Rosacea

Patient is 76-year-old man who discussed with me that he has had increasing runny nose and nasal congestion for the last two years as well as watery eyes. He does also have swelling in his face and eyes in the morning and redness/flushing occurring on his face. He has seen his primary care provider and a dermatologist for this and they have expressed to him that this may be rosacea, but he is wondering if it may be associated with allergies. He states that his father and brother both had very severe allergies in the past as well.

He has had allergy symptoms all his life but within the last year it has been becoming worse. He states that he has clear nasal discharge, postnasal drip, frequent nose blowing, nasal stuffiness, mouth breathing, frequent nose bleeds, snoring, and heartburns that occurs everyday. He has had chronic sinus infections in the past. He had nasal surgery in the year 2000 and that really reduced his sinus trouble. He gets frequent headaches behind his eyes. He denies any nasal polyps, TMJ, aspirin-induced nasal symptoms, or frequent bad cold. He did have frequent tonsillitis as well prior to sinus surgery. He states that his nasal symptoms are moderate. He used Benadryl, Claritin, or Allegra in the past. They do seem to affect his prostate function so he tries not to use these. He did have his last CT scan of sinuses done in 2000.

He denies frequent ear infection, dizziness, or lightheadedness. He does have some hearing impairment and wears hearing aids.

He does admit to having eye itching, redness, tearing, light hurting his eyes, eyelid swelling, or eyelid irritation. He denies dryness, burning, and yellow discharge from eyes. This occurs a lot of the time. It does seem to be worse at certain time of year than other times.

He denies any history of wheezing or lung troubles. He denies any allergic skin troubles and he has never been evaluated for allergies before.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Rosacea.
4. Coronary artery disease.

PLAN:
1. At this time, I discussed with he is significantly allergic to his environment and it may be contributing to his chronic nasal congestion as well as eye puffing and irritation that is occurring regularly. I would like him to do a prednisone dose of 30 mg for the next four days to help resolve some significant inflammation that I saw on physical exam.
2. I also gave him a prescription of Nasonex nasal spray to use one spray each nostril twice daily to help maintain control of his allergy after the prednisone dose is done.
3. We did discuss that he can try using Claritin or Zyrtec as needed to see if it helps flushing of his face and swelling however he stated that it does affect his prostate so he will use it minimally as needed. It may be more of a rosacea that is hard to treat and he may need to identify his certain triggers and avoid them to help with this.
4. We will follow up in one month to see how he is doing if this treatment has been working. He was interested in allergy immunotherapy potentially and we can pursue that if medication interventions are not effective.

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