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Dead skin due to allergic reaction, muscle pull in nose and jaws. Can I fix face structure to normal?

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Dermatologist
Practicing since : 1996
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I would like to chronologically describe the events that have transpired over the last 9 years leading to this problem.
When I was in my high school I had an acute acne problem, to surmount the disease I was recommended a coal tar based cream. I applied the cream liberally and copiously for the next 4-5 months. The cream had a peculiar tendency that it used to very hard when left to dry over the skin and used to put a lot of pressure on my face to extent that I was unable to move my facial muscles for the time it was applied. Once the acne subsided I discontinued the cream, but I noticed a strange deformation/change in my facail structure. Very soon (in one year's time of application of cream) my facial structure was changed so much so that people familiar to me: close friends, relatives etc. whom i have met after a hiatus of 6 months' time refused to recognize me, according to everyone without exception I had changed a lot in those 6 months. Though I had very few photos of my recent past I tried to compare 1 year back me with present me and noted following observations: eyes had sunken in, nose had protruded out, lips swollen, forehead swollen out, chin dropped down and the area from temple to cheeks had become remarkably swollen. Meanwhile the same time another development took place which continues till date: the area where the nostrils meets the face there was a growth of dead skin and the covering that you typically see during healing of a wound, I have consulted a lot of doctors to get rid of this outgrowth but to no avail. There is another phenomena that continues till date: there is a continuous pull up of facial muscles from bottom of my face(jaw area) and near temple area towards the nostril area where there is 'wound healing type outgrowth'. This continuous pull up muscles happens day in and day out 24X7, sometimes with less intensity and sometimes with more intensity. In the initial days when the intensity of the pull was of very very high I could feel a slight but sure change in the facial structure with eyes filling in, chin moving up etc, basically what seemed like a facial restructuring. This phenomena is very very disturbing for my concentration while studying and my concentration span has decreased drastically because of this movement.

I hypothesize my problem due to following: Due to the application of the coal tar cream my face has become completely deformed almost instantaneously( span of 4-5 months) after discontinuing the cream my face tried to gain it's original structure by pulling up the muscles from the nostril area and by healing the wound there, but has been largely unsuccessful in doing so and continues to try till date.( though the intensity of pull was very very high in the initial 1 year it has gradually faded to a constant value over the years).

Why I need to fix the problem:
1. This problem i.e of dead skin and 'wound healing type outgrowth' continues till date for the last 9 years, it looks very ugly and embarrassing, though I have brushed it aside as an allergic reaction till now.
2. The continuous muscle pull over for last 9 years from the jaw and temple area towards nose area is a real concentration breaker and is making it more and more tough for me to concentrate on anything.
3. The damage to my facial structure leads to people I XXXXXXX after some time totally not recognizing me, which is very embarrassing and a self confidence dampener.

What Needs to be fixed: My facial structure to it's original form

How to fix:
By accelerating the healing process near the nose etc ????

I have undergone some medications over the years to surmount the Problems 1 & 2 mentioned above but to no avail. The doctors over time have concluded that I have no neurological or psychiatric problems and my blood test reports are completely ok. Though I have not described my problem to any of the doctors in such length and have just stated the problem without the background.

Thank you for the help
Posted Fri, 13 Apr 2012 in Skin Hair and Nails
 
 
Answered by Dr. Bharat Chawda 4 hours later
Hi,

Thank you for posting the query,

You have provided with good information regarding your skin problem and it is a very good description. I appreciate it.

I understood your problem; however I would be grateful if you can answer a few questions so that I can help you better:

1) Why have you been using coal tar for acne? It is not usually prescribed for acne.
2) Was the cream given to you was only coal tar preparation or a combination with salicylic acid cream also? I would like to know the exact name of the cream.
3) What other medication were prescribed to you at that time when you had acne?
4) Did you use a sunscreen during that time?
5) What kind of treatment you have taken for your present problem and have you at any time consulted a dermatologist for your present problem. In case you consult a dermatologist (which you should) please do tell him about your coal tar abuse.

Before I discuss further, I would like to tell you that coal tar is not a treatment for acne. In fact , people who are exposed to coal tar can suffer from "Tar acne".

To begin with, there are lot of side effects of coal tar cream applied topically over the sun exposed areas of the body. Use of sunscreen is a must in such a case. Application of coal tar can lead to tingling and burning sensation .It has a malignant potential too (can lead to cancers) especially in long term exposure over sun exposed areas of the body.

