Not sure if I over exfoliated or some other skin condition

[Ang0485]

Hi-
I am not sure what is going on with my face but I am freaking out a little. For a little less than 3 weeks, i was using a Salicyclic acid toner 2% (which I have used before in the past). Then I started to use a mandelic 10% serum on my trouble areas nightly. Again, used it for a little less than 3 weeks. I had no adverse reactions.
Then one night on the 3rd week I used a clarasonic face brush and I didn't realize how hard I pushed or how long. I used it for probably over a minute
As soon as I got out of the shower, my face stung. I didn't use the mandelic acid serum that night or since then. Now it has been 4 weeks and my skin is still extremely hypersensitive and sore. It burns, throbs, and feels irritated. But it is not red or anything visible. Even after I used clarasonic, it didn't get red. It just stung.
My face stings horribly even washing with water. I can't even let it touch my pillow because it will hurt. Even Vanicream stings it, but doesn't turn red.
I don't know if I over exfoliated or maybe caught a bacteria infection from the clarasonic (which I only used once or twice a week, if that). I did notice two pimple looking things form on the skin that hurts and I popped them and then they crusted in yellow. So I am asking 1. Did I over exfoliate?  2. Could I have caught a bacterial infection from my clarasonic brush? I have left it in the bathroom (maybe mold grew on it). Shingles? Cellulitis? 3. Is this burning feeling forever? It has been 4 weeks.  I can't tolerate it. Pillows and even water hurt it.  How long until it stops?  4. Is there anything a doctor could prescribe for pain? I have tried Allegra, Benadryl, Claritan, and Ibuprofen with no success. Would a low does pain modifying medicine be able to help until the burning subsides?
Your help is greatly appreciated.

[Bhupinder Kaur, MD]

Hello,
If the symptoms are improving and the burning sensation is reducing then it may be the start of recovery.
I sincerely hope that helps. Take care and regards.

[Ang0485]

Hi Doctor-
Thank you for clarifying that. You don't think the burning/hypersensitive feeling in my face is permanent do you? Sometimes it has subsided, while sometimes I feel it. Whereas before I felt it all the time. At least now my face can actually touch my pillow.
Does that mean I am in the path to recovery?

Thanks again Doctor!

[Bhupinder Kaur, MD]

Hello,
Thanks for writing back to me.

Overexfoliation can cause swelling and inflammation of epidermis and dermis. Chances of nerve injury are very less by use of Clarisonic because for nerve pain to occur the trigger must be strong enough and the nerves effected are the deep nerves rather than the superficial lying nerves. However other than nerve pain, burning sensation can occur because it is caused by activation of sensory pain nerves in the facial skin. These pain fibers are primarily triggered by the heat associated with increased blood flow. These nerve endings can also be activated by inflammatory substances that leak through blood vessels.

You can take Gabapentin but take it under medical supervision and only for the prescribed time period.

I sincerely hope that helps. Take care and regards.

[Ang0485]

Hi-
Thank you for responding so quickly and giving me suggestions. Even though there are no skin changes or redness, does that mean the skin below is inflammed?
Another doctor previously told me that the skin/nerves below surface of skin are irritated or inflammed and it can take up to 2-3 months for nerves to recover. And that a low dose gabapentin or amitryptyline can be prescribed if burning/pain is bothersome.
Do you agree?

Thank you for your help.
Thanks.

[Bhupinder Kaur, MD]

Hello,
Thanks for posting your query.

I can understand your concern for these symptoms.

Without examination it is very difficult to confirm a diagnosis but from what you have described it looks like the skin irritation is due to over exfoliation of the thin and sensitive facial skin by Clarisonic. Signs of over-exfoliated skin include, noticeable dehydration, patchy areas of dryness, skin tautness, redness and itchiness, increased sensitivity and inflammatory acne and irritation.

It does not look like an infection which usually causes redness, warmth, pus discharge from any lumps. The two pimples that you had could be due to folliculitis skin, again due to irritation from Clarisonic. Folliculitis is the inflammation of one or more hair follicles and presents as red pimples with a hair in the center of each one. The pimples may have pus in them, and they may itch or burn.  The burning sensation may persist till there is complete healing of the skin and the time taken varies with each individual.
Mild folliculitis usually heals on its own in about 2 weeks. Other than that, you can apply warm compresses.

Regarding the skin irritation, keep the area clean and apply calamine lotion or aloe vera on the face. Other than that, Aveeno (oatmeal) lukewarm baths are useful. Wash your face with a mild cleanser with moisturizing properties like Cetaphil. Pat your face dry. Then apply a good hypoallergenic moisturizer over the area or Aquaphor on the area. The treatments of this condition are application of topical corticosteroids (betamethasone, clobatesol, flucinolone) which will reduce the inflammatory process but they are available under prescription. Topical immunomodulators like pimecrolimus and tacrolimus can be used in severe conditions and you can get them prescribed from your doctor. Creams containing ceramides and emollients, dimethicone can also be used. Use of propylene glycol, lactic acid, urea, salicylic acid which are found in many therapeutic skin products should be avoided. Other than that, oral antiinflammatories like ibuprofen/acetaminophen are also helpful but should be taken under medical supervision. Also ensure to use good quality non perfumed sunscreens atleast 30 minutes before going out in the sun. Exposure to sun can cause further irritation.

Hope that this information helps and hope that you get better soon.

Wishing you good health.