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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for rashes on the face

I am 34 year old Chinese female. My normal facial skin used to be always clean, fair (with yellow based tone not pink based tone), and thin, and NO Redness or Pinkness. Since summer 2012, my face skin has started to become more sensitive and allergy prone. The only difference happened in my life was steroid creams and injections. In Mid-July 2012, after I was bitten by some bedbugs in a hotel, I was given by a relative some cortisone cream (cannot recall the exact cream) to apply to all the bite spots (about 15 on face and more on arms, hands, legs, body. I applied the cream couple times a day for 7 days and felt it didnt help much with the bites, so I stopped. The bite marks later on healed natually. Since then, I sometimes got face rash after eating some tropical fruits or prepared food from grocery shops. Rash usually went away completely in 3-4 days. In late December, I got windburn on my upper cheeks area after walking outside for about 30 minutes in Shanghai. The redness from windburn healed in 4 days. In early February 2014, I was injected by doctor some small amount steroid under skin for 2 scars recovery on my groin area. Steroid injection did not help my scar recovery at all. In late April 2014, I was injected some kind of steroid into my left hand (palm) to treat the pain. In late May 2014, I got a very big water blister in my left eye whites which lasted 5 days. By the time I was able to see an opthalmalogist 1 week later, the blister already went away. But, the doctor prescribed Tobradex eye drop for inside eyes and Tobradex eye ointment for both eye lids and inside eyes. Both drop and ointment contain Dexamethasone. He told me to apply to both eyes for 2 weeks. In mid June, less than 1 month after I stopped Tobradex (Dexamethasone), my left eye again got a similar blister in the whites. It went away in 5 days. Ever since then, my eyes become itchy and watery often, and easier to become red. I was told by doctor to apply Tobradex eye ointment when those symptons occur, and so I did sometimes. Also, I started to get stye like swollen eye lid randomly, which usually went away in 1-2days. In mid-November 2014, my orthopedist conducted fast injections of lidocain and cortisone on my neck and upper back along both sides of my spine. The injections were deep inside because he had to operate under machine image. In less than 2 weeks time, I developed many big red chunks all over my face and upper chest area. Those chunks are flat but a little bit higher than the rest normal skin. Also there was a little bit itchiness but no need to scratch. Those red chunks went away completely in 3-4 weeks. In late april 2015, the same orthopedist did a second round of fast injections to my upper back and neck. In early December, my face had the first time allergic reaction (redness on upper cheeks) to a Shisheido sunscreen which I had been using for over a year. It went away in 4 hours. Then in mid December 2915, I received third round fast injection from this dictor. 3 weeks later, I woke up in the morning and saw my face is covered in large areas of red rashes. Again, those rashes went away in 3-4 days. Then in February 2016, I had second time allergic reaction to sunscreen, and this time I was allergic to a different Shisheudo sunscreen which I had been using for almost 1.5 years. In late March 2016, I noticed my cheekbone areas had some light redness after I removed makeup with Bioderma makeup remover water. Those redness went away completely in 3 weeks. On July 10, 2016, I used Vichy sunscreen which I had used for 4 years previously (2010 - 2014), I was fine on that day. Next day, July 11, 2016, I again used this Vichy sunscreen, I had a very bad allergic reaction --- thus, this is the third time allergic reaction to sunscreen. My face (center cheeks close to nose, part of forehead, eye lids, a bit on nose and chin) became red. Initially I did not pay much attention to this issue because I thought it would go away quickly as it happened twice before (allergic reaction redness in previous 2 times were much less and went away within 1 day). But this time it did not go away. 10 days later, after eating some home cooked vegetables with green curries, I realized my face redness flushed. Then, in the next 5 days, I applied saffron with milk on my face as a mask daily and also drank the remaining, and my face redness looked worse with more easy flushings. On August 3 2016, I went to see a dermatologist in Shanghai. He said I had allergic reaction to sunscreen and my skin barrier is hurt. Also he said I may have seborrheic dermatitis because he saw some oily parts. He prescribed 6 weeks of Ebastin pills and 2 different chinese medicines which are supposed to disperse the redness and heatyness on my face. But within 2 daysafter I started those medicines, my face, hands, and feet became more heaty and much warmer. I continued those medicines for 5 weeks until September 10. During those 5 weeks, I noticed my face redness baseline from the sunscreen allergic reaction did not change, but my face skin sensitivity to heat and sun became much worse --- the affected area got flushed much more easily to heat than in July, and I even started flushing with raising face temperature whenever I used laptop. When I tried to do walking exercise for 10 minutes outside at night (no sunlight but heat --- I live in Dubai), my entire face (not just the