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On behalf of my sons facial skin issues

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  • On behalf of my sons facial skin issues

    Hi,
    I am posting on behalf of my son. He is 23 and developed a red rash on his forehead and cheeks about 4 years ago. He had no prior issues. His skin becomes bumpy, red and dry. On a good day, it is slightly red. On a bad day, it is very red and bumpy.

    He went to see a dermatologist once, they gave him a topical. He tried it once and it made the condition worse. He never went back and never used the topical again.
    He is having trouble asking for help with this, so I wanted to jump in and do some of the foot work with him to see if we can get a diagnosis on this. If anyone can help narrow down what this may be or help point us in the right direction for help, it would be so appreciative. I had no idea how much this has impacted his self esteem.

    I am attaching three recent pictures of what this looks like.

    I appreciate any input and help with this as I have never experienced this myself.
    Thanks
    Rod
    Attached Files

  • #2
    Originally posted by rodwilsonsr View Post
    Hi,
    I am posting on behalf of my son. He is 23 and developed a red rash on his forehead and cheeks about 4 years ago. He had no prior issues. His skin becomes bumpy, red and dry. On a good day, it is slightly red. On a bad day, it is very red and bumpy.

    He went to see a dermatologist once, they gave him a topical. He tried it once and it made the condition worse. He never went back and never used the topical again.
    He is having trouble asking for help with this, so I wanted to jump in and do some of the foot work with him to see if we can get a diagnosis on this. If anyone can help narrow down what this may be or help point us in the right direction for help, it would be so appreciative. I had no idea how much this has impacted his self esteem.

    I am attaching three recent pictures of what this looks like.

    I appreciate any input and help with this as I have never experienced this myself.
    Thanks
    Rod
    I'm just a lay person here not an MD. The redness looks like it could be Rosacea possibly type 2. If this condition is Rosacea Subtype 2 it is likely caused by the very common, microscopic demodex skin mites. Everybody has these. A normal healthy immune system keeps the mite population in check. If the immune system is down due to illness or stress, the mites can get overpopulated causing serious skin issues.

    For Rossacea subtype 2, the typical prescription would be for Soolantra a topical 1% Ivermectin creme. It causes the mites to die which can temporarily make the skin look worse. The die offs cause pustules full of dead mites. But the die offs are actually a good sign that the treatment is working. Once the skin is purged of the mites it gets better. But that can take a few weeks at least depending on the level of parasite infestation. The full course of recommended topical treatment is 12 to 16 weeks. A 2 drug, inexpensive, generic, oral treatment that takes 2 weeks is also available.

    3 questions for you:
    1. What skin condition did the dermatologists diagnose?
    2. What was the topical treatment prescribed?
    3. What was the overnight reaction to the treatment? Was it more of an allergic reaction - hives, or itching, intensified redness?

    Comment


    • #3
      ElaineA is spot on with what we need to know more about, especially the diagnosis. She does know about phenotypes but no big deal she didn't mention them. Subtypes have been around since 2002 and it is not easy for us to make these changes, but phenotypes of rosacea are a superior classification. Even dermatologists keep referring to subtypes even though they should know better. Recent clinical papers also keep referring to subtypes so ElaineA is in good company.

      Whenever you get a topical, it is best to apply a little dab on the inside wrist to see if one is allergic to it, which usually happens within the first hour or so, and it gets red and irritable.

      Diagnosing on the internet
      is now possible, but is best done online by a dermatologist who charges for the session, and it would probably not be a good idea to ask a group of rosacea sufferers 'what is this?' since the bias is strong in such groups.

      A more objective diagnosis from a dermatologist would be more appropriate, since it could be something else. This differential diagnosis of other skin conditions that look like rosacea is a long list. Second opinions are also helpful since diagnosis is an art, and misdiagnosis is not uncommon.

      ElaineA's mention of topical ivermectin is part of the gold standard for rosacea treatment, which also usually includes an oral low dose timed released doxycycline. She also mentions oral ivermectin which has been shown to also be effective.

      If you don't know what your son's dermatologist diagnosed him with it would be prudent to call the physician and ask what was written on his chart. If you do get a second opinion which is not uncommon, you may want to know what to ask your physician.

      While the photos you have posted look like rosacea, it is important to rule out other possibilities.

      And ElaineA's remark that treatment for demodex mites 'temporarily make the skin look worse' is part of the 'it gets worse before it gets better' if you son does indeed have demodectic rosacea.

      Keep us posted on your son's progress and your investigation.
      Brady Barrows
      Blog - Join the RRDi


      Comment


      • #4
        Hi Rod,

        Brady and Elaine are right in that a diagnosis is needed - and not possible to get on the forum. There are many different variations of red-inducing skin conditions. A telemedicine appointment with a dermatologist given this pandemic would be helpful.

        Even then, sometimes skin conditions can be confused by even the best doctors. From the photos, I would say rosacea is a definite possibility. Also you can have characteristics of more than one subtype, as I did. The main thing is not worrying about those labels as much as your son's particular symptoms.

        You mentioned dryness and we can see redness and bumps - what look like pustules (pus-filled small bumps) versus papules (no-pus, pea-sized red bumps under the skin). It could be rosacea. It could also be sebhorreic dermatitis. This can have dryness, sometimes flakes, redness and some bumps. My nephew had sebderm and his condition looked similar.

        I'm so glad to see that you are getting involved and helping him. One very difficult thing about these skin issues is that family and friends sometimes understandably think that the redness is the only issue - and that it's a vanity/cosmetic issue. But when the skin is inflamed, red, dry and broken out as your son's is - the skin almost always HURTS. There is burning, stinging, heat, tingling, etc. There is the feeling that one is always "aware" of one's skin. You can't "not think about it" - as it's like someone tapping on your shoulder and not easing up. So the redness can hurt self esteem but so can the exhaustion and emotional withdrawal from 24/7 skin pain. Having family understand when he doesn't feel well - or is feeling hesitant to eat and do some activity that might cause skin flareups will help your son a great deal.

        Other things that can help your son with his skin issues are lifestyle factors.

        - Sunlight, with rosacea, can inflame skin and make it flare up. Make sure your son wears sunscreen and maybe a hat/visor to protect his skin.
        - Heat (hot temps, indoor heat, hot showers) can flare skin and make it worse. He can try drinking cold water during the summer to cool his body and try a low fan if needed).
        - Diet. In my own case, for example, cutting out milk and milk products helped with breakouts. Dairy can cause inflammation, which aggravates your attempts to lower inflammation and keep the body systems cool and calm. Other foods that may cause allergies or simply sensitivities in some people can be an issue. For example, heavy carbohydrates. Have your son lower his intake of breads, pizza crusts, pasta, etc (along with milk, yogurt, ice cream and sweets) for a week - and see what the effects are. It takes experimentation to see what might be triggers - but know that many of us have some kind of food issues that we have to be mindful of. For me, it's sugar and milk products.
        - Skin care. Make sure your son uses skin products that are gentle on the skin. Cleansing and moisturizing products that are made for sensitive and rosacea-prone skin are best. These usually are fragrance free and alcohol free.

        Hope this helps! I've found this forum to be so helpful and always happy to help out fellow skin-afflicted guests. So please don't hesitate to keep everyone posted on what the dermatologist says and how your son is getting along.

        If it helps, I used to have severe flushing rosacea and was house bound! Now after past medical intervention, I now have just a mild case, which I can manage with diet, skin care and keeping out of sun and hot temps. Solutions can be found! Good luck to your dear son. You are a great dad to help him with this.

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