You may notice as you browse this site that I always place quotes around the term “Rosacea” whenever I speak of it. The reason is because, in my opinion, there is no other inflammatory facial condition that has been misdiagnosed and mismanaged as frequently. Not surprising is the global pessimism, retirement, and depression surrounding a condition that is fumbled with as the standard of care.


The scary part is that most of these diagnoses and treatment attempts are coming from the most credentialed board certified dermatologists around. When a consensus of real experts are seen as off-point so often, it has to be considered that there is not only a diagnostic inconsistency, but maybe one of a semantic discrepancy…? (i.e. doctors are calling anything that is red rosacea as a “working diagnosis” to introduce treatment attempts. This idea would be reasonable except…, the diagnosis itself often times creates a self-victimizating mindset which can then perpetuate the spiral of hopelessness.)


When I make an adamant stance on this blog, I’d like it to be understood that these expert opinions are being made within the reality that there is no right and wrong in the world of art, and that medicine is certainly not a hard science. The “standards” of westernized medicine have accidentally mislead many people to believe they are speaking in fact rather than outcome statistics. Given that I’ve spoken to thousands of people who are needlessly suffering from “Rosacea” despite treatment at this time, it seems appropriate to both challenge the standard algorithm and to give insight into the treatment of skin that is inflamed, red, flushing, and uncomfortable. As always, these opinions have not been generated from any form of solitary imaginative thinking. Rather, they have been derived from paying extremely close attention, succeeding in the most hopeless clinical situations, and of course, video taping the results.




I will break this important post into two main categories. Those who have been misdiagnosed with “Rosacea” and those who have been accurately diagnosed yet still have failed the standard of care.

1) The Epidemic Misdiagnosis of Rosacea:

If your skin is red, raw, irritated, has broken blood vessels, has sensitivity to light, spicy foods, alcohol, and heat…., you will probably get a diagnosis of Rosacea from many primary care physicians and dermatologist alike. As mentioned above, they may be using this diagnosis as a quick “working diagnosis” to initiate attempts at treatment.
Here’s what physicians and patients are not taking into consideration when making this diagnosis:


-Oily skin alone can cause all these symptoms also.
-Acne prone and inflamed skin from acne can also cause these symptoms.
-Seborrheic Dermatitis causes all these symptoms as well as eye irritation. (there is also an epidemic misdiagnosis of ocular rosacea)

Read this part closely:
-Oily skin causes Seborrheic Dermatitis. (a chronic skin thickening and sensitivity due to oiliness or what is called “seborrhea”)
In a high maintenance patient, Seborrheic Dermatitis will not have the classic scaled and thickened appearance because this patient is constantly removing the flakes every day. Instead, they will present with only red, sensitive, flushed, uncomfortable skin. This presentation is not easy distinguishable on physical exam from rosacea and the misdiagnosis and lifetime treatment failure are driving millions of people crazy.


Here’s a very important sidenote to prevent any new self-vicitimation after hearing the diagnosis of Seborrheic Dermatitis:

All oily-prone and acne-prone patients are also prone to a bit of thickening and seborrheic dermatitis. This diagnosis is simply descriptive and in no way dooms people. It’s tricky, but like acne, is always treatable as proven in the redness videos on the home page. I refer to this type skin as “troubled skin” to avoid the emotional pitfalls of hopelessness that are generated from labels and diagnoses.

2) Those with Classic Rosacea who are still suffering:
If the diagnosis of Rosacea has led you and your doctor to a victory over your facial inflammatory ailment, I’m very glad to hear it. This section of the post is for those who have the classic and obvious diagnosis of rosacea yet still have not achieved inactivation despite going deep into the 20 year old algorithm of topicals like metronidazole, antibiotics like tetracycline, and finally isotretinoin. What is important for this group of sufferers to know is that all inflammatory conditions of the face and body are treatable. Inflammation only propagates for years when improperly treated. Let it be known worldwide that the classic rosacea treatment algorithm has helped millions and failed millions. Do not be baffled or depressed if your rosacea is not responding. It happens all the time. This condition is also completely treatable in this practice. Feel free to send your story and focused photos if you’ve tried “everything” and still need some help with it.




This post is intended to be read by both confused patients and practitioners themselves.


To the passionate doctors of the world,

“Please hesitate before dooming someone with the misdiagnosis of Rosacea. All that is red, sensitive and irritated is not “Rosacea”. Here’s some tips that will prevent the misdiagnosis:

-Tip #1: If a patient has a history of acne, oily skin, blackheads, and sensitivity issues, consider you are working with an acne-prone skin manifestation we call seborrheic dermatitis.

-Tip #2: Many patients with Seborrheic Dermatitis won’t present will scales because they are diligently removing them in a desperate effort to get clean.


