Flushed, tight, flaky skin after washing: just sensitive?

[Shmo]

Have had this problem without much variation since I was 19, am now 23. The main issues that concern me are:

1)Dry skin on face after washing. Even covering my face with Dermol 500 and rinsing my face with water will cause it to get dry and tight and flake particularly on the temples and lower cheeks/jaw unless I get thick moisturiser on there fast. I've tried not washing at all but that makes the next symptom much worse. Generally gets better over summer.

2)An uncomfortable burning/prickling/stinging sensation on the face and neck that begins during exercise or when I get hot or flustered. Usually only occurs once a day. This is most severe when I haven't washed recently in which case it is extremely painful (feels like boiling oil running down my face) and can last for up to 30 minutes. During this my skin gets slightly reddened but no visible rash appears.

Have seen a dermatologist just after christmas and was diagnosed with sensitive skin. Have been using Dermol 500 moisturiser for washing and Dermol cream afterwards. The Dermol cream really helps the dryness and flaking but applying after my evening wash  causes stinging on my upper cheeks and forehead making getting to sleep difficult. Also since starting this routine my cheeks and forehead appear red and flushed after my morning (hot) shower. The sensation in 2) has been reduced in severity but not eliminated. I dislike having greasy skin all day due to moisturing.

Possibly unrelated are pustules that appear on my back,chest,upper arms diagnosed by the dermatologist as acne. Am currently taking Minocin daily for these since February and some impovement has been seen.

I guess I'm mostly concerned that these issues are part of something that will get worse as I get older. Am already extremely aware of skin being either greasy (if I moisturise after washing) or flaky (if I don't) and the burning sensation makes any activities a bit of an ordeal once it kicks in. Also am embarrassed by the facial redness when I get out of the shower in the morning. Thanks for any advice.

[Alan Rockoff, MD]

I think you have eczema, which does all the things you describe.  Eczema is hereditary, although you may not know anyone in the family who has it, because they may have a mild case they just ignore as dry skin.  In any case, you don't need to change your soap and other facial products.  I suggest you try 1% hydrocortisone (over-the-counter) twice a day for a week.  Then call the dermatologist you saw, tell him or her what response you had, and get a prescription for what the doctor thinks would be best.  Eczema does come and go, more in the winter, but does not get progressively worse over the years.

Take care.

Dr. Rockoff

[Educ]

Hello Dr. and Shmo,
my son has exactly the same symptoms and face issues as mentioned in the posting, "Flushed, tight, flaky skin after washing: just sensitive?"  He has been struggling with the same problems and was amazed that someone wrote about the exact same facial/skin problems that he has been dealing with.  He would like to talk with Shmo if at all possible  via email.  He is 21, in college, and has been under the care of a dermatologist for several years.  Really...nothing has been very effective.  The facial burning, itching, and redness are extremely problematic. He talks about a couple areas on his face that never stop itching.  In addition to this, he feels like he'll never be able to stop using topicals with hydrocortosone....and even though his dermatologist says to use these creams....we are worried about the side effects of using these for a long period of time.   He gets very agitated with the facial redness and having to deal with the emotional side of this.  What works?  He has been diagnosed with acute dermititis.  We are hoping for some sort of breakthrough in dermatology for this facial issue.  thank you!  Please respond to my email and I'll pass it along to him.

[SensitivePeach]

Your son almost certainly has had his skin thinned and gotten iatrogenic rosaca thanks to this dermatologist.  He should try and wean off the topical steroid.  If the doctor tells you that low strength hydrocortisone can't cause rosacea, you should look online and in medline...  It can.

As for sensitive skin, try non-water washes I would suggest "Tolerin dermo cleanser" (fluid, not foam) for cleaning the skin (wipe off with cotton pads) and "Tolerin light facial fluid" as a moisturiser, finish off with Linda Sy Zinco to protect the skin.  Stay away from ANYTHING with alcohols in, including cetyl, benzyl and cetereal alcohols, they will make him burn and sting and flake.

I've been where your sun is, there is a way back.