YANM...I don't even know what
October 7, 2015 8:33 AM   Subscribe

I've now had 3 episodes of a weird skin thing (specifics within) that is painful and perplexing and google-resistant. I have an appointment with a dermatologist, but it isn't for several weeks, and I'm not even sure this is actually one for the dermatologist, rather than a GP or even an OB/Gyn. It starts with hot itchy skin and evolves to a pimple-like rash, and it is exclusive to my jawline and chin. Do you know what it might be, and exactly which doctor I should see about it? I really hate going to doctors, so I’d love to get the right doc the first time with this.

(Anon because medical history stuff and because I have spoken to people IRL about this. I’ve provided as much info as I could think of…)

So this is the quite consistent sequence of events. Exactly the same, each time:

Day one: a painful, hot-feeling itch on my jawline and chin. This is the sole symptom for about a day. The skin doesn’t appear red or swollen unless I scratch it—which I try not to do, but I have woken myself up scratching in my sleep. Benadryl and diphenhydramine lotion don’t do anything about the itch. Cold packs on the skin ease it temporarily.

Day two: Tiny, white, fluid-filled bumps appear in all of the itchy places. These look like little bitty zits, rather than blisters. They appear both alone and in little gross clusters, and increase throughout the day, very rapidly; every time I look, there will be more. They break or pop easily—several broke open just from me washing my face with water and fingers. When this happened I noticed that some had clear fluid, others white fluid. At this point it's not very itchy anymore, but still feels hot/irritated.

Day three and onward: The itching/hot feeling stops but the bumps remain. They gradually heal/scab over, and they leave behind rough, dry skin at first, but eventually it heals completely and is soft and normal. The whole process, from itch to normal, takes about a week and a half. The healing is by far the longest part.

This has now happened three times. The first time was a few days after dental surgery. It started the day after I finished a course of heavy antibiotics, and between all the meds and all the stuff that had been on and near my face for surgery, I really didn’t think much of it. I assumed it was just some sort of freak allergic reaction or the bacteria on my skin rebounding after the antibiotics. Now, it's happening in the absence of all of that, so I’m wondering if it’s not something more systemic. But at no time, so far, knock on wood, has it affected anything except my chin and jaw. It hasn't spread to the rest of my face, or even my neck.

Timing: The first episode was in April, the second in September, the third is currently in progress (early October).

Possibly relevant details:
Female, early 30s, generally sensitive skin, no history of bad acne but I’ve always been prone to have between 1 and 5 zits on my face at any given time. No suntanning; I wear an SPF 30 moisturizer daily. The only medication I take is hormonal birth control, which I've taken uneventfully for years. No history of thyroid problems, or any major health problems really. No sexually transmitted infections, no history of recurring infections or gluten sensitivity or anything. I’m not even particularly under stress right now, though I sure was the first time this came around.

Things I don’t think it is related to:
-Birth control pills (the dates of each breakout don’t line up with anything)
-Alcohol (at least one episode happened when I was abstaining completely)
-Makeup or cleansers (I use no cleansers on my face, and only wear eye makeup.)

So, that’s the full story of my gross lower face. Does this sound familiar to anyone? Should I try to get in to see my GP, before the derm? Could the antibiotics back in April have thrown off my system in some big, recurring way? All help and ideas appreciated.
posted by anonymous to Health & Fitness (14 answers total) 1 user marked this as a favorite
 
I'd stick with the dermatologist; they are much more likely to know something about a facial skin situation. I'd be surprised if they can't diagnose it. Although they might want you to come back when it is actually happening for a look-see.

It actually sounds like cold sores. Check out the pictorial guide of 31 "skin bump" conditions.
posted by beagle at 8:39 AM on October 7, 2015 [1 favorite]


I would guess some form of herpes. I get cold sores on my lip, generally after a cold/ flu, and I also get a rash just like you describe on my nose in similarly stressful situations. It starts out painful and itchy, then is a scabby ugly thing. It is quite contagious, esp. in the early stages, and it is responsive to anti-viral meds. Abreva is over-the-counter and pretty effective. Early treatment helps keep outbreaks shorter.
posted by theora55 at 8:40 AM on October 7, 2015 [2 favorites]


Oh, and take some good pictures for the skin doc.
posted by beagle at 8:42 AM on October 7, 2015 [2 favorites]


Sounds like cold sores (herpes). I get them when I am being immuno-challenged, like sick with some other infection. There are really great prescription medicines for it.
posted by stowaway at 8:46 AM on October 7, 2015


I get this. It's cold sores plus staph. :(
posted by Hermione Granger at 8:50 AM on October 7, 2015


Sounds like perioral dermatitis.
posted by thetortoise at 9:08 AM on October 7, 2015 [1 favorite]


My mother and I both had this - multiple cycles of it - and both got treated by the dermatologist. I am drawing a complete blank on the name of the cream he gave us, but it did the trick.
posted by Lyn Never at 9:08 AM on October 7, 2015


Agreeing that except for the location, it does sound like cold sores. I've gotten those damned things for decades! A couple of years ago, I read that Ariel Meadow Stallings at Offbeat Bride took lysine every day six weeks before her wedding to prevented them. (She's not a medical professional but she's cool and I like to give her site a plug when I can.) I took it for a long time and had maybe one cold sore. Now I only take it if my lips get chapped (usually a precursor) or if I feel that itchy weird sensation. And the outbreak is headed off at the pass.

