Question: Hi. I am a 37 year old European female (ca. 170 cm/55 kg) and I have a problem with a certain history. I will therefore try to explain all the happenings by now in order for you to get a full overview of my current condition. It might take a little longer to read but I want to make sure you know everything that happened.

I have been experiencing a red rash on my face on a rather regular basis for close to 5 months. It looks as if my face was nettle irritated-thousands of tiny little red dots covering my cheeks, the area above my lips and chin. Sometimes it would blush badly not not often. It is itching, sore, hot, feels inflamed, very tens and very dry. It makes my face little swollen. Sometimes I feel cold and sore all over my body when I get it, although it is just my face that is affected. Even when this inflammatory rash goes away there are always reddish spots that remain on my face. They look like little reddish discolorations, even with my skin level, not raised, just little reddish spots. It is itchy all over, but mostly in the evening, early morning and in the frame areas of my cheeks and chin. It affects my face only. When my face inflames, little red dots raise a bit above the skin level.

I even get a couple of pimples (without any peaks) in connection to this, but it is the rash that bothers me. I have noticed that it has something to do with „itchy dots“ that I sometimes get. These look like mosquito bites, itch like hell and they usually appear with a rash or prior to rash. They usually appear in my lower face, on my chin and on my cheeks. Lately, i started noticing them on my neck or sometimes on my arms, but rarely. These last from a couple of hours to a couple of days period of time, then they disappear and re-appear a couple of days later...

I saw 7-8 different doctors and they all claimed it was Rosacea, but none of them could explain the „mosquito like bites“...Many would usually set the diagnose right at the door step without ever suggesting me to make any further examinations. I followed a full Rosacea treatment for close to two months (cream+tablets) but it just got worse, so I kept visiting different dermatologists.

The last one I saw did a visual laser test examination and told me it was not Rosacea because there was nothing wrong with my blood vessels, although it definitely looked like a classic Rosacea case. He suggested I should do some allergy testing. I did an allergy test and my total IEG was close to 1000.

It turned out I was allergic to pollen, house dust and mites. My food allergy tests were negative although my face would severely react to almost all food (I would blush, get itchy „mosquito like bites“ and would rash all over my face)...

I feel I should mention that I first got this rash some 4 years ago. It was not very bad and it stopped after I applied some chemical-free facial creams. Somewhere around that time I started working out in a gym (body-building training 3-5 times a week) and using some Protein supplements. Since I was a vegetarian for almost 20 years (no red or white meat, no fish, no sea products, eggs only in baked food), these Protein shakes were almost all I had of proteins. I was a vegetarian but was not a big fan of almonds or for example milk products in general (I usually took milk only as a part of a protein shake), or cheese...My diet consisted of various vegetables, lots of carbo-hydrates and lots of sweets. I had horrible sugar cravings so I consumed all sorts of processed consumer-sweets along with sweet fruits such as grapes and bananas ...My face was great and a rash appeared only a couple of times during that 4 year training period.

However, last spring (spring and summer 2011) I decided to take a longer brake in order to go back to my feminine shapes again. This is when I stopped taking protein shakes but continued with my usual diet.

So, when this rash appeared beginning of September last year I though it would go away, but it turned out it came to stay. As I sad I visited many dermatologists but no one could help me.

That is when I decided to take things into my own hands and do some Internet research. I decided to do Helico pilory and Demodex folliculorum tests. Helico pilory was negative, but Demodex was positive. My dermatologist suggested I should continue using my Rosacea (Metronidazol) cream by adding some severe alcohol lotion and a sulfur based cream. I followed that treatment for ca. 15 days and my face literally exploded. It felt it was about to burst any minute, it was worse then ever...

Then I found a text on Candida problems on the Internet and remembered I had a very bad vaginal infection not a full year a go. Although the infection did not last long (it reacted fine to prescribed therapy), I decided to make a home “spit“ test with a glass of water. Within 5 minutes the water was full of tales and looked as if the test was very positive. I decided I had nothing to lose (since my face could almost not get worse), so I started to give it a try with a Nystatin cream for a start.

