Red patch in moustache area that never disappears

[Jools Holland]

I noticed around 2014 some weird red patch that developed above my lip that almost looks like a moustache if you don't look at it that closely. I've been to a few doctors and dermatologists now over the years (for a while I stopped caring because I was preoccupied with other health and appearance issues, and have always just grown out my facial hair across this time to cover it up). Every doctor (1 gp and two dermatologists) has told me it is a different thing.

A dermatologist told me it was contact dermatitis from using a safety razor, and recommended I try using an electric shaver instead. But when I tried that it didn't help at all. Also, the redness remains there even if I don't shave for months. (If I look closely I can still see it through my trimmed facial hair, and if I shave after a few months it is still there.)

A gp a few years later told me it was folliculitis or pseudo-folliculitis and to try 1% hydrocortisone cream for 6 weeks. That didn't work. (And may have potentially made it worse.)

Another dermatologist then told me it was actually seborrheic dermatitis. This dermatologist recommended hydrozole cream for a few weeks and to try nizoral shampoo as well. That didn't work either.

Does anyone have any ideas? I want to sort out the problem because I prefer being clean shaven but the area above my lip just looks ugly when I am clean shaven.

 

[Lou]

ask your doctor to give you a prescription for metronidazole cream. if it doesn't get better in a couple of weeks then that wasn't it either.

 

[Jools Holland]

ask your doctor to give you a prescription for metronidazole cream. if it doesn't get better in a couple of weeks then that wasn't it either.

OK, why do you think that one would work?

 

[Lou]

OK, why do you think that one would work?

I have a prescription for it and it works for me. The diagnosis was rosacea. Sometimes called adult acne. it wasn't ever very bad for me. My only symptom is redness and bumps, it comes and goes for no apparent reason. Seems like maybe you got the same thing. I don't even have to use the gel very often. When it appears to be coming back I use the gel till it goes away again.

Rosacea - Wikipedia

Rosacea

What is rosacea? It is a long-term disease that causes reddened skin and pimples, usually on the face. It can also make the skin thicker and cause eye problems.

www.niams.nih.gov

Rosacea - Symptoms and causes

www.mayoclinic.org

the people in the pictures have it really bad.

 

[Jools Holland]

Well that's the thing actually. I have always had some very faint rosacea on my cheeks my entire life that really only becomes particularly noticeable when sleep-deprived, anxious, embarrassed, eating spicy foods, etc., but never above my lip. That redness above my lip only started happening around 2014. So why would the rosacea randomly start spreading there at that time?

Also, if you look at it directly under a light. You can see a lot of little red bumps, like you mentioned. Also, I did actually have a pharmacist tell me once that it could be rosacea.

Also, how many days do you find that you have to use the gel to make the redness go away? And how long after it goes away does it usually come back again for you? And could it potentially make things worse? I'm worried that the drug might cause some type of dependency as well such that it gets worse when I stop using the drug.

And I'm pretty sure that the problem arose when I started having sleeping problems, which I still have. So I don't know if the metronidazole would work if I continue to not have great sleep.

 

[Lou]

When it was first prescribed to me I misunderstood the directions and used it every night before bed. Then when it was all gone I didn't have it again for a really long time. But it did come back. I complained to my doctor and he told me to use it only when I have it. and not to use it when I don't have it. I still use it at night - and maybe just for a few days. It goes away pretty quick and it returns very randomly
It comes back without any rhyme or reason as far as I can tell. which jives with those articles.
Since I burned thru the first tube the second tube lasted almost a year. just a guesstimate that there are 30 applications in a tube. I might use it 2 - 3 days in a row. So maybe we are taking about it coming back once a month.

I have been diagnosed with maintenance insomnia. I have no problems falling asleep but have troubles staying a sleep. I have a list and dos and don'ts. when I do all the dos - most of the time I sleep ok. I and others have discussed sleep issues. See if you can find the right thread or drop me a PM

 

[Jools Holland]

Yes, I'm exactly the same - I usually don't have difficulty falling asleep but my sleep maintenance is awful. However, I've noticed that if I go to sleep very early to avoid having to sleep through any noise in the early morning that improves the sleep maintenance issues quite a bit (as I think at least some of the reason for my sleep maintenance issues might be because of being very sensitive to noise, even when I use earplugs). Even if there is some noise in the first few hours I sleep, I think I am a bit better at sleeping through noise in the first few hours of sleep (but I think this might only be the case if I go out for a walk for around half an hour soon after I wake up in the mornings.) but not so much in the later hours of my sleep. So if I go to sleep very early I am usually OK. However, I still feel like my sleep can be quite unrefreshing and pretty much every night I have nightmares or very disturbing or depressing dreams. At the moment I think that could at least partially be because I don't have any friends or girlfriend and don't have anyone to talk to.

Do you find that your rosacea gets worse (and that you have to apply the gel more) when your sleep gets worse? Or have you not noticed any relationship there?

That sounds like the metronidazole is effective if it makes your problem go away very quickly.

Thanks so much for all your help. I will ask my doctor about the metronidazole gel.

 

[Lou]

Yes, I'm exactly the same - I usually don't have difficulty falling asleep but my sleep maintenance is awful. However, I've noticed that if I go to sleep very early to avoid having to sleep through any noise in the early morning that improves the sleep maintenance issues quite a bit

For me going to sleep early is like the worse thing. I even have developed a little equation. I can only stay asleep for 6.5 hours. but every hour before midnight counts as 2. so if I got to bed at 10 I wake up 2:30. If I got to bed at 11 I wake up at 4:30. However I have a hard time making it to midnight.

