Q. A few months ago my face started breaking out with red bumps and blotches. At first, I thought it was acne, although it seemed odd for this to be returning at age 39. My dermatologist tells me I have acne rosacea, which is not the same as the acne one gets during adolescence. I understand there's no cure for this skin condition, only medicine to control it. Are there any new treatments on the horizon?
A. You're right about acne rosacea being different from ordinary acne. Rosacea usually starts at an older age, between 30 and 50. Like regular acne, rosacea causes pimples and cysts; unlike regular acne, rosacea also produces a reddish flushing of the face, especially around the nose and cheeks.
Since I last wrote about acne rosacea two years ago, a couple of new treatments have come along. The standard treatment for rosacea has been tetracycline. You can take this antibiotic in pill form or rub in on your face in cream form.
The newest topical medicine for rosacea is metronidazole (Metrogel), another antibiotic. This drug seems to be both safe and effective; the main side effect is irritation if you get any medicine in your eye. In one study, topical metronidazole worked just as well as tetracycline pills. Using a topical medicine avoids the small risk of internal side effects of oral tetracycline. Both of these medications are available only by prescription.
Some dermatologists have used the acne drug Accutane to treat severe cases of rosacea. Although not officially approved for this treatment, Accutane has been successful in clearing much of even the worst blemishes of severe rosacea.
In addition to taking medications, there may be some other things you can do to improve your rosacea. Certain foods, such as alcohol, coffee, tea and spicy foods can trigger flushing of the face, and make the rosacea look more noticeable. Cutting back on them may reduce the amount of redness you have. Other triggering factors include sunlight, extremes of heat and cold, and emotional stress.
Q. Our teenage daughter had her first epileptic seizure last year. Since then she has had two others, and is now controlled on medication. What are her chances that she will "outgrow" the problem? One of our concerns is whether she will still be taking her seizure medications if she ever becomes pregnant. Are there any support groups we can turn to for more information?
A. Many people used to think that once you had epilepsy, you always had it. Not true. In fact, chances are your daughter will outgrow this problem.
In general, once children have been free of seizures for two years, chances are about 75 percent that their doctor can safely take them off their medication and that they will remain seizure free. Those chances are higher if the child's EEG (brain wave test) is normal or nearly so and there are no signs of brain damage. Your daughter shouldn't stop taking her seizure medicine on her own, though. Doing so could spark a convulsion. Medicine should be slowly tapered under her doctor's supervision.
For information and support of adults with epilepsy and parents of children with epilepsy, contact the Epilepsy Foundation, 1012 14th St. NW, Suite 901, Washington, D.C. 20005, (301-638-5229). Groups meet in the District, Maryland and Virginia.
One helpful book on this subject is "Seizures and Epilepsy in Childhood: A Guide for Parents" by John M. Freeman, Eileen P.G. Vining and Diana Pillas (Johns Hopkins University Press, Baltimore, 1990). It discusses most concerns that parents of children with epilepsy have. Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.