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Redness on outer cheeks, burning, itching. Rebounding from locoid cream?

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Attention Dr. XXXXXXX Chawdra:

A couple weeks ago, we were corresponding in regards to my burning face. Below is a summary of our most recent conversation. My new question is at the bottom:
XXXXXXX wrote:

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 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 are..

Your response:

Hi XXXXXXX 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” Regards, Dr XXXXXXX chawda XXXXXXX specialist, Dermatology.


I cannot get in to see my dermatologist until next week for a follow up. I stopped using the locoid cream and within a day or 2, my symptoms came back. My face gets very hot and burning and I will look red. I have not been out in the wind or cold when this is happening.

Any ideas? Could it just be that I am rebounding from the locoid cream? I also want to mention that the redness is not in the middle of my cheeks but outer cheeks. It is not red all of the time but burns and itches a lot.

Thank you, XXXXXXX
Posted Wed, 25 Apr 2012 in Skin Rash
 
 
Answered by Dr. Bharat Chawda 7 hours later
Hi! XXXXXXX

Thank you for the follow up,

I do remember our complete discussion.

You are right about the rebound phenomenon or what is actually called withdrawal symptoms of the steroid cream (locoid) that you were using. We commonly come across such problem with patients who have been on long term topical steroids. Burning and itching is a symptom of such withdrawal.

As discussed earlier the best cream to help you withdraw from the steroid would be tacrolimus or pimecrolimus cream .You can even gradually withdraw locoid .Use it for just two days in a week and then gradually taper it off while you are on tacrolimus cream. But do use a sunscreen and a moisturizer when ever required.
For symptomatic itching, you can even take a course of oral antihistaminic like cetrizine tablet.

I hope I have answered your query. Should you have additional concern regarding the same, I would be happy to address it.

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: Redness on outer cheeks, burning, itching. Rebounding from locoid cream? 14 hours later
Hi Dr. Chawda,

Thanks for your message. I was only using the steroid for 2 weeks twice a day. Is that enough time to feel withdrawal effects?

My symptoms are both burning and itching but more burning. Occasionally I will look a little red. I have some dark circles under my eyes that are new since I started having these symptoms. Is that typical of AD?

I don't understand why my cheeks will feel warm and burn/itch for no reason. I was doing great on the steroid, I wish I could use it longer but I know steroid use long term is not good. At my dermatologist appt. next week, I will ask my doctor about those other creams. I really just want this to go away!

Thanks, XXXXXXX
 
 
Answered by Dr. Bharat Chawda 11 hours later
Hi XXXXXXX
Thanks for reverting.
At times it takes a long time to recover from the withdrawal effects of the steroid cream. Please do not worry. I can understand how you would be feeling and must be eager to use the steroid again. But I would say that this is your testing time and you should try and avoid it or withdraw from it as soon as possible.

I am sure your dermatologist would help you in that.

Dark circles may be due to stress or lack of sleep and might not be related to the AD.
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: Redness on outer cheeks, burning, itching. Rebounding from locoid cream? 13 hours later
Thanks Dr. Chawda for your answers. I have read that Elidel has a blacl box warning, is it safe to use?
I don't understand why my cheeks will feel warm and burn/itch for no reason. Is that from not using the steroid? What causes the warm/hot feeling? Inflammation?

Thank you, XXXXXXX
 
 
Answered by Dr. Bharat Chawda 5 hours later
Hi XXXXXXX ,

Thank you for writing back,

Elidel contains pimecrolimus .FDA has given the black box warning. According to a FDA news release, the warning states that there have been rare reports of cancer (for example, skin and lymphoma) in patients who had been receiving the drugs. However, the drugs haven't been proven to cause cancer, says the FDA.

The drugs' makers are studying the cancer risk, but it could take many years for the results to come back, according to the FDA.

The new warning also states that the drugs aren't recommended for children younger than age 2.

We have been using this drug for a long time and have not come across any such side effects. I personally feel that the drug is very safe to use. However you can also confirm from your dermatologist.
And yes, it’s the inflammation causing the problem and these drugs and steroid are anti-inflammatory in their action. There are various cells in the blood which causes this inflammation and the burning symptoms.

I hope I have answered your query.
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: Redness on outer cheeks, burning, itching. Rebounding from locoid cream? 16 hours later
Hi Dr. Chawda,

I saw my dermatologist this afternoon and he said that I could use the locoid cream for another few days and then switch to Elidel cream that he gave me. He said that I would be ok with stopping the locoid cream cold XXXXXXX but I told him that when I stopped it the other day, the burning came back. (According to my dr., a person can use locoid cream for up to a month before they would have any problems).

Could you maybe offer me a "taper plan" to stop using the locoid on to using the elidel? Can I use them 2 together?

Can locoid cause visible blood vessels? Before I began using the locoid, I did not have any noticeable veins near my nose and now I have a few. My dermatologist said that I do not have rosacea and just sensitive skin.

