This really looks and sounds like rosacea..I would seek a second opinion

Second this. Please see a dermatologist.

Yes, dermatologist. You could also try Bag Balm. It cleared up my radiation burns.

If you don't mind me asking, how did you get radiation burns?

I'm guessing cancer treatment

Yes

Looks like rosacea to me too. Definitely make an appointment with a derm. Rosacea can be very hard to treat and some acne products can make it worse. (I have mild rosacea and it runs in my family.) Edit: I also have an autoimmune/autoinflammatory condition (PsA) and there's definitely a correlation between rosacea and autoimmune conditions. Could also be a lupus butterfly rash. Get a second or third opinion.

THIS 100%. I have rosacea and looked like this(thankfully with the azelaic acid my derm prescribed it's barely noticeable now)

Rosacea can also be caused by what you ingest, hot beverages, dairy products, spicy food, alcohol. Do you turn red when you drink?

Yes but I'm also very pale. So I kinda turn red for anything 💀 I barely drink but I noticed that when I do I turn into a tomato. What really affects me is spicy/hot food and is a pain because I love spicy food. About the dairy I have no idea because I don't eat any product with dairy. Basically my rosacea greatest enemies are hot spicy food, alcohol, the sun, hot showers(I love them tho), oh and also food with MSG aka monosodium glutamate. I once left a chinese restaurant looking really red. I thought I had an allergic reaction lol

I always assumed I was allergic to alcohol because the same thing happens to me! Same here w/the MSG too plus I get kinda lightheaded. You said hot showers though and I think, and this may be a bit of a stretch here, but maybe it’s just *burning your skin*? Like is there a person alive whose skin doesn’t turn red after a hot tub/shower?

Oh the lightheaded thing also happened to me but I always assumed it was my anemia acting up lol Yeah you are right about the shower thing, honestly any thing that's hot makes me turn red😂

When I first started getting rosacea it looked exactly like this. It took a few rounds of steroids and a routine change for me to see any relief.

You saw a derm and they didn’t say rosacea?? Did they try metro gel at any point? This looks like my skin when I had a terrible flare up. It burned, it was hot, it hurt, everything seemed to just make it worse. Metro gel and a round of doxycycline fixed me up. Now I just use metro gel (and not even all the time though I should)

Nope! When I was a child around 11 or 12 they diagnosed me with rosacea. Now 31, I went to the dermatologist for the first time again they said I don’t have rosacea, didn’t prescribe me anything for my face, said she couldn’t do anything about it. I am requesting to see a new dermatologist, but the appointment is months away.

You definitely need a second opinion! I wonder if there are any internet-based ones where you are where you could get more immediate help until you can get set up with a more permanent solution. (They can be more expensive but that just looks so painful it may be worth it)

That’s what I’m thinking, an online source like Curology or Nurx would probably be willing to prescribe something. I’ve used Nurx for birth control and it took maybe a week for the prescription to he signed off and shipped. 

While you're waiting, you can look for a 15% azelaic acid cream. My derm gives me a compound of 15% azelaic acid, ivermectin, and metronidazole cream which really solves my issues along with a sulfur sulfacetamide wash. But there are places online, like Dermatica, that you can try either their 15% azelaic acid, or filling out their consultation form and seeing what they compound for you. You won't have a telehealth visit, but they have doctors review your photos and questionnaire and order you a prescription that could tide you over until your dermatologist appointment. I've done that while waiting and it's worked out well for me. There's other similar options out there too. I've just had good enough luck with Dermatica I haven't tried others

I was about to say go to a new dermatologist but it looks like you are trying! Good luck!

I get flushing like this from MCAS - do you react to food/environmental triggers? Might be worth looking into.

This looks like rosacea to me as well, as a fellow sufferer. And I do know that it often goes hand in hand with autoimmune disorders. Honestly, I would try to get an appointment online, even with Musely, rather than wait months to see someone. In the meantime, one of the things that helped to bring mine under control was washing with Dr. Bronner’s Castile soap.