Check your local health food store for lysine. Try taking 500 mg twice a day to see if the outbreaks stop. Good luck!
posted by Beti at 9:36 AM on October 7, 2015


I had these exact symptoms starting over the summer on my forehead near my hairline. At first I thought it was a spider or a bug bite because I had been on a family trip and we were outside at night a good bit. Once I got home it got better for a few days. Then it flared up much worse. I had changed hair products and thought it was the newest thing. A few more days and it was getting progressively worse especially the burning, itchiness and it was spreading to my eyelids and cheeks.

Turned out to be contact dermatitis due to an allergy to argan oil. I had been using argan oil for 9 - 10 months before this with no problems of any kind. I was sweating a lot and swimming on the family trip so I think that the argan oil was seeping onto the skin of my face in a way that it had not before. Once I stopped using the argan oil, it slowly subsided. The burning and itchiness took a week to fully go away. The bumps took longer and I still have scars on my forehead near my hairline where I had the worst of the bumpiness and irritation.

Hope this helps. Please look at all the products you use on your hair and skin and google "product name allergy". That's how I found out about the argan oil allergy and saw an exact description of my symptoms on a QVC forum about argan oil.
posted by narancia at 10:43 AM on October 7, 2015


If you got a new post-dental surgery mouthwash, then drop it. It sounds like proximity to the lower gums, where a substance can remain, a new toothpaste, or mouthwash. If you have started using coconut oil in your mouth around your gums, then stop, it is making some anaerobic seal on your lower teeth, and infection, allergy, or irritation is expressing topically in the most adjacent area. Buy plain yogurt, or an immune boosting yogurt and eat it, rinse with water, avoid flouride mouthwash or toothpaste for a while. I have heard of people developing allergy to fluoride in topical products. Don't use any product that seals your lower gumline, or whitening strips. Probiotics after antibiotics, to restore or even establish beneficial bacterial balance.
posted by Oyéah at 11:03 AM on October 7, 2015


My sister has had something very similar twice on her jaw and her hairline - folliculitis. It came on really rapidly over the course of a few hours. The only difference is that you had it after strong antibiotics, whereas she was prescribed strong antibiotics which cleared it up well. She thinks it was due to using a face cloth one too many times, so you might want to make sure you are using clean face cloths every day and washing your towel regularly to see if that makes any difference.
posted by tinwhiskers at 1:47 PM on October 7, 2015


Did you have chicken pox as a kid? Could be a mild presentation of shingles. The jawline-only description makes me think it has something to do with the nerve that runs along the jawline. Is it on both sides or just one? The dermatologist should be able to diagnose but I'd think your GP would be able to as well.
posted by eldiem at 2:29 PM on October 7, 2015 [2 favorites]


Yes. I'd bet money it's oral herpes/cold sores. Have you ever had a cold sore before?

For whatever reason, although I used to get more typical cold sores next to my lip, in the past few years I only ever get cold sore outbreaks like this -- it follows the exact timeline of symptoms you've described, and happens on my cheek and upper jaw.

I went to my GP the first time I had this kind of outbreak, because I didn't recognize it and worried that it might be some kind of staph infection. My GP diagnosed it immediately and prescribed Valtrex (valacyclovir).

My doctor explained that the location of the outbreak happens because the virus lurks in the trigeminal nerve, which runs along the jaws. So it can break out anywhere along the nerve. If that's what's happening to you, then I bet yours is hanging out in the lower branch of the nerve; mine is clearly hanging out in the upper branch.

Dental surgery is a well-known trigger for an outbreak, by the way.

So if you can get an appointment with your GP sooner than with the dermatologist, then I'd suggest doing that. They will likely be able to figure out what it is -- whether it's cold sores, as I suspect, or some other kind of infection or rash.
posted by snowmentality at 6:03 PM on October 7, 2015


Clearly you need to see your derm, since we can't agree. Take pictures now in case it is gone by the time you go in.

To me this sounds exactly like perioral dermatitis (perioral just means around the mouth, so this doesn't say much). In me it is triggered by using toothpastes that don't agree with me.

Fluoride is not the ingredient that bothers me, personally. For me it seems to be sodium laurel sulfate (even sodium laureth sulfate, supposedly milder, has been bugging me lately). This is good because SLS doesn't do anything useful- just makes the toothpaste foam and also makes your orange juice taste bad. (Fluoride is actually useful for protecting your teeth, so if that turns out to be your problem ingredient, you should probably ask your dentist what to do about it).

Mine just started sometime in my twenties. I remember when I was little my folks thought I was allergic to toothpaste but that passed; I guess it came back.

Anyhow stupid SLS is in a lot of toothpaste brands, and so is fluoride. It especially might be in new dental products given to you after surgery, or your sensitivity to old products maybe got affected by exposure to stuff then. Check your product labels, call your dentist in addition to your derm.

And in the meantime, if descriptions of perioral dermatitis sound at all possible, I would see about getting mouth care products which have as few ingredients as possible, and especially no SLS. If it is ok with your dental regimen, lose the flouride too. It might take time for the rash to clear, and honestly I often end up needing an antibiotic to get it to go away even if I just end up using a bad product for a week. Either way, you should wait long enough to be sure the elimination helped. Then you can try adding ingredients back in until the problem recurs.

In sum-- check ingredient labels on products, especially but not only new ones. And call your dentist about this too.

(FYI if it does turn out to be SLS you might check out your shampoo and body wash label too. Once I switched my lifelong scalp itchiness went away.)
posted by nat at 10:35 PM on October 7, 2015


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