rosacea?

[saby11998]

Hello,

1 year ago (1-2 months after the birth of my premature baby) I had a red, dry rash on my chin, above my lips and on my nose. The dermatologist told me I had sebhorreic dermatitis and prescribed me steroids (I used it for 2 weeks but i did not help) and nizoral. The redness was gone, but the skin seemed to be big pored and a little bit swollen. I went to see another dermatologist. She told me I had rosacea and prescribed me Metrogel. It made the whole situation worse. My whole face turned red and burned constantly. A month or 2 after that little red bumps appeared on my chest, bach of my arms, back and legs. Inflamed oilglands was the answer. I used a cream and the bumps disappeared. After that I noticed a few little red bumps reappearing. The skin on all those parts also seemed red spotted and swollen (dermatologist told me I had keratosis pilaris, but where does the swelling come from?)Especially my legs seemed to  feel heavier. My husband also noticed that whenever I carried my bag around my shoulder the bag left deep red lines behind in my skin. The red lines wouldn't go away for a while. Also whenever I scratched my skin it just burned, and on the place were I scratched red lines showed up and stayed there for a while. I never had this before . Around that time my scalp started to get flaky and oily . I also noticed hairloss. When I  ran my fingers through my hair , my hands were full of hair. It doesn't look like round bald patches, but more like thinning of the hair. I'm still not done, there is more.
After all that, my chin, cheeks and the nostrils of my nose were swollen. No persistent redness of the face, my face only turned red when I went in the sun or whenever it was hot. Pores in my face are bigger than they used to be. My face burns constantly. My eyelids are swollen, especially in the morning after waking up. I had every bloodtest you can name done, but nothing out of the ordinary. A skin biopsy of my chin revealed a mild perivascular lymphocytic inflammation without epidermal alteration . Still dermatologists have no clue. My tongue is also swollen (for 3 weeks now). Doctor has no clue. Nobody seems to know what's going on. The hairloss still hasn't stopped. My hair is getting thinner. Can you maybe help me? I don't know what to do anymore. We even had a waterfilter put in, thinking the water would be the cause. I know this story sounds crazy, but it's true. I hope you can help me a little bit. I'm only 28 years old and I want to enjoy my life with my baby and husband. It's pretty hard for me to do that since my face is burning constantly and I'm embarrased to be seen.

[Alan Rockoff, MD]

The doctors did a biopsy to look for something.  They didn't find much--perivascular lymphocytic inflammation is so common and nonspecific as to mean little or nothing.  It would not in any case explain large pores or swollen legs.

Since you saw Stanford dermatologists who did a biopsy, they would be in the best position to answer your questions.

Dr. Rockoff

[saby11998]

Hello,

Well sure I'm pretty depressed. My face isn't constantly red only when I'm hot or when I'm in the sun. It does burn a lot.  My face just looks terrible. The swelling in my face is noticeable.  My skin is very oily and big pored. I always had flawless skin and no big pores. Even 1 month after I had my baby it was ok.
I'm not making this up. Dermatologists in Stanford would not advise me to do a skinbiopsy if there wouldn't be anything wrong. I certaintly would not allow them to cut a piece out of my skin if it wouldn't be necessary. The skinbiopsy did reveal a perivascular lymphocytic inflammation. My legs seemed to be swollen. I'm not the only one noticing it, my husband noticed all these things too.
Now in the past I used to get a red rash on the side of my nose, it went away after a few days. It came back every 6 or 7 months. the rash I had on my chin, above my lips and on the nose looked the same.

[Alan Rockoff, MD]

I really don't know where to begin.  Seborrhea and rosacea only affect the face, so neither would explain the various symptoms on your body.

I have never seen Metrogel make the face red and burn constantly, certainly not after the gel was stopped.

Keratosis pilaris is a common hereditary condition.  Red marks under areas of pressure reflects histamine release.  It happens to everyone.  Saying you never had this before only means you didn't look for it or notice it.

Your face turning red in the sun and pores looking larger than they used to are also normal findings that you are paying attention to now in a way you never did before.

Eyelids are often puffy in the morning.

Women often get accelerated hair loss a few months after delivery, or sometimes after other forms of stress.

Swelling of the tongue does not fit with anything else you've listed.  Neither does heaviness of the legs.

What disturbs me espeically about your list of common and normal skin variations is your last sentence:

I want to enjoy my life with my baby and husband. It's pretty hard for me to do that since my face is burning constantly and I'm embarrassed to be seen. . .

Why should you be embarrassed to be seen?  Nobody can see the burning, and you say yourself your skin is no longer red.

I suspect you will not appreciate my saying so, but your concerns have a ditinct emotional flavor.  After all the exams, the blood tests, and the biopsies, I think you should strongly consider consulting not a dermatologist but a psychiatrist.  Your symptoms may be associated with depression or with Body Dysmoprhic Disorder, the overwhelming sense that the body is not normal-looking, when in fact it is.

Most patients who write or come to me with problems like yours become very angry with me for making suggestions like these.  I hope you will not, because they are sincere and soberly offered.  They deserve at least your seriously consideration.

Best.

Dr. Rockoff