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Diagnosed with sensitive skin and dermatitis and using hydrocortisone. Can little sleep cause this? Is it rosacea?

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I was diagnosed with sensitive skin and mild dermatitis on my face. My skin doesn't look bad at all but it feels pretty uncomfortable at times.

My doctor gave me a prescription hydrocortisone cream to use for 2 weeks and it has been helping. The cold wind seems to flare my face up and cause it to burn so I have been wearing a scarf outside. Ii noticed today that my face feels uncomfortable and hass a slight burning sensation. I did not get a lot of sleep last night and I think that's what caused me to flare up because a situation happened like this before (lack of sleep/burning face).

What is going on with me? What's the connection between little sleep and sensitive skin flare up? It never fails, if I don't sleep right, my skin pays for it the next day by feeling irritated. My dermatologist ruled out rosacea and said that I just have very sensitized skin.

It seems that when I am stressed, tired, etc. I cannot tolerate wind or cold weather. When I am fully rested, not feeling anxious, I am not as bothered by the extreme weather temperatures. I am confused and is this sommething that will go away?

I also want to add that I have bad allergies, seasonal and perennial.

Posted Sat, 21 Apr 2012 in Skin Hair and Nails
Answered by Dr. Bharat Chawda 2 hours later

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 too; however it would be good if you can answer few of my queries:
1) How long have you been having this problem?
2) Does sunlight play a role in aggravating your problem?
3) Do you see redness of cheeks?

I shall address your concern based on your current given information. There seems to be couple of possibilities in your case. One is of Rosacea (even though your dermatologist has ruled it out) & second is of Atopic dermatitis (AD).

In Atopic dermatitis, one does get dry sensitive skin along with seasonal & perennial allergies. One may also have asthma, hyper-linear palms, folds below the lower eyelids, dry skin, itching over the folds, family history of allergy etc.

Emotional & psychological stress also plays a role both in AD & Rosacea. So lack of sleep can aggravate your problem.

Hydrocortisone cream would help in both the condition. And being a steroid it would flare up your problem once stopped abruptly (as happened in your case). It should be gradually tapered & should be replaced by a non-steroidal cream like tacrolimus or pimecrolomus. Both these creams are very safe and effective on long run and can be used on face too. But, I warrant the use of any topical applications without consulting your Dermatologist. Please discuss about this with your doctor.

Rosacea flares up on sunlight exposure, excess tea and coffee, spicy foods and AD by lack of sleep, stress and contact with allergens.

Both conditions are different, but have common aggravating factors.

Treatment primarily consists of avoidance of aggravating factors, proper cleansing of skin with a moisturizing cleanser & daily use of moisturizers
I would suggest you to consult a competent Dermatologist for physical examination, evaluation and to get the creams prescribed to you by them.
Also if you can answer my above questions and send me a close up picture of the problem you have, probably I would be able to suggest you better. You have a feature to upload the reports / image by yourself at the right side of the query page, please utilize that so that I can answer your queries better.

I am awaiting your reply.

Dr.Bharat chawda
Above answer was peer-reviewed by
Follow-up: Diagnosed with sensitive skin and dermatitis and using hydrocortisone. Can little sleep cause this? Is it rosacea? 24 minutes later
Dr. Chawda,

Thank you for your response. I have not abruptly stopped the cream: I am still using the locoid cream once a day, this is my second week. I should talk to my doctor about tapering to a different one?

Why do you still think that it is rosacea even though my doctor ruled it out? I really do not want to have that :(

There is really nothing visible on my face: no redness, just some burning that flares up from wind and lack of sleep. The sun does not seem to bother my skin. If I sent you a picture, I would look completely normal. When it 'flares up', it gets a little blotchy but not too bad. It is not red at all right now, just feels irritated and dry.

I am just confused as to what iss going on. My eyes burn a little too and that happens with my allergies and dry heat.

The main problem is the burning sensation that I get on my face from lack of sleep and wind. Can AD cause that? It is really painful and I have to use ice packs to calm it down.

My dermatologist said that could be due to lack of moisture in my skin.

Thank you, XXXXXXX
Answered by Dr. Bharat Chawda 4 hours later

Thank you for the reply and the pictures.

