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Suggest remedy for severe face rash

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Posted on Wed, 25 Feb 2015
Question: My 18 year old daughter has been battling a severe face rash for approx. 4 months, we started with a derm who just gave her oral and topical steroids, no matter what it was back in a few days. Went to Allergy/immune Dr. who said she had a sinus infection and she would grow out of it. She is with a derm and XXXXXXX Clinic now. She has had extensive Blood work, everything came back Negative as far as Auto immune Disease. The derm now thinks it is an allergen , her biopsy came back contact dermatitis. She has been on house arrest for a week not leaving the house and the rash has worsened. I have washed everything in hot water, she is on special shampoo, soap and crème from the Derm. I have been using no cleaning products, air fresheners, perfume , everything. and Still rash continues. It is primarily on her face sometimes arms and neck , but that's all. We have had a dog for 4 years now, golden retriever. She is being patch tested next week. Her food allergies came back negative. I am looking for any hope to get this resolved she is in her XXXXXXX year of high school and has missed most of the year. It has at times been crusty and oozing, not always . Her Ige level was raised also.
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Answered by Dr. Parin N. Parmar (4 hours later)
Brief Answer:
Allergy testing, antihistamine and topical steroids

Detailed Answer:
Hello XXXX,

Thank you for asking at HCM.

I went through you daughter's history and would like to make suggestions for her as follows:

1. As an Allergist-Immunologist, I see some confusing reports. As her IgE level is raised and all autoimmune workup is negative (as you have mentioned), it is suggestive of allergic disorder.

However, IgE levels are raised in atopic dermatitis and not contact dermatitis (both are allergic conditions), while biopsy is suggestive of contact dermatitis.

2. So at present, as an Allergist-Immunologist, I would suggest you to wait for patch testing, which may find some offending allergen. If it does not help, I would suggest her allergy testing for air-borne allergens, such as animal dander, house dust mites, molds, etc. History of worsening of rash during house arrest also supports some indoor allergen.

3. Rightly, her food allergies are negative and I would suggest her not to restrict foods as they are not causing her allergies.

4. Of course, for rash on face, the first thing to think about is cosmetics. But as you are already put on prescribed shampoo, soap, cream, etc, I assume cosmetics are not causing her symptoms.

5. As her rashes are dominantly on face, arm and neck (exposed parts of body), I would also suggest you to observe whether her rash are worsened by sunlight exposure. In that case, sunscreen lotion/cream (SPF 30) may help.

6. For treatment purpose, I would suggest her to use antihistamine like cetirizine, fexofenadine, levocetirizine orally for itching. For treatment of rash, I usually prescribe my such patients topical corticosteroids like hydrocortisone.

7. If her skin is dry (in general), I would suggest her to apply moisturizer cream/lotion regularly for 2-3 months all over body skin to improve moisture content of the skin. Also, I usually suggest my such patients a good multivitamin-multimineral supplement (especially containing vitamin A, E, D, zinc, selenium, essential fatty acids) for 2-3 months, which may improve her skin in general.

Hope above suggestions will be helpful to your daughter.

Should you have any further query, please feel free to ask on follow-up. I would also appreciate your feedback, thoughts and follow-up on my comments.

Wish your daughter the best of the health ahead.

Thank you & Regards,

Dr Parin N Parmar
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Answered by
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Dr. Parin N. Parmar

Allergist and Immunologist

Practicing since :2006

Answered : 870 Questions

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Suggest remedy for severe face rash

Brief Answer: Allergy testing, antihistamine and topical steroids Detailed Answer: Hello XXXX, Thank you for asking at HCM. I went through you daughter's history and would like to make suggestions for her as follows: 1. As an Allergist-Immunologist, I see some confusing reports. As her IgE level is raised and all autoimmune workup is negative (as you have mentioned), it is suggestive of allergic disorder. However, IgE levels are raised in atopic dermatitis and not contact dermatitis (both are allergic conditions), while biopsy is suggestive of contact dermatitis. 2. So at present, as an Allergist-Immunologist, I would suggest you to wait for patch testing, which may find some offending allergen. If it does not help, I would suggest her allergy testing for air-borne allergens, such as animal dander, house dust mites, molds, etc. History of worsening of rash during house arrest also supports some indoor allergen. 3. Rightly, her food allergies are negative and I would suggest her not to restrict foods as they are not causing her allergies. 4. Of course, for rash on face, the first thing to think about is cosmetics. But as you are already put on prescribed shampoo, soap, cream, etc, I assume cosmetics are not causing her symptoms. 5. As her rashes are dominantly on face, arm and neck (exposed parts of body), I would also suggest you to observe whether her rash are worsened by sunlight exposure. In that case, sunscreen lotion/cream (SPF 30) may help. 6. For treatment purpose, I would suggest her to use antihistamine like cetirizine, fexofenadine, levocetirizine orally for itching. For treatment of rash, I usually prescribe my such patients topical corticosteroids like hydrocortisone. 7. If her skin is dry (in general), I would suggest her to apply moisturizer cream/lotion regularly for 2-3 months all over body skin to improve moisture content of the skin. Also, I usually suggest my such patients a good multivitamin-multimineral supplement (especially containing vitamin A, E, D, zinc, selenium, essential fatty acids) for 2-3 months, which may improve her skin in general. Hope above suggestions will be helpful to your daughter. Should you have any further query, please feel free to ask on follow-up. I would also appreciate your feedback, thoughts and follow-up on my comments. Wish your daughter the best of the health ahead. Thank you & Regards, Dr Parin N Parmar