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Suggest remedy for reddish scaly lesions on face

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Posted on Fri, 20 May 2016
Question: last year my daughter got a strep or staph skin infection on her face (they never swabbed to find out which one) ever since then her skin will flare up all red where the infection was. it's not infected now, it's sort of like a rash, it does it quite often.
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Answered by Dr. Shuba Hariprasad (3 hours later)
Brief Answer:
Butterfly rash of systemic lupus erythematosus

Detailed Answer:
Hello Ms. XXXXXXX
I'm Dr. Shuba Hariprasad and will be answering your query today.

Would you please clarify a few things for?
1)you mentioned a skin infection last year. Could you please describe it? (any fever, pus, blisters, scaly patches)
2)How long did it last and what kind of treatment was administered? Did she have any other symptoms,? (rash anywhere else, joint pains, for instance)
3)any family history of auto immune disease?
4)do the flare ups occur when she is in the sun or when she is stressed? (illness or emotional). Any associated symptoms or triggers? Does it spontaneously subside?

Based on your query & the photos, I would like to primarily look for Systemic lupus erythematosus. (before looking for other causes).
I would elicit a detailed medical, family and personal history with a thorough clinical exam and would run
blood tests (Complete blood count, ESR, CRP, clotting parameters, antibodies (ANA, anti dsDNA, anti Ro-SSa, La-SSb, anti cardiolipin, anti Sm), complement levels, creatinine)
urine test to monitor kidney function that could help to confirm diagnosis.
I recommend early diagnosis & treatment to slow the disease process in case of Sle.

Hope this helps. Please get back to us if you have further queries.
If you do not have further queries,kindly close this discussion and rate the answer.
Wish you both good health
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Shuba Hariprasad (59 minutes later)
hello, the infection was red and a little scaly. no blisters or pus, but hot to touch.
I can't remember exactly what the antibiotics were, but I think it was penicillin of some sort.
no other symptoms that I can remember, she didn't have a fever.

no family history of auto immune disorders.
doctor
Answered by Dr. Shuba Hariprasad (6 hours later)
Brief Answer:
SLE to be ruled out

Detailed Answer:
Hello ,

Thank you for the details.

Could you please let me know if the flareups are similar to the initial infection?And if they get triggered by sun light or stress?
I would go ahead and do the physical exam and blood/urine tests to rule out SLE (systemic lupus erythematosus). your description of the rash is similar to the Malal /butterfly rash seen in SLE.
Even if the tests turn negative, I would keep a close eye to monitor for any systemic involvement. This is important as early treatment can help to slow or even arrest disease progression.

Absence of family history is great news and hope that I will be proven wrong and that the cause of the rash is limited to just the skin.
If a strong suspicion and diagnosis of SLE is made, it is better sooner than later.
Treatment would be based on the extent and severity of systemic involvement.

Please maintain a time and duration log of her symptoms (flare ups, triggers, relievers ).
I hope I've helped.
Please get back to us if you have further queries. If you do not have further queries, kindly close this discussion and rate my answer.
Wish you both good health
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Shuba Hariprasad (4 hours later)
the flare ups are different to the initial infection. I would call the current rash more of a blush. I think it's possibly triggered by the sun.
doctor
Answered by Dr. Shuba Hariprasad (4 hours later)
Brief Answer:
SLE to be ruled out

Detailed Answer:
Hello Ms. XXXXXXX

Rash in SLE exhibits photosensitivity (flare-ups when exposed to the sun). The symptoms & duration of the cutaneous manifestations in Lupus can vary widely in presentation & duration.
As this rash (and triggers) closely resemble the rash associated with SLE and is long standing, I would go ahead & rule out SLE.

This may be limited to only the skin or may involve other internal organs (not always symptomatic).

Please maintain a log of her symptoms, triggers & duration. Examine her from head to toe (including scalp) regularly & during flare-ups.

Hope this helps.
Please close this discussion if you are satisfied and rate my answer.
Any further queries are welcome
wish you good health
Above answer was peer-reviewed by : Dr. Sonia Raina
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Answered by
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Dr. Shuba Hariprasad

General & Family Physician

Practicing since :2002

Answered : 1087 Questions

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Suggest remedy for reddish scaly lesions on face

Brief Answer: Butterfly rash of systemic lupus erythematosus Detailed Answer: Hello Ms. XXXXXXX I'm Dr. Shuba Hariprasad and will be answering your query today. Would you please clarify a few things for? 1)you mentioned a skin infection last year. Could you please describe it? (any fever, pus, blisters, scaly patches) 2)How long did it last and what kind of treatment was administered? Did she have any other symptoms,? (rash anywhere else, joint pains, for instance) 3)any family history of auto immune disease? 4)do the flare ups occur when she is in the sun or when she is stressed? (illness or emotional). Any associated symptoms or triggers? Does it spontaneously subside? Based on your query & the photos, I would like to primarily look for Systemic lupus erythematosus. (before looking for other causes). I would elicit a detailed medical, family and personal history with a thorough clinical exam and would run blood tests (Complete blood count, ESR, CRP, clotting parameters, antibodies (ANA, anti dsDNA, anti Ro-SSa, La-SSb, anti cardiolipin, anti Sm), complement levels, creatinine) urine test to monitor kidney function that could help to confirm diagnosis. I recommend early diagnosis & treatment to slow the disease process in case of Sle. Hope this helps. Please get back to us if you have further queries. If you do not have further queries,kindly close this discussion and rate the answer. Wish you both good health