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Dr. D. Love
Dr. D. Love, Doctor
Category: Dermatology
Satisfied Customers: 17977
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am a 32 year old male. I have had 24/7 swelling in my

Customer Question

I am a 32 year old male. I have had 24/7 swelling in my cheeks since I was 18. It began out of the blue around my mouth. Since then it's around my mouth/cheeks and sides of nose. I have dark eyes from it and get asked if I have a black eye. the swelling is not affected by changes in my body weight. So its not just fat. It feels like it weighs my face down and sometimes it's too tiresome to smile because it has to lift up so much weight I suppose. I get pressure between my ears and the side of my temples. I randomly feel the fluid move or touch a nerve. Sometimes it gives me facial tics. I get heavily fatigued easily. I can feel this intense swelling at all hours of the day. Its very distracting and feels very foreign.
I have seen many doctors and no one has found anything to help. My sinus scan was perfect. My thyroid tests are fine. Allergy tests showed small/insignificant reactions to a few things which I did allergy shots for years for and nothing changed. I've been diagnosed with non allergic rhinitis but never get any of the normal rhinitis symptoms... I.e. Stuffy nose/runny nose/sneezing. I get post nasal drip sometimes but it's minor.
Ive taken every antihistamine and nose spray to no avail. As well as singulair. I've moved across the country into a completely new environment and nothing has changed. Have lived with/without a pet -no change. Changed my apt for dust mites -no change. I've tried gluten free/dairy free/ low histamine diets with no change. Some days are really bad and feel/look very full. Red marks are left after i hold a smile for a while. I've tried to identify patterns with what I eat/do but it's inconsistent and can't link it to anything.
Medical history- I had one full allergic reaction to a wasp sting that I went to the hospital for. I caught staph infection in high school and since then I have had 3-4 major boils over the last 13 years. I read that staph can lead to increased chronic rhinitis responses. I don't know anything about that. I get random sensations sometimes in the sides of my face and scalp. Similar to what I experience if I run for a long time- I believe it is lymph movement but I don't know. I take antidepressants now... Mainly because of this condition and the frustration/agony I deal with every day. This has made me very depressed/anxious and helpless feeling. I am going insane from it. I feel hopeless writing this because I'm so used to no one knowing anything that can help. I've about given up and helplessly depressed. Please help me if you know anything or have an idea...
Submitted: 1 year ago.
Category: Dermatology
Expert:  Dr. D. Love replied 1 year ago.

Hello from JustAnswer.

I am sorry that you are having so many problems.

Based on your description, I have a couple thoughts that may be helpful.

You say that the thyroid blood test were normal, but do not mention any other metabolic/endocrine evaluation. Specifically, there can be changes in the face related to abnormal levels of adrenal hormones. So, if cortisol levels have not been checked, it would be reasonable to do so.

It is also possible that certain systemic inflammatory conditions can present with facial sin symptoms, including redness and swelling. You do not mention whether there has been any evaluation for systemic inflammatory conditions, but if not, it would be reasonable to start with generic tests of inflammation, such as a sed rate and C-reactive protein, as well as an ANA and RF.

Lastly, it would be appropriate to consider consultation with a referral medical center, which is usually associated with a medical school. You can consider being seen at a regional facility in your state or at a nationally ranked facility, such as the Mayo Clinic in Rochester, MN. The doctors that work at these medical centers have greater experience in evaluating patients with rare diseases or unusual presentations, as well as are involved in research to generate new knowledge. Whenever someone has symptoms that cannot be explained by community specialists, particularly when the symptoms are more severe, it would be appropriate to consider consultation at a referral medical center.

If I can provide any clarification, please let me know.

Customer: replied 1 year ago.
Hi. Thanks. How would I get a metabolic/endocrine evaluation and evaluation for inflammitory conditions? How do I get the cortisol levels checked and the sed rate, c-reactive protein, ANA, RF tests?I also took Accutane at one point a little bit before this all started happening. It's been 13 years since I've been off it. Could it have anything to do with this.Thanks
Expert:  Dr. D. Love replied 1 year ago.

Your primary care physician can start the evaluation, but it may be necessary to consult with an Endocrinologist for the adrenal evaluation or a Rheumatologist for evaluation of the inflammatory conditions.

Accutane can cause facial redness as well as sensitivity to sun, but it would typically resolve over several months after stopping the Accutane. It would not be typical for these symptom to be due to Accutane and persist for 13 years.