Disconnected symptoms?

[Jackson]

Hi,

I have been following this forum for the last few days, and although I have found many answers to my own questions on what has been discussed so far, something I read in another post led me to this question that I never thought about. This is about two separate problems, or at least I thought they were so, but with a common characteristic of an allergic reaction: one manifesting in the nose, and the other in the face/beard skin. Happens that in another post there was an indication for the use of a medicine, namely Flixonase (fluticasone propionate), for nose symptoms similar to what I have. What caught my attention on that, however, was the fact that I have used fluticasone propionate (cream 0.5mg/g) before for a temporary treatment of the skin irritation I mentioned above. This was prescribed for me in Brazil some years ago, but not advised for long term use. I did stop using that cream, but so far it was the only treatment it actually worked to control the irritation in the face/beard skin. My natural question then is: Is it possible that these two problems are related? Any indication of a treatment?

For completeness I will describe the symptoms on both problems.
Nose: Basically, I have been having more and more often symptoms of what seems to be hayfever: it starts with an irritation in the nasal mucosa (like an itching between the back of the nostril and the palate) and after 1-2 days of irritation, cold symptoms start such as swelling of the throat and running nose, eventually becoming a cold, indeed. But what is concerning me is the fact that this has been happening quite frequently: at least once a month, but sometimes I am just recovered and then that initial irritation comes back again. This happened throughout the last year, and still happening, so I don't think it has a seasonal cause. The increase may be associated with a change of residence, where I am now leaving in an appartment that is located in front to a field (lots of grass...). Yet, back in my childhood/teenage I used to live in a house surrounded by grass and never had this problem that time.

Face/beard skin: it starts with the skin getting reddish, feeling a bit burning too, and in the next day the skin begins to flake and keeps like that for a few days, sometimes with the reddish getting back and restarting the cycle, some others it gets healed for a few days and it comes back again. This all happens mostly in the region surrounding my mouth and below my nostrils. Given that I have beard in these regions, I (and some dermatologists) first thought this is related to the shaving. This might be the case, but after some time with this (more than 3 years for sure) I noticed that shaving or not is not actually what triggers the irritation, but just make it get worse if I shave when it is already irritated.

Needless to say that a solution for any of them would be very appreciated, but if they can be solved together...I lack the words to say what would that represent for my life quality.

Btw, just want to congratulate you for this forum. It is a great idea, somehow much more informative than many GP consultations.

Best,
Jack

[Dr Joanna Lukawska]

Dear Jack

1. Facial symptoms (around the nose and mouth) difficult to answer without seeing you, but the most likely diagnosis is seborrhoeic dermatitis, which is a skin reaction to a very common fungus that tends to live on our skins, mainly in the relatively greasy areas.
It can be treated with intermittent topical steroid creams such as hydrocortisone 1% twice a day for a week to get it under control and then antifungal cream (usually containing ketoconazole - Nizoral, but most other antifungal creams are equally good, the pharmacist will be able to advise you). You could also try a tea tree oil in the affected area as well as washing the area a drying agent such as benzoyl skin wash (again ask your pharmacist).
2. Nasal symptoms (irritation, itching, turning into a cold) - it is possible that you are experiencing allergic reactions to a common aero allergen (house dust mite, pet dander, mold) it is also possible that these symptoms are related to viral infections (and are indeed just a colds). As you quite rightly identified they will not be related to grass pollen allergy as grasses pollinate only for a relatively short period of time in this country (May/June).
You could try treating your nasal symptoms with oral antihistamines and nasal steroid spray +/- and see if it makes a difference (significant improvement would point towards an allergic cause). In due course you may be able to arrange for an allergy test if you still need it.
Hope this helps,
Best wishe - Joanna

[Jackson]

Dear Dr Joanna,

Thank you very much for your answer.

Your diagnosis of a seborrhoeic dermatitis seems quite right to me, as it is not the first time I heard this name. I was just wondering about a possible connection with the nasal symptoms because I was once prescribed a treatment (like the control you suggested) with fluticasone propionate cream, but just realised this is also used for the nasal symptoms. Anyway, I will try your suggestions of hydrocortisone and an antifungal cream with the pharmacist. I'm just still not much used to asking these stuff directly to a pharmacist as is done here in the UK..

I also appreciate a lot your comments about the nasal symptoms. Indeed I forgot to mention what I have been trying to deal with this. In the beginning I tried the antihistamines sometimes, but the recurrence led me to leave them aside. I just didn't know that these were to be used for as long as you think the cause of your symptoms would be around. As they were usually sold in 7 pills packs, I thought they were recommended only for a week of treatment. Recently, a nurse told me I should be taking them everyday to see what happens. I started doing this about 2 weeks ago, with Loratadine, so I am still waiting to see how it goes. In the meantime, I have also tried a nasal steroid spray (Beclometasone Dipropionate), which was recommended to me after trying Xylometazoline Hydrochloride (Otrivine) to alleviate the symptoms. The steroid worked quite well in the first time I used. However in the last time, when the irritation just started I re-started to use the steroid spray again (should I have continued with the spray?) and it did not work so well, apparently causing some throat irritation after the spray. At least that was what the nurse that told me. So, I guess I should just keep with the antihistamines for some time? I was thinking about the allergy testing, and I just thought it was a bit expensive but recently I found a Multi Allergy self Test that is not so expensive. However I don't known whether this is really to be trusted?

Once again, thank you very much for your comments. And it is definitely helping!

Best,
Jack

[Dr Joanna Lukawska]

Hi Jack
non drowsy over the counter antihistamines have very good safety profile and if required can be used daily. Having said that their onset of action is quite quick, which means that if they are going to work you should see results in days rather than weeks.
The story is different with topical nasal steroid sprays, you need prolonged daily use in order to see improvement.
Decongestant nasal sprays like the one you have described (Otrivine) are not recommended for prolonged use and should only be used for 3 to maximum 7 days. For best results you could try topical steroid nasal spray and by mouth antihistamine combined.
I am unable to comment on the allergy test you refer to, as I have no experience of this technology and don’t know how reliable the results are. In allergy specialist clinics we use simple skin prick testing and occasionally blood testing in order to make a diagnosis.
Allergy testing does not have to be expensive as the above service (skin prick testing and blood testing) is available on the NHS, however I do appreciate that depending on where you live, access to the specialist clinics could be difficult.
And finally do speak to your pharmacists about different brands of products we have discussed. they are a fantastic free resource and will be more than willing to help.
Good luck,
Joanna