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Suggest treatment for rough skin spots on forehead and face

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Posted on Mon, 18 May 2015
Question: I am a man aged 74, 6' tall, 180lb, retired but still active, help out in the district with general farm work, take various supplements, don't smoke, drink alcohol or

coffee.
I had four, rough skin spots on my forehead/face, removed with liquid N, because it was thought they could eventually become skin cancer. Four dabs each - really hurt.
Four days later I was given "Aciclovir" 5/day x 7days for shingles.
The treated places were one on each side of forehead, 2" above outer edge of eyebrow. The other two were on RHS; one in the eyebrow at outer edge (not the nose end)

and the other was 2" further out in the sideburn hair. 13 weeks later everything LOOKS normal, but I still have considerable pain. My RHS scalp is numb. My RHS

forehead is numb but also sensitive - how can it be both! I've cut my hair short here so it can't brush against it with the wind when I'm driving. Can't have a sheet

touch it either. The pain is concentrated at the two eyebrow level sites. A permanent ache, with intermittent bursts of an explosive burning pain.

My doctor has me on ParacCodine 500/8, two @4times/day, says he doesn't think it's PHN, expects the pain to fade with time. (fade to what level, in what period of

time?) But I'm getting the shakes, don't want to be a trainee drug addict! So have stopped the pills, (they were working, but I can live without them)

I consulted Dr Google, found these two eyebrow level sites are directly over the forked ends of a nerve. Could the liquid N be the cause of my shingles?
The general opinion seems to be shingles is caused by stress or low immune system. This bothers me because I think of my self as reasonably healthy.
I can go to sleep while watching a "wifes" tv program. Am I stressed?
I never have a cold/sniffles for more than a few hours, always gone when I wake up next morning. Is my immune system down?

I am reluctant to, but will probably have to, go back to my doctor and ask for a referral to a specialist. He will tell me not to waste my money. I accept that he is

probably right on all counts, but if remission doesn't start soon, I'll probably feel I have to, in case delay is causing something else. Like stress!

On reading this I see I have asked a number of some what rhetorical questions.
But there are only two important questions:
1) could the liquid N be the "stress" that caused the shingles?
2) what is the name of the specialist branch of medicine that I need to see?
Thanks, XXXXXXX
doctor
Answered by Dr. Olsi Taka (37 minutes later)
Brief Answer:
Read below

Detailed Answer:
I read your question carefully and I understand your concern.

I don't believe the liquid nitrogen to be the cause of shingles. Yes cryotherapy is known in rare cases to have the potential of being complicated with damage to the peripheral nerve and painful neuropathy, which can cause pain to the area, but apart from being rare I don't see how it caused the activation of a dormant virus in the nerve origin, with its skin manifestations.
While it is true that often herpes zoster (shingles) is manifested in situations of lowered immune response or stress keep in mind that that is not a rule, it can very well happen in the absence of such factors, so shouldn't think too much about that. Also one could argue that the skin procedure itself was a stressful event at the time.

The pain that you describe seems like neuropathic pain. It could very well be in the setting of postherpetic neuralgia but also from damage to the peripheral nerves from the procedure. They both have the same manifestations so hard to distinguish the cause really. I tend to blame shingles more just because post herpetic neuralgia is much more common than nerve damage from cryotherapy.
However from a practical point of view in both cases it's basically a nerve damage which can take months to heal, at times over a year (only in 3% persists later than a year). The treatment also remains the same, medication for neuropathic pain like Gabapentin or Pregabalin which are more specific for this type of pain than paracetamol/codein and carry no addictive properties.

If you decide to see a specialist on the other hand it would definitely be a neurologist.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3668 Questions

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Suggest treatment for rough skin spots on forehead and face

Brief Answer: Read below Detailed Answer: I read your question carefully and I understand your concern. I don't believe the liquid nitrogen to be the cause of shingles. Yes cryotherapy is known in rare cases to have the potential of being complicated with damage to the peripheral nerve and painful neuropathy, which can cause pain to the area, but apart from being rare I don't see how it caused the activation of a dormant virus in the nerve origin, with its skin manifestations. While it is true that often herpes zoster (shingles) is manifested in situations of lowered immune response or stress keep in mind that that is not a rule, it can very well happen in the absence of such factors, so shouldn't think too much about that. Also one could argue that the skin procedure itself was a stressful event at the time. The pain that you describe seems like neuropathic pain. It could very well be in the setting of postherpetic neuralgia but also from damage to the peripheral nerves from the procedure. They both have the same manifestations so hard to distinguish the cause really. I tend to blame shingles more just because post herpetic neuralgia is much more common than nerve damage from cryotherapy. However from a practical point of view in both cases it's basically a nerve damage which can take months to heal, at times over a year (only in 3% persists later than a year). The treatment also remains the same, medication for neuropathic pain like Gabapentin or Pregabalin which are more specific for this type of pain than paracetamol/codein and carry no addictive properties. If you decide to see a specialist on the other hand it would definitely be a neurologist. I hope to have been of help.