Facial rash

[GoSox]

Three months ago I developed a facial rash.  It is located on either side of my nostril, beneath my nostrils, and slightly inside one nostril.  It consists of many tiny red bumps which are sore and do not itch at all.  If left alone the rash will start shedding a tiny amount of dead skin at the top of each bump.  The rash doesn’t form whiteheads.

Treating with Fluocinonide 0.05% twice a day keeps the rash mostly under control.  Without the Fluocinonide, the rash starts to spread and becomes extremely sore and red.

I started taking Adderall (adderrall) around the time the rash started,  though I doubt it is the culprit.  I use cosmetics (Chanel pressed powder) occasionally.

I'm a 33 year old female and have no health problems.

I have an upcoming appointment with my PCP, but with the Fluocinonide there isn’t too much to show her – just a slightly red area with a few mild bumps.

What might this rash be?  Thank you for your help.

[Alan Rockoff, MD]

I think you have steroid rosacea.  This looks exactly like what you describe: red bumps around the mouth which get better--but not gone--when you use a strong steroid like fluocinonide, then flare when you stop. so you use it again, and round and round it goes.

My advice:
1.  Stop the steroid (it will flare somewhat--please ignore this.)
2. Get a prescription from your doctor for either metronidazole cream or oral doxycycline (or both).  

The rash should be gone for good in about 30-60 days.

Take care.

Dr. Rockoff

[GoSox]

I omitted an important piece of information in my original post:  I had the rash for seven weeks before I started using the steroid cream.  I started using the cream because the rash was worsening and spreading.  What do you think the original rash was?

I've stopped the steroid cream and the rash is indeed flaring.  I see my PHP next week.

[GoSox]

I just found some pictures on the web of perioral dermatitis that look just like the rash I had.  I use neutrogena liquid soap and neutrogena senstive skin moisturizer.  Should I switch to different products?

[Alan Rockoff, MD]

Perioral dermatitis can be aggravated by steroid use to produce steroid rosacea.

Dr. Rockoff

[jaquie]

how did his recommendation help you?  I have the same red and itchy/painful rash with little pimples under my nose and finally resorted to a mild steroid.  It didn't help other than when I used it all the time and now I am left with the stuff activated unless I use some over the counter antiobiotic ointment and EMU oil (anti bacterial) and they are only managing to keep it from spreading and becoming worse.  Is yours gone and if so what did you do???