Itchy pimples on forehead

I’ve seen multiples dermatologists about this problem to no avail.  Over the past 2-3 years, I’ve been getting these extremely itchy pimples randomly on my forehead and, on rare occasions, other t-zone areas.  The areas start out very much like a hive (red, blotchy, extremely itchy skin), but, unlike hives, end up leaving a red papule with the occasional white center that stick around for days to weeks.  To provide some context, this all started after seeking treatment for mild acne (whiteheads on my forehead and extremely oily skin) about 3 years ago.  The dermatologist I saw then prescribed Ziana gel, which worked relatively well (never completely cleared the whitehead problem, though it helped).  After almost a year and a half of using it, however, I started getting the above mentioned itchy pimple problem and was also left with noticeably red and flaky skin all over my nose and on many portions of my forehead.  Even after stopping the treatment, however, the itchy pimples, red/flaky/oily/whitehead-filled skin persist!  The multiple dermatologists I’ve seen for this problem have diagnosed me with either Rosacea and/or seborrheic dermatitis.  Funny thing is, none of the multiple treatments I've tried for either of these conditions have worked!  So far the treatments I’ve tried are:

Dandruff Shampoo on the face (zinc pyrithione and Nizoral)
Clindamycin topical
Sodium Sulfacetamide
Differin
Epiduo
Nizoral Cream
Plain water
Desonide

Zinc pyrithione worked OK for a few weeks, but it eventually became extremely irritating and seemed to make the redness and itchy pimples worse.  Also, Desonide cleared the problem completely, but as soon as I tried tapering off, the problem rebounded like crazy.  It actually took almost a month of using just water on my skin for the problem to calm a tad.  

Currently, I’m on Doryx 150mg, finacea twice daily and zyrtec once a day for the problem, but, like most of the above treatments, nothing good seems to be happening. Any ideas as to what is going on here or what my next step should be?  I’ve even had allergy testing done, but the results showed no reactions to anything of significance.  I’m at a loss here and don’t know what my next step should be.  This is extremely frustrating, especially when considering the fact that I had perfect skin till I turned 27 years old 3 years ago! Ever since then, my skin has gone completely crazy.

[Bhupinder Kaur, MD]

Hello,
I agree with your dermatologists as rosacea and seborrheic dermatitis are the first possibilities that come to mind with such symptoms. Rosacea is a cutaneous disorder of the central part of the face , such as forehead, cheeks, nose and chin. Pimples or acne are sometimes included as part of the definition.
It is really frustrating whemn none of the treatment works. I suggest you to get a biopsy skin done to confirm the diagnosis and then start with the treatment. Topical antifungals and mild steroids are the usual treatment and combination of the two can be used to treat stubborn patches of seborrheic dermatitis.  Oral antifungal drugs and immunomodulators such as tacrolimus and pimecrolimus are used in very severe cases. But for that we need to confirm the diagnosis first.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[Bhupinder Kaur, MD]

Hello,
I agree with your dermatologists as rosacea and seborrheic dermatitis are the first possibilities that come to mind with such symptoms. Rosacea is a cutaneous disorder of the central part of the face , such as forehead, cheeks, nose and chin. Pimples or acne are sometimes included as part of the definition.
It is really frustrating whemn none of the treatment works. I suggest you to get a biopsy skin done to confirm the diagnosis and then start with the treatment. Topical antifungals and mild steroids are the usual treatment and combination of the two can be used to treat stubborn patches of seborrheic dermatitis.  Oral antifungal drugs and immunomodulators such as tacrolimus and pimecrolimus are used in very severe cases. But for that we need to confirm the diagnosis first.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[trellos]

i have red spots on my forehead. some of my nails have little holes what is this. i dont know if its nail pitting.