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Random breakouts on cheeks, around eyes and forehead. Given oral and topical for rosacea. No change. What else should I do?

DOCTOR OF THE MONTH - Dec 2013
Dec 2013
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Dermatologist
Practicing since : 2002
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Question
Hi for the past 3 months I have been dealing with these random breakouts in my face mostly cheek area around eyes and forehead tiny little pimples in clusters no whiteheads if I pop them tiny amount of blood comes out I went to dermatologist he treated me for folliculitus not sure what type but it improved over a course of doxycycline a Duac cream but never went away I finished course and everything started to come back again but worse went for second opinion then was told it was rosacea was given a oral and a topical but within 2 days of using that it only got worse so I stopped I started using only antibacterial soap and I bought clorizitramole over the counter what else should I do it's getting ridiculous
Posted Sat, 16 Nov 2013 in Skin Hair and Nails
 
 
Answered by Dr. Sanjay Kumar Kanodia 30 minutes later
Brief Answer:
Kinldy upload a good resolution picture of face

Detailed Answer:
Hi,
Welcome and thanks for posting your query to Healthcare magic.

I can understand from your query that you are really tensed regarding the recurrent eruptions on your face.

There can be mutiple of possibilities of these eruptions including simple acne, folliculitis or acne rosacea too. Many a times we see sudden eruptions without any pinpoint cause which we correlate to environmental factors including hot humid weather or sudden change in weather too. Application of creamy or oily products on not only face but on scalp can also induce the eruptions on face.

I request you to please kindly elaborate your query in detail so that I can help you best regarding the health issues. Kindly elaborate the problem in terms of -

- Are these eruptions stated suddenly and simultaneously or gradually one after the other.
- How many of the eruptions comes pr day or per week.
- Had you gone for any kind of massage or facial or anything related to face or any long term out door activity.
- Do you feel any thing aggravating these eruptions like by exposure to sunlight, heat or humidity
- Are these increase after consumption of spicy food.
- Any other systemic change you experienced.
Kindly also provide anything related to query which you think is important to tell us.

It would be best if you can upload a picture of the affected area. For that you have a feature to upload images by yourself at the right side of the query page. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia.

Hope to hear you soon from your side to help and guide you best.
With best health wishes,
Dr Sanjay
MD Dermatology
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Follow-up: Random breakouts on cheeks, around eyes and forehead. Given oral and topical for rosacea. No change. What else should I do? 10 minutes later
These breakouts are constant they do not go away and come back only with the course of medication i was given did they sunside less red less swollen but never fully gone i eat healthy no spicy foods i take a multivitamin every day i notice if i am outside fresh air it looks less irritated then if im sweating at the gym or after a hot shower i do buzz my face every couple of days and shave my head with a clean razor every time but i never get and breakouts on my beard or scalp area it just keeps coming out on my cheeks forehead and eyes some days worse then others i used cloritrizomole last night for the first time and today it doesnt look bad at all
 
 
Answered by Dr. Sanjay Kumar Kanodia 9 hours later
Brief Answer:
Kinldy go through the deatiled mail

Detailed Answer:
Hello young fellow,

Welcome again to the forum. I beg your pardon to reply bit late.

I have gone thorough the pictures sent by you and correlated the latest informations provided by yourself. After complete correlation there can be many a possibilities of your problem.

Actually as I said earlier the manifestation is exhibited in this manner in many a conditions including acne/ pimples, folliculitis, rosacea and or may be presentation of something unusually appearing condition. It would be too early to reach to pin point diagnosis.

Anyhow in any of the case the condition is not at all showing any serious signs and appears completely benign nature, so do not worry about some serous issue.


As you have already consulted two dermatologists before and each have had different of diagnosis so it would be better for you to get it diagnosed properly for good health reasons.

In such a case where I myself find bit different opinions from one another then always chose the Gold standard in diagnosis of skin disease with – “ SKIN BIOPSY”. It is a simple test where a very small part just 3millimeter of skin is taken out and is anlaysed microscopically. It gives the to the point diagnosis of one and all skin problems.

So it is my personal suggestion for you to go for biopsy from any of dermatologist you are meeting in near future. It will guide you as well as your treating dermatologist for the diagnosis and management of the problem.


Application of clotrimazole cream will not be helpful in this condition as it is not at all related to fungal infection. Fungal infections do not manifest in this manner. Anyhow it is always better to apply and eat medications under medial supervision only.


