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Thread: facial erythema, scaling, wrinking???

  1. #1
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    Default facial erythema, scaling, wrinking???

    I really don't know what is going on with my skin. The sole trigger seems to be UV light, staying in complete darkness for 6 days is the only thing that has made any difference to the intense burning and redness and facial oedema.

    Bad flush of redness/burning last week - cheeks still look swollen/oedemic, but a lot better than previously:


    This is how it started in March - my face went very red with oedemic swelling over cheeks, which became horrendously wrinkled, with scales over the reddest patches. The wrinkling appeared almost overnight, I did not look like this before (keratosis?)



    The redness doesn't show very well, but top edge of ear has red patches with pronounced veins, the skin is coarse, wrinkly and flaking; the patches had thick yellowish scabs when I first noticed them about a month ago:


    Inside of ear has red patches with pronounce veins, and shiny 'mummified' skin as well (erythema, keratosis?). The skin went like parchment and all peeled off earlier in the year, before I'd realised what might be going on.


    To my eye, they look very like photos of mild discoid lupus I've found on the web, and I have a pre-existing diagnosis of UCTD, which is also known as sero-negative lupus. Medscape lists "discoid rash, oral or nasopharyngeal ulcerations,...skin tightening or thickening, photosensitivity and periocular oedema' among the cutaneous manifestations, and I'm also having problems with severe irritation inside mouth and sinus/pharynx, so I'm seriously doubting this is rosacea now.

    http://emedicine.medscape.com/articl...clinical#a0217

    I've been taking plaquenil for the UCTD, I increased the dose from 200-400 a month ago, but no sign of any improvement so far.

    Steroids (oral and topical) have rapidly made the problem worse on all occasions though, most people with lupus seem to find they work will. I've been taking lymecycline for nearly a month with no effect on skin or eye discomfort, I'm not happy taking it because of the risk of making the photosensitivity worse.

    Photos of discoid lupus for comparison:
    http://www.dermis.net:80/dermisroot/en/38406/image.htm
    Last edited by y-gwair; 20th May 2011 at 05:38 PM.

  2. #2
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    Hi

    Hmmm, i'm not sure that this is Discoid lupus as doesn't tend to look like that (tends to be scarring, round disk leisons type of thing) but Systemic Lupus butterfly rashes can mimic Rosacea type 1 symptoms. I think you need to get 2 biopsy's done: 1. in areas where the inflammation is, and 2. where the inflammation isn't. This would give you much more insight into whether this is lupus or not. Also get all the blood tests done such as ANA, Anti-dsDNA, ENA, Anti-Ro, ESR, CRP, complete blood count, urine analysis etc... see: http://www.uklupus.co.uk/tests.html

    Another thing to consider is a combo of Rosacea type 1, and SD. You mention flaking, and this is why I wonder if there is a combination of 2 things going on. Have you trialed topical anti-fungal cream such as Miconazole ever before? it is dirt cheap and can be bought at the Pharmacy... it could be worth a try. Miconazole is probably the best anti-fungal for super sensitive skin so you should be ok trialing it.

    Lymecycline is a tetracycline broad-spectrum antibiotic and makes some very sun sensitive; if i were you I would go back to the GP/Derm and let them know if it is making you very photosensitive and whether it is worth stopping the med altogether. Personally, I don't think antibiotics are going to help your symptoms but i'm certainly not a doctor...

    I think stay on Plaq for anti-inflam benefit, trial the anti-fungal cream for a few weeks and see what happens, get off antibiotics completely, and have the biopsies and all blood tests done to provide new insight. This is just what i would do.... best of luck in your decision.

    Shantelle
    Last edited by shantelle; 20th May 2011 at 11:27 PM.
    Shantelle

    31 Year old female from NZ

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    Default seborrheic dermatitis maybe?

    I have sebderm along with rosacea. Sometimes I have a hard time trying to figure out which is flaring up and how to treat it. From your pics i see some flaking, oilyness, and redness. Could be SB? My SB effects my scalp (itchiness & dandroff), face (redness, burning & flaking), and my ear (redness, oilyness, irritation, and sores).

    If the sun is affecting you skin it may also be rosacea. Do you have any bad effects from any food, drinks, heat/cold, facial products etc... Don't use too much medications or products all at once you need rule out what helps or hurts you. Use suncreen, where hats, and stay out the sun at the hottest time of the day.

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    Tests all negative, apart from speckled ANAs and elevated IgG/IgM, which were down a bit this time (you'd hope so after taking plaquenil for so long).

