU DON’T KNOW IF IT’S GONNA BE HARMFUL OR
NOT, AND IT’S NOT REGULATED. SO YOU DO HAVE TO MAKE SURE THAT YOU GIVE
THAT ADVICE TO THE PATIENT, THAT IF THEY’RE GONNA TRY IT, THAT IT’S AT RISK.>>DR. PETER SALGO: WELL, OKAY, FOLKS, THAT’S ABOUT
ALL THE TIME WE’VE GOT. BARBARA, I WANT TO THANK YOU FOR BEING HERE
AND SHARING YOUR STORY WITH US. AND, OF COURSE, PANEL, I WANT TO THANK YOU
FOR ALL OF YOUR INSIGHTS. WONDERFUL AS EVER. LET US KNOW WHAT YOU THINK ABOUT TODAY’S DISCUSSION
AND BARBARA’S SECOND OPINION BY TWEETING US OR BY COMMENTING ON OUR FACEBOOK PAGE. AND NOW HERE’S THIS WEEK’S “SECOND OPINION
5.”>>DR. MANASI LADRIGAN: HI. I’M DR. MANASI LADRIGAN, AND I’M HERE TO TELL YOU
ABOUT FIVE COMMON SKIN CONDITIONS THAT ARE FOUND ON THE FACE AND HOW TO TREAT THEM. THE FIRST IS ACNE. ACNE IN MEN, WOMEN, AND TEENS IS CAUSED BY
DIFFERENT FACTORS. ACNE AT ANY AGE IS NOT JUST A COSMETIC PROBLEM. UNTREATED INFLAMMATION IN THE SKIN CAN SOMETIMES
CAUSE SCARRING AND MAY BE A SIGN OF A PROBLEM ELSEWHERE IN THE BODY. NEW TREATMENTS ARE EMERGING REGULARLY, SO
GET IN TO FIND OUT WHAT YOU CAN DO ABOUT YOUR ACNE. THE SECOND IS SUN SPOTS AND WRINKLES, BOTH
SIGNS OF SUN DAMAGE. PRODUCTS WITH RETINOL AND PRESCRIPTION RETIN-A
CAN HELP WITH BOTH CONCERNS, BUT YOU’LL BE WASTING YOUR MONEY IF YOU DON’T COMMIT TO
USING A SUNSCREEN GOING FORWARD. A WIDE-BRIM HAT IS MUCH CHEAPER THAN EXPENSIVE
PRODUCTS, LASERS, AND PLASTIC SURGERY. THE THIRD ARE BROKEN BLOOD VESSELS, A FORM
OF ROSACEA COMMONLY SEEN ON THE CHEEKS, NOSE, AND CHIN. A SPECIAL TYPE OF LASER THAT TARGETS THE RED
COLOR OF THE VESSELS CAN EASILY TREAT THIS CONDITION. THE NEXT IS DRY SKIN. DRY SKIN NOT ONLY MAKES YOU LOOK OLDER, BUT
ALSO ALLOWS ALLERGENS TO GET INTO THE SKIN, MAKING IT MORE SENSITIVE AND PRONE TO INFLAMMATION,
LIKE ACNE, ROSACEA, AND RASHES. INCORPORATE A DAILY MOISTURIZER WITH SUNSCREEN
TO KEEP YOUR SKIN’S THIRST QUENCHED IN FIGHTING BACK AGAINST THE STRESSES OF THE ENVIRONMENT. THE LAST IS DARK CIRCLES UNDER THE EYES CAUSED
BY ALLERGIES, SLEEP DEPRIVATION, POOR HYDRATION, AND SUN EXPOSURE. WANT TO HAVE BETTER-LOOKING EYES? MAKE SURE YOU’RE GETTING AT LEAST SEVEN HOURS
OF SLEEP AT NIGHT, TRY NOT TO RUB YOUR ITCHY EYES, AND ADD AN UNDER-EYE MOISTURIZER — BEST
IF IT HAS CAFFEINE, ANTIOXIDANTS, AND SUNSCREEN. AND THAT’S YOUR “SECOND OPINION 5.”>>DR. PETER SALGO: THANK YOU SO MUCH FOR WATCHING,
AND REMEMBER, YOU CAN GET MORE SECOND OPINIONS AND PATIENT STORIES ON OUR WEBSITE, AT SECONDOPINION-TV.ORG. YOU CAN ALSO SEND US YOUR SHOW IDEAS AND SHARE
YOUR OWN HEALTH STORY. MAYBE — JUST MAYBE — WE’LL INVITE YOU TO
BE ON THE SHOW WITH US. YOU CAN CONTINUE THE CONVERSATION ON FACEBOOK
AND TWITTER, WHERE WE ARE LIVE EVERY DAY WITH BREAKING HEALTH NEWS. I’M DR. PETER SALGO, AND I’LL SEE YOU NEXT TIME FOR
ANOTHER “SECOND OPINION.”>>ANNOUNCER: “SECOND OPINION” IS BROUGHT
TO YOU BY BLUE CROSS BLUE SHIELD, ACCEPTED IN ALL 50 STATES. BLUE CROSS BLUE SHIELD. LIVE FEARLESS.>>ANNOUNCER: “SECOND OPINION” IS PRODUCED
IN CONJUNCTION WITH UR MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW
YORK.

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