I can see from the IP address that you belong to United States (US), so it will be not feasible to suggest for any of the medications. In US most of the medications are not be available over the counter and you might do unnecessary exercise of searching them. So I will not be guiding for any of the medications, neither by mouth or to apply.
Rather I would like to guide you for the preventive care till the time you XXXXXXX your dermatologist. These are as follows:

1.     Do not pinch, pop or squeeze any of the affected areas.

2.     Do not apply any creamy or oily stuff or any other cosmetics over face.

3. Try to avoid any home remedies suggested by your friends or family members or otherwise self implicated therapies also.

4. Try avoiding situations of direct continuous exposure to sunlight or heat and humidity for long hours. Do not take hot showers and avoid heavy exercise and gym for few days.

5. Kindly do not use any antibiotic or any other creams as self medication.

6. Take two times bath. Gently wash the affected areas with the antibacterial soap which you are already using.

Lastly do not get panicky about the condition and do not try multitude of medications as it may change the original appearance of the condition and can misguide your treating dermatologist who has the best physical access to diagnose the condition.

Hope these informations will help you. If you have any further query I will be glad to help.

Regards.
Dr Sanjay
MD (Dermatology)
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Follow-up: Random breakouts on cheeks, around eyes and forehead. Given oral and topical for rosacea. No change. What else should I do? 4 minutes later
I attached a few more pics below from before i took any medication prior to seeing the 2 dermatologists it was pretty bad it goes from bad to ok whenever it wants its been like this for a few months from these pics in your opinion does itlook like folliculitus or rosacea or is just some type of acne issue
 
 
Answered by Dr. Sanjay Kumar Kanodia 6 hours later
Brief Answer:
Pictures in favor of acne like lesions

Detailed Answer:
Hi,
Welcome again to the forum.

I have gone through the latest of the pictures sent by yourself. These are totally different form the two pictures which were previously attached. I can make out that the previous pictures are after the resolution of the lesion. The latest of pictures goes more in favor of acne rather than rosacea.

In rosacea the central area of the face near the nose is always and most commonly involved. There is always a moderate to deep redness in rosacea. All of these features are not present in your case.

So in my point view it is more towards acne rather than rosacea. Anyhow simple measures told in the previous Mail will help in any of the issues. This is totally a benign issue, I have seen many a times young men like you getting this type of problem for few months and then it resolves by itself. .

SO do not get stressed as stress itself induces lot of problems. I can see a lot of excoriation marks too in the pictures which means you might have tried to pinch or pop these lesions so the important of the thing is not to scratch any lesion. Even mere touching the area makes initiation and aggravation of any type eruptions. So do not even repeatedly touch the area.

Hope these informations will help you. If you have any further queries I will be happy to help.

With good health wishes,
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Follow-up: Random breakouts on cheeks, around eyes and forehead. Given oral and topical for rosacea. No change. What else should I do? 8 hours later
Thank you for the advice but what do i do in the meantime before i go see my dermatologist on the 6th i have small tiny pimples scattered on my forehead upper cheeks and around eyebrows a little plus i woke up this morning with a large pimple on my jawline under my skin ive stopped all medication and basically using the antibacterial soap an clindamycin like you stated will this go away by itself without treatment or will this get worse one day it looks fine then gets worse out of nowhere i just never had this problem in my life and not sure where its coming from i apprecaite the help
 
 
Answered by Dr. Sanjay Kumar Kanodia 2 hours later
Brief Answer:
Kindly go through the mail below

Detailed Answer:
Hi,

So Good morning to you young fellow. Have you slept well or not. I think you are still in multiple of dilemmas. I can very well understand how bad it feels for a young man to get fixed in a health condition that too particularly related to face and exposed areas of body.

This is good that your appointment with the dermatologist is on 6 November 2013. You want a solution till that time. You can continue with antibacterial soap that will help you. You never told me before that you are using clindamycin 1% gel for your condition. Since how long you are using clindamycin gel, has it given any relief after application.

In United States it is really difficult to get frequent appointments with specialist and especially with dermatologist. So my main motto is that your condition must be diagnosed properly in this appointment.

Now there are three main points in your condition when you will be meeting your dermatologist:

1.     Proper and best physical examination of the skin

2.     If needed the biopsy can help best in the pin point diagnosis of the condition

3.     The best of the treatment according the diagnosed condition.

The worth of my online suggestion as a dermatologist is not just to prescribe any medication but is in the guidance of proper diagnosis and then best treatment of the condition. Therefore the problem can be dealt best in future and best preventive measure applied accordingly.

