Dr. Payal Chauhan
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have strange redness and red spots on my face. I have photos to attach. It came up one day six months ago for no particular reason. Since then, it has been on and off in terms of severity but never completely disappeared. At first, I thought it was dry skin and tried some moisturizer and reduced the use of hot water on my face, but no change. It seems to be getting worse and getting better for absolutely no reason. I am unable to pinpoint any cause for it. I have never had this before ever in my life, and as I said, it came up one day for no reason. I had not changed anything. I have used Proactiv for my whole life. But not that high on my face, so it is unrelated to that. Past history of the same issue. Never until six months ago out of the blue.
Hello,
Welcome to icliniq.com.
It looks like an eczematous rash only (attachment removed to protect patient identity). It could be due to dryness, or excess seborrhoea which is getting exacerbated by sunlight exposure.
Use the following medicines they should help,
1. Fluticasone propionate 0.05% cream once a day at night.
2. Cetaphil gentle cleansing lotion twice a day for washing the face.
3. Cetaphil moisturizer twice a day.
4. A good sunscreen of SPF 30 at least at 9 am, 12 pm, 3 pm, 15 to 20 mins before going out in the sun.
5. Tablet Levocetirizine 5 mg, if there is irritation or itching.
Follow-up in two weeks to see whether this needs to be continued as such or if any changes are required.
Patient's Query
Hello doctor,
I have been using a moisturizer for previous images sent, which has helped. The problem is that lately, I have been getting this weird rash on both sides of my face in the exact same spot. I have never had this in my life before until the last couple of weeks. It is really strange. I am wondering what your thoughts about it are. A bit of history is that I have used Proactiv on my face since I was 17 and I am 31 years old right now and still get breakouts so still use it. But like I said this seems unrelated to that as I have never dealt with this before. They are not like pimples. They are more just red pores or rash. Just wondering for some advice on this. I am attaching pictures for your reference. Kindly suggest.
Hello,
Welcome back to icliniq.com.
Along with seborrheic dermatitis, rosacea can be the other possibility. As the moisturizer helped it a bit, you should continue that along with the sunscreen and the cleanser but stop using Fluticasone if you have started that. Use the following cream which will work in both conditions and is used in place of steroids to avoid the side effects. Use it once at night only on the red spots. Elidel (Pimecrolimus) cream 1 %. Seborrheic dermatitis can be due to excess seborrhea (dandruff) and rosacea is an inflammatory condition that initially starts as persistent erythema, prominent pores which increase on sun exposure, eating hot and spicy food, or having emotional bursts.
Thank you.
Patient's Query
Hello doctor,
Yes, the moisturizer definitely worked. The problem is I cannot really put it where this rash has come up in the photo I sent you as this will cause a breakout. I use Proactiv on most of my face and have done so since I was 17. I am now 31 and still get the occasional breakout, which makes me wonder when that is ever going to stop. But anytime I have tried moisturizer in the parts of the face where I have used Proactiv it seems to result in a breakout, even when I do use the ones that say they do not clog pores etc. I feel like this is linked to that somehow. I have tried going off Proactiv in the past and it has ended badly so that definitely is not an option at this stage. I do not believe it is rosacea though. It is just very strange and frustrating. The rash seems to come and go for no particular reason. Sometimes there are little pussy pores and other times the pore themselves are just red.
Hello,
Welcome back to icliniq.com.
Another possibility is superficial bacterial folliculitis. Which present as tiny about mm size red papules or yellowish follicular pustules or pus-filled tiny bumps or without it. They can also be recurrent and itchy. The main reason for these folliculitis lesions to recur is Staphylococcus aureus in the nasal vestibule and other skin surfaces. If that is the case then, they can be treated by removal of these bacteria starting with topical antibiotics for seven to ten days. Use the topical antibiotic in the nasal vestibule, nasolabial area, skin behind ears, nail margins, and chin fold such as cream T-bact (Mupirocin) twice a day for 10 days. And then follow up once
Thank you.
Patient's Query
Hello doctor,
These photos are now the worse it has ever been. Do you think it is rosacea or not? I am going to have to go see a dermatologist face-to-face.
Hello,
Welcome back to icliniq.com.
Yes, it looks like early rosacea to me in the photographs (attachment removed to protect the patient's identity). Use Elidel 1 % cream I have prescribed and sunscreen. Visiting a dermatologist in person is definitely the best option as it gives the best possibility of reaching a correct diagnosis. But it looks like rosacea to me.
Thank you.
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