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dermdoc19
dermdoc19, Dermatologist
Category: Dermatology
Satisfied Customers: 4124
Experience:  30 years practice in general and cosmetic dermatology
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Is it steroid induced rosaceslike or something else?

Customer Question

I am writing this email seeking your help with my condition described below, I would really appreciate giving me your medical opinion/advice about it.

Since May 2014, I noticed some tiny spots around my T-zone, they were not red or anything.

 I went to a dermotolgist in the UK, where I am studying and he said that I have seborrheic dermatitis and he advised me to use Nizoral shampoo as a face wash and a shampoo. Unfortunately, my skin did not improved.

 Just to let you know that my face and particularly my T-zone was the only affected area of my whole body, there was not any symptoms in my hair or scalp. 

I wen back home for the summer vacation, I wen there and saw a couple of other dermatologists.

 

First dermatologist: (June 2014)

- Same diagnoses 

-Prescription given: Sporanox tablets + cream with 1% Hydrocrtozone & 1% Nizoral.

-Result: was not effective.

 

Second dermatologist: (July 2014)

-Same diagnoses

-Prescription give: 

1- Gupisone (Corticosteroid 5 mg) 2 tablets a day for 30 days.

2- Locoid Lipocream 0.1% (hydrocortsone 17-butyrate 1 mg per g)

Result: It made wonders to my face, my face was 100% clear and even better than before!

At that time, I got married and after coming back from my honeymoon, I was noticing that the symptoms are starting to come back and worse than before!

I went back to the same second dermatologist hoping that he can help me after his magical first prescription!

 

(September 2014)

- Prescription given: Betnovate, a topical corticosteroid

- Result: It did help in calming up the flare up and the redness of my skin but it wasn't as the first result, I decided at that point to stop the treatment, and I stopped it gradually because I was aware of the rebound affect of the steroid creams. 

(October 2014)

Came back from home to the UK to start university after summer vacation, I went to the same first dermatologist I saw first.

- He was surprised that I was given strong and potent steroid creams and he said that it made it much worse than the first time I saw him.

 

- He prescribed me a Protopic Ointment cream (non-steroid based cream) for a duration of four weeks.

- Result was satisfying at first but my skin started to flare out at end to treatment duration. 

I went back to follow back with him with frustration, he was suggesting to take  isotretinoin (Viitman A) for three months. I read a lot about this medicine and that its given to sever cases where nothing responds but I was so anxious to take it because I was told that I cannot get pregnant even after stopping the treatment for at least 1 month, and I know that patients who take this medicine should do a regular blood test every four weeks to check that the level of the lipids and liver enzymes are ok, otherwise, the medicine should be stopped and continued when everything is back to normal. And this going to take for ever + I didn't think that my skin reached that level of severity to take isotretinoin.

(November 2014)

I have decided to go a different dermatologist, a dermatologist who is specializing in complex medical dermatology.

His description and diagnosis was: " On examination there was monomorphic micro papular rash affecting her forhead, medial cheeks and chin. Tiny micro-pustuls were evident under magnification. There was fine scaling in places. The scalp was spared and there was no involvement  of her ears".

He was suspecting that the rash represents perioral dermatitis, possibly with an element of sebhorrhoeic dermatitis.

Treatment given: 

- Lymecycline 408 mg daily 

- Elidal cream ( twice a day for only two weeks).

Result so far: my skin started to return to normal by time, and now after a month of taking the tablets, my skin is almost back to normal only 15% left to get there. I am happy about that but I am still worried that I need to be on these tablets for a long time, especially that I can not be pregnant during the treatment. Me and my partner want to have a baby soon and I am just worried that if I stop the treatment, I might got the same skin problem during pregnancy. I have read that there are safer alternative medicines such as erythromycin tablets, clarithro-mycin, oral metronidazole. I am worried that they might not be affective to solve the problem in case i get pregnant, which I am hoping to!

From my early childhood, I used to get red checks whenever I play or under the son or even when I feel shy, but I did not feel any kind of burning sensation at the time, it was just a red color on my cheeks. But in my teens, i started to feel my checks … and sometimes  it feels like burning. However, my skin was clear and I rarely get spots!

 

I have been reading a lot in the internet, I became obsessed about my skin, I red about steroid induced rosaceslike dermatitis, I think I probably have this condition because if i compare my skin back in May 2014, when I started seeing my skin being changed, my skin was not as  bad as after using all the steroid based treatments. In addition to this, this is the first time in my entire life that my skin gets bad as this!

 

I am so worried, I have red that these conditions are chronic and they might be with me all my life and I might need to be on a regulated does of tablets all my life!

I am worried about this and how it is going to restrict me in planing my future family .. I am currently taking folic acid supplements because I am hoping to get pregnant soon. 

 

Do you think I should be waiting till I become sure that my skin is not going to flare up after stopping lymecyline or shall I not restrict my self from getting pregnant? 

 

 

Please don't share my question.

 

Lookinf forward for your answer.

 

Thank you,

Submitted: 1 year ago.
Category: Dermatology
Expert:  dermdoc19 replied 1 year ago.
Customer:

These answers are for informational purposes and do not replace a physician head-to-head visit. A patient-physician relationship is not established.

Customer:

Thank you for requesting me and providing such a complete history. Is it possible to forward photographs. It would be helpful to examine photos before, and during treatment besides photographs of your present state.

Customer:

Thank you. I look forward to helping you.

JACUSTOMER-opg8jt7p- :

Hi doctor,

JACUSTOMER-opg8jt7p- :

I don't want my pictures to be shared anywhere

JACUSTOMER-opg8jt7p- :

how can I make sure e of that

JACUSTOMER-opg8jt7p- :

Are you offline?

JACUSTOMER-opg8jt7p- :

This is a bad service and I regret getting into this website.

JACUSTOMER-opg8jt7p- :

I want my money back

Customer:

Hi

Customer:

The only way, you can be absolutely sure that your pictures will not be shared is to send to***@******.*** or***@******.***. The former is preferred.

Customer:

These go directly to my inbox.

Customer:

A few comments. I would not recommend erythromycin at all during pregnancy. In some of the older literature, this was considered acceptable. In fact when I was a resident, this was a good alternative. However, now it is regarded as teratogenic in that it can cause heart abnormalities and possibly pyloric stenosis. In fact, many physicians even fear this drug in non-pregnant patients as it can cause heart arrhythmias.

Customer:

Long term usage of Oracea or Periostat is much safer and preferred since you can stay on this for years. It may even protect against heart attacks and work as an anti-aging treatment. However, if you are plannig to become pregnant you should not take this one either. However, if you do, stopping this in the first trimester should avert problems.

Customer:

I agree with the physician that potent steroids should not have been used in your conditon. I usually reserve its use for something such as discoid lupus.

Customer:

From the sounds of it, you might have had a case of stubborn seborrheic dermatitis. The treatment with steroids possibly transformed this into either perioral dermatitis or rosacea. You probably noteded this on the internet as steroid induced rosacea ( or peri-oral dermatitis). I can only really tell from the photographs when they arrive.

Customer:

Topical sulfur would be a good treatment for you since it shows benefit both in rosacea, peri-oral dermatitis and seborrheic dermatitis. Whatsmore it can be used during pregnancy, if this happens. Also Finacea gel ) Azelaic Acid) helps all three conditions and is very safe during pregnancy.

Customer:

I await the photographs and hopefully can give forth better and more specific advice.

Customer:

I appreciate your patience but I have had a busy day. Again, I appreciate your requesting my services.

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