Maybe the most important thing I have learned and now do differently is when I do wake up is to stay in bed and listen to something to quiet my thoughts. Even if I don't fall back to sleep - I think laying in bed and not being anxious is almost as good as sleeping.

It's also very cyclical with me. One bad night means it's extra hard to stay up till 10 or 11. And going to bed or falling asleep on the couch just means I'm up at 3.

(as I think at least some of the reason for my sleep maintenance issues might be because of being very sensitive to noise, even when I use earplugs).

Have you tried a white noise maker? Our brains learn to tune them out and they mask noises.

every night I have nightmares or very disturbing or depressing dreams.

I don't have nightmares but I do have disturbing dreams too. I've been told Melatonin causes it but I've had them even without melatonin. BTW have you tried melatonin. I think it helps me.

At the moment I think that could at least partially be because I don't have any friends or girlfriend and don't have anyone to talk to.

Check with your local health services. Some have classes - like Managing Anxiety.

Do you find that your rosacea gets worse (and that you have to apply the gel more) when your sleep gets worse? Or have you not noticed any relationship there?

I have tried to figure what triggers the rosacea. I can't spot any relationships.

That sounds like the metronidazole is effective if it makes your problem go away very quickly.

Thanks so much for all your help. I will ask my doctor about the metronidazole gel.

You are welcome - I'm so glad I could give you some advice. Please let us know what happens.

 

[Jools Holland]

For me going to sleep early is like the worse thing. I even have developed a little equation. I can only stay asleep for 6.5 hours. but every hour before midnight counts as 2. so if I got to bed at 10 I wake up 2:30. If I got to bed at 11 I wake up at 4:30. However I have a hard time making it to midnight.

I might be wrong about this, because not entirely sure, but I think I might be similar in that I think my sleep quality might be worse when I go to sleep early. I think the best time for me to go to sleep might be around 11 but unless I'm living in a house by myself (which is pretty much impossible) then it's impossible for me to get enough sleep if I go to sleep around 11 because I need ten hours sleep and people usually wake up around 7- 7:30 and start moving around the house, and in the current place I am in people wake up as early as 5am.

Maybe the most important thing I have learned and now do differently is when I do wake up is to stay in bed and listen to something to quiet my thoughts. Even if I don't fall back to sleep - I think laying in bed and not being anxious is almost as good as sleeping.

I think this is true for me as well but even if I can get back to sleep quickly upon waking up in the middle of the night I can still feel my sleep is unrefreshing.

Have you tried a white noise maker? Our brains learn to tune them out and they mask noises.

This just makes the problem worse for me. I can't sleep through the white noise. I can't even sleep through the noise a box fan makes.

Check with your local health services. Some have classes - like Managing Anxiety.

This is a good suggestion but I'm kind of reluctant to try things like this until I've tried getting friends, etc. first. I used to think that I don't need friends or a girlfriend and I never need to talk to anyone to not get depressed but I'm not sure about this now. I know in the past that when I have had good friends and people to talk to that I end up being happy and really productive. The last few months I have had nobody to talk to and it feels really difficult to get any work done. But if I find friends, etc. and I still feel depressed then I might try some classes like you suggest.


Also, I got a prescription for metronidazole now but I didn't realize that it is just an antibiotic. A GP actually already gave me an antibiotic for six weeks (clindamycin) but it didn't have any effect. Do you think the metronidazole might be more effective?

 

[Lou]

This just makes the problem worse for me. I can't sleep through the white noise. I can't even sleep through the noise a box fan makes.

From what I've heard, (noise has not been an issue with me), white noise takes some getting used to. It's like your brain adapts to it and then tunes it out - and if it's covering up other noises - they get tuned out as well. Not sure how long it takes, or how loud it needs to be. Maybe some experimenting?

This is a good suggestion but I'm kind of reluctant to try things like this until I've tried getting friends, etc. first.

My class was on Zoom and one of the guys in the class and I got to talking afterwards and we started meeting on Zoom even after the class was over. So I got a guy to talk things over with too. The textbook we got had exercises and we continued working on the exercise till they were done.

I used to think that I don't need friends or a girlfriend and I never need to talk to anyone to not get depressed but I'm not sure about this now. I know in the past that when I have had good friends and people to talk to that I end up being happy and really productive. The last few months I have had nobody to talk to and it feels really difficult to get any work done. But if I find friends, etc. and I still feel depressed then I might try some classes like you suggest.

About a year ago I felt healthy and safe enough to start going out. I found a hiking group that met regularly on NextDoor. We have been hiking together for almost a year now. You probably have something similar where you live. I also found a Meet Up group and joined it for hikes and concerts. I even made a good friend via meet up.

Also, I got a prescription for metronidazole now but I didn't realize that it is just an antibiotic.

I didn't know that. I guess I should have.

A GP actually already gave me an antibiotic for six weeks (clindamycin) but it didn't have any effect. Do you think the metronidazole might be more effective?

Might be. in the reading on Rosacea I did it was mentioned a few times.

Metronidazole (Topical Route) Proper Use - Mayo Clinic

Topical Metronidazole Maintains Remissions of Rosacea

Background Rosacea is a chronic skin disease that requires long-term therapy. Oral antibiotics and topical metronidazole successfully treat rosacea. Because long-term use of systemic antibiotics carries risks for systemic complications and adverse reactions, topical treatments are...

jamanetwork.com

Metronidazole Topical: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD

Find patient medical information for metronidazole topical on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings.

www.webmd.com