Any ideas on skin condition please (picture)

[Claw001]

In early December my son had a tiny patch of dry skin on his face. Late December i made a GP appointment. Before appointment my sons face flared up really severely. Swollen, hives etc.

Managed to get same day appointment. GP didn’t know what it was, said definitely not Dermatitis. Called in a 2nd GP for opinion, didn’t know either. Gave my son anti allergy meds and made appointment to see GP, who specialises in skin.

Anti allergy meds, didn’t help. GP who specialises then gave antibiotics, steroid tablets, steroid cream and more anti allergy meds. It cleared up within 3 days.

The minute he stopped taking meds, it flared up again. Back to GP, who just gave a moisturer on Thursday.

Today, it is getting worse. The whole of my sons face is like this.

Any ideas please?

• [Message from MNHQ: the pic has now been removed at OP's request as she's concerned for her DS's privacy]

Ooh thanks Katie. Referrals take so long too. My son doesn’t want to go to school or leave the house.

On Thursday when I saw GP for 4th time, it wasn’t like this. Not sure if moisturer is making it worse or just steroids have worn off.

Thank you all again, need to try sleepy x

I have a friend who suffered from lupus, and the first sign was a facial rash, not too dissimilar to this. It looked almost as if she’d been scalded. She eventually developed other symptoms, such as rash appearing on other exposed areas of skin, due to extreme light sensitivity I believe. And she started getting joint pains etc. Just thought I’d mention in case it is remotely connected!
Your poor boy, do hope it’s resolved soon.

I know you said 2 doctors have said it's not psoriasis, but that 2nd pic makes it look even more like psoriasis. The fact that it responded to a steroid as well would strengthen that idea. The 2 doctors who said it isn't psoriasis haven't been able to tel you what it is either; have you still got steroid cream?

Moisturiser makes my daughter's worse too. It is red and scaly on her cheeks but comes and goes. Hers looks like lupus rash photos on internet but I don't think it is that. I'll let you know any good ideas from tomorrow. We have private cover so haven't had a long wait.

I sympathise with your situation - I have a son with Aspergers and that's hard enough. He needs a filling and I just can't face it :(
Xx

potato yes we still have the steroid cream. GP told me not to use it. Although that will probably change tomorrow, when they see it!

Exactly potato, they haven’t been able to say what it is. We have seen a different GP each time, each saying something different! The last said likely Dermatitis.

How is psoriasis treated?

Thank you Kitty an update would be much appreciated.

Just checked and it is spreading. My son now has it on his shoulders, neck, inside of arms, back and on his thumb. However, it looks different to his face.

This seems like fungus (yeast ) ... I bet you a round of flucunazole like diflucan will sort it within couple of days!
Could you suggest this to the gp?

Yes I agree it does look like a fungus infection. I’m wondering if it started as a small spot of eczema, which became infected with fungus,

The small spot of dry skin originally on his face, looked dry and like eczema and overnight it grew!

Some parts of his skin look (the bits which are not red) dry and the red bits look wet.

I will definitely mention it to GP.

The bigger pic is a lot better OP. It does look fungal...had similar under my armpits recently and it looks burnt/discoloured like that. Go back to GP and maybe he needs the anti fungal tablets you take orally to clear it out of his system. Poor guy...

And if its weeping/wet then its def also infected.

It looks very like the sebbhoreic eczema (no idea on spelling!) my kids had as babies. Aqueous cream in their baths helped almost immediately.

Seborrhoeic dermatitis is fungal.

Thank you, everything they have given, has been very short lived effect!

The moisturer seems to have the opposite effect!

He woke this morning, it seemed slightly better, apply moisturer cream (it did seem quite dry) and it flares, red patches become even more red and sore looking.

He cannot go to school, which is worrying. We cannot do this every week!

I also, like a pp, thought of Lupus. It's not unheard of in teenagers.