Within 3 days of time my face was 80% better and within one week it was as clear as it can be, as if I never had any rash... Of course, I immediately started with an appropriate Candida diet. I used the Nystatin cream for almost 3 weeks but when I finally stopped my face got worse. Then I started taking Oregano oil. As long as I used 9 drops a day my face was just fine, but when I decided to increase a dose to 12 drops a day the old problems returned. My face was so bad with „mosquito like bites“ and old rash again that I started doubting Candida and decided to do some additional testing. I did full microbiological analysis of face and tongue but all the tests were negative. Not even Demodex could be found on my face any longer. Then I returned to 9 drops daily and my face got better again. However, lately I found that these symptoms might be what some call a „die off“ faze, so I recently decided to introduce „yeast fighters“ by Twinlab in addition.

I have been on 12 drops on Oregano oil a day (a full dose) and 4 tablets of „yeast fighters“ a day (not full 5 tablets dose yet) for 4 days now and my face got worse again. This time however, it is bearable and it is not as half as bad as it was the first time I decided to introduce a full dose. I decided to stop with XXXXXXX 35 for a full month to give these medications a chance (I have been taking XXXXXXX for many years beacuse of extra mail hormons that my body could not tolerate well).

I eliminated carbohydrates almost completely and now I am on veggies + meat only. I feel great. I regret I had to start eating meat but I am hoping it will last as long as this diet does. My face is so stable that I even started working out again and taking nothing but an L-Glutamine to support my work out plan. My face immune system is much better now and I can easily do my eyebrow depilation with no long term effects (a couple of months ago it would take me right to the hospital). However, in spite of all these improvements, my face is not completely clear and there are still some tiny dots visible when I get really close to a mirror. I also get blushed when I am on a business trip and eat something I should not.

Can you please help me and tell me what is it that I have. I have never heard of a „facial Candida“ and it was my personal decision (based on some Internet research) to start this treatment. Do I have Rosacea after all or is it something third? Are there any additional tests I should do to find out what was wrong with me. I can not make any alterations in my diet either because I do not know what condition do I have. Can I start using some sugar free protein supplements as a support to my work out plan? I have not done that yet because Rosacea does not tolerate proteins, right?

I will try to send some photos of my inflamed face so that you can have an even better overview. Please help me. Thanks and best regards. XXXXXXX

Dear Dr. Chawda,

First of all, please allow me to thank you for your detailed answer as well as for your thorough questions involving my previous history.

I am sorry I did not respond yesterday, but I wanted to make the newest lower abdomen scans as you requested and the first appointment I could get was this morning. I am sending you these findings attached.

I am very happy to answer your questions, as I really do hope that we will manage to find the actual cause of my skin problems. Apart from answering your questions, I will also try to provide some additional information that I did not mention in my introduction letter and that I find might be important to you as well. Therefore, please let me answer your questions first:

1) I believe I have been diagnosed with PCOD, but not sure. You see, my problem with hormonal imbalance has been dragging for many, many years. As I mentioned I am 36 now (I was born on the 13th. Of March 1975) and my problems began when I was ca. 20 years old. The symptoms were extremely painful (but regular) periods and very unclean skin. My face, part of my shoulders and my upper back were fully covered with very painful acnes. The acnes were big, red, swollen, painful and were coming from XXXXXXX within. Every day I had many new and no topical treatment could help me. My gynecologist in Austria first prescribed me XXXXXXX Miete (equivalent to XXXXXXX 35 I believe). My face cleared very quickly and most of my problems disappeared. However, a couple of months after my condition improved I stopped taking the pills as I did not have any other need for them. Soon after that however, my condition got worse again and I found my self facing the same (or even worse) problems then before my XXXXXXX treatment. When I visited my gynecologist again I think he told me that I had light case of PCOD and that the cysts are actually producing too many hormones that cause my cosmetic problems. Anyway, he prescribed me a new therapy which was: Mercilon (21 days/month) and Androcur 50 mg (15 days/month, starting from the first day of period). I was on that therapy until the end of 2008 I believe, so for well over 10 years. I stopped taking it when I came back to my country as I started a project here. Of course, a couple of months after, my skin condition deteriorated again. The acne problem returned and I visited a local gynecologist who prescribed me Jasmine pills. This doctor told me that I do not have PCOD but that I probably have too much men hormones that my body just can not tolerate (or has an allergic reaction to it). I have to mention that I did not make any hormonal test then because my doctor believed it was not necessary.

