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What Causes Persistent Flaky Red Rash On Different Parts Of Body?
Question: Hey there,
I am a 25 year old male and have had a persistent, flaky, red rash on different parts of my body for over 4 years. I have also been taking Vyvanse (lisdexamphetamine dimesylate) for about 2 years, up too 50-90mg a day.
The rash started out around my eye sockets on either side of my nose initially, then grew so that it actually crossed my brow from time to time. The rash seemed to flare up or shrink randomly, perhaps related to stress. After a while the rash also started to appear at the top of my forehead along the hairline, just like the first, it started as a red discolouration and then raised up slightly and started to shed dry skin flakes from the top layer of the rash.
The rash stayed in those 2 locations for quite some time and didn't wander onto my scalp more than half an inch past my hairline. When I started taking Vyvanse the rash slowly started to get worse until it progressed to where it is today (not sure if it is related) Now it covers the previously mentioned areas along with my entire scalp, including around my temples and behind my ears. It has also spread to my eyebrows, and I get a similar flare-up on the center of my chest from time to time.
If I scratch the skin flakes off, the underlying irritated red skin becomes moist with a clear slippery feeling fluid, if I scratch enough it sometimes starts to bleed (not a lot). The rash is not painful or irritating unless I have scratched the area. It is also not itchy most of the time but it does get itchy occasionally.
I have tried numerous shampoos and lotions over the years;
Shampoos - Nizoral (2% Ketoconazole), Head and Shoulders and similar.
Lotions - Spectro Clobetasone Cream, Polysporin 1% Collodial Oatmeal Cream, multiple Hydrocortizone creams (over the counter and prescribed)
The only things that seemed to work at all were the Spectro Clobetasone Cream and Hydrocortizone creams. Most of the time on the areas where applied the rash would shrink and the redness would be reduced significantly. However, no matter how long I had being applying the cream for, after 24-48 hours of stopping using the cream the rash would fully return.
Now that the rash is also on my scalp, applying the cream effectively on a regular basis is virtually impossible (and expensive). I have resorted to wearing hats as throughout the day my hair becomes riddled with skin flakes of different sizes. Whenever I remove my hat a shower of white flakes come off with it. If I don't wear a hat, anytime something touches my scalp skin flakes detach and stay in my hair and it gets worse throughout the day. If I ever attempt to scratch the flakes off, it seems like a never ending shower of dry skin.
Any advice would be greatly appreciated.
I am a 25 year old male and have had a persistent, flaky, red rash on different parts of my body for over 4 years. I have also been taking Vyvanse (lisdexamphetamine dimesylate) for about 2 years, up too 50-90mg a day.
The rash started out around my eye sockets on either side of my nose initially, then grew so that it actually crossed my brow from time to time. The rash seemed to flare up or shrink randomly, perhaps related to stress. After a while the rash also started to appear at the top of my forehead along the hairline, just like the first, it started as a red discolouration and then raised up slightly and started to shed dry skin flakes from the top layer of the rash.
The rash stayed in those 2 locations for quite some time and didn't wander onto my scalp more than half an inch past my hairline. When I started taking Vyvanse the rash slowly started to get worse until it progressed to where it is today (not sure if it is related) Now it covers the previously mentioned areas along with my entire scalp, including around my temples and behind my ears. It has also spread to my eyebrows, and I get a similar flare-up on the center of my chest from time to time.
If I scratch the skin flakes off, the underlying irritated red skin becomes moist with a clear slippery feeling fluid, if I scratch enough it sometimes starts to bleed (not a lot). The rash is not painful or irritating unless I have scratched the area. It is also not itchy most of the time but it does get itchy occasionally.
I have tried numerous shampoos and lotions over the years;
Shampoos - Nizoral (2% Ketoconazole), Head and Shoulders and similar.
Lotions - Spectro Clobetasone Cream, Polysporin 1% Collodial Oatmeal Cream, multiple Hydrocortizone creams (over the counter and prescribed)
The only things that seemed to work at all were the Spectro Clobetasone Cream and Hydrocortizone creams. Most of the time on the areas where applied the rash would shrink and the redness would be reduced significantly. However, no matter how long I had being applying the cream for, after 24-48 hours of stopping using the cream the rash would fully return.
Now that the rash is also on my scalp, applying the cream effectively on a regular basis is virtually impossible (and expensive). I have resorted to wearing hats as throughout the day my hair becomes riddled with skin flakes of different sizes. Whenever I remove my hat a shower of white flakes come off with it. If I don't wear a hat, anytime something touches my scalp skin flakes detach and stay in my hair and it gets worse throughout the day. If I ever attempt to scratch the flakes off, it seems like a never ending shower of dry skin.
Any advice would be greatly appreciated.
