nonresponsive chronic impetago or ecthyma

[ruinedface]

Dear Dr. could you please tell me if a biopsy could only say "dermatitis' but really be imetago or worse? I have had this horrible HORRIBLE skin rash on my face for over 3 years and had 3 biopsies, two said "dermatitis", one said "connective tissue disease" but my bloodwork was neg for lupus. Only one culture was done (not recent) and it did not show bacteria. The lesions lOOK just like what I see online for impetago photos and the derm did just give me mupirocin topical so he must now be considering it possible impetago.......it might, might be improving ???? on this the third day of mupirocin but if it is it is very SLOW improvement (if any) and still some new lesions come daily. It is a blistery type rash. It does not itch but is VERY painful and bleeds or oozes clear fluid. Until they drain, the area swells which hurts a lot. They drain, then they scab over which prevents more draining so they swell again. It is a vicious cycle and most have never healed for years. How long should it take to know if the mupirocin is working? I have lots of trouble with oral antibiotics, including anaphalaxis so I was not given any at this time. but I am worried the topical is not enough. Other topical antibiotics have seemed to make it worse, as do steroid creams, antifungals and other topicals such as tazorac, rosacea meds, protopic, ivermectin, apple cider vinegar, hydrogen peroxide etc etc. I have tried anything and everything possible to cure this to no avail. I am currently on oral prednisone pills because the facial swelling was out of control. You could not even see my nose bones and eyes were swollen nearly shut. Oddly steroid topical creams make it worse while pills or IV steroids do help the swelling. Will the prednisone delay/prevent the healing? The lesions are oozing than ever now more following the application of the ointment, is this "poison' coming out? Does it mean it is working? These lesions bleed so easily and profusely that I do only warm water cotton balls to soften scabs before application of the ointment. The scabs seem to be much darker and very hard now which seems odd since they are constantly  covered in ointment. Is this normal? When/how does this become classified as ecthyma vs impetago? Mine seems very chronic and severe and the lesions never completely heal, even if the surface does they seem to be lumpy and can "reactivate' anytime for no apparent reason. The worst are on the nose and cheeks but they are also on my forehead and chin and sometimes a few on my ear lobes. They do seem to run in lines and tend to match bilaterally. This has ruined my life. I look like a monster so I am a recluse. Now the derm here is passing me to the medical school although the soonest they can see me is nearly two months away unless someone cancels. I have read on this forum that some people have gone thru this for 20 years! Personally, I am at the end of my rope.

[Karaph]

Hi, I have something very similar to your condition. I was just curious if you were ever able to get rid of it or not?

[maatson]

Do consult your Doc. Would appreciate if your biopsy report is available. Relationship to Staph aureus is mentioned in literature.
Regards.

[maatson]

Acne necrotica is a mysterious disorder, unknown to many dermatologists and usually not mentioned in recent texts. We acknowledge its existence despite its rarity. It has been calledacne necrotica, acne necrotica miliaris, acne varioliformis, acne frontalis, acne atrophica, or pustular perifolliculitis. Acne necrotica is actually a misnomer, because it is not a variant of acne and bears only a superficial resemblance to an acneiform eruption. We suggest the termnecrotizing lymphocytic folliculitis.
http://link.springer.com/chapter/10.1007%2F978-3-642-59715-2_64

[maatson]

Acne varioliformis is my impression.Not thought of many a times,rare though.

[ruinedface]

There is now an album labeling rash Jan 2014 with mupirocin with photos of the rash. Keep in mind this is immediately after cleaning and applying mupirocin so it does not show the drainage which is profuse and either clear or bloody. Lots of blood and it bleeds very easily. The scabs became very hard and dark after using the mupriocin and were not able to be dissolved/removed by warm compressing. Over a week's time, the mupriocin became so irritating that I stopped using it yesterday. It was making the lesions drain more and more, and my face hurt and swelled more and more. I could not sleep. Initially like most things, I had high hopes for this ointment working, but this is typical that things got worse. I don't know what to do now.

[ruinedface]

The one I posted just now under profile was taken at the hosp a couple months back. I had a full blown anaphalatic shock reaction to a sulfa antibiotic on day 8 which caused a body rash/throat swelling shut etc  in addition to the facial rash that was *always there*. so the face is representative of my rash, only now it is MUCH worse on a daily basis, but swelling is less due to high does oral pred I am on now, although lesions are worse and draining/bleeding more profusely. I will post another more current photo momentarily.

[ruinedface]

Yes, I will do that now. Be prepared, it is ugly.