Furthermore, when confronted with a real case of classic non-oily rosacea, think twice before ending the management of it after the basic cookbook algorithm is exhausted. These chronic conditions sometimes take more touch than knowledge. We know they don’t really teach the art of medicine in medical school. It’s something that needs to be indulged and cultivated by each and every passionate practitioner.”




The Acne Practice video project represents much more than just an acne solution for those who have become hopeless.

In a world where Acne, Rosacea, Seborrheic Dermatitis, Low Back Pain, and Heartburn are not curable, I’m introducing and illustrating, in high definition, a completely new medical treatment paradigm that is a step forward from the approaches of both traditional Western Medicine and ancient Eastern healing. I will be detailing this new medical paradigm for all chronic ailments in a future post which will break down the history, strengths, weaknesses, and fundamentals of all medicine that is commonly practiced at this time.

I’ll be here,
-Dr. Neal







©2011 “The Epidemic Misconception of “Rosacea” by Dr. Neal Schwartz

For those of you I’ve never met in person, there is now a short introduction video clip on the About Dr. Neal page:

My skin feels great today. It’s not just that it looks alright. The sensation of heaviness, itchiness, heat, bumps, and irritation has been removed. Like removing a thorn from a paw, the physical catharsis feels incredible. For those of you who know me from the former office, you’ll quickly notice my first beard in 35 years. This transformation of feeling ultra-clean while growing facial hair seemed an impossibility a few years ago. Whenever the 48 hour mark of not shaving would come around, my face would get uncontrollably oily and the resulting irritation and bumps would be unbearable. It was yet another great journey of life I avoided due to my skin. I’m happy to say that this inhibition is gone and my face feels completely comfortable with the beard. The freedom and level of control is hard to believe sometimes.

You may be wondering why I keep showing my surf videos on an acne practice site…

It relates to the conversation above. While battling with my own skin for the past 20 years, I found myself avoiding many situations that would send me over the edge.

Here are some of the things I used to unconsciously and consciously avoid in an effort to maintain a reasonable level of control in my life:

the beach (suntan lotion, sweat, and humidity was quite a stress test)

skiing (sweat and goggles, hats, and neck warmers caused trouble for me)

any outdoor activity like a barbeque, outdoor party, or gathering. (the humidity or the cold would cause my angry skin to act up)

any sun exposure (due to direct discomfort of inflamed skin)

daytime socializing in general. (outside weather of all types would cause facial discomfort)

It wasn’t exactly the most chill existence…, 20 years of it on and off in varying degrees. Come to think of it now, it was a living hell inherently. But as a very resilient and optimistic person, I developed many methods and tactics to cope with the discomfort of life. One of those was to recklessly throw myself into projects and work. The classic workaholic is someone who immerses themselves in their passionate work partially to escape the pain of the world outside of work. In my case, the pain was a day off. The idea of taking a stroll in the park on a day off sounded like a day to be reminded that my skin was tingling, red, flushing, and angry. It was the perfect setup for imbalance, a life of stress and disease, and an existence that would surely have been riddled with deep regret if not corrected.


While running from aggravating circumstances, I found myself not eager to get to the beach or to the mountain ever. This lack of desire was in absolute contrast to my childhood and looking back, was a clear sign that my health was not in balance. The idea of blazing my already inflamed skin with sun and lotion was just not worth the pain of both the day’s discomfort and the inevitable aftermath of oil and bumps. Simply put, it wasn’t worth the consequence and I made unconscious and conscious decisions to avoid some of the best things in life. For example, a stroll outside on a sunny day…

So here’s the story of transformation:


I’m no longer inhibited. I’m not scared of suntan lotions, and not scared of the sun. I’m not avoiding outdoor activities in any way and can control my skin in all environments with efficient efforts. While there is no cure for anything chronic, now that my mind has eased and my skin feels comfortable, I feel that I am “cured”


This video below represents my newly found celebration of life as a person who is no longer punished by enjoying a beautiful day outside in the water. I live without fear or inhibition. I’m currently working on a new video tutorial project to ensure that no one else ever needlessly suffers and avoids life like I did.


(just started surfing a few years ago. try full screen)

It’s been a wild journey.
I hope this blog helps others observe their own emotional reactions to the challenges of life.
-Dr. Neal

My hope is that many people will show this next video to both their dermatologist and their ophthalmologist.

Chronic acne is not just about bumps. There are many things going on with the skin and the surrounding structures. Many people with this irritating condition complain of eye itchiness, discomfort, sensitivity, tearing, a tired look, discolored lids and under eye area, and sometimes even incapacitating stinging. Acne patients will often times not make the corrolation that this eye problem is related to the chronic condition on their face and seek an eye specialist.

Here’s the problem:

Most eye specialists are not experts of oily, dry, or acne prone skin and will attempt to treat the eye alone without noticing the rest of the face is activated. This type of experience causes regular acne patients to take home misdiagnoses of ocular rosacea, dry eyes, foreign bodies, or any other diagnosis that slightly fits the presentation of uncomfortable eyes.