I have carefully gone through all the image links that you have provided. Your skin looks absolutely normal at the moment, but I can understand your problem and worry when it flares up. The reason for this is that you are using Steroid cream. Kindly get it changed to a safer option as steroid cream should not be used for long time on face. At times patients get addicted to use of steroids.

Burning sensation due to lack of sleep can be seen in both AD and Rosacea. We have to look for other factors too which I had mentioned previously, so as to differentiate between the two.

Probably you just have a sensitive skin which gets aggravated by the cold weather. The most common finding in Rosacea is redness which get flared up by stress, lack of sleep, tea, coffee, sunlight, etc. Rosacea is a chronic problem, but there are good remedies available now a days. There are also lasers available for the same.

But looking at your problem now, I would advise you to use a good moisturizer daily with a good sunscreen and instead of lobate, use Tacrolimus or Pimecrolimus cream topically. You can get these drugs prescribed from your Dermatologist after his consultation.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. Please accept my answer in case you do not have further queries.

Wish you Good Health.

Dr.Bharat chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
Follow-up: Diagnosed with sensitive skin and dermatitis and using hydrocortisone. Can little sleep cause this? Is it rosacea? 9 hours later

Thank you for the response and for taking a look at my pictures. I have removed them because I do not think that I look particularly becoming in them because I was half asleep and my eyes were swollen. The public will not be able to view those photos, correct? Did you notice my swollen eyes? My eyes have been feeling burning and itchy and I wonder if it is from the dry heat. I do have allergies so hopefully it will go away soon.

Back to my skin: even before the use of the steroid, my face looked normal. It just felt dry, warm, burning from time to time, very tight and slightly itchy. If it flared up, it would burn bad for a while and be blotchy. The next day it would be back to normal.

Can atopic dermatitis present as the symptoms I described above with little visible symptoms? When I look on the internet for pictures of AD, it looks very dry, red and crusty. Mine does not look like that. I have researched sensitive skin and it seems that I have a lot of symptoms for sensitized skin.

I do not believe that sun affects me.. this has only been occurring for a couple of months and I have only been out in the sun a few times due to the cold weather. I have not been bothered those times.

I seem to have a low tolerance for wind and cold when I did not get enough sleep the night before. Why is that? Could you please further explain that?

I do not think that I have rosacea. I have been told no by a few different doctors (dermatologist, allergist, PCP). I still am upset about the burning sensation though and hope that will get better in time.

Is it possible that my skin's barrier has been compromised? Please see the article below for further explanation:

I will make a follow up appointment with my dermatologist next week and will ask him about the creams you recommended.

Also, did you view the picture of the chest rash that I get from time to time? It has not occurred in a week or so but am not sure why. Any idea what that looks like?

Thank you, XXXXXXX
Answered by Dr. Bharat Chawda 8 hours later

Thank you for writing back.

I read the link which you had sent with great interest.

I also went through your description in detail.

AD (Atopic Dermatitis) can have sensitive and dry skin with symptoms of burning and itching. And this can wax and wane too. Lack of sleep can aggravate the symptoms. In AD, allergies are common (even the eye allergy), so probably the swelling over the eyelids is a part of that. A full blown case of AD can show crusting on cheeks, but not so in mild cases.

I did notice the redness over the upper chest, which could be the part of any allergy. This can be seen in AD too.

In AD skin barrier does gets compromised and patients’ skin becomes very sensitive to external allergens or even environment. Cold weather can flare up the dryness and thus the irritation. Lack of sleep works on the immune system of the body, and thus the depressed immunity compromises the barrier function leading to sensitive skin. So it’s all related.

I would say that you are just in the initial stages of AD, and that doctors would say that you have a sensitive skin and not a full blown case of AD.

The treatment would be same as I had mentioned previously.

Regarding your pictures which you had posted, are visible either to me or to the doctor moderating my answer and are not for public viewing.

I would be keen to know what your dermatologist has to say & how he proceeds with the management. Kindly keep me informed regarding the progress of the problem if possible.

Wish you Good Health.