Jasmine pills made my condition even worse so 2 months after, he suggested that I switch to XXXXXXX 35 + 25mg of Androcur a day (Androcur only 15 days a month), and my condition improved very quickly. A couple of months after, my doctor suggested that I stop taking Androcur (to save my liver) and that I continue with XXXXXXX 35 only. And that is what I did. I was on XXXXXXX 35 therapy until 20 days ago when I decided to stop the therapy for short because I believed I had Candida infection maybe and because I wanted to make all hormonal examinations I could not make while on pills. I have to mention that I have been cleared of that type of acne since 2009 (since I started with XXXXXXX therapy again) and that XXXXXXX have done a very good job. These types of acne are always gone whenever I am on a hormonal therapy, they only appear when i am off the therapy. The types of acne that sometimes appear with my rash (but rarely) do not look like acne at all. They look like pimple shaped, red elevations of skin that have no peak. These are dry elevations without any form of liquid within. These can sometimes itch too, but not often. Only when my rash gets really bad I get very small actual pimples with a yellow centre that itch more often and that usually appear above my upper lip and on my wider chin area. These two conditions sometimes appear with my rash, but sometimes my rash appears without those two. I will try to explain the rash in more details. It is thousands of little red dots, a little bit raised above the skin area that sometimes cluster into patches that are sore and harsh to touch. Sometimes in case of clusters, a yellow liquid comes to the surface of the patch as if the patch broke, but these are not acne like formations, the liquid just appears on the surface of the whole patch and dries forming a surface. In most cases, or in the most areas of my face, only nettle-like rash appears (like nettle irritated skin), and the patches appear only when the condition gets more serious and usually on the areas beneath outer lower corners of my nose down and wide out to inner cheeks. The rest of the face is just covered with small, simple little red raised dots that are hot and reddish. "Mosquito like bites" are extra and they appear almost every time prior and at the time of rash. They itch horribly.

2) Yes I do, I have excessive hair all over my body (my arms and my legs are very hairy). Since my hair is naturally black, this problems tends to be very visible...

3) Yes, I had regular menstrual cycles because I was on a XXXXXXX therapy. I do not know what will happen now I am off the therapy. I know that before I started a hormonal therapy (in my early 20s), my cycles were regular I believe, but they were horribly painful. Since I started using hormone pills, my cycles gotten shorter and completely painless.

4) No. I do not have regular Rosacea reactions and that is what confused some of my doctors before. I can stand lots of sunlight (I actually love it and I use every opportunity to get to sunlight). Of course, I use 40-50 protection factor, but even if I do not use any my face is just fine. However, if outside is very hot, I sit in a closed hot car without any windows open and I sweat all over my face, I will get rash. I do not react to hot drinks, hot meals, I can stand lots of hot tea and hot coffee, I get regular sleep and my job is sometimes stressful of course, but I could never connect my facial rash to my stress (or it never came to my attention). I usually drink herbal tea only, but I sometimes get rash when I drink tea with any kinds of flowers. My doctor believed that it might be connected to my extreme allergy to pollen. I can stand hot showers, hot- steamy kitchen pots and my face does not react a bit. This is now and whenever I am free of rash. However, when I get rash, my face sensitivity is 1000 times increased and then I react to anything. I react to almost all food, to any facial physical irritations, to change in temperatures, to almost anything... I also have to mention that I have noticed that I seem to flush when I lay back (not lay down), and when my face is just little above my heart level or when I am steadily exposed to over heated room temperatures or when I am steadily exposed to sources of heat, such as when I am very close to a fireplace. I need to mention that my facial rash occurs almost ONLY while I am indoors, never when I am outdoors. It can also happen with cool room temperatures. Also, in 99% of cases I wake up with it, meaning I see it when I wake up or it starts late in the evening.

