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Suggest Treatment For Facial Redness And Swelling During Nights
Question: Hi. I am experiencing facial redness and swelling, a few hives that become acute at night, specifically (approx.) between 11 PM and 4 AM. I get up, use hydrocortisone (helps) and ice (face hot to the touch).
It gets better during the day, but since it has been chronic for the last 2 weeks, my face is still a bit swollen during the day. I have changed detergents, washed linen repeatedly, even bagged my pillows, plastic cover on mattress, etc.. examined mattress for any infiltration of any insects-nothing. I took 25 mg. of OTC Benedryl which seemed to partially help by morning. However, the redness is somewhat self limiting by the hour (better by AM). Baffled. I cut out aspirin. Hats on in the sun and snow. Baffled. No previous Thyroid or other issues. I do have sensitive skin)chlorine, etc.) and am allergic to pesticides so no use at all of those. I am a bit overweight and maintaining a protein to vegetable ration, cutting out gluten. I have asthma but it is so minor now, I only use Bronkaid as needed. Previously, used another OTC. But, using so little and only as needed so the does doesn't correspond to the red face. Baffled. Thanks.
It gets better during the day, but since it has been chronic for the last 2 weeks, my face is still a bit swollen during the day. I have changed detergents, washed linen repeatedly, even bagged my pillows, plastic cover on mattress, etc.. examined mattress for any infiltration of any insects-nothing. I took 25 mg. of OTC Benedryl which seemed to partially help by morning. However, the redness is somewhat self limiting by the hour (better by AM). Baffled. I cut out aspirin. Hats on in the sun and snow. Baffled. No previous Thyroid or other issues. I do have sensitive skin)chlorine, etc.) and am allergic to pesticides so no use at all of those. I am a bit overweight and maintaining a protein to vegetable ration, cutting out gluten. I have asthma but it is so minor now, I only use Bronkaid as needed. Previously, used another OTC. But, using so little and only as needed so the does doesn't correspond to the red face. Baffled. Thanks.
Brief Answer:
Acute urticaria, likely
Detailed Answer:
Hello and Welcome
I appreciate your concern
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Since there was response to Benadryl, its most likely acute urticarial rash Though the dose of the Benadryl is inadequate. Initially up to 50 mg can be used thrice a day. As it has sedative properties then double non sedating antihistamines such as fexofenadine and desloratidine in combo with montelukast would help. Local calamine lotion and hydrocortisone would help, too. Changing clothes after a thorough bath with lukewarm water (with a few drops of Dettol , added) should also help. If the distribution of the rash is in a butterfly manner pathognomonic of SLE then one can proceed to further workup but since the initial response was to the Benadryl, its unlikely. If there is associated shortness of breath, voice changes or extension of rash despite treatment then you should go to a hospital near you to assess for the need of injectable steroids.
Wishing you best of health
Thanks
Let me know if you have any query
Please consult your doctor before deciding on any further course of action.
For future follow up / correspondence you may ask me directly at the link given below
Acute urticaria, likely
Detailed Answer:
Hello and Welcome
I appreciate your concern
The picture you send will not be published. Your privacy will be protected.
Since there was response to Benadryl, its most likely acute urticarial rash Though the dose of the Benadryl is inadequate. Initially up to 50 mg can be used thrice a day. As it has sedative properties then double non sedating antihistamines such as fexofenadine and desloratidine in combo with montelukast would help. Local calamine lotion and hydrocortisone would help, too. Changing clothes after a thorough bath with lukewarm water (with a few drops of Dettol , added) should also help. If the distribution of the rash is in a butterfly manner pathognomonic of SLE then one can proceed to further workup but since the initial response was to the Benadryl, its unlikely. If there is associated shortness of breath, voice changes or extension of rash despite treatment then you should go to a hospital near you to assess for the need of injectable steroids.
Wishing you best of health
Thanks
Let me know if you have any query
Please consult your doctor before deciding on any further course of action.
For future follow up / correspondence you may ask me directly at the link given below
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi. Thank you so much. The rash is not a butterfly type but extends from the eyebrows to the chin, sometimes neck. I am experiencing frequent urination but no evidence of UTI or odor, etc.. Not sure why this is occurs but it is consistent with the onset of the chronic rash. Curious as to the onset being at night, almost consistently? No shortness of breath or voice changes. Is pituitary malfunction a possible variable? Thanks!!!
Brief Answer:
Explained
Detailed Answer:
Hello again.
The frequent urination is unrelated to the rash. Polyuria is a sign of diabetes mellitus. Its just one sign, polydipsia and polyphagia can also occur. Some people don't present with the classic Ps of type 2 diabetes and can be asymptomatic. Fasting blood sugar and HBA1C levels subsequently, can be done for this purpose, in consultation with your doctor.
Urine culture sensitivity testing and vaginal swab sampling may be considered if the blood sugar and HBA1C are normal. If the urine culture also does not show any growth then cystometric studies can be done.
Pituitary pathology specifically the posterior pituitary is involved in diabetes insipidus. However, the rash is unrelated to any pituitary gland issue.
The onset at night is typically related to either a trigger e.g bed clothing, food or weaning effect of the drug in use.
The treatment options as described in the previous answer should be availed. A short course of oral corticosteroids may be necessary based on the extent and severity of the rash.
As part of the differential, herpes zoster , contact dermatitis and drug reaction are other possibilities.
Wishing you best of health
Thanks
Let me know if you have any query
Please consult your doctor before deciding on any further course of action.
For future follow up / correspondence you may ask me directly at the link given below
Explained
Detailed Answer:
Hello again.
The frequent urination is unrelated to the rash. Polyuria is a sign of diabetes mellitus. Its just one sign, polydipsia and polyphagia can also occur. Some people don't present with the classic Ps of type 2 diabetes and can be asymptomatic. Fasting blood sugar and HBA1C levels subsequently, can be done for this purpose, in consultation with your doctor.
Urine culture sensitivity testing and vaginal swab sampling may be considered if the blood sugar and HBA1C are normal. If the urine culture also does not show any growth then cystometric studies can be done.
Pituitary pathology specifically the posterior pituitary is involved in diabetes insipidus. However, the rash is unrelated to any pituitary gland issue.
The onset at night is typically related to either a trigger e.g bed clothing, food or weaning effect of the drug in use.
The treatment options as described in the previous answer should be availed. A short course of oral corticosteroids may be necessary based on the extent and severity of the rash.
As part of the differential, herpes zoster , contact dermatitis and drug reaction are other possibilities.
Wishing you best of health
Thanks
Let me know if you have any query
Please consult your doctor before deciding on any further course of action.
For future follow up / correspondence you may ask me directly at the link given below
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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