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Thread: Please help, desperate for advice. Pics Included

  1. #1
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    Default Please help, desperate for advice. Pics Included

    I've spent so much time reading many different threads on this forum, it's been great and really helped me so far. BUT I've hit a bit of a wall and I am desperate for advice.

    First some details about me, I'm 30 years old, and I've never had any skin problems or allergy issues in the past. My diet is clean Monday to Friday with some cheat meals on the weekends.

    The background, around 2 years ago I had a strange reaction whilst drinking, my face all puffed up and was really red (photos to come). This didn't happen again for ages. Fast forward to now and I can no longer drink beer, wine or cider as I instantly get that reaction. The strange thing is it doesn't happen with vodka, gin or spiced rum. I'm not sure about other spirits as those are the only ones I've tried. Although annoying this isn't a huge issue as I can just not drink or if I really want to I can just drink spirits.

    The issue is in the last 8 months i started to develop a bit of an issue with blushing/flushing, dealing with groups of people is a bit part of my job and the flushing was becoming a bit of an issue. I saw my gp for this and was prescribed Propranolol. I must say its been fantastic and completely controls the flushing. Sometimes it feels like it may happen but doesn't.

    Recently though I've started flushing to many other triggers such as heat, excessive exercise (although I go red all over with this and it lasts for over an hour). Also I've had some permanent redness appear either side of my nose. Sometimes it's smooth, sometimes it's really bumpy and can look pretty bad.

    I finally got to see a Derm and he said he thinks its sub Derm due to the roughness, he gave me hydrocortisone cream to use twice a day and Nisoral shampoo. Now I've looked long and hard at sub Derm and I personally don't think it's that as I don't currently have any dry skin on my face or scalp (although I did have a bout of dry skin which lasted a good few weeks a few months ago). He said try this treatment for 6 weeks then go back. I'm also having allergy tests done in a few weeks to try and determine what's making me flare in alcoholic drinks. Personally I think these are non related! I just think they've developed at the same time.

    When I left the Derm I didn't feel to confident as he didn't seem to ask me many questions, I felt like I was doing most of the talking. I'm including some pics, if anyone has any info for me on what they think it may be that would be great!!!

    Thanks for reading this massive thread ha.

    Normal face -

    Top - Night, Bottom Morning

    Beer, cider, wine alcohol flush


  2. #2
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    Hi Jabarian,

    Your skin looks similar to mine (both the 'normal' and the flush pictures) and I have been diagnosed with mild rosacea. The flushing triggers you mention all sound like text book rosacea. Have you started using the hydrocortisone cream yet? I'd be wary - from what I've heard it can trigger a very bay reaction in some rosacea sufferers.

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    I'm not a doctor, but it looks like it could be seb derm. The problem with the any type of steroid cream is it doesn't fix the problem, it just masks it for a while. I occasionally use desonide steroid cream if my skin is in a bad place and I've got a big event to go to like a wedding. I use it for 4 days before the event and a few days after and then get off it. Long term use will eventual stop working and make things worse. The nizoral may help if the problem is seb derm, you should be able to tell if it's helping within a few days.

  4. #4
    Senior Member Tom Busby's Avatar
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    You can easily do a differential diagnosis for seb derm. About 4 days after using the Nizoral on a daily basis (where you let the shampoo-lather stay on your head for 5-10 minutes), dry off, get dressed, and then stand in very bright sunlight and scratch your scalp -- if the air around you is full of hundreds of dandruff looking skin flakes, then you have a good diagnosis for a malassezia-induced skin condition, which most people call seb derm.

    Seb derm redness is not usually so evenly spread across the entire cheek, like your pictures seem to show. Still, you may have co-existing conditions and maybe your doc wanted to eliminate seb derm, but he should have told you about the bright sunlight test.

  5. #5
    Senior Member nat007's Avatar
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    Quote Originally Posted by Tom Busby View Post
    Seb derm redness is not usually so evenly spread across the entire cheek, like your pictures seem to show. Still, you may have co-existing conditions and maybe your doc wanted to eliminate seb derm, but he should have told you about the bright sunlight test.