Dr.Bharat chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
Follow-up: Diagnosed with sensitive skin and dermatitis and using hydrocortisone. Can little sleep cause this? Is it rosacea? 6 hours later
Hello again, Dr. Chawda,

Thank you again for responding to my questions; you are so very helpful. I will let you know the outcome of my follow-up dermatologist appt. I am not sure if I can get in to see him this week due to the holiday, but am going to try. In regards to the locoid cream, I don't want him to think that I do not trust him (he said to use the cream 2x day for 2 weeks and then stop.) Well, like you said, I should switch to something else, but I don't know how to ask him without feeling like I am doubting his expertise. I'm sure I will think of something. Any ideas how to bring this up to my dr. without sounding like I am questioning him?

Thank you for reading the article and finding it interesting. I have done a lot of research trying to figure out what is wrong with my skin. I have horrible allergies so I am truly hoping that this is a sensitivity thing rather than a skin disorder (rosacea). It sounds to me like that is *not* what you believe I have which is good news.

What causes the skin to become sensitized and besides using creams, hydrocortisone ointments and avoiding triggers, what else can I do to aid in fixing the problem? This is fixable, right? I was not always this sensitive to the cold and wind so is it safe to say that it will and can get better?

You mentioned how lack of sleep works on the immune system which makes it worse. I also have been diagnosed with fibromyalgia, but did not mention that because some doctors do not seem to believe in that or they are just quick to say my symptoms are from the FMS. My immune system is slightly depressed due to the illness so it could be making this all worse. You also said that I am at the beginnings of AD; what can I do to ensure things do not get worse? I am feeling a tab bit depressed because I am scared to do things for fear I will have a flare up.. even though things have been ok for the past couple of weeks except when I did not get a lot of sleep.

Burning and tightness of face are my worst symptoms and I use ice packs to help with the inflammation and burning. I often sleep with an icepack at my cheeks. Is it XXXXXXX to keep ice on my cheeks for a long time? I do wrap it up in a towel but I have a sinking suspicion that prolonged use of ice is probably not good for me.

I also suffer from dermographic urticaria. If I scratch my skin it turns bright red. I do not get the welts but the scratch marks are XXXXXXX red. My dermatologist also remarked that I have "eczema hands" meaning I have a lot of little lines on my palms. Have you heard of this? Hopefully this gives you an idea as to how bad my allergies can be.

In regards to my eyes, I use thera tears (preservative free) eye drops for my dry, irriitated eyes and it only helps some. Is there something else you can recommend that may help better?

Thank you again, you have been extremely helpful, XXXXXXX
Answered by Dr. Bharat Chawda 7 hours later

Thank you for writing back,

After reading your this text ,I think I am sure that we are dealing a AD case here.You mentioned about having lot of lines on palm (hyperlinear palms) ,is what I had mentioned in my first reply to you.This is one of the signs of AD .

Secondly about dermagraphism .which is also seen in AD patients .Dermographism means getting redness and itching where ones scratches.

So ,probably we are dealing with AD here.

Now regarding asking your doctor about the course of medicines and its side effects.I think, if your doctor is a specialist (dermatologist) then he would rather appreciate your knowledge about skin and creams & its side effects .I am sure he would start taking your problem more seriously .You can even tell him that a dermatologist friend overseas guided me regarding the side effects & the newer alternatives .Even though locoid is a mild cream & can be used on face ,but should not be used for long .This can cause dependency and when ever you try to withdraw from it ,would lead to flare up of symptoms.

Your condition is treatable ,but may take long time to cure it completely.
In your case as I had discussed earlier ,you would require a moisturizing cream and a moisturizing face wash,tacrolimus cream /pimcrolimus cream for local application & a sunscreen .This would surely reduce your burning sensation and dryness.

Also avoid any trigging factors and yes a sound 7 hours sleep is a must.And in case you need a sedatives for sleep & some thing to tackle your depression ,you should consult your doctor for the same.This would definitely help in dealing with AD.
Avoid direct contact with dust , avoid pets ,avoid excess use of soap & use moisturizing lotions frequently.

Regarding keeping ice packs on face for long,I would not advise you that.

At time the eye allergy is due to the pillow one uses. Kindly consult eye specialist for this .Try changing the pillow cover of the pillow you are using.

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.

“ Wish you Good Health”

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