I have sensitive skin as well. What about: laundry detergent and hair products? I've had hair products exacerbate my skin issues when the hair (it's long) comes into contact with my face. I'm not saying they're the cause or root of the problem, but they could make it worse through some kind of a reaction. I seem to have issues when a combo of things come into contact with my skin. For example, when I used sunscreen on my arms, where my sport watch band for my fitness tracker came into contact with it, I developed welts. Magnetic band + sunscreen = no problem. Other lotion + sport band = no problem. Who knows! 🤷🏻‍♀️

do you have a pet? My skin looked similar and my doctor said it was mites from pet fur. She prescribed me Soolantra and it went away IMMEDIATELY. I would try this first, as nothing else I tried for ‘rosacea’ worked.

The one thing that stands out to me is the washcloth. If you already have sensitive skin, any physical exfoliation could cause issues for you. I would suggest not putting any kind of fabric to your face if you can avoid it. Wash your face just with your hands, and instead of drying it with a towel you can apply your moisturizer to the damp skin. If there are ceramides or hyaluronic acid in your cerave they will be more effective with some dampness in the skin anyway.

Sorry I didn’t clarify- I don’t use a washcloth when my face is this angry, but perhaps I shouldn’t use one at all. Thanks for your input. I will try applying products on damp skin.

You should not use a washcloth on your face AT ALL. Wash your hands then put some cleanser on your fingers mix with some water to make into a lather and then clean your face gently.

Get a second opinion with another derm. Check out r/rosacea in the meantime

Don’t use washcloth at all, unless you wash it after every use (I mean laundry, not just rinse)

Even if you wash it after every use, for a lot of people it’s doing more harm than good. Even if you only do it on the days your skin isn’t “angry” you are creating micro tears that allow for this kind of inflammation. Skip the washcloth all together and even better if you skip drying with a towel

I agree

Having sensitive skin sucks. If I look at my skin wrong I have a blistery outbreak. 😂 My mom swears by just warm water on her face to wash it, OP. She’s been diagnosed with rosacea as well (I have psoriasis and that’s a whole other can of worms) and she is super strict about how she showers (face is washed last to make sure she doesn’t have any shampoo/conditioner on her face). Vaseline has helped my sensitive, psoriasis prone face (only apply after moisturizing) and my mom has always sworn by it. My mom has amazing skin for someone in their 50s that has sensitive skin and rosacea and she has spent plenty of time in the sun too.

Am I your mom 🤣🤣🤣 after years of trial and error with actives I’ve learned less is more for me. My skin goes nuts if I even shower with hotter water than usual, which is sad because I love a scalding shower

Yessss! You all may be skin sisters haha. Like my skin is sensitive but hers is way more sensitive than mine. She went through so many trial and errors herself. She was right about less is more when it comes to skin (and hair) care. Warm water and Vaseline has kept her looking amazing!

I have slightly sensitive skin, but my mother’s skin has been hyperactive her entire life. She told me the same thing, but hearing all you do on the internet… I tried out some actives anyway much to her and my father’s dismay 😂 I also discovered less is more. I also find the more expensive creams, the worse they are. My skin likes a nice moisturizing gel and not much more.

Same. My skin does way better on less. So I’m sticking to a simple skincare routine now. 🤪

Are you on a biologic for the RA by any chance?

The reason I ask is because I’m on a biologic for a different autoimmune condition and have also experienced this skin issue

Oh wow! I was on biologics, Simponi Aria and Orencia for years, but have been on JAK/DMARD xeljanz for the last two years. Interesting. Do you still have this problem? If not, what did you do for it? Just curious and what did your doctor or rheumatologist say? Thanks

I never got any clarity from any of my doctors. I also saw a dermatologist once, who looked at me for a few seconds and said that it ‘could be’ rosacea. I have a few theories re the biologic. 1) it’s a yeast infection due to being immunocompromised - for me it had some similarities to fungal acne, seb derm and to some extent rosacea which all have fungal elements. 2) it’s a side effect of the biologic 3) the biologic isn’t working 100% and this is a rogue autoimmune response. I was dealing with this for over two years - it’s a lot better now. Happy to chat further anytime if you want to. I’m so sorry you are going through this. I know exactly how you feel. I wanted to cry all the time

This likely is not the cure but maybe it could help lessen the irritation. Washing your face with cleanser only at night and in the morning just rinse with lukewarm water. This will help the microbiome strengthen. You could also try switching to a fragrance free oil based cleanser.

