Crusty rash on forehead

[Marina]

I'm a 33-year-old male. Recently I've had a couple of flare-ups that I haven't had since I was in my late-teens and early 20's. It starts with a slight tingling sensation at the center of my forehead. Later a red, itchy rash develops on my forehead. After a day or so, the rash usually "scabs" over with crusty, flaky skin. Eventually, after a few days, I can wash the "dead" skin away, apply a moisturizer and the skin returns to normal. But I never know when the rash is going to pop-up. It seems like heat and/or sun is usually the trigger. I can go weeks and months at a time with no problem, then, all of sudden, there's a tingling sensation, followed by the rash. The rash doesn't really bother me, but it's embarrassing to go out in public with a red, crusty rash on my forehead.

I have a similar problem with the skin on my upper cheeks and nose. The skin there is never smooth; it's always slightly red and crusty, especially just below my eyes. I can wash away the dead skin, and it will look fine (although slightly red) for a few days. But then, eventually, that crusty, flaky layer of skin will start to form on top of it. It's an on-going problem, and it's not very attractive to look at. The skin on my nose and upper cheeks seems very thin due to years of sun damage (I have some "spider" veins on my nose), so maybe that has something to do with it. I've never used moisturizers on my face due to my sensitive skin. Perhaps I should apply a moisturizer to these crusty, flaky areas?

Any ideas what I can do to have more "normal" skin? Thanks for your help.

[Alan Rockoff, MD]

There are a couple of possibilities.  First is seborrheic dermatitis, a condition which affects all ages, from infancy up.  It produces skin which feels and looks dry, but is actually inflamed.  Common areas include the sides of the nose and the eyebrows, but other sites may be involved.  Hydrocortisone 1% (over-the-counter) usually makes this go away quickly, though of course it returns when it wants to.  Soaps and other products are irrelevant.

The other outside chance is that your forehead rash is a herpes infection ("fever blister") in a somehwat unusual location.  This is easy to deal with, but proper diagnosis will involve a doctor seeing you at the first sign of an outbreak.  If you can't easily arrange this, a good photograph taken at the time may help.

Get this checked out.

Best.

Dr. Rockoff