Q. I have scaly rashes on cheeks without itching. What could it be?

Hello,

Welcome to icliniq.com.

I saw your picture (attachment removed to protect patient identity). I can very well appreciate the redness over your both cheeks, around lips, and some redness on my ears also along with a raised lesion on the left cheek. My best possible diagnosis is rosacea.

Rosacea is a skin disease common in fair skin people, and it presents like the red colored rash mainly on the face with few papules and dry flaky skin which you mentioned as your complaint also.

So, I would like to know whether the redness gets aggravated by any factor like after taking hot spicy food or drink or on exposure to sunlight? Any of these will support our diagnosis. I would appreciate that you have applied the right medication that is Metronidazole gel, but the problem is that alone will not help much.

I will advise you to apply a broad-spectrum sunscreen with SPF (sun protection factor) 60 over the whole face in the morning hours and repeat every three hourly like you can use at 9 AM, 12, and 3 PM. Additionally, you can wear a broad-brimmed hat also for sun protection. Also, take tablet Doxycycline 50 mg twice daily after food for at least six weeks. Apply Metronidazole gel and Azelaic acid 10% cream on an alternate daily basis in night time over the lesions only.

But, for any improvement to occur, you have to take treatment for at least 6- 12 weeks and avoid the things that aggravate the redness. Do not worry. You will get better.

Hello,

Welcome back to icliniq.com.

Hydrocortisone lotion contains steroid, which is not recommended in patients with rosacea. It will not reduce, rather it will aggravate the problems. So, please do not use it at all on your face. It will worsen only.

I would be happy if you will give a reply to my questions asked in my previous answer. Do you feel some irritation in the eyes also?

Hello,

Welcome back to icliniq.com.

If your dermatologist has diagnosed you as having seborrheic dermatitis, then please tell me if you are having scaling on your nasolabial folds or retroauricular folds means on sides of nose and back of ear folds? Are you having dandruff or scaling scalp? These feautres if present, will go in favour of seborrheic dermatitis.

And even if it is seborrhoeic, it is very easily treated with mainly creams and lotions. So, kindly tell me the answer of my questions. I would be pleased to help you further.

Hello,

Welcome back to icliniq.com.

It is a good news for you if you are having these signs and symptoms. Then it is more likely seborrheic dermatitis. And believe me, it is very easy to cure but regular treatment is advisable.

For scaly scalp, use antidandruff shampoo with combination of antifungal and salicylic acid available with various brands like Salisia KT shampoo or if mild scaling you can use plain antifungal like Scalpe shampoo.

For scaling on face, apply Eumosone M cream that is a combination of Clobetasol propionate and Micogel. This has to be applied once for folds and twice for cheeks. Use Flucort lotion once daily for scalp scaling once a week. It contains Fluocinolone acetonide. Try these medications for at least one week. Then reply to me about the condition. And once it is gone, I will tell you what to do to prevent frequent recurrences.

Hello,

Welcome back to icliniq.com.

I saw your pictures (attachment removed to protect patient identity), this time I could see the small blood vessels also clearly on your face, these are called telangiectasia. These again goes in favor of rosacea. In addition, you are not responding to steroids and fungicidal creams also.

I would like to know whether the redness exacerbated after applying Clobetasone butyrate, as I already mentioned in my previous replies that rosacea often gets exacerbated with steroid application?

For rosacea, you should use a broad-spectrum sunscreen protecting against both UVA and UVB (ultraviolet rays A and B) radiations with SPF 50 to be applied at 9 AM, 12 and 3 PM regularly. As of now, apply Clindamycin gel twice daily for at least a week.

Avoid any factor that exacerbates the condition like spicy food, hot or cold drinks, cold winds. I will advise you to take tablet Tetracycline 500 mg twice daily for at least a week. You can take the medications as advised by me under the supervision and kindly reply to my query.

Hello,

Welcome back to icliniq.com.

I could appreciate a liltle puffiness, visible small blood vessels and redness on your face. If you are not comfortable with oral medications, then you can proceed with topical Clindamycin gel twice daily along with sunprotection using sunscreen and physical barriers. As such there are no tests for rosacea, it is a clinical diagnosis.

I will like to know whether you have any gritty sensation in your eyes? Do you feel uncomfortable with sun exposure? Have you noticed any aggravating factor like hot/cold drinks, spicy food, emotions? As such it is not usually associated with any vitamin deficiency.

In previous queries, you told me about the scaling on your scalp, sides of nose, and ear. How is it now? So, kindly reply to my questions and start treatment preferably under supervision.

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Dr. Charu Bansal

Experience: 14 + Yrs

Dermatology

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