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Had itchy bumps on cheeks and neck. Told to be Rosacea. Advise?

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Dermatologist
Practicing since : 2006
Answered : 2016 Questions
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Derma: I went to a dermatogist 3 months ago re: some itchy bumps I had started getting about a year ago. I would get a large collection of the mainly on my cheeks and neck. I didn't know if it was an allergy or what. She says it's rosacea. I researched rosacea but cannot see any reference to itching. I mean SERIOUS ITCHING! Is it normal for rosacea to cause itching?
Posted Thu, 12 Sep 2013 in Skin Hair and Nails
 
 
Answered by Dr. Kalpana Pathak 47 minutes later
Brief Answer:
Rosacea lesions can itch

Detailed Answer:
Hi,
Thanks for writing to us.
I have seen the images attached. These are good quality pics showing lesions prominently. However I would prefer that you upload a slightly distant shot front view image of your face too as it makes diagnosis more clearer.

Now from what I can see, these itchy lesions could be
Rosacea
Acne( even an acne lesion can itch)
Allergic reaction to some cream, cosmetics, allergen, chemical, plant source etc
Acne agminata.

Rosacea presents with flushed face, thread veins and red bumps which can burn or itch
Acne presents with comedones, red bumps, pustules etc
Allergic reaction has an underlying cause


I would like to know since how long are you having these lesions
its onset like the area was red initially and later on developed bumps
If thread veins are seen
any cosmetic medicines used over face
if there are comedones too( black heads white heads)

Also if possible please attach reports of your doctor.
Hoping to hear from you soon.
Take care
Above answer was peer-reviewed by
 
Follow-up: Had itchy bumps on cheeks and neck. Told to be Rosacea. Advise? 13 minutes later
Well, I have attached one more photo i took during a flare up and one from today when it seems to be ok. I have always had some small level of acne (mostly subdermal) and blackheads around my nose and chin. My skin is still shiny (oily) at 45 yrs old.
I have been having this issue on and off for about a year. Worse after a recent surgery (disc fusion in neck) I suspect because of my antibodies focusing on healing the neck that other areas (face) had to sacrifice their protection.
 
 
Answered by Dr. Kalpana Pathak 30 hours later
Brief Answer:
It could be rosacea, acne, seborrheic dermatitis.

Detailed Answer:
Hi,
Firstly please accept my apologies for delayed response.
As I have limited the differentials to acne, rosacea and seborrheic dermatitis, I would like to know
Since how long are you having these
If having greasy dandruff in scalp, behind ears, around or in eye brows etc
how did the lesions begin. If they began as areas of redness over face first and then small elevated lesions developed.
If the redness over your face increases with hot beverages, spicy food or alcohol.
If you have thread veins over your face too( telangiectasia)
If you have comedones , develop pustules too
if you have been applying any medicine over face

Answering these queries would help in ascertaining a probable disease.
hoping to hear from you soon.
Regards
Above answer was peer-reviewed by
 
Follow-up: Had itchy bumps on cheeks and neck. Told to be Rosacea. Advise? 2 hours later
Get an oily scalp if i do not wash hair every day (without dandruff), redness was / is minimal for about 18 months ago, elevated, itchy bumps about 9 months ago on rare occasions. Now, the lesions are every day. Dr. prescribed Oracea and Metrogel 1% 3 months ago. I live in Las Vegas so the sun / heat could very well be factors. Only have hot beverages during the winter months (not a coffee drinker). I do itch behind ears and around eyebrows and eyes but cannot tell if there are any lesions behind the hairline. Regarding the redness, no thread veins.
 
 
Answered by Dr. Kalpana Pathak 1 hour later
Brief Answer:
It could be seborrheic dermatitis.

Detailed Answer:
Hi,
Thanks for writing to us.
Its a very close call between seborrheic dermatitis and rosacea.
Seborrheic dermatitis is a type of eczema characterised by red itchy skin with elevated bumps and greasy scales in between eyebrows, over eyelids, behind ears and nasolabial fold.

Rosacea as I said presents with erythema/flushing, thread veins and red bumps or pustules over face

Sometimes rosacea and SD can coexist.

Your doctor has prescribed doxycycline and metronidazole gel. If you have been using it since three months, you should have got some response. Isotretinoin, benzoyl peroxide, minocycline are some other drugs tried in rosacea apart from doxy and metrogyl for desired response. Rosacea also requires a good sunprotection by using a good sunscreen. Atleast with the prescription provided, your red bumps should have subsided.

On empirical basis, you may treat it as SD.
For the same
Take tablet cetrizine daily
Use an antifungal shampoo like ketoconazole to wash your hair alternate days
Apply a mild steroid antifungal cream. For the same mix hydrocortisone cream/ fluticasone cream with terbinafine cream and apply it over affected area twice in a day.

Just follow these suggestions for five to six days and see if these lesions improve or not. If they do, then do continue for few more days.

Having said this, I would like you to know steroids should not be used for long over face ie not beyond two weeks without doctor's prescription and steroids if used for long can also induce rosacea.

Follow these and let me know after few days if you are having response or not.
I shall be available for follow up.
Take care
Regards



Above answer was peer-reviewed by
 
Follow-up: Had itchy bumps on cheeks and neck. Told to be Rosacea. Advise? 28 minutes later
Thanks for the help! Ill ask my dermatologist more. :-) Very informative having another doctors train of questioning. It helps!
 
 
Answered by Dr. Kalpana Pathak 8 minutes later
Brief Answer:
yes,please consult your doctor before starting med

Detailed Answer:
Hi,
I would definitely encourage a dermatologist's visit before starting any treatment as what is seen with naked eyes clinically helps most in making the diagnosis.

Discuss with your doctor keeping SD as well as rosacea as two probabilities.
If your dermatologist strongly believes its rosacea go by his discretion but then do try other drug combinations meant for rosacea.
Wishing you speedy recovery.
Regards
Above answer was peer-reviewed by
 
Follow-up: Had itchy bumps on cheeks and neck. Told to be Rosacea. Advise? 3 minutes later
Just looked up SD. Doesn't look like SD is likely. Thanks though. :-)
 
 
Answered by Dr. Kalpana Pathak 17 minutes later
Brief Answer:
Seborrheic dermatitis has many variants

Detailed Answer:
HI,
SD has many variants. Sometimes it may just present with itching, redness and small bumps
As I said rosacea and SD can coexist and SD can mimic rosacea and acne too. That is why these are differetial diagnosis of each other esp over face.
As SD is a type of eczema so while googling you might have seen images of completely eczematous oozy lesions with extensive greasy scaling.
The presence of redness and itching in between eye brows and behind ears along with oily scalp points towards SD too!
Whenever you will read about rosacea, SD is always mentioned a close differential.
I still believe if you do not get good response with rosacea medicines, SD treatment should be tried empirically!

Take care
Above answer was peer-reviewed by
 
Follow-up: Had itchy bumps on cheeks and neck. Told to be Rosacea. Advise? 6 days later
Ok. Thx :-)
 
 
Answered by Dr. Kalpana Pathak 11 hours later
Brief Answer:
Wish you a speedy recovery!

Detailed Answer:
Hi,
Thanks for writing back.Should there be no further query, you may close the discussion and review the answers.

Regards.
Above answer was peer-reviewed by
 
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