    No I don't think it's SD. The skin is oily in the areas that are oedemic, but I think there's other fluid leaking through the skin as well as oil (derm didn't think it was SD). I did try miconazole a few months ago when it first began, it made no difference.

    Lymecycline has made no difference, am stopping it now as it will probably just make the photosensitivity worse. There are round patches that are red, over large broken veins on cheeks, where the skin is puckered/wrinkled, also similar ones inside the ear. It's fairly subtle I know, but it is strange. Remember, the redness, broken veins and intense burning/pins and needles sensations extend inside my mouth too, and sometimes the skin feels so tight around my mouth it's difficult to talk; lips, tongue, palate and throat all worsen in parallel with the face. The oral problems did respond well to plaquenil when I started taking it last year, so I'm sure it's part of the same disease process. The derm. was pretty categorical that rosacea etc wouldn't affect the oral mucosa (it's not allergy either, avoiding dental products completely makes no difference to it).

    The only thing that makes any difference is zero UV - hot food, drink, baths etc all the things I'd been suspecting are absolutely fine after a few days of staying in a room with blackout blind until after 6 pm; even short exposure earlier in the day can set it all off again, factor 50 sunscreen doesn't help (guessing even small amounts of uva can trigger a flare). Sun exposure also sets off numbness/pain/pins and needles in hands too, this has been much better since staying indoors too. Being imprisoned in the dark all day is really beginning to get me down a bit now, even direct light through blinds downstairs can set it off.

    I just wish I could have some definitive dx, as messing with different medications isn't helping.
    Last edited by y-gwair; 21st May 2011 at 04:01 PM.

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    y-gwair,

    If you think you might be interested in alternatives at all, here's a link to a page about lupus and homeopathic remedies for its relief.

    http://knol.google.com/k/a-few-homeo...ies-for-lupus#

    Your symptoms do sound like those of lupus to me. Maybe it's so subtle, though, that clinical tests bring back negatives.

    hwyl fawr
    "It's all illusion anyway."

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    My mother had lupus and scleroderma together. The scleroderma made her face feel tight and affected her lips as well. Do you have any joint pain? That would be another indicator. She could not go in the sun at all after acquiring lupus. It would worsen the facial rash and give her hives. Steroid cream (Kenalog) did help her as well as oral Prednisone. However, the Prednisone really messed up her immune system in the long run. In the early stages, it is sometimes difficult to distinguish lupus from rosacea and other skin diseases. You will need to keep after your doctors and keep testing until you have a definitive diagnosis. An anti-inflammatory diet also helped her--no sugar, alcohol, red meat, dairy products, simple carbs.

    Katcar

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    Hi

    If you had a positive speckled ANA is could mean lupus or scleroderma or mixed connective dissue disease, but the speckled ANA is also commonly found in completely healthy people too (5%). What Drs do next is look at the titier. I.E. Mine was ANA + 1:640 which was high enough titer to indicate that something was a-miss with my system and so this result was enough to tell them to to keep doing more tests and further investigate. My ESR was also off the charts of normal (indicates level of bodywide inflammation). Over time Plaquenil is actually having a remarkable effect on lowering both my ANA and ESR which is also reflected in my much better health.

    What helped me was also wearing wide brimmed hats whenever outside- do you do this? sometimes sunscreen isn't enough.

    So when you have no UV exposure... during that hibernation... having hot baths/showers, hot food/drinks and exposing yourself to other typical rosacea triggers etc doesn't exasberate facial symptoms?? if not, then it is unlikely Rosacea and it is likely soley autoimmune as Katcar has made suggestions of.
    Shantelle

    31 Year old female from NZ

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    looks like you have hyper sensitive skin which most of us on this forum have as well. I don't know if you have lupus which you should get that medically diagnosed. What I recommend is getting a strong VBEAM tratment with busing to knock out the redness in the cheeks. Make sure you go to a qualified laser surgeon who specializes with VBEAM perfecta.

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    Quote Originally Posted by polster View Post
    looks like you have hyper sensitive skin which most of us on this forum have as well. I don't know if you have lupus which you should get that medically diagnosed. What I recommend is getting a strong VBEAM tratment with busing to knock out the redness in the cheeks. Make sure you go to a qualified laser surgeon who specializes with VBEAM perfecta.
    Until Y-gwair really knows what is going on with her system Vbeam laser or any other sort of laser/light treatment is not a safe option and might not even help at all if it isn't Rosacea.
    Shantelle

    31 Year old female from NZ

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