Brief Answer:
Seborrheic dermatitis
Detailed Answer:
Hello and welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have also looked at the Images.
This is classical seborrheic dermatitis. Seborrheic dermatitis clinically presents with ill-defined erythema at sites of involvement, along with itching. Apart from the ill-defined erythema seborrheic dermatitis also presents with yellowish/greasy adherent scales which when forcibly scraped/scratched exposes raw skin which oozes scantily and subsequently re-accumulates crusts/scales.
Seborrheic dermatitis patients have an overgrowth of yeast, malassezia furfur which may be pathogenetically related/contributes to the inflammation of seborrheic dermatitis.
The involvement can be limited to the scalp or it may affect other areas like face, chest and back as well. Facial seborrheic dermatitis classically involves the eyebrow skin, glabella, sides of nose, beard, chin etc.
Seborrheic dermatitis is a steroid responsive dermatosis as you must have noticed that it gets better when you use hydrocortisone and clobetasone, both of which are topical steroids.
However, seborrheic dermatitis is a remitting and relapsing condition, therefore once you stop using the steroid it can relapse.
If I was the treating doctor I would have suggested you to continue with 2% ketoconazole shampoo, thrice weekly for 2-4 weeks followed by once or twice weekly for maintenance. It is available OTC as Nizral 2% solution. Ketoconazole is antifungal,antiinflammatory. It inhibits the yeast Malessezia furfur which is present in abundance in seborrheic dermatitis and thus benefits seborrheic dermatitis. You may also use a topical steroid lotion (mometasone furoate lotion) once daily at night for faster relief.
For facial involvement, you may use a moderately potent topical steroid rather milder steroid like hydrocortisone or clobetasone e.g fluticasone propionate (Flutivate cream), twice daily would dramatically clear this within 2-4 weeks.
An OTC antihistamine e.g cetrizine 10 mg once daily would help you symptomatically with itching.
However, as you must be aware that topical steroids have certain harmful effects like skin atrophy etc and therefore cannot be use for ever. So, after the initial 2-4 weeks of topical fluticasone propionate, I usually shift my patients to topical immunomodulators like pimecrolimus or tacrolimus. Unlike steroids, topical immunomodulators are safe for long term use and can be used for maintenance. These immunomodulators are available in both cream/ointment form as well as in lotion form (for scalp application)
These are prescription drugs, therefore I would suggest that you seek an appointment with a dermatologist in your region before trying these.
Regards
Seborrheic dermatitis
Detailed Answer:
Hello and welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have also looked at the Images.
This is classical seborrheic dermatitis. Seborrheic dermatitis clinically presents with ill-defined erythema at sites of involvement, along with itching. Apart from the ill-defined erythema seborrheic dermatitis also presents with yellowish/greasy adherent scales which when forcibly scraped/scratched exposes raw skin which oozes scantily and subsequently re-accumulates crusts/scales.
Seborrheic dermatitis patients have an overgrowth of yeast, malassezia furfur which may be pathogenetically related/contributes to the inflammation of seborrheic dermatitis.
The involvement can be limited to the scalp or it may affect other areas like face, chest and back as well. Facial seborrheic dermatitis classically involves the eyebrow skin, glabella, sides of nose, beard, chin etc.
Seborrheic dermatitis is a steroid responsive dermatosis as you must have noticed that it gets better when you use hydrocortisone and clobetasone, both of which are topical steroids.
However, seborrheic dermatitis is a remitting and relapsing condition, therefore once you stop using the steroid it can relapse.
If I was the treating doctor I would have suggested you to continue with 2% ketoconazole shampoo, thrice weekly for 2-4 weeks followed by once or twice weekly for maintenance. It is available OTC as Nizral 2% solution. Ketoconazole is antifungal,antiinflammatory. It inhibits the yeast Malessezia furfur which is present in abundance in seborrheic dermatitis and thus benefits seborrheic dermatitis. You may also use a topical steroid lotion (mometasone furoate lotion) once daily at night for faster relief.
For facial involvement, you may use a moderately potent topical steroid rather milder steroid like hydrocortisone or clobetasone e.g fluticasone propionate (Flutivate cream), twice daily would dramatically clear this within 2-4 weeks.
An OTC antihistamine e.g cetrizine 10 mg once daily would help you symptomatically with itching.
However, as you must be aware that topical steroids have certain harmful effects like skin atrophy etc and therefore cannot be use for ever. So, after the initial 2-4 weeks of topical fluticasone propionate, I usually shift my patients to topical immunomodulators like pimecrolimus or tacrolimus. Unlike steroids, topical immunomodulators are safe for long term use and can be used for maintenance. These immunomodulators are available in both cream/ointment form as well as in lotion form (for scalp application)
These are prescription drugs, therefore I would suggest that you seek an appointment with a dermatologist in your region before trying these.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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