Once in a while, a clever ophthalmologist will recognize the oil on the face combined with the thickened lids and correctly diagnose the patient with seborrheic dermatitis of the eyelids. However, when it comes to chronic condtions, the correct diagnosis is not the tough part. Treatment of seb derm (oily thickened skin) is far more tricky than the recognition of it.

These patients will typically go home with the proper diagnosis and several ways to remove the thick flakes and oil from their eyelids in an attempt to get comfortable eyes. It will alleviate many patient’s symptoms but leave others with a partial band-aid that never really makes it to the threshold of comfort.

I lived with uncomfortable eyes for about a decade, sometimes so sensitive that a moment of sunlight would cause a blinding sting and tearing. It’s uncomfortable and distracting from any normal social interaction. If you are panicked without your sunglasses like I was, consider you may have a little irritation of your eyelids.

Here’s the interesting part:

When you control the rest of the acne and oil on the face, the eyelids will follow. This next video shows an amazing example of how when you fix a person’s skin activity, the eyes can heal up completely. (we did not use any special eye treatment in this case. They become less inflamed as his face began to heal)

Please show this video to your ophthalmologist and your dermatologist if you have ever suffered from acne and are now dealing with sensitive eyes. Your doctor can call me anytime.

(the full screen button is in the lower right corner)

©2010 “Sensitive Eyes and Acne?” by Dr. Neal Schwartz

Our mission of bringing hope to those who have failed “Everything” continues with this unbelievable case.
(The full screen button is located in the lower right corner)

Enjoy!

Part 2

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©2010 “Severe Acne: A Case Study” by Dr. Neal Schwartz

If you’ve been reading my blog for awhile, you may have picked up some of the new language I use to describe issues of the skin.

Here’s another term I like to use to describe one of the trickiest skin situations that is commonly encountered.

Dr. Neal’s definition of “Troubled Skin”:

acne-prone skin that is oily, sensitive, thickened, prone to flushing, prone to redness and flaking, prone to premature aging, prone to discomfort and often times intolerant to all types of topical preparations. (Although often times seen in post-accutane patients, this situation can occur in any chronically oily patient)

If left inflamed for decades, the uncomfortable sensation and premature aging can dramatically effect a patient’s emotional stability and wellness.

Anxiety is the norm in patients caught in this chronic situation.

Case Presentation:

This highly intelligent and likable guy suffered for 10 years despite the greatest of efforts to get past the beast of troubled skin.

He had tried and failed:

Accutane
Benzamycin
Epiduo
Sulfacetamide
minocycline
Alkaline Diet
multiple other food restrictions
All OTC combinations

When he arrived at The Acne Practice, he was very anxious and complained of acne, oily skin, uncomfortable skin, flushing, and redness.

Watch very closely as the most difficult type of Post-Accutane skin situation can also be completely transformed.

This case, and others like it to come, represent both the stuggle I myself went through for years and what is possible for ALL chronic inflammatory conditions of the human body.

If you listen to my bio, pay close attention to the time in my life where my skin could not even tolerate exposure to water. During this time, my skin was very “troubled” and it took some time to get out of that highly inflamed situation.

Patients who have already taken Accutane often times run into the situation of Troubled Skin because they are unable to remove the ever-present oil due to issues of extreme skin sensitivity. Any product they use to cleanse the skin can turn them bright red and flushed. It’s a very tricky situation to navigate as too little cleansing leaves them an oily mess and too much leaves them flushed, inflamed, and often times incapacitated by facial discomfort.

My hope is that this blog, these videos, and this practice will bring awareness to this real health issue.
(I call it “Troubled Skin”)

For awareness sake, I think its fair to say that most dermatologists, primary care doctors, and skin care experts fumble around with this type of ultra-sensitive, troubled skin. You may be handed a diagnosis of “Rosacea”, “Seborrheic Dermatitis”, or “Eczema”. And then may be handed guesswork from topical anti-inflamatories, metrodnidozole, tetracycline, tar, zinc, selenium, special diets, and the list of guesswork goes on and on.

The real diagnosis in this situation is usually Acne combined with Seborrheic Dermatitis, but this doom and gloom diagnosis will not help anyone whose face turns bright red with the immediate application of any topical preparation.

The new term “Troubled Skin” has a much more clear and optimistic plan as a patient can imagine that what gets troubled, can eventually get Well in time with the proper assistance.

The diagnosis Seb Derm or the common misdiagnosis of “Rosacea” for this situation will only enhance the self-victimization of those who will inevitably focus on the misconceived idea of “no cure”
(we’ll talk more about “no cure” for all chronic conditions in future posts)

I hope this video and blog will create global awareness and optimism for this relentless situation.

-Dr. Neal

©2010 “Troubled Skin” by Dr. Neal Schwartz