You should not be worried about anything serious in your skin. I have never seen anything going undiagnosed in skin condition. So hopefully this appointment will prove the best in your condition. Till that time you can continue with preventive measures suggested by me.

With good health wishes,

Dr Sanajy
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Follow-up: Random breakouts on cheeks, around eyes and forehead. Given oral and topical for rosacea. No change. What else should I do? 8 minutes later
Ive been using the clindamycin for the first month for treatment of folliculitus which was diagnosed ny first dermatologist didnt really help so after the 30 day course of doxycycline and the gel i stipped both and went for second opinion i just started using clindamycin again about 2 days ago to see if it would give any help im only applying to affected areas upper face area and forehead now this morning i have a bunch of little pimples in like a cluster by the corner of my eyes and a larger one on my jawline and by my ear its just getting very frustrating can it be my bodies bacteria going crazy because im not taking any meds now also about 6 months ago i had the same type of larger pimple in the same spot on my jaw and doctor said it was a staph infection because it opened up and was spreading could yhis have anything to do with it now coming back
 
 
Answered by Dr. Sanjay Kumar Kanodia 43 minutes later
Brief Answer:
Do cold compression over affected area

Detailed Answer:
Hi,

Yes, the previous staphylococcal infection can be stimulating factor or main initiating factor to the same. I asked you in the first mail regarding any systemic change or any aggravating factor related to the problem, so this can be a part of previous staph infection. As I said earlier, the eruptions are quite common but the only part is the troublesome off and on occurrence.

Clindamycin is also antibacterial medication mainly used in acne. But now days it is generally used in combination therapy because of resistance of bacteria to single application. So the application is combined with multiple other of things like benzoyl peroxide or adapalene to reduce the resistance. It may help you little in the eruptions.

But all of these preparations irritates and dries the skin more and gives an angry looking appearance of eruptions for some times. A simpler of the method is to do cold compression with wet towel over the affected area for 3-4 times each for around 5 minutes. This will soothe your skin and irritate it less.

Hope these information will help you.

Regards,
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Follow-up: Random breakouts on cheeks, around eyes and forehead. Given oral and topical for rosacea. No change. What else should I do? 4 hours later
Ive use doxycycline and the clindamycin with benzoyl peroxide it did not work only subsided now that i finished it seems like it is just coming back all over again in the same spots i need to get rid of this and get it under control
 
 
Answered by Dr. Sanjay Kumar Kanodia 8 hours later
Brief Answer:
Go for nose swab and culture sensitivity

Detailed Answer:
Hi,
Welcome again to the forum.

I can get the multiples of problem by the condition your suffering. As you have mutiple recurrent bumps which were not controlled by simple antibiotics, so these eruptions can be due to resistance of the antibiotic Doxycyline which was not able to control the infection. I have already told you the problem of resistance of antibiotics. So the best way to control the problem is to take a more potent and better antibiotic. You should not take any antibiotic by your own. It will be best to undergo two tests :

1. Nose swab for culture and sensitivity

2. Pus swab from the eruption on face for culture and sensitivity.

Both the tests will give us an exact idea of what type of bacterias are actually causing the problem and the type of antibiotic which is best suitable to you. You can XXXXXXX your local doctor for these tests or can talk to your dermatologist too for the same.

Do not worry, the kind of problem is quite common and is very well treatable.

Hope these informations will help you,

With regards,
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Follow-up: Random breakouts on cheeks, around eyes and forehead. Given oral and topical for rosacea. No change. What else should I do? 7 hours later
I went for nose seab waiting for results so your saying the breakouts are somw sort of bacteria infection and not acne or is it one in the same why do i need to keep taking antibiotics to get rid of this can this be resolved without antibiotics and possibly just topicals meant for acne because i applied the clindycin with benzoyl perixide last night and my face looks 90% better today i dont know why
 
 
Answered by Dr. Sanjay Kumar Kanodia 3 hours later
Brief Answer:
Proiding you the compelte details

Detailed Answer:
Dear young fellow,

It is really a good to read that you are feeling better. In this long of the discussion for the first time you felt better within overnight.

Now regarding your further query of bacterial infection or acne or the nature of eruptions-

Let you understand the basics of your problem. The origin of the problem basically appears to be mainly from hair root or oil gland. Now both of these structures are interrelated. Each of our oil gland is attached to hair root and it opens on the surface of skin. So if there is problem to either of the structure then that will affect both.

When the oil gland gets blocked then the oil secreted from the glands is not able to come out on surface leading to noninfectious or non bacterial folliculitis which is known as acne. These pose no problem of pain or itching or redness and are common entity.