I would also like to have a clinical look at the lesion or the skin problem you are having .If you can post me few pictures of the same using the Upload your reports section on your right, I would be able to help you further.

I can completely understand what you are going through and the answers you are seeking, but all your questions can only be answered once we have reached to a conclusion.

Awaiting your reply

Awaiting for your reply.
Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: Dead skin due to allergic reaction, muscle pull in nose and jaws. Can I fix face structure to normal? 1 hour later
Sir,
Thank you for your valuable insight.

I am attaching the photos for your reference. As can be seen the region near nostrils are affected with extra growth and this is after I used tweezers this morning to remove them. The whitish color in the complete area near nostrils is distinctly visible after face wash. The various features like "eyes had sunken in, nose had protruded out, lips swollen, forehead swollen out, chin dropped down and the area from temple to cheeks had become remarkably swollen" that I have described earlier can be seen here.(Though these features might be subtle at first look they are remarkably different from that of my earlier look)

Answers for your queries are as below:
1) Why have you been using coal tar for acne?
Ans:- It was as prescribed by the doctor.

2) Was the cream given to you was only coal tar preparation or a combination with salicylic acid cream also? I would like to know the exact name of the cream
Ans:- As far as I remember it was a combination with salicylic acid. I am sorry but I cannot give you the exact name as it was not a proprietary medicine but just a concoction(maybe copy of some proprietary medicine) prepared by the chemists/doctors of XXXXXXX Lal Nehru Hospital, Bhilai.

3) What other medication were prescribed to you at that time when you had acne?
Ans:- With this cream some antibiotics were prescribed for 3 weeks' period as far as i remember.

4) Did you use a sunscreen during that time?
Ans:- No

5) What kind of treatment you have taken for your present problem and have you at any time consulted a dermatologist for your present problem. In case you consult a dermatologist (which you should) please do tell him about your coal tar abuse.
Ans:- Sir, I have been to 2 skin specialists and 1 General Physician over the last 3 years. After I told them about the muscle movement/pullup problem, all of them referred me to neurologist, psychiatrist and recommended tests for complete blood picture, liver function test, Thyroid test etc. The blood tests were ok all the 3 times and I was cleared off by neuro and pyscho as ok both times. Though it was a mistake on my part for not telling the background and only the problem.

Thank you for the help.
 
 
Answered by Dr. Bharat Chawda 3 hours later
Hi! XXXXXXX

Thank you for the reply and the pictures,

Well as far as the preparation which was dispensed to you is concerned, was from a reputed hospital ,and I have my own doubts whether it was actually coal tar or was it calamine lotion along with salicylic acid.Salicylic acid is a common prescription given for acne and is often mixed with calamine lotion.This makes the lotion pink in color.
Excess use of salicylic acid does cause dryness of skin and peeling of skin.Kindly check out the lotion which you had used for acne.You can even get it confirmed from the hospital staff as to what was prescribed to you.

As fas as your pictures are concerned ,it seems to be pretty all right to me ,except for the slight prominence over fore head and sides .This can also be the change which takes place because of the hormones and can be related to the age.Similar changes are also seen when one on on oral steroids .

The scaling (white skin peeling off) which is seen over the sides and nostrils seems to be seborhheic dermatitis .This a very common condition and is nothing but due to over secretion of sebaceous glands(oil) .Probably the stretching of skin which you are feeling is also a part of either seborheic dermatitis or of Rosacea (redness over cheeks).

You have already got some tests done which you mentioned were normal.Apart from those I would also request you to get a complete hormone profile done and serum cortisol level done.An X-ray of the skull can also be done to confirm changes in the facial bones .

Psychiatric evaluation is also very important (which you have already got it done ),since certain times one feels that they have a cosmetic problem(which they don't have actually) . This is also important since this is disturbing your studies and concentration .

Its also important to know what the two dermatologist had prescribed to you later on and how long you have used it.

As of now you can use a mild steroid and a anti-fungal combination over the sides of nose .You can also use tacrolimus cream over the cheeks where you see redness.Also use a good spf sunscreen daily thrice.

As these are prescription based cream ,I would advise you to consult a dermatologist for the same .

I thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns I would be happy to address them.

