Steroid Rosacea or Eczema or something else?

Hi,

I'm a 21 year old white male. A few months ago i noticed some redness on my face which would sting a little if i got sweaty or went in the shower. This went away after a week or two and for around a month i had normal skin. Then my face started to go red. I have been using hydrocortisone 1% very frequently (almost every other day, sometimes every day) for around two years. This redness got worse and i was prescribed zinc actetate, which stung my skin. I went back to the doctor and was put on metronidazole 0.75%. When i stopped hydrocortisone and just used metronidazole my skin went very red, dry, itchy and slightly raised. My skin was also weeping and my eyes started to swell. I got quite scared and used some hydrocortisone which made the skin almost return to normal after just a couple of applications. But as soon as i stopped the steroid cream all symptoms would come flooding back.

I went to the doctors and for the past month i have used no steroid cream, just metronidazole 0.75% and oral Oxytetracycline. After an initial flare up my skin calmed itself, the redness and itchiness lessened and for about a week i was just slightly red. I had another flare up about a week ago (which was less intense than the first) and for the last four or five days my skin has just been a little red and dry but not too itchy. Today my skin is slightly more itchy again and maybe its the start of another flare up.

I know the red, dry and itchy symptoms sound like eczema (which i have a little of on other parts or my body). But i can't help thinking the long use of the hydrocortisone 1% on my face may have caused it. Can steroid induced rosacea cause dryness and itchiness as well as the redness?

I've had some eczema almost all of my life but never on my face.

What does this sound like from the symptoms?

[Dr Santos]

Hi,

This could be a case of perioral or orofacial  dermatitis which presents as groups of itchy or tender small red papules  that may appear round the mouth, upper lip, chin and cheeks. The surrounding skin may be pink, and the skin surface often becomes dry and flaky. The most common cause is the application of moisturisers, cream cleansers, make-up foundation, sunscreens  and especially topical steroid creams or ointment. Once this condition develops, topical steroid creams seem to help, but the disorder reappears when treatment is stopped. It usually comes back even worse than it was before use of steroid creams.

It responds well to treatment but can recur  at a later date or when the antibiotics are discontinued.  It is important to wash the face with warm water alone while the rash is present. It is best that you have this evaluated by your doctor for proper diagnosis and management. Finish the full course of antibiotics prescribed by your doctor to prevent recurrence. And it is important that you avoid the triggers mentioned above.

Take care and keep us posted.