Undiagnosed rash on outer cheeks

I have a "rash" on both outer cheeks. At it's worst it crusts over, then crust/scab falls off, leaving slightly reddened skin. Cycle takes 4-6 weeks from bad to good, then repeats.

Dermatologist did biopsy in 2008. Said probably not Lupus, chance of Actinic Keratosis, probably Rosacea combined with Seb Derm.

Tried OTC cortisone ointment, Metrogel, Sulfur-Sulfacetamide, Protopic with little results. Desonide gave temporary relief, not long term.

I do have ruddy complexion and a little Rosacea flushing in central face area but no bumps like shown in textbooks. Using multiple dandruf shampoos in case of Seb Derm but don't think that's it either. Rash is on outer cheeks, not up against nose like classic Seb Derm.

I'm thinking AK but trying to avoid another biopsy with more vague results.

I ordered an ANA test on my own that came back negative. Ordered general blood test that had good results except bad cholesterol 1 or 2 points over typical high end. Good cholesterol right in the middle.

[Bhupinder Kaur, MD]

Hello,
From the symptoms it looks like actinic keratosis. I cannot confirm anything without examination but a biopsy is needed to confirm the diagnosis. So please get it done.

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 dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[sj528]

Thank you for the response. The biopsy in 2008 was performed slightly behind the affected area, closer to my ear, a 4mm square incision. Not sure why the doctor did not perform a shave biopsy on the problem area itself? Maybe an attempt to avoid a scar where I would easily see it. I can see a slight vertical scar where the biopsy was performed.

I would prefer to try Photo-Dynamic light treatment instead of another biopsy. But I'm a little concerned about PDT with aminolevulinic acid while the skin is still red and irritated. I may see if the dermatologist will let me try diclofenac gel. Or possibly I could try a weaker PDT treatment without any topical solution. I would have to pay out of pocket for PDT.