what is this rash? How can a doctor properly diagnose it?

[lance]

In November my husband developed what looked like a dry skin patch just below and to the side of his eye.  It got bigger and itchy so we went to the doctor who thought it was bacteria.  The oral antibiotic prescribed caused an allergic reaction and caused a chest and back rash which later went away.  The rash near the eye was still there. Another dermatologist prescribed a topical anti-biotic but for the longest time it did not go away.  We think that spot is gone now but the area is still a little red so we're not sure.  He now has about 7 to 10 of those same red spots on his face and neck.  They appear to have spread.  They are itchy and my husband scratches them.  They are not wet nor do they ooze pus or anything else.They are a little scaly but not much.  They first look like little red spots and then turn into a rash the size of a dime. The most recent diagnosis is Seborrhoeic dermatitis.  They were also previously diagnosed as contact dermatitis.  It doesn't appear as if anyone really knows what it is and no one has done a test.  What do you think it could be and what test can dermatologist do to properly diagnose this.

Also, a few months ago, my husband went running and sweat quite a bit but was not able to wash his face for about 1/2 hour.  He then developed a rash on his forehead.  A big rash which is being treated with topical steroid. The steroid is working on the rash on the forehead.  But if he stops using the steroidthe rash comes right back.  This rash appears to be different from the dime size rashes but i can't be sure.  

I'm frustrated with all of the misdiagnosis and want to know what you think could be causing these dime size rashes and the rash on the forehead? How can a doctor properly diagnose this?  What tests can they do?

[Alan Rockoff, MD]

From what you say, I think your husband has eczema.  Seborrheic dermatitis is a synonym for this.  In retrospect, this never was bacteria, so the antibiotics were beside the point.

Eczema refers to a senstivity of the skin.  The face (and eyelids) are common locations in adults.  The affected skin develops "dry" patches which are red, scaly, burning, itchy, etc.  These spots come and go for no reason.  Soaps, moisturizers, or (in women) makeup make the spots redder and itchier but don't cause them.

Eczema comes out of the blue and goes away that way too.  In other words, there's probably no way to explain why it's bothering him suddenly.

Topical cortisone creams can make eczema go away very quickly.  There are also newer preparations like Protopic or Elidel which can do the same.  But--as soon as you stop, the eczema comes back when it wants to.  That's just what eczema does--you just reapply whatever cream works.

Don't worry--your husband won't be treating this forever.  The condition will "give up" and leaves him alone.  Don't know why--it just does.

I recommend another dermatologic opinion.  The doctor might suggest allergy testing (to something touching the skin, not a food or drug).  Generally, these tests are not useful, but it deserves being thought about.

At the end of the day, though, if the diagnosis of eczema or dermatitis is confirmed, your husband will be able to control his symptoms quite easily and safely with occasional application fo whatever works.

Take care.

Dr. Rockoff

[dj150]

A related discussion, is eczema contagious was started.