I thought maybe this might be interesting for people not yet diagnosed or with a dubious malar rash....
Today I've been at the dermatologist's for my face.
Whilst oral medication has helped my malar rash, it is anything but cured, so my rheumy sent me to the dermy for advice. He looked and felt very carefully, and has come to the conclusion that I have both a malar rash caused by SLE and rosacia. This actually makes sense to me because the rash spares the nasaolabial folds which is typical of SLE, and also has pustules sometimes - typical of rosacia.
Of course this is a clinical diagnosis (based on observation). He said that he could biopsy to confirm, but since I didn't need it to confirm the SLE diagnosis he wouldn't biopsy as it changes nothing in my situation.
Anyway, what I thought might be useful to those of you wondering which type of facial rash you have is the fact (we don't often hear discussed) that it is perfectly possible to have both at the same time. One diagnosis does not exclude the other.
The treatment for rosacia and lupus are different, so if you are in doubt about your situation and management - get an expert opinion
I've also had what seem like two different rashes. I've had the lumpy bumpy one (comes up almost in pustules, but they don't burst open like acne) which I've been told is rosacea, and been given antibiotic gel for it. I've also had on a much more long term basis a fairly classic looking malar rash that comes and goes (but never completely goes), that several doctors have thought was lupus and one dermy recently was absolutely sure was lupus. As both things tend to be triggered by sun, it could be either or both. I'm still none the wiser though as I've never had the kind of blood test results that I need to get a lupus diagnosis, and the one biopsy I had (of an arm lesion) didn't actually show lupus. I've only seen a rheumie once, and that was when I was largely in remission and he saw it as more of a dermy problem at the time, so didn't start me on hydroxychloroquine. I'm waiting to see him again, as things have got so much worse recently. The second to last dermy I saw was going to do a biopsy of the malar rash, but that never happened either.
I had this conversation with my rhumey. I was treated for rosacia for several years. When I first started going to my now rhuemy, he took one look at me and said it was malar rash. I quit taking the medication for rosacia and the rash didn't change at all. He always looks at the malar rash everytime I go there and makes a note about it.
He also said if you wanted to hear a good discussion about rosacia verses malar rash. Throw the question out to a room full of dermys.:lol: It could get to be a heated discussion.
Ah well, that is interesting. Having been told today I don't have lupus (hooray-hooray), my GP looked at a photo I had taken it of my red face which I had thought could be malar rash and said, "That's rosacea". I had thought rosacea caused lumps but investigation on-line shows that's not always so. No wonder we patients all get so blooming confused!
Im still waiting on a diagnosis,but funny enough I went to my GP 7 years ago as I thought I had Rosacea and she dismissed it saying it was probably through stress as I had just lost my Mum.I saw a Rhemetologist for the first time 2 weeks ago and the first thing he mentioned was the redness on my face and asked me if it was sore,which it never is!I am confused.
The nasolabial folds are on the face on either side of the nose and above the top lip of the mouth. It is the area that creases when you smile.
The treatment I've been given is metronidazole cream. It has totally eliminated the pustules (not that they were bad). It also reduced the swelling/slight odema under the skin. The redness is unchanged, but the dermy did warn me that was pernament although laser treatment might help somewhat.
One area that is flakey and raised is comletely unchanged, so I'm interested what the dermy will say about that at my followup appointment. My feeling is that that patch is probably lupus related.
I have the definite mylar rash on cheeks before and during my flare ups (on off between flare ups). I get rosacea when Im on prednisone. The doctor told me the immune system lowers and rocasea can pop up. I get rosacea on my chin mostly. Some get it on the cheeks too. Its like little watery pustules that turn the area reddish. I take the antibiotic Doxycycline and within a day or two it clears. Good Luck. :rose:
I have been diagnosed with everything from Rosacia, to excema, to a ton of other skin conditions. Absolutely nothing worked treatment wise. I am now been told that it may be Lupus and I am going to a dermy next week, he is going to do a biopsy, it will be interesting what he comes up with. As some parts looks like rosacia (lol, the meds they gave me for this had some severe side effects), some excema, but the medications for them don't work on my skin. It just gets progressively worse.