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Puzzling Facial Problem
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Puzzling Facial Problem

My sister has had a strange problem on her facial skin for over two years.  It is so ugly as to be deforming, and so painful that it keeps her awake at night.  She has seen several doctors, who have said, variously, that she was imagining it (although it's extremely visible), that they did not know what it was, or that it was a fungus.  It has changed shape and form several times.  Right now, there are wide inflamed red areas under her chin, across her chin, and up one cheek as far as the cheekbone.  Within the red areas are swollen areas, half an inch or more across, that are grey or greyish-white, as well as swollen stretches that look like cord, three or four inches long, a deep red.  This whole area itches; in addition, she experiences sharp, shooting pains in it.  When the distress is too much, she presses the swellings, much as you might do if you were squeezing a pimple, and out comes a long, thin thing that looks like an iron filing, black and narrow.  Thinking these might be spores, I told her to try not squeezing them out, but she said she couldn't leave them there, they hurt too much.  The doctor who thought it was a fungus had prescribed an antifungal cream and an antifungal inhaler, and there was significant improvement, but just as it looked as if it was going to heal up, it suddenly erupted over a much wider area of her face. Earlier doctors prescribed steroid creams, and with each, there was some early improvement, and then it got worse.  Some of the newest spots have a sickening gray colour.  The whole area is extremely tender.  I offered her some ointment with tea tree oil in it, which I find very soothing for itchy conditions, and when she applied some, it caused intense pain.  Have you any idea what this condition could be and what could be done for it?
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No, I have no idea at all.  I know of no diseases that exude things that look like, "an iron filing, black and narrow."  Likewise, I know of no ski problems that produce shooting pains or "a sickening gray colour."  Certainly, this sounds lke no fungus I ever saw or heard of.  If your sister ever rubs or squeezes the rash, she absolutely must stop doing so.  In general, things don;t ooze anything, of whatever color, unless they are squeezed.  Beyond that, I have no other specific suggestions.

Take care.

Dr. Rockoff
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