Thank you so much for your assistance!
XXXXXXX
 
 
Answered by Dr. Bharat Chawda 9 hours later
Hi XXXXXXX

Thank you for writing back.

I think your dermatologist has given you a good advice regarding stopping locoid cream & switching over to Eledil cream.
Yes you can use the two creams together, but one at a time. The tapering plan for locoid would be as follows:
Use it thrice a week (alternate days) for a week and then make it twice in a week for another week. Later on make it once a week and then stop it completely. All through this time you can use Eledil cream daily. Eledil cream is slow to work and may take a month’s time to show its effect.

You are also right about the visible blood vessels near the nose. They are known as telangiectasia which is a common side effect of long term use of steroid cream. But it may not vanish on its own and neither Eledil would work on that. You can either take a IPL (intense pulse light) or a 532nm KTP LASER for that .

I hope I've answered your query. Should you have additional concern regarding the same, I would be happy to address it.

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: Redness on outer cheeks, burning, itching. Rebounding from locoid cream? 18 hours later
Dr. Chawda,

Thanks for getting back to me. I will taper the locoid cream per your instructions. My dermatologist was very blase about my discontinuing of the cream meaning that he didn't feel that stopping it would be an issue. Could you please explain why my skin gets hot and burns when I try to stop it? Is that rebound?

My dermatologist feels that I just have sensitive skin but I am still worried that this could be pre rosacea. My dermatologist does not even want to entertain the idea of possibly having rosacea because I look normal. Are you sure that my symptoms do not sound like that? I have read on the internet that pre rosacea symptoms can be burning and patches of redness that come and go with a tight/dry feeling on face. Wouldn't a steroid cream worsen rosacea because it helps me?

I hope to be all right and NOT to have rosacea but I want to be sure. When I research atopic dermatitis, most people don't complain of burning, just itching. Although I have read that flushing can happen with AD. I'm just confused and want to get well.

Thank you so much, XXXXXXX
 
 
Answered by Dr. Bharat Chawda 11 hours later
Hi! XXXXXXX

Thank you for the follow up,

I would like to put it this way that there is a thin line between having a sensetive skin and having Rosacea. When a patient develops redness of skin with burning sensation on face, one does start with toical steroid cream to begin with. But this should not be continued for long, as steroid withdrawal itself can lead to similar complaints. Thus, we always consider steroids as a double edged sword.

Feeling of heat and burning sensation could be a rebound phenomenon or even your initial complaint. It could be that your skin is very sensetive to either cold, emotional stress or lack of sleep. These all lead to inflammatory changes in skin.

Common complaint of AD (Atopic Dermatitis) is itching rather that burning sensation. Flushing can be a feature of AD.

I am happy that you have started Elidel cream. I would suggest you continue treatment as advised by your dermatologist and keep me updated regarding the response.

I hope this answers your query. Please accept my answer in case you do not have further queries.

Wish you good health.

Regards,

Dr. Bharat Chawda. XXXXXXX specialist, Dermatology.


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Follow-up: Redness on outer cheeks, burning, itching. Rebounding from locoid cream? 58 minutes later
Dr. XXXXXXX

Thank you for writing back. That is interesting about there being a fine line between rosacea and sensitive skin. I don't flush with change of temperatures, with exercise, hot drinks, or sun. I do flush and get the burning sensation with windy, cold weather and emotion.

I will continue to use the elidel and taper off the locoid. I will definitely keep you updated.

Last night, I was trying to fall asleep and my face felt warm. I looked in the mirror and it was blotchy and warm. What is that?! It went away after a few minutes but it is very disconcerting. I was not doing anything except trying to fall asleep. My skin was not burning at the time.

A few months ago, I was getting facials at a local spa. The estetetican did a course (3 or 4) of microdermabrasion treatments on my face and I remember them really hurting me. It was very harsh and I was really red for a couple of days. This was around March-May. Could this have caused the problems that I am dealing with?

I have read of a sensitive condition called "Burning and Stinging." Could I have that rather than rosacea or AD? I don't think that I have rosacea though.

Thank you so much for all of your help! XXXXXXX
 
 
Answered by Dr. Bharat Chawda 20 hours later
Hi! XXXXXXX

What I actually mean by having a thin line between rosacea and sensitive skin is that the symptoms of both the conditions are similar. I would also grade rosacea more severe than a sensitive skin as far as symptoms are concerned.

As you mentioned that you don't flush with change of temperatures, with exercise, hot drinks, or sun, but do flush and get burning sensation with windy, cold weather and emotion. These symptoms would probably go towards having sensitive skin rather than rosacea.

You also mentioned that while you went to sleep you started getting warm and blotchy which subsided later on. Did you use any face wash or soap just before that or do you have a habit of scrubbing your face harshly or any such activity before going to bed which could have made your face sensitive (like smoking or having a drink ) .I am just trying to find out a cause here. Kindly let me know if it is so.

