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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64288
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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HiI frequently get what I can only describe as small red

Customer Question

Hi

I frequently get what I can only describe as small red vesicle like papules on the upper half of my face. They sometimes itch mildly and although bright red they often look semi transparent, like a blister.

This particular type of spot never affects my beard area and isnt a problem (that im aware of) anywhere else on my body. It mainly affects the forehead hairline, crease / sides of nose and fronts on cheeks.

It seems to be associated with sweating but doesn't fluctuate obviously with the seasons.

Any ideas what this could be? I have a number of photos I would like to upload to help you see what I'm talking about.

I should add these papules usually dry up after about 5 days but sometimes they linger around for much longer.

Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.
This is Dr. David

thank you for all of those photos

those small red pimples are most likely from blocked skin pores.

sweating more will often block more skin pores.

and in 5 days, these skin pores become unblocked.

you might need to use more of an expholiating soap in the slower daily to help open up your skin pores.

that could help

they don't look dangerous or contagious

they don't look like skin infections so hibiclens most likely won't help

they don't look like acne.

I think they are just temporary blockage of skin pores.

let me know if you have questions.
Customer: replied 2 years ago.

Thanks for your fast reply.

To be honest, you haven't really told me anything I didn't already know - I know it's some kind of blockage but that doesn't really help me.

I'm already using adapalene and have been on Roaccutane yet I still get this type of pimple.

I've been told it might be pityrosporum folliculitis by a dermatologist...

If you are not able to offer further help would it be possible to relist this question and maybe another expert might be able to help me?

Expert:  Dr. David replied 2 years ago.
Pityrosporum folliculitis is a condition where the yeast, pityrosporum, gets down into the hair follicles and multiplies, setting up an itchy, acne-like eruption

have you tried antifungal creams? like clotrimazole?

you should also get your thyroid hormone levels checked as well. thyroid abnormalities such as hyperthyroidism or low thyroid can also cause skin changes as well.
Customer: replied 2 years ago.

Thanks for getting back to me.

Can you suggest how thyroid hormone levels might bring about these types of pimples in my skin?

(For example a previous doctor suggested it might be diabetes as excess sugar could be feeding a fungus. But this came back negative, if anything my blood glucose was low...).

I've not tried any anti fungals yet no, trying to get an idea if they are worth trying or whether it is something else entirely?

Expert:  Dr. David replied 2 years ago.
low thyroid hormone can cause weight gain and cold clammy skin and more oily skin which can clog pores.

I don't think you have Pityrosporum folliculitis.

I think your skin could be oily or prone to blocked skin pores and you could be getting these blocked skin pores reguarly.

using an antibacterial soap and scrubbing more in the shower and using a loofah sponge when you wash could help.
Customer: replied 2 years ago.
Relist: Answer quality.
Sorry I don't feel an answer of "blocked skin pores" is very helpful.
There is conflicting advice in answers 1 and 3 about using antibactetial face wash.
I dont think this expert is an expert in dermatology.
Expert:  DrRussMD replied 2 years ago.
Hello
You should always look at our expert profiles.
I am a double board certified doctor in internal medicine [and we train and test in dermatology], as well as integrative medicine with advanced training in functional dermatology.
Let me ask you, have your doctors ever tested one of these lesions, with a swab to the lab? Or sent a biopsy?
Customer: replied 2 years ago.

Hi thanks for responding.

Never had a swab or biopsy - it is quite difficult to organise this in the UK. My GP suggested any organisms found are likely to be commensal anyway, like s.aureus or malassezia yeasts. But maybe I could ask again?...

I can tell you the lesions do not respond to mupiricon or hibiclens which suggests to me it perhaps isnt bacterial but im not sure...

Expert:  DrRussMD replied 2 years ago.
I don't think it is bacterial.
I think it is simply milia, since this typically comes and goes.
It can be a somewhat atypical form of acne.
Musculosum [which can come and go] also would fit, which is viral, but no actual medicine to treat it.
I don't see the hairs in this to indicate foliculitis, and it does not lock like foliculitis, which usually is more read, flat, excoriated and spreads.
The next time this happens, I would start with a simply pure soap scrub, using ivory soap. two times a day for 2 to 3 days.
If this clears it up faster it is most likely acne.
Milia needs no specific treatment.
I do not think it is musculosum. That was suggested by another expert as I have been showing your pictures around.
OK, so that is an initial answer….
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 2 years ago.

Ok, thanks again for your thoughts.

These lesions absolutely do not contain any waxy / cheese like sebaceous material. I think that rules out both Milia and Molluscum...

I'm not sure how to proceed with this question now? I appreciate your time and you replied to me promptly, but I'm still no clearer on what these lesions really are.

However if you have any more suggestions I would interested to hear them...

Expert:  DrRussMD replied 2 years ago.
It does not rule out either.
Particularly not milia.
I think you misunderstand the site.
We do not diagnose....that we can not do without exam and testing.
I have recommended specific testing, which your doctors have not done.
I disagree with your doctors statement in this regard.
I believe this is occasional small cystic acne.
A biopsy will show if this is
infectious
autoimmune
dermatitis
rare condition
cystic
etc.
OK, so that is an initial answer….
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 2 years ago.

Ok, how would I go about getting a biopsy? Would that be a punch biopsy?

Expert:  DrRussMD replied 2 years ago.
Yes, very simple, any doctor can do it and send it to the lab.
Dermatologists due them more frequently.
please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64288
Experience: Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
DrRussMD and 3 other Medical Specialists are ready to help you
Expert:  DrRussMD replied 2 years ago.
thanks
I am board certified in integrative medicine, internal medicine, trained in functional medicine and homeopathy, etc. I am here daily: use my request link as needed and “for Dr. Thomas” in the question title. Give that link to friends, family, associates, etc. Find me as needed for correct, safe and accurate answers.

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