To Your Good Health: Rosacea Makes Sun Exposure an Enemy

Dear Dr. Roach: I am a 95-year-old, fair-skinned woman in good health, except for rosacea on my nose in the past year. Sunshine is my worst enemy. Is there any advice you can give me before I see my dermatologist? I’m not too eager to use oral antibiotics. — H.B.

Answer: Rosacea is an inflammatory skin condition affecting the central face. There is no cure, but the disease can be managed. You are quite right that sunlight can be a big problem for people with rosacea. Stay out of the sun when you can, and when you do go out, use a wide-brimmed hat and generously apply moisturizers with sunscreen. This can be a big help.

Mild soaps used once a day are best. Stay away from chemicals like toners or astringents. Hot foods (temperature, not spice) often cause redness and flushing, and should be avoided.

If these behavioral changes don’t help, then topical antibiotics, such as metronidazole or topical azelaic acid, can be very helpful in mild to moderate cases. Laser therapy often is used in more severe cases. Oral antibiotics are an option for some people, but there are many other available treatments. Your dermatologist will help you sort through these choices. There are several subtypes of rosacea, and a dermatologist’s advice will be based on your particular case.

Dear Dr. Roach: This will sound ridiculous, given the life-or-death problems that you comment on. Now that the days are getting sunnier, I am reminded of a problem I have had since childhood. (I am now 62.) Virtually every time I step outdoors from a darker environment into bright sunshine, I sneeze, usually twice. If I am with someone and explain it to them, I am looked at as if I am insane. Have you ever heard of this? If so, why does it happen? — R.F.

Answer: You are not insane, and you are not the only one to experience this condition, which is called the photic sneeze reflex. Aristotle and Sir Francis Bacon both knew about this reflex, so you need to get some more philosophers as friends.

This is a genetic condition — at least one of your parents had it — but it doesn’t cause any other conditions or problems. It is thought to be caused by the reflex causing your eyes to constrict in the sun, which is mistakenly picked up by the nerve from your nose to trigger a sneeze. As many as 10 percent to 35 percent of the population have this condition.

A military study of fighter pilots showed that wearing sunglasses eliminates the sneezing.

Dear Dr. Roach: Before I go for my blood labs, I have to fast for 12 hours. Chewing gum would be a welcome relief. Sugarless gum has something called “sugar alcohols.” Will that break my fast and spoil my glucose reading? — R.K.

Answer: Sugar alcohols, like xylitol or sorbitol, aren’t absorbed as much as sugar. But they are partially absorbed, and that can confuse your glucose reading. The range of normal blood sugar levels is very different if you are fasting compared with nonfasting. Sugar alcohols, because they aren’t well-absorbed, can cause diarrhea in some people.

A 12-hour fast? Your doctor is cruel — eight hours is sufficient for fasting glucose. Water, black coffee or tea (no sweetener) won’t upset your sugar reading.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.