5) Yes, I sometimes (but very rarely) get „mosquito like bites“ on my neck, behind or below my ears and on my upper or lower arms. These itch badly and they usually go away soon, but they are definitely in some way connected to a facial rash. Usually, when these itchy spots appear on my neck or in my chin area, I get rash only on my chin. But if they appear on my upper face (such as on my cheeks), I get rash all over my face. These "mosquito like bites" look like tiny spots with a red dot in the middle, they have pale inner circle and very red and irritated outer circle that can be very wide. If these itchy spots appear on my arms, I do not get any rash on my arms.

6) No, I never get itchy over my eyelids. My eyelids are just fine. My eyebrows sometimes itch when I get significant or mild rash on my face or I get itchy spots above my eyebrows but never on my eyelids.

7) Yes, I used stereoid cream once but very shortly. When this major face rash just appeared last year I went to a pharmacy and they gave me corticosteroid based cream. I used it and it cleared my face within two days. I used it then 15 days again when the rash reappeared and it cleared my face again. But then someone told me that it can be very XXXXXXX in a long-term so I never used it again.

8) To be honest I do not know if I ever used oral retinoids. I just goggled it and found out that they may be used in cosmetics or against acne or psoriasis. I do not think I ever got prescribed anything against acne or psoriasis (I am very sorry for this skinny answer but I really can not tell for sure, I do not really know what that is).



Now, please, let me give you some information about skin problems that run in my family so to speak (if it might be of any importance). My father has a bad eczema right between his eyebrows for ages now, he never managed to get rid of it. My mother has a seboroic dermatitis on her scalp for ages. Her hair falls out, it is very itchy and scaly. My sister has a history of neuro-dermatitis which is present only in the outer lower corners of her nose. Sometimes it gets very red and affects a wide circle down to outer corners of her lips. These (+ chin) are also the most affected areas when I get my rash.

Last time I did not mention that I have allergic rhinitis. No one knows what triggers this but I even went so far to think that maybe some bacteria from my nose affects my face (I was hopeless in guessing...). It happens while I am in my office, at my desk, while I am home watching TV, on all kinds of unconnected places. I have no idea what triggers it, but I know that if I hurt my nose or blow my nose that I would definitely start sneezing. When I start it can go on and on (20-30 times easily) in a row and there is almost always something to blow out. The irritation-itchy signal comes from somewhere XXXXXXX inside the roots and gets to my nose. I do not know how else to describe it.

I always had fully healthy stomach and regular stools (normally once a day). However, many years ago I was diagnosed with Helico pillory bacteria, but with a help of medications I got rid of it within 1 month. It was never found again. My stomach would usually happily process what ever I feed it and would never ached. All my endless food intolerances (that is how I call them since my face started reacting to almost anything I eat) started suddenly within one week.

I also forgot to say that I smoked A LOT. I was a heavy smoker while on XXXXXXX for years. I stopped when I turned 35 (my doctor told me I should) but I still had some shorter smoking phases well beyond that age. I completely stopped in summer last year, when this rash became persistent.

Regarding pictures of my irritated face, I am trying to send some other pictures, but I am afraid they are all of very low quality too. It is just that I never knew I would need them and it never crossed my mind to get pictures of my face in such ugly phases. I took these pictures back then, just to show my sister how bad a was once she was out of town...My face does not look like that now but if you want I can send you a picture of my current state because there are still some traces of previous irritation. If you can, try to decrease frames of these pictures (by clicking minus while viewing them) and you will be able to get a much smaller but also much clearer picture.

I am also sending you pictures of my ovary and lower abdomen. They were made today. My doctor said they are the same as two years ago (when I started with XXXXXXX 35 only).

Should these not be enough and you want me to take any additional examinations of any kind, I will gladly post a brand new paid query, or as many of them as needed. I hope there is a way to request you as a doctor, so that we can keep up with this as long as a cause of my problems in known for certain.

If I understood your last mail properly, you named some possible causes and gave suggestions regarding adequate medication treatment, but I am not supposed to start with any of these medications until we know what causes the problem, right?? Or should I maybe start with some of the treatments you suggested? Should I keep taking „Yeast fighters“ and Oregano oil or should I stop?

Thank you so much for your effort and dedication, I really cherish it very much.

Thanks and best regards.

XXXXXXX