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NOTE: this question was posted under "EYE" by accident; it

**NOTE: this question was posted...

**NOTE: this question was posted under "EYE" by accident; it was supposed to be a general question for MD's**

Hello,

I am a 30-year-old male (non-smoker) with a long history of eczema. It started around age 10, on my hands. Since then, it has grown to include my ear lobes. I use a combination of elecon cream and urea-based moisturizers for my hands (using elecon only during flare-ups) and 0.5% hydrocortisone for my ear lobes.

In the last month, the skin underneath my eyes has begun to get dry and red, and also on the bridge of my nose and near my nostrils. I was worried it might be a thyroid problem or other glandular problem, but I had blood work very recently for thyroid, liver, and pancreas function, and they were all normal.

Could it be my eczema or could it be rosacea? I have looked at photos of rosacea online, and my redness is similar in distribution to typical cases, although mine is very mild in appearance -- at least at the moment. I know that rosacea is linked in many cases to gastrointestinal issues (such as bacterial overgrowth), and I have also had a worsening of my IBS in recent months.

Note that I generally do not drink alcohol, except on rare social occasions.

The following image is not a picture of me, but my redness looks very similar to it:

http://www.skinqure.co.uk/wp-content/uploads/2011/06/rosacea_skin.jpg

My redness is milder, and worse under my right eye than my left eye.

My question is: could this redness be my eczema or is it rosacea, and what tests would distinguish the two? At the moment I have access to the following topical medications:

-elecon 0.1% (prescribed for eczema on hands)

-hydrocortisone 0.5%

-urea 10% moisturizer

-retin-a (prescribed for mild actinic keratosis and acne on face)

Would any of these be useful for the redness I am describing?

Thanks!

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Answered in 6 hours by:
9/15/2013
Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 11,654
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
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Hi. My name is***** and I am online and available to help you today. Thank you for your patience.
Have these changes under your eyes and on your nose gotten worse since you first noticed them?
Do you have any other medical problems or take any medications?
Can you upload a few pictures of this area? That may help me to tell if it is your eczema or rosacea. Here is a good way to upload a picture:
Save your picture on your computer, someplace easy to find it such as your desktop.
Go to www.tinypic.com
Upload your picture to the site tinypic.com by browsing for it as directed.
This opens up files on your computer. Double click on the picture you want to upload then hit open (bottom right of the screen). This will take you back to the tinypic page. Hit "upload now" then do the secret code thing and your picture will upload into the system.
Once you do that it gives you a bunch of links you can use, one of which says "direct link for layouts" It is important to use this box. It is the forth one down from the top of the page.
Copy the link from inside this box and then paste it into your justanswer dialog box and send it to your expert.
This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
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Family Physician
Category: Medical
Satisfied Customers: 12,816
Experience: Emergency Medicine and Family Practice for over 26 years
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I'm sorry for the delay in getting an answer to your question:

The use of steroid creams can induce or aggravate rosacea. For this reason, I believe most physicians would strongly advise against self-treatment with any steroid cream (including the Elocon or hydrocortisone) for a rash on the face without a confirmed diagnosis and recommendation by a physician who has examined your rash).

You may find some relief with one of the over-the-counter antihistamines (Zyrtec, Claritin) until you can be examined by your physician.

If this is in fact rosacea, your doctor may need to prescribe a different type of cream such as Metrogel or Metrocream.
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Customer reply replied 4 years ago

Hello,

Thank you for the response. I will have the my physician examine it, and I will not use steroid creams near the affected area.

In the meantime, can I ask whether or not you believe there is a serious underlying cause for the redness, in your opinion, given my description of the affliction and also given that all of my blood work is normal?

Thanks.

With normal lab work - this would suggest that this is very unlikely to represent thyroid or liver disease. The one thing that can cause a rash in this area is lupus - an autoimmune disorder.
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Customer reply replied 4 years ago

Hello again,

I read an article on the "butterfly rash" associated with lupus. The article I read mentioned that the rash is usually not itchy. In my case, the rash is itchy (although not severely).

At this point, perhaps I should say that I have had many health changes within the last 12 months: worsening IBS, migraines (lasting for much longer than the usual 72 hours), eye pains, neck pains, random lymph gland activity (lymph nodes rising in neck and armpits then falling a few days later), gastritis, a worsening of eczema, and other problems.

I have had a large range of tests, including cranial CT and MRI scans, ultrasounds on various parts of the body (including lymph nodes), UGI series, gastroscopy, stool tests, pathogen screenings (h. pylori, hepatitis A/B/C, etc.), and of course a lot of blood work, every couple of months for all the various functional tests and CBC count. Everything always comes back normal.

Could this be lupus?

Thanks.

Unfortunately, it is not possible to exclude a diagnosis over the internet. It is NOT the first thing that comes to mind, but I did feel it was appropriate to mention this condition since it can cause a rash which can be confused with rosacea.

If your doctor had any doubt, a few simple blood tests can help to eliminate this as a possible diagnosis.
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Satisfied Customers: 12,816
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Customer reply replied 4 years ago

Hello again,

Since our conversation, I did research on lupus, and found several checklists of common early symptoms. I feel I might have a large number of symptoms associated with the early stages of lupus. Here are the things I experience that appear on the checklist:

-butterfly rash on face as discussed earlier (comes and goes)

-chronic, worsening eczema

-chest pains during exertion and sometimes when at rest, during breathing (I have had chest x-rays, heart monitoring, and endoscopy to rule out pathologies of lungs, heart, or esophagus)

-tingling fingers (at least several times a week; I have had brain CT and MRI and glucose testing to rule out nervous system disorders or diabetes)

-increased frequency of headaches

-foamy urine (I have had urine testing in the past, but blood / pus / sugar is also negative and protein levels normal)

-pain in joints, especially in ankles and knees, and especially in last few months

-fatigue, even after sufficient sleep

-chronic prostatitis, with no accompanying infection, bacterial or otherwise

There are other symptoms, too, but these are the major ones.

I do understand there could be harmless causes for all of these, and that these symptoms are not necessarily connected. But given that all of these are common lupus symptoms, do you think I should seek ANA testing?

Thank you.

Based on a rash in the distribution you describe, it should be a serious consideration. These other symptoms while non-specific could also increase the likelihood that you may have lupus.

Testing for ANA is simple and relatively inexpensive, so I believe most physicians would consider this a reasonable test to include in your workup.
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