Dear Doctors, I have struggled with rosacea and associated inflammation/infection for 17 years. I hope the following information regarding my symptoms and treatment will provide enough information to help with suggestions or recommendations about this condition. At 16 I began developing inflamed red blotchy raised patches on my face. The rash originated on the sides of my chin and under my nose, and over time spread to my eyes and even into my nostrils. The rash was less inflamed in the mornings, but became increasingly inflamed as the day progressed. The use of over the counter acne treatments (benzol peroxide products, astringents, etc.) were ineffective and often further inflamed the rash. Following a year of unsuccessfully battling this condition, a family member offered me a tube of lotrizone. The improvement was immediate. The rash disappeared in only a couple of days. The only problem; when I discontinued the cream, the condition quickly returned. I did seek the help of the physician in our small town, but my doctor wasn’t able to diagnose the condition, and continued to prescribe me lotrizone. Two years later, I moved to a larger city, where I had the opportunity to visit a dermatologist. She instructed me to not use the cream for a week. Once the rash returned, she examined it and quickly diagnosed me with rosacea and an acne related infection. She prescribed 1000mg per day of tetracycline, and MetroGel for topical use. The gel was harsh on my face and I only used it for a couple of days. However, the antibiotics worked and within a week of the month long antibiotic regiment, my skin had cleared. Over the years, most often triggered by cold weather, the condition has flared, and a coarse of antibiotics is prescribed. (A second dermatologist some years later, disagreed with the rosacea diagnosis, stating the condition was eczema. However, he prescribed the same treatment regimen of antibiotics / MetroGel. ) 17 years later, I feel I’m back at square one. Over the last couple of years, the tetracycline has become ineffective, which is thought to be the result of having developing resistance to the medication. Doxycycline was prescribed, but due to an acute reaction, I had to discontinue use. The antibitic ‘Sulfa’ was considered but rejected by my doctor due to dangerous side effects. Following a recent visit to the MD, I am now taking a new class of antibiotic, (keflex – which was actually a recommendation made by a pharmacist following my severe reaction to the doxycycline ) and a Metro Cream instead of gel, which has proven less irritating to my skin. In addition to an oral antibiotic, the doctor suggested I mix a very small amount of lotrizone, (clotrimazole and betmethasone dipropionate Cream USP, 1%/0.5%) with the newly prescribed Metronidazole 0.75% and apply topically. I ‘initially’ opted to not to mix the two, preferring to stop use of the topical steroid altogether. But after only two days of not using it, the inflammation returned, spread quickly, and my skin became sensitive to even the slightest touch. Assuming both dermatologists were right, and I have a combination of rosacea and eczema, can you offer some suggestions and information about the following concerns/questions? 1. Is it possible my skin has become addicted to the lotrizone? 2. If so, how do I wean myself off without having major flare ups? Can using increasingly milder steroid creams be a reasonable method of achieving this, or is the mixture recommended by my current MD a suitable option? 3. Does the use of lotrizone inhibit the effectiveness of an oral antibiotic by hiding or suppressing the symptoms? 4. Is there a way to reinforce my skins strength in areas where the lotrizine is being applied to thwart thinning skin? 5. Could resistance to the appropriate class of antibiotics mean I may have to resort to long term topical steroid treatment? Despite many years of repeat flare-ups, varied creams, and month long cycles of antibiotics, I have been fortunate to have not sustained any real, or at least visible, skin damage. When free of flare-ups, my skin is quite healthy and clear. And at 35, I realize my skin may not continue to be as resilient as it has been. In addition to help with the questions posed, I would welcome any suggestions or guidance on how to manage this recurring condition in a way that minimizes the negatives, like further antibiotic resistance and skin damage. Thank You.