Rash for 3 months face/chin

[dougpug]

I have had a rash on my chin (going from near the corner of my mouth towards my jaw line) for nearly 3 months. I am pregnant (33wks) and it started out as what I though were a few little zits, I typically have extremely clear skin but just chalked it up to the pregnancy. I treated it with all the over the counter acne treatments, but after a week or two decided it must be a rash. At this point I tried some hydrocortisone 1% OTC, I didn't really see much improvement and so I also tried some Neosporin but just waited a few days to show my OB. My OB said she really didn't have any clue what it was but gave me some AmLactin lotion to try on the rash. I tried this with no results, it pretty much just dried out my skin and made the rash flakey. After a couple more weeks I got an appt with a Derm and he checked it out. The derm (who is a resident) didn't know what my rash was and brought in a 2nd derm for a glance. They mentioned that perhaps it was a Herpes rash but weren't convinced, they looked at it and determined that it was not fungal in nature and sent me home with Desonide oint to try out. After a few weeks with the desonide the rash seemed a little better, no bumps, but it was still red. Except if I tried to quit the desonide the bumps came back even worse than before. I made an appt to go back to see the derm again, and quit the desonide the day before so the rash would be at its worst for him to see. The derm resident saw the tiny white pus-filled bumps and seemed convinced now that the rash was Herpes, he scraped it and sent it off for a culture. He gave me some Zovirax which I decided to take after finding out the results of the culture (since I'm preg, I hate to take unecessary meds). The culture came back negative after two weeks but the Dr still wanted me to take the Zorirax??? I insisted on a second opinion at this point b/c I just wasn't convinced that what I had met the criteria for herpes (the little zits never pop, there has not been any scabbing, no pain/itch/discomfort, just redness and little bumps that come up for a few days and go back down cyclically and is ever so slightly itchy when at its worst point). I went in for the 2nd opinion, my derm looked at it another minute then called in his friend. The other Dr looked at it for what seemed like <1min and they both left the room w/o even saying a word to me! My Dr came back alone with a prescription for Metronidazole, but no diagnosis. The 1st Dr still thinks it is Herpes, the 2nd Dr wanted me to try the antibiotic cream, but I never got to say a word to him so I don't know if he just did it to appease me or if he truly thinks I need it? Now I have used the Metronidazole for a week and I don't think that my condition has really changed much. I have fewer little bumps and less redness but the rash is by no means gone. I feel like my condition most closely matches Perioral Dermatitis but isn't that relatively common for a derm to diagnose? What is the likelihood that an active flair of herpes would have resulted in a negative culture (there were LOTS of bumps the Dr got lots of pus it seems like it was an active flair b/c it was still getting worse when I saw the Dr?) The pics I find on the internet of herpes look nothing like my rash but the ones of perioral derm seem like an exact match along with the symptons. I just don't know what to do, I feel like the Dr has written me off as this crazy pregnant lady who's just a thorn in his side, and I don't know how long to try the Metronidazole cream before going back can you please review my case and let me know your own opinion, I have attached a pic. The rash has only spread a very little bit since the beginning, going from a small finger print to the size of a thumb print, and is nowhere else on my face/body.

[dougpug]

This pic is 1 week ago when the rash was at its worst. It actually looks a bit better now but I thought for diagnosis it would be easiest to see it at its worst. Thank you.

[Bhupinder Kaur, MD]

Hello,
From the symptoms and picture,it looks like perioral dermatitis. Perioral dermatitis is a chronic papulopustular and eczematous facial dermatitis.Treatment consists of oral antibiotics and anti-inflammatory drugs. A mild soap or soap substitute, such as Dove or Cetaphil should be used for washing. Scrubbing should be avoided.

If the symptoms are not controlled by topical antibiotics,then oral antibiotics may be needed.Pls consult your dermatologist and discuss this with them.

Hope it helps.Take care and pls do keep me posted on how you are doing or if you have any additional doubts.Kind regards.

[dougpug]

I have now been using the metronidazole cream for two weeks (exactly) and I am not seeing any results? The 1st week things looked like they were perhaps ever so slightly better but as of yesterday the rash flaired again and looks just as bad as it ever has. To make things worse I now have a very tiny bump above my upper lip. This bump could quite easity just be a zit but I am just panicked at the idea that I will have this misserable rash spread over even more of my face. My questions:
1) At what point do I go back to my dermatologist?
2) Is there any merrit to the herpes theory?
3) Will applying the metronidazole more than the prescribed twice daily cause me harm?

[dj150]

I feel I'm in the same boat ..but my doctor is out of town..click on my page and check my chin picture..I don't know..I feel its viral and it may clear up with possibility of reoccuring..I've read others and have seen noone with success..and I feel I got mine from someone eles...rash ..spread slow..dries n flakes reoccurs reddish breakout..not bad so far but fear it wont go away and may be contagious..they all say ...eczema/or  dermatitis..pos. herpies (herpes) but comes back negative..God help and I don't want to spread it..

[dougpug]

I have used the Metronidazole for just over a month with increased success after upping my application from 2x daily to 4-5x daily, however the bumps have now spread upwards around the corner of my mouth to the little divot just beneath my nose and also to my forehead just between my eyebrows. The bumps are more sparse and less red but they are also spreading and if they have moved to my forehead that seems to rule out perioral dermatitis???  I am now 37wks pregnant and due to have the baby anytime, any suggestions?

Thank you.

[Bhupinder Kaur, MD]

Hello,
The second possibility is of papular dermatitis of pregnancy.i am not convinced with the herpes diagnosis. Abnormal blood hormone levels are linked with popular dermatitis of pregnancy especially chronically raised levels of gonadotrophins (hormones produced by the pituitary gland of the brain, and which regulate sex hormone levels) and lowered cortisol and oestrogen levels.

This rash can erupt at any time during pregnancy and then spots continue to appear until childbirth when they clear rapidly.Pls get a second opinion from a good dermatologist as steroids is the standard treatment for this and it should not be prescribed unless diagnosis is confirmed.

Hope it helps.Take care and pls do keep me posted on how you are doing or if you have any additional doubts.Kind regards.

[lieseld]

i've been experiencing a similiar situation since i was 19 yrs old, i am 42 yrs old now, at times it will completely go away but then it comes back, for about the past year it will not go away, i've been using  some type of cortisone cream prescribed by my family doctor. all it does is keep it from beaking out too bad, but it's always there, i'm so sick of it i could scream. next week i'm going to houston to supposedly see a very good dermatologist. i'm praying he's going to be able to help me

[Weesy68]

My first thought looking at your picture before reading your post was that it is herpes.  That is exactly the location where I get my cold sores and those look exactly like herpes blisters.  If you have had chicken pox or the immunization then you can get a cold sore.  When you're pregnant your immune system is lowered.  Personally I think you need to stick with the Zovirax.  They come in treatments of three vials and you need to use all three.  Not only that, but herpes does itch like a bugger when it looks like yours does.  Maybe your immune system is taking care of it after a while and it keeps  coming back because you have a weakened immune system and aren't using medications.  You can also try Abreva which is over-the-counter but the Zovirax is much faster.  If you scratch one of the blisters and fluid comes out, it will spread so I would not scrub them or pinch them at all.