Please accept my answer in case you do not have further queries.

Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: Dead skin due to allergic reaction, muscle pull in nose and jaws. Can I fix face structure to normal? 16 hours later
Sir,
Thank you for your insight.
I have attached some new photos, as you can see it appears distinctly after face wash, this buildup was at least 3 times of this in the initial days.

Though it was not a proprietary medicine it was written on the tube that it was a coal tar based cream, it was not pink in color but white which turned whitish black after some time of exposure, even the texture and smell didn't feel like calamine.

Presently i am not on any medication and i have at no time consumed steroids. Though sometimes I have applied betnovate in the affected region, I have also undergone anti-fungal and antibiotic treatment but all have been unsuccessful.

As for the pysch evaluation it is very easy to clear because the effects are tangible and not hypothetical. Once a gazetted officer refused to sign my 10th board certificate because he thought I am not the person in the photo and this is not a one off phenomena and is very common, I am standing next to the person and he is asking where I was, when my parents told me that I am standing next to him, he is in for a complete surprise, this is the level of distortion.
The other tangible is the muscle pull from jaw area, this has resulted in formation of XXXXXXX lesions on the inner side of my cheek just below the upper jaw(i eat no gutkha etc.), this i can explain as follows: there is a continuous movement of facial muscles the but jaw blocks the movement which results in this buildup.

As for your suggestion of: "Psychiatric evaluation is also very important (which you have already got it done ),since certain times one feels that they have a cosmetic problem(which they don't have actually)": This condition is called 'somatization' and I have undergone treatment for that too.

I have not sought any help for a long time as I thought that:
1. There's no problem it's just in my mind, I will slowly forget about it.
2. The self healing mechanism of the body with take care of the problem.

But the tangibles that I see now are like an elephant in the room for me to neglect.

Thank you for the help
 
 
Answered by Dr. Bharat Chawda 1 hour later
Hello XXXXXXX

Thank you for reverting.

I appreciate your patience as far as your problem is concerned. You also seem to be a very intelligent and understanding person, especially the way you have answered my questions and explained me the whole thing.

I would like to know what your family members feel about this and how concerned they are regarding the issue.
I went through the pictures again and I think you have severe seborrheic dermatitis all around the nose .Probably that's the reason you were prescribe betnovate cream. For this problem, I would advise you to apply tacrolimus cream over the area and also take a oral dose of tablet fluconazole .Oral retinoids can also be prescribed if they are really required. Since these are prescription drugs, I would suggest that you consult a dermatologist who would be able to physically examine you and prescribe appropriate therapy.

Regarding your other issues, I would still suggest that you get your hormone profile done as discussed earlier. I would also suggest that a peripheral smear should also be done.

You might be right regarding the coal tar thing, but I am still puzzled as to why it was prescribed to you.

Kindly consult an endocrinologist and a dermatologist in tandem and discuss your problem. A dermatologist would be the best person to treat your seborrheic dermatitis since the above medicines are prescription based medicines.

Kindly let me know if I can be of any further assistance to you.

Wish you good health.

Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: Dead skin due to allergic reaction, muscle pull in nose and jaws. Can I fix face structure to normal? 1 hour later
Sir,
Thanks a lot for your response. I will undergo the tests and treatment as recommended by you.

As for my family members, they are well aware of the problem because all this 'alien person thing' happens in right front of them most of the time. They are also supportive because i think in a way they themselves feel responsible for what has happened. But i have not been living with them for the last 8 years so there's nothing much they can do to help.

I am pursuing this on a war footing now because i got calls from IIMs and with my very bad experience with this problem in IIT and in job i am not sure how i will manage my studies in IIM.

Thank you for all the help.
 
 
Answered by Dr. Bharat Chawda 5 hours later
Hi Again XXXXXXX

Thanks for writing back again.

I am happy to learn that your family is very supportive, but I wish that you were with them so that you don't have to face it all alone. One does need guidance and motivation from the family members all the time.

You are a brilliant boy and I think you should go for higher studies in IIM. This is going to make your future bright and probably help you divert your mind too. If this is what interests you then you should go for it. When the going gets tough the tough gets going.

I'll take your word that you don't have a psychiatric problem, but believe me a psychological counselling would definitively help you in this. Kindly consult a psychotherapist also for the same when you get time.

You can write back to me for further guidance .

Wish you good health,

Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
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