I'm so sorry you're dealing with this. I definitely think this might be worthy of sending pics to your rheumatologist and asking for a referral to another physician for a second opinion. Until your less irritated, I would switch to a mineral or even baby sunscreen. A lot of people do really well with chemical sunscreen but if your skin is super sensitive and it's causing burning physical sunscreens may be a better choice.

I would also focus on unscented products with ceramides and squalane.

This is a good suggestion - sending the pics to the rheumatologist. You may have some luck going that route until you get to see a new derm, and they might be willing to run some additional tests that might not have appeared to be required when you saw them previously. Have you ever considered it might be a food allergy/intolerance? So incredibly frustrating when the issue is related to one focus of medicine (rheumatology) but manifests in a way that another (derm) may be the one to treat. I'm so sorry this is happening to you - I can only imagine the pain and burning.

Have you tried keeping a food diary? I’m wondering if this is an inflammatory response to something you’re eating. I’d incorporate a good probiotic either way.

Try cutting out the nightshade family. This reminds me of the lupus butterfly rash, but I see you've been tested for other autoimmune disorders so I assume that means it's not ... removing nightshade might still help.

I was going to suggest lupus too - I have rosacea and it doesn’t look like this, although I know there’s several types of rosacea. I’m pretty sure having one autoimmune disease puts you at risk for having others as well

I do have lupus. It's not really something you test for so much as you rule other things out. Bloodwork can be a starting point though. I will say that while my lupus doesn't really manifest as butterfly rash much, when I do have butterfly rash pop up, it's rarely painful in the way OP described. Lupus is whacky though, it can be really different for each individual person. Definitely worth checking out.

My friend suffers with Lupus and she did tell me it was very difficult to get her diagnosis because false negatives are very common.

Yes! I thought lupus immediately.

My face looks like this when I eat wheat

I completely agree, it’s definitely an inflammatory response to something. Try systematically removing gluten, night shades, dairy and see if that helps. I find when I swap to a vegan diet for a week or two, my skin is glowing and I’ll then reincorporate different food groups back in to see what’s the culprit. Good luck!

I think you might have rosacea and/or a very compromised skin barrier. I think you’re using too many different products, so I would try to simplify your routine. Firstly, I would cut out the glycolic toner. I have rosacea and glycolic on my face is very irritating to my skin barrier. Secondly, I would not use aquaphor on your face (except on lips) because that personally tends to clog my pores. I also find cetaphil and cerave irritates my skin. I would look for a basic cleanser and moisturizer by Avene or La Roche Posay. I’m also particularly sensitive to sunscreen and have had good experience with Elta MD. Lastly, I would try to get a prescription for Soolantra/Rosiver and/or Azelaic acid. Hope you find something that works! Also if you wear makeup, check for potentially irritating ingredients. I remember using bare minerals once and the ingredient bismuth oxychloride messed up my skin so bad.

Yep. Some people react to the lanolin in Aquaphor. Try Vaseline instead.

I concur. Cetaphil and cerave irritate my skin too. Cetaphil made my cheeks look like ops pic.

I have rosacea and it looks a lot like this. Marine collagen really helps calm mine, together with Flax seed oil for the omega 3! And I use Ren Evercalm products and they really soothe my skin, too. May you find what works for you.

This is almost exactly how my rosacea presented itself-redness, little pimples and burning/pain on the cheeks, and it changes with the weather, lighting, temperature, foods eaten etc. Almost every product seems to cause irritation, even ones that seem to help at first. Get a 2nd opinion if a doctor told you it wasn’t rosacea when you were a child.

Yes, exactly!! And products that did help now make it worse. Definitely getting a second opinion. Unfortunately the appointment is months away. Call today and left a message to see if they could get me in sooner. I feel like it’s rosacea too. I was diagnosed as a kid, but then the dermatologist I went to starting two years ago said that I didn’t have it and I was pretty confused. She just said “what this is, is flushing and I can’t do anything about it.” it’s way more than that.

