Ask a doctor on the topic of Dermatology

Scalings on the face

October 9, 2014 | 30,00 EUR | answered by Dr. med. Frauke Gehring

In September, I was at the skin clinic in Stuttgart. I was apparently treated with Advantan (cortisone) for a year mistakenly. The doctor there said he thinks I have rosacea or perioral dermatitis. But having it on my forehead also points to rosacea.

I have been using a sulfur-zinc ointment for 3 weeks now. It hasn't gotten any better. I have to say that I was fired from my job on September 29th. It was a terrible shock, it still is. That's why I am extremely stressed and suffering from anxiety.

Right with the termination came new areas: now I also have it on the sides of my nose and upper cheeks. It is now itching, which it wasn't before. It's simply hell: I shower and afterwards my skin in those areas is totally tight, it looks like white parchment paper over the red face skin. Then I apply the ointment. A few hours later, the skin flakes come off. I just have to run my finger over my chin and the skin flakes down. It looks unkempt and disgusting.

Now here comes the worst part: Because I can't stand looking so disgusting, I almost pull off my skin flakes from my face with tweezers almost every day. I almost feel like I want to dissolve myself.

There are things that speak for rosacea as a disease:
- Alcohol and stress worsen the size of the inflamed areas
- The forehead is also an affected area

But there are also things that speak against it:
- I don't have otherwise reddened facial skin (maybe a little, but not more than anyone else)
- I have never visibly turned "red" during sports, stress, embarrassment etc...
- It is said that rosacea is a disease of very fair skin types, who occasionally have problems with redness, which is not the case with me.
- It's only the inflamed areas that are problematic, otherwise the skin is completely normal.
- What are "flushes"? Is that "blushing"? I don't react to spicy food, heat, or hot drinks... Or are "flushes" the flaking?
- The flaking of the skin is the worst.

I could live with "red skin", you can cover it up with makeup, but these flakes are the worst. I think I am sick from the inside out. My body is fighting against something. I just don't know what. I am totally desperate and I don't know what to do.

I have now bought the skincare series for "sensitive skin" from Avene, including makeup, so I can at least go out in public again. I don't know what to do. I never had sensitive skin, rather just normal and inconspicuous. I didn't even have pimples or anything. And now this. I have a job interview next week and I don't want to look like I have a contagious serious illness.

What do you think I have?
What are these flakes?
Will it eventually go away?
If so, how?
I heard that it could be caused by a yeast infection in the gut. Could that be it?
Should I ask the doctor for a blood test? Or stool sample or skin sample? There must be something that can be done.

Thank you for your response.

Dr. med. Frauke Gehring

Good day,

Your symptoms do not remind me so much of rosacea (flushing is redness, no scaling), but rather of seborrheic dermatitis. Typical for this are the affected areas, exacerbation by stress, and scaling.

For this dermatitis, Nizoral cream (available without prescription, apply twice daily) and, if the scalp is affected, Terzolin shampoo twice a week, are helpful.

Intestinal fungi never cause something like this, blood, skin, or stool samples do not provide any further information at this time.

If it is such a dermatitis, the symptoms should improve after a few days, including the itching. However, since I cannot and should not make remote diagnoses, I cannot tell you whether the proposed therapy will help.

Take breaks, avoid too much alcohol, coffee, and spicy foods.

Good luck for the job interview!

Warm regards, Dr. Höllering