This has quite a good graphic about the symptoms, which include the facial rash and the tips of the fingers.
www.webmd.com/lupus/ss/slideshow-lupus-overview

Thank you. That’s interesting, someone else mentioned anxiety earlier. My son suffers with severe anxiety, part of which is severe fatigue and aches and pains.

I will also mention this to my GP.

Would blood tests no pick up on this? He recently had a full test, to check thyroid function (due to his tiredness)

I know I’ve already mentioned it OP, but do ask your GP about having an ANA antibody test. Lupus is an auto immune condition, which is often characterised by facial rash like this, as well as the hands sometimes. And the fact you mention he has aches & pains etc...it’s worth checking it out. GPs are not always quick to explore this. It took my friend nearly a year to get a diagnosis, and that was because she specifically asked for the test herself! Steroids will help with most inflammatory skin conditions, so it would make sense it would improve with this, but of course if the underlying issue continues, it is only a short term measure. Do let us know how you get on.

Thank you, I’m writing all suggestions down to mention to GP.

I phoned GP at 8 this morning. Was told no appointments! I told receptionist it is an emergency and he needs to be seen today. She told me to phone back at 3.

I will ring back at 3. If no joy, I will go to GP surgery and insist on being seen.

Couldn’t get an appointment at my GP’s. Had to go to urgent care centre.

GP there told me to use steroid cream again and go and see my GP for a referral to a Dermatologist.

I did ask about fungal infection, he said no, steroids wouldn’t have worked if it was. He said it didn’t look like Lupus, however he couldn’t say for sure, as he isn’t a specialist.

Ask for a second course of antibiotics.
Did you stop the first course before the end of the prescribed treatment once you saw it had cleared up. Say you were told to take for 5 days but stop after 3 because skin had healed?

OP, hopefully you’ve managed to see someone by now. I’m not sure exactly what that is but I have had all sorts of extreme rash episodes over the years - including being allergic to a cat scratch and the print on one of my pyjama tops. And if it were me, I’d smother that rash in Betnovate and check there’s not something new and allergy-causing in close contact with his skin - bedding, a new piece of clothing or something random like that!

King My son took 7 days of antibiotics (full course) 3 days of steroid tablets (full course) anti allergy tablets he had been taking everyday since 1st GP appointment before Christmas. Steroid cream for 7 days (full course)

The day after above treatment stopped, it flared up again!

Next GP just prescribed moisturer. This made it worse!

Urgent care GP said to stop using the moisturer, as it was aggravating the skin. Use steroid cream again for 7 days and get a referral to a Dermatologist.

My GP has made the referral. I have a GP appointment next week to discuss what to do, while we wait for referral!

I’ve wrecked my brain regarding any changes, I can’t think of anything!

Have they ruled out staphylococcus scalded skin syndrome (SSSS) . It looks like burns, hence the name, and to clear for good it you need IV antibiotics

Has a skin culture being suggested to identify if it is a bacteria (and which) or a fungus. While you wait for the referral, could this be an option to discuss? It might have to been a skin biopsy. It won't leave any scar but is a bit painful

I commented on the Antibiotics because the fact that you mentioned it started on other parts of the body made me think of insufficiently treated skin infection.

They haven’t ruled anything out, we are just going in circles, depending on which GP we see!

Last GP said Dermatologist would be responsible for any investigations. He mentioned Dermatologist scraping skin and looking under a microscope.

Would SSSS respond to steroid cream? As skin has shown an improvement since applying cream.

No, I don't think so, and I looked more into SSSS, and it doesn't fit. Sorry.

Because your son received oral steroid and antibio it is hard to tell which did the trick. some skin infections are very resistant to antibiotics and it takes a while to identify which is best.

Sorry, hopefully someone with expertise will step in the conversation

Thanks for comments, much appreciated. I don’t think I’m going to get any answers, until we see the Dermatologist. My suggestions to GP, were met with ‘I’m not a specialist’!

Although GP who we are seeing next week, has a special interest in skin. She didn’t know last time either and prescribed to cover all bases!