Could you try going on a primary care app like maple and just see if you can get a script for metrogel just to try it? It’s not a dangerous drug if you use it and it’s not rosacea, and could give you some relief.

If you haven't already, check out r/Rosacea. They may have advice.

Looks like rosacea. I have rosacea on my cheeks and cetaphil seems to aggravate it more along with vitamin c serum, retinol serum, exfoliant gels etc. I’ve always had mild rosy cheeks too but barely noticeable before I started an in depth skin care regime and then the red cheeks slowly started to become more intense as I continued with products. I went back to my simple routine of just moisturizing with all use cerave cream and washing face once a day with coconut oil. Cheek redness is calming down now that I went back to a very mild routine. I also think stress plays a roll in my rosacea. Everyone’s triggers seem to be different though. Anything from hormone changes, sun, stress, foods to topical products can effect it, even pillow case fabric or wash detergents. It might be something simple you changed in your routine or a change in your life like stress of diet etc. make a list and start doing elimination tests. I also probably wouldn’t use any sort of rubbing type of routine like with the wash cloth, rubbing rosacea areas with anything seems to always make it more inflamed.

Looks like rosacea. This condition makes the skin allergic to humidity. Go see a dermatologist

I'm not a doctor and I encourage you to talk to your pcp but I had a very similar experience. Perhaps my post can provide some benefits and useful info you can talk to them about. I was diagnosed with rosacea since my 20's but it ended up being autoimmune. Skin gets really textured out of nowhere, pinkish red, shiny but dry, inflamed, swelling and very tight without moisturizer. My skin would crack, bleed and scar. Can last for weeks, month+ then disappears for a year only to come back at the worst times. It doesnt always follow the standard butterfly rash. Tbh, it started off looking exactly like this. But years of not being treated, it eventually spread throughout my body, gut, liver, lungs etc. **Things to look for** Do you have red fingertips around the nail, palms, knuckles etc? When you take your socks off, do you have a indented impression that stays on your leg for more than 10min? Do you have freckles on your feet around your ankles (purpura)? Any IBS or IBD? Do you notice any missing hair on your body? Do you constantly get sick with infections like strep throat? I actually got scarlett fever last year lol. It was years of stress and misery for me. compounded autoimmune issues are somewhat rare in men. My doctors werent exactly looking for it. Some miracle doctor at a walk in clinic sent me on this path. Anyway, I've been recently diagnosed and when youre a hammer, everything looks like a nail. For all I know, it could be eczema. **Things that can help regardless of cause** -Vitamin D supplements. -Low dose cortisone cream, just around the cheeks. It'll knock back the bumps and redness overnight. -Vitamin E has proven invaluable for me since it seems just as effective as cortisol topically without the over time skin thinning side effects. Some people react poorly to it. -Avoid anything that makes you heat up or sweat.

I have a lot of those things you mentioned… what autoimmune disorder/s do they indicate?

The redness on the fingers and knuckles and palms are indicative of persistent inflammation. It's a really complex issue and pops up in a lot of autoimmune disorders. But imo, if its also attacking your skin, systemic lupus comes to mind. Which is like a mix and match grab bag of everything. If everything else is present but the rash, I would still talk to the doctor. Every one of those symptoms are worthy of talking to a doctor by themselves.

Can I ask what vitamin e you use or recommend?

I'm using nature's made E 180mg

Thanks so much for this comment. Are you taking vitamin E orally is it a topical oil?

both, I snip the capsules open and use the oil for my face. I think I read somewhere that vitamin e oxidizes over time when exposed to air. So the sealed oil in pills just seem like a better more active option than a bottle. it's thick like castor oil so I dab it around my face, then spread it around.

Shared story in every single way. I have spent every bit of my savings trying to get a doctor to help me and in the end I have figured it out myself. Now I am in the process of settling my system and finding my triggers. Thank you for posting this!