Our skin harbors millions of bacteria which normally and usually do not cause any infection. When the oil glands or hair root get infected by any infectious agent then it leads to folliculitis proper. In this condition we find pain, itching and redness of variable nature. If the infection is superficial then it causes less of pain and redness and called as superficial folliculitis and if it is deep then it causes higher of these symptoms and known as deep folliculitis.

It is important to know that the causative infectious agent also vary form different of bacteria to fungus too. Many times I have seen fungus rather than bacteria responsible for these eruptions.

In rosacea as I already told some of the points, there is hypersensitivity of the underlying blood vessels leading to over activity of the glands and then inflammation.

All of these things I prefer to designate as eruptions till properly diagnosed. I do not want to give a proper term in your case because of the reason that it needs physical examination personally to see thoroughly the eruptions and then act accordingly.

Recurrent eruptions of any nature are where the infection keeps coming back, although it disappears with treatment. The gaps between episodes may get shorter and then leads to chronic eruptions. For these cases culture and sensitivity of pus is done by taking a sample by swab. This swab then shows the exact nature of organism present in the area and the antibiotic effective for it.
Many a times the organism is harbored in nose. So this can also be a reason for recurrent eruptions. These organisms are eradicated by most appropriate antibiotic by sensitivity of the organisms.

Now the antibiotics also are of two kinds – one is to apply and the other to eat. I am in more favor of the antibiotic to apply according to sensitivity of the bacteria otherwise resistance can occur. In previous mail too I had raised this issue and suggested to apply either with adapalene or benzoyl peroxide.
If at all there is recurrence then best measure is to give most suitable and sensitive of antibiotic by mouth.

Many times I have seen fungus no proper guide way for these eruptions. In these cases where all the things fails then biopsy tell the ultimate answer. That is why I suggested you to ask for biopsy as one very important option from your dermatologist in next appointment.

So you got the complete idea that all of these are broadly Eruptions of different nature, but exact cause is yet to be find out in your case. You have got ample of knowledge regarding you problem. My main aim is to suggest a path towards proper diagnosis and prevention of the problem.

So kindly follow the preventive measures as already mentioned till we find the exact nature of eruptions.

Do inform me reading your nose swab report.
With good health wishes and early recovery from the problem.
Dr Sanjay

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Follow-up: Random breakouts on cheeks, around eyes and forehead. Given oral and topical for rosacea. No change. What else should I do? 5 days later
Results came back positive for staph taking murprocin twice a day in nose for 10 days does that sound right a
 
 
Answered by Dr. Sanjay Kumar Kanodia 4 hours later
Brief Answer:
Kinldy go through the mail below

Detailed Answer:
Hello young man,
Welcome again to the forum.
So your result is positive for staphylococcus. You need to be worried about the same. In 40 % of the people in general population can carry the bacteria and show positive results. Only some of them show features of recurrent folliculitis like yourself.

You can apply the Mupirocin cream continuously for 4 weeks. It is a very potent antibacterial cream. There is no problem in continuing the same medication. You be in follow-up of the doctor so that your problem can be best sorted out.

With best wishes of early recovery of the problem.

Dr Sanjay
Above answer was peer-reviewed by
 
Follow-up: Random breakouts on cheeks, around eyes and forehead. Given oral and topical for rosacea. No change. What else should I do? 3 hours later
So that cream is meant for nostrils in your opinion is that why i have been getting those random breakouts because its been in my system due to the staph and then gets infected and i guess its folliculitis so dont take anything else except the murprocin cream and thats it and that should work ?
 
 
Answered by Dr. Sanjay Kumar Kanodia 4 hours later
Brief Answer:
Kinldy go through the mail below

Detailed Answer:
Dear young fellow,

Welcome again.

As I told you previously that topical creams are one of the way to take care of the bacteria. As nose harbors the staphylococcus bacteria most often so antibiotic cream application in nose is one of the way to get rid of the bacteria.

To understand it better, whenever there is breech in the immune status, then it leads to proliferation of bacteria on the skin. Nose being one of the carrier place for the bacterias so it is always better to clear the carrier state.

Other this all the measures to improve the immunity like good diet less stress and least application of things on skin helps in minimal proliferation of the bacterias. So kindly follow above things also. Do not take lot of stress too as stress itself is very important cause of immune dysfunction and thus to eruptions.

I hope these informations will help you.

Take care.
Above answer was peer-reviewed by
 
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