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Dr. Andrew Rynne

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What causes red, swollen and hot forehead with a history of discoid lupus?

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Dr. Albana Sejdini

General & Family Physician

Practicing since :2006

Answered : 3676 Questions

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Posted on Tue, 5 Jul 2016 in Ear, Nose and Throat Problems
Question: Hello Dr.,
My red, swollen, hot forehead (duration 6 months) is stumping my Internist and Dermotologist. Concurrently, I have had hair loss that is much more significant than any I've had before. I have had Discoid Lupus for 35 years and Sjogren's for ten or so years. This redness is covering my entire forehead and has gotten slightly better after 3 weeks of 2 1/2% hydrocortisone, but had no response to Elidel. They want my next step to be a biopsy. Someone told me to be checked more closely for an ear infection. I do not have any symptoms of that but I do have significant tinnitis in one ear. I wonder what you think? Thank you, XXXXXXX Miller
doctor
Answered by Dr. Albana Sejdini 2 hours later
Brief Answer:
Erysipelas/cellulitis to rule out

Detailed Answer:
Hi Ma,

I have gone through your medical history carefully and the photo you sent in.

Apart an acute attack of lupus, my thoughts go for possible erysipelas (infection of local skin caused by streptococcus) or cellulitis. As you suffer of discoid lupus, skin barrier is being damaged often. This will serve as entrance to bacteria that would cause infection like erysipelas or cellulitis.

You can discuss this further with your doctor.

Tinnitus is less likely to be related to infection . However , a good ENT examination is advised to rule out ear problems.

Keep good local hygiene. Can apply cold compresses locally and take OTC painkillers.

Wish fast recovery.
Dr.Albana


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Albana Sejdini 30 minutes later
I forgot to tell you before that I had bloodwork done at my first visit and all results of these were normal. I had a complete metabolic panel, an LDH, a C reactive protein, sed rate (at 9 which is typical for me), a TSH ultrasensitive and a CBC with autodiff.

Would these tests have ruled out either erysipelas or cellulitis?
doctor
Answered by Dr. Albana Sejdini 40 minutes later
Brief Answer:
Can you send a copy of results to me?

Detailed Answer:
Hi back,

If everything was ok, then could be due to lupus. Can you please send the results to me to analyze myself?

Thank you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Albana Sejdini 39 minutes later
Thank you for you help. I have attached the test results for your review.
doctor
Answered by Dr. Albana Sejdini 6 hours later
Brief Answer:
Test reports all within normal range;no recent test noted;get another cbc

Detailed Answer:
Hi back,

Thank you for providing the requested test reports.

As I was going through them, I noticed, that all the tests were within normal range, including white blood cells although none of them were recently done (within a couple of weeks).

To my opinion, apart skin biopsy, I also suggest to run complete blood count to evaluate the white blood cells at this moment. If still no increase, then, most probably the hot and red forehead skin could be due to an acute attack of Lupus. If confirmed, treatment strategy should be changed and more potent drugs should be used.

Hope it helped!
Dr.Albana
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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