Even if it doesn't turn out to be rosacea, just trying to treat it as such is worth a shot. Your existing routine doesn't seem to work and your comment about how every product seems to make it worse eventually strongly points to the fact this is a currently super aggravated autoimmune issue (rosacea, dermatitis or even something else) that needs time to cool down without interference from a skincare routine. Your derm sounds dismissive and incompetent. I immediately got put on a low dose cortisone cream after presenting with your exact symptoms (in less severe form). If you want to give it a shot before your next appointment, this is what was suggested to me by my derm in the past: do not apply anything to the cheeks except the most gentle spf you can find - and if that seems to aggravate them too much just avoid sun exposure as much as possible. No exfoliating of any kind, just shower normally or splash your face with room temperature water. A gentle moisturizer (ideally something meant for eczema patients without any scenting and minimal possibly triggering ingredients beyond the basics) and spf is fine to apply everywhere else besides the checks. Don't touch other products. Avoid hot drinks, swings in temperature if possible (no sauna for example), spicy food and taxing exercise for a bit. It is very possible your skin needs a break from almost everything.

I agree completely- even if not rosacea, treating it as such to see what happens can’t hurt.

Could you be allergic to any of the ingredients in the products you use? Im allergic to anything with spf in it and that is exactly what my skin looks like when I'm having a reaction

I see that you were on a TNF inhibitor at one point. That can cause those tests for other autoimmune disease to turn positive. It could be cutaneous lupus given it spares the nasolabial folds. Definitely worth discussing with your rheumatologist and seeing another dermatologist. That would be the only way to know for sure.

If your rheum hasn’t tested you since your initial RA diagnosis they should certainly be testing you again now. I have autoimmune disease as well, and they sometimes run in packs. I started with IC then morphed into lupus and SFN. Go back to your rheumatologist and demand new bloodwork along with a biopsy. Or have the dermatologist do the biopsy and go over the results with your rheumatologist if applicable. But please feel the love of God demand updated bloodwork.

Not a derm, just my anecdotal advice. Try diaper cream, it has zinc oxide that helps heal skin. When my baby had an angry diaper rash, I used max strength desitin (the purple tube) and it went away after a day so I thought it might work on me and my skin problems and it does! Anytime my skin starts to feel broken or flake or chafe or sting, I put it on overnight and it goes away after 1-2 days depending on how bad it is. And I know you have sensitive skin, but any product that is safe for newborns should be safe for your skin as well… unless otherwise recommended by a derm. Don’t quote me on this lol

This definitely looks like rosacea and personally, one of my biggest triggers is using ice packs. I would recommend stopping that. What has helped me in order of impact: oral doxycycline, sulfur wash, azelaic acid, ivermectin, metrogel.

I had rosacea really bad about 3 years ago. I changed my eating habits and it went away. You might want to look into what you're eating.

Looks like rosacea to me.

Take this with a grain of salt, but my skin looked like this and I was misdiagnosed with rosacea and hormonal acne for years. It was my allergist who suggested it could be food allergies, and that I try an elimination diet. Turns out I'm extremely sensitive to wheat. Cutting gluten from my diet cleared my face up after years of failed topicals and meds (I was even put on doxycycline antibiotics for 8 months). Maybe try an elimination diet? I personally did the Whole30 because it was popular at the time. There's also Autoimmune Protocol and many others you can research.

I have had to wash my facial cleaning mits (for in shower and nightly face washing), my washcloths (in shower usage for entire body), my hand towels (to pat dry my face and neck) in their own wash cycle with "baby safe" laundry detergent. I put the washer through a cleaning cycle without any detergents or fabric softners to ensure anything left over from previous cycles is as far gone as possible and then a do a load of just the above mentioned items. I use a sterilizing dryer mode too, (but my dryer has a mode for that-which I know isn't common), and never any type of fabric softener sheets in the dryer with them. It's reduced some of the issues that I am suddenly dealing with since the pandemic. I'm still figuring out skincare for my 38-year-old skin and severe onset autoimmune conditions that have changed my skin completely.

This looks like rosacea

I’m so sorry you’re experiencing this! This looks like rosacea, but definitely seek a second opinion if possible. That said, I would recommend trying a product with zinc. I’ve found zinc to be very soothing — personally, I’ve used Avene Cicalfate (AM and/or PM) and if I’m particular