Black oily spots on cheeks appear daily

Doctor,

I have a strange problem.  Almost every day, I get black (or maybe dark purple) spots all over my upper cheeks (on the cheekbone area mostly).  They always can be wiped off with a little water.  I tend to get them when my face is flushed or when I exercise.  Sometimes they just appear for no reason.  The best way I can describe them is that they look like ink.  If I gently squeeze my cheeks, lots of the black "ink" will come out.  I do not squeeze it on a regular basis but only to show my dermatologists.  They offered no explanation.  I have mild acne and pseudofolliculitis on my neck.  My cheeks are usually red and my dermatologists have said this results from either rosacea or sun exposure.  I currently use Klaron and wear sunscreen every day.  I am a 26 year old male with a career where I am in front of large groups daily.  The spots are really embarrasing, and people point them out to me every day telling me I have dirt on my face.  Do you know what this is, what is the cause, and what treatment options are available?

Thanks

[Alan Rockoff, MD]

The only condition I've ever heard of that sounds anything like what you describe is chromhidrosis (colored sweat.)  I've never seen a case.  Facial chromhidrosis is very rare, and there isn't much you can do about ti except for reducing facial sweating as much as possible.  There's a product called Xerac AC, marketed for acne, which functions as a facial sweat reducer.  Have your dermatologists actually seen this?  Can you have it photographed if it comes when you aren't in their offices?  Are you absolutely sure these spots are black or almost?  If so, then I suggest you go to an academic medical center for evaluation.  Bring photos, and work up a sweat before you keep the appointment.  Maybe they can tell you for sure.

Best.

Dr. Rockoff

[heavybeard]

Dr. Rockoff,

My dermatologist said that it might just be blackheads because, like you, has never seen chromhidrosis.  He gently removed the dark stuff and that kept it at bay for two days but then I developed blackheads and white heads all over the area.  Should I continue to remove the black stuff or just wash it off when it comes out?  The Dr. mentioned laser treatment to close up the pores.  Do you have any comments on that suggestion?  Also, the black spots tend to show up more often when my face flushes.  Sometimes my neck, ears, and cheeks will turn bright red and feel really hot.  He suggested antibiotics such as doxycycline for the redness and the acne that results.  Is my condition treatable with antibiotics?

[ne1]

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[hey90]

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