As far as microdermabrassion (MD) is concerned, I would consider it as a big no to anybody who has a sensitive skin or rosacea . In fact I don't think it helps any kind of skin. I have stopped doing MD for my patients long time back. But I don't think it to be the sole reason for your problem.

Yes, I do feel that you have a sensitive skin (similar to having burning & stinging) and not rosacea .

I hope and wish that you recover soon.

Wish you good health.

Regards,

Dr. Bharat Chawda. XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: Redness on outer cheeks, burning, itching. Rebounding from locoid cream? 36 hours later
Hi Dr. Chawda,

I am now on thee elidel cream and am trying to taper off of the locoid steroid. I guess we will see how it goes.

In regards to my face getting blotchy and warm when I am in bed, I am not sure what causes it. I am not scrubbing my face harshly before bed or using anything differently. This morning I woke up with a warm, flushed face (I was warm in bed) and as soon as I got up and moving, showered, the redness and warm feeling went away. I am trying not to get too upset about this but I am just confused. Can this be from my "eczema sensitive" skin?

I also notice around my menstrual cycle, I will get blotches on my face but they go away fast.

Like I said before, I do not flush with exercise or sun or temperature change. I sometimes use an icepack on my face and when I take the ice off, my skin will get warm and flush. Is this some sort of rebound redness?

Could the microdermabrasion that I received a few months ago caused my skin to become sensitized? Does it take this long to go back to normal?

Thank you for all of your help, XXXXXXX
 
 
Answered by Dr. Bharat Chawda 18 hours later
Hello again XXXXXXX

We don't call it a "eczema sensitive" skin ,rather just a sensitive skin .

Ice packs or its rebound also won't cause your skin to be blotchy or flush.

But yes microdermabrassion may lead to sensitive skin, as it actually scrubs away the top layer of epidermis and exposes skin to the the harsh environment. But anyway, I hope and wish that Elidel does the trick and gives you relief. And it does take long in such cases.

Vit K is also known to reduce the redness and work on the fine blood vessels, but I don't have much experience on that since its not available in my country where I practice. Kindly talk to your dermatologist if its of any use in your case.

Hoping for the best.

Take care,

regards,

Dr. Bharat Chawda. XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: Redness on outer cheeks, burning, itching. Rebounding from locoid cream? 11 hours later
Hi Dr. Chawda,

I apologize if you are getting frustrated with me and my questions. It's just that I was getting NO answers from my dermatologist or allergist and it was very upsetting. I was having these episodes of burning and redness and it's been very confusing. I really do appreciate you helping me.

You said that using an icepack on my face will not cause rebound redness. What if it's used for a longer period of time? You asked what I was doing preceding the episodes of blotchy skin and it was icing my face to help with the burning. It seemed that when I took off the ice, parts of my face would heat up and blotch- particularly old acne scars. I am now trying not to use ice for long periods of time.

I hope that the elidel helps me too. I would like to put all of this behind me. Do people usually recover when their skin has become sensitized if they take precautions and help heal their skin?

Would you recommend me getting a patch test done to see what chemicals I am possibly allergic to?

I am thinking of trying vitamin k to help with the blood vessels around my nose.

One more thing.. I am experiencing dry skin around the corners of my nose that flakes sometimes. No moisturizer that I put on helps. Should I use the elidel?

Thanks, XXXXXXX
 
 
Answered by Dr. Bharat Chawda 3 hours later
Hi XXXXXXX ,

You don't need to apologize for the questions you have. It’s absolutely fine with me. I would more than happy if you benefit from these suggestions.

I think you should avoid using ice packs, as it has a tendency to dry your skin further.

Creams like Elidel have definitively helped my patients, but take a long time to work.

I don't think you require any patch testing at the moment, though we can keep it as a option later on.

The problem you have mentioned around your nose is called as Seborrheic dermatitis .You can apply Elidel cream over there along with any antifungal cream like ketoconazole cream. A couple of days of locoid would also help (but only for few days).Moisturizers won't help much.

Take care

Regards,

Dr. Bharat Chawda. XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: Redness on outer cheeks, burning, itching. Rebounding from locoid cream? 2 hours later
Dear Dr. Chawda,

In regards to the ice packs, I will stop using them. Last night I had one on my cheek on and off for about 2 hours. After I had it off for awhile, my cheek got very hot and started burning. What happened? Was that a side effect of keeping the ice on too long? Now do you see why I am anxious? All of these weird things keep happening to me that I cannot explain :(

Can dermatitis cause the flush? Or my sensitive skin?

Thank you for helping, XXXXXXX
 
 
Answered by Dr. Bharat Chawda 7 hours later
Hi! XXXXXXX

The feeling of heat and burning after the use of ice pack could be because of the vasoconstriction caused by the chilled ice pack.

A dermatitis can lead to itching ,but usually not a flush on skin.Yes a sensitive skin can lead to flush .

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
 
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