affected area) became extremely red. Then, I went to a dermatologist in Dubai on September 11 2016 (exactly 2 months after the sunscreen allergy incident happened). She said I dont have seborrheic dermatitis or rosacea, and she could only see healthy face skin. When I showed her my face photos I took when sunscreen allergy happened and also when I went outside at night with whole face becoming red, she prescribed Elocom cream (mometasone furoate 1mg) to apply to my entire face twice daily for first week, then once daily for second week, then gradually cutoff in third and fourth weeks. I did not know Elocom is a potent steroid cream which is not meant to be used on face and also should not be used on other parts of body unless patient does not respond to other milder treatments. I stupidily followed her instruction for 2 days with daily 2 applications (morning and night). I started application on September 12. After first application, my face turned a bit more red for couple hours then it subsided. After second application, my face suddenly became ghostly 3 shades whiter than before sunscreen allergy incident and alarmingly entire face horizontally swelled up like ballon, but no redness. On September 13, the next morning I applied third time, and I saw 2 medium big size blisters showed up my face (1 on left side forehead and 1 on nose). Then in the afternoon I felt my face started heating up with some redness, and I noticed an irregular shape of white patch appeared on my lower chin towards right side. That night after the fourth application, my cheeks became much more red and the 2 blisters became bigger. On September 14, after I woke up and washed off my face, I immediately saw redness came out on my face. I decided to stop steroid cream. By early afternoon, my entire face became very red --- the whole cheeks all the way to the side hairline and down to my neck instead of the front central area close to nose from sunscreen incident, majority of my forehead includes both sides, my nose, and entire chin --- all areas where I applied the steroid cream. Also my face started burning. On September 15, my face was swollen --- both cheeks especially the lower 2 sides which were not affected by sunscreen incidents previously, and my chin became a bit hard and swollen. Also on my entire cheeks, chin, and nose area, I started to feel a lot muscle pains from deep inside and clench pain and sting pains from both surface and under skin. Then, the burning started on my face later that day. Besides all those, I started to display flu symptons --- sore throat, itchy throat, coughing, sneezing and feeling feverish. So it has been 54 days since I stopped Elocom steroid cream on my face. I have not got any better. My cheeks are always red and both cheeks and sides look like having a pink film, as if my skintone was changed from fair-yellow based to bright-pink based. My chin, nose, forehead and eyelids are red too. The burning hot feverish sensation on my face is present most of the day. That flares up with the swelling, pains, and redness flushing. My family members and I all can see the swelling and redness, both of which do not even go away when my face is at its calmest time, and it immediately becomes much worse (more swelling) whenever the burning and redness flushing flareup, and also more swelling when I wake up in the mornng. I feel my face skin currently has no self-moderation/self-adjustment to any temperature change. All the above mentioned problems flare up the minute I get into a couple degree hotter environment or just go outside even without temperature change. Sometimes the flareups have no relation to heat either --- I just sit in sofa or lean on bed and the flareup starts. Also, my face skin cannot withstand even a bit light wind because I get windburn sensation. I have not been able to find any moisturizer I can use because they all make my face hotter and consequently redder. My face sometimes is much more oily than July 11 --- when I wake up in the morning, especially T zone. Also my face looks very shiny even when it is actully dry and not oily. Also all pores have been enlarged and there have been a lot white heads growing from places where did not before. I noticed my face skin appeared to be crumple / lack of elasticity from the day I stopped steroid cream (September 14 2016). On my face skin, I do not have itchyness, skin shedding/flaking off, oozing, papules or pustules (couple ball-point size blisters appear sometimes). I am in despair and would need some help. How to constrict / shrink all my currently dilated micro-calliparies on my face so that my face will stop being red/pink? Also, how to stop all those flares? Please help me.
Tue, 5 Feb 2019
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General & Family Physician 's  Response

As a first line management, you can apply low potency steroid creams like betamethasone for symptomatic relief. If the lesion persists, it is better to consult a dermatologist and get evaluated.

Hope I have answered your query. Let me know if I can assist you further.

Dr. Shinas Hussain, General & Family Physician
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Suggest treatment for rashes on the face

Hello, As a first line management, you can apply low potency steroid creams like betamethasone for symptomatic relief. If the lesion persists, it is better to consult a dermatologist and get evaluated. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Shinas Hussain, General & Family Physician