    I agree. Seb derm tends to be visible around the T-zone of the face, with red rashes around mouth, nose and eyebrows usually. Its not giving an evenly red tone to the full cheeks, that comes up quickly (like after drinking wine) and calms down in some hours or day. From what I can see on the pics I would guess you have rosacea, or flushing tendencies at least and perhaps there is some seb derm too, although I can't see it.. Derms are great at misdiagnosing you and sending you off with either a cortisone cream (if it does nothing we'll see again) or antibiotics. I wouldn't use the cortisone cream either, it can make your rosacea flare badly and is absolutely contraindicated for rosacea. I agree that your triggers seem like textbook rosacea triggers and the fact that the propranolol is lowering the flushing threshold is another indication for rosacea related facial flushing. I hope some allergies show up, so you have some guidelines to follow, but most here have not found clear allergies that can be linked to their flushing. There have been other threads in the past however about how especially red wine and beer trigger much worse flares for people than vodka. Red wine and rosé contain tannins and they are vasodilators and full of histamine. White wine should be less problematic, but alcohol in general is also a blood vessel dilator so it is very likely that there won't be an allergy for alcohol or wine detected, and it just comes down to the (types of) alcohol themselves and their general effects.

    You can always start using an over the counter anti fungal cream like Lamisil, or even better a cream like ketoconazole, which should clear up seb derm. Howver, as you stated yourself, seb derm tends to come with scaly skin, often a bit greasy and sometimes with dandruff like powdery flaking on the scalp. If you have none of that and compare your skin with images of seb derm skin, you might have gotten the wrong diagnosis (but I am no doctor and can only base this on your description and pictures).

    Hope you are well, best wishes Nat

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    Hi guys,

    Thanks for the replys! I agree with all of you, I have no flaky skin at all, none. That's what makes me skeptical about sub derm. I really don't know what to do about the cream! I had used it for quite some time already (nearly 2 weeks). On the ther hand I feel that I should try the treatment he's recommended. Arghh this is difficult.

    When I go back and see the derm what should I say him?

  7. #7
    Moderator phlika29's Avatar
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    Your skin looks very similar to mine. I have seb derm (and rosacea) but don't have flakey skin so I don't think you should rule it out. Having said that its not a good idea to use hydrocortisone for too long no matter what it is. Did the steroid cream help at all though? How about the nisoral?

    i find that when my seb derm is under control so is my flushing but this changes on a day to day basis and is related to my sugar intake, sun, emotions, weather, etc.

    When you go back to your derm you could say that you tried the treatment for a few weeks and it helped/didn't help but you don't want to use steroids in the long term. You could ask to be transferred to professor Chu at Hammersmith hospital who has much experience of these co existing conditions.

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    Quote Originally Posted by phlika29 View Post
    Your skin looks very similar to mine. I have seb derm (and rosacea) but don't have flakey skin so I don't think you should rule it out. Having said that its not a good idea to use hydrocortisone for too long no matter what it is. Did the steroid cream help at all though? How about the nisoral?

    i find that when my seb derm is under control so is my flushing but this changes on a day to day basis and is related to my sugar intake, sun, emotions, weather, etc.

    When you go back to your derm you could say that you tried the treatment for a few weeks and it helped/didn't help but you don't want to use steroids in the long term. You could ask to be transferred to professor Chu at Hammersmith hospital who has much experience of these co existing conditions.
    Hi Philka!

    Thanks for your reply. To be honest I don't think the cream helped at all. My skin is looking a little better now though I've ramped up the Nisoral usage. My derm told me to use it once a week and I've started using it 2-3 times a week. Only used it 3 times in total though. I guess I've have a better idea in a few weeks though. It's funny that your flushing is related to your sub derm! You say you have both, how is your rosacea presenting? Also how similar is mine to yours?

    Sorry about all the questions ...

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