DEAR DR. DONOHUE: As a teen, I never had acne. Now, at age 46, I do. I have tried many of the acne preparations on drugstore shelves, but I haven’t had much luck with them. In addition to the acne, the tip of my nose has turned red. Have you got any tricks for me to try? — L.J.

ANSWER: Acne in adults isn’t as rare as you might think. However, you ought to consider another possibility: rosacea (rose-A-shuh). Its onset is between 30 and 50. The people who come down with it are, for the most part, fair-skinned and have a tendency to blush easily. These characteristics are not true of every rosacea patient.

Redness of the tip of the nose, the forehead, the cheeks and the chin is often how it starts out. Tiny, spider-weblike blood vessels sprout up on the same skin areas. And an outbreak of acne on those places takes place. At least, it looks like acne. When all these classic signs are present, the diagnosis of rosacea isn’t hard to make. It’s more difficult when only one or two of those signs are seen. A dermatologist can give you a definite answer on this diagnosis.

If you do have rosacea, stay away from spicy foods and hot drinks. Limit alcohol use. Avoid the sun. When you go outside, no matter how briefly, cover your skin with sunblock that has an SPF (sun protection factor) of at least15.

Metronidazole is one of the medicines that control rosacea. It comes as a gel, lotion or cream. Finacea gel is another often-prescribed product. If your skin doesn’t respond to medicines applied directly to it, the next step is oral antibiotics. Oracea (doxycycline) is one example.

For the tiny blood vessels that spring up, the doctor can use a laser to rid you of them.

Quite often, the eyes are involved in the rosacea process. They dry out and feel like grit is in them. They have to be kept moist with artificial tears or similar products.

Do yourself a favor. Contact the National Rosacea Society at 1-888-NO-BLUSH or at www.rosacea.org. The society provides people with up-to-date information and alerts them to any new treatments.

DEAR DR. DONOHUE: My doctor shocked me when she said I had a ruptured eardrum. This was on a routine exam. She didn’t elaborate at all.

Do I need a specialist? Will this progress to deafness? The ear isn’t painful. I can’t remember injuring it in any way. — R.K.

ANSWER: A perforated eardrum is a less-unsettling term than a ruptured eardrum. It’s a hole in the eardrum. Most such holes are small and heal on their own. You ought to be on guard about getting water in that ear. You need to follow up with the doctor to make sure the hole has healed. It won’t make you deaf.

Sometimes people create a hole when they try to dislodge earwax from the canal with a cotton-tipped applicator. A slap to the ear is another cause of eardrum holes. An infection of the middle ear can lead to one, too. I’m sure you’d remember if any of these things had happened to you.

DEAR DR. DONOHUE: I have to take Coumadin to thin my blood. It always is ordered by the brand name. My doctor doesn’t want me to take a generic. When I went for my last refill, the pharmacy was out of brand-name Coumadin. The pharmacist gave me a generic version. After taking one tablet, my tongue swelled, and my husband rushed me to the hospital. They gave me an injection that took the swelling down. How could the brand name and generic be so different? — E.K.

ANSWER: They aren’t different in the active ingredient in the tablet; they can be different in additives, like substances that affect the drug’s ability to dissolve or the coloring used or additional filler material. This sort of reaction happens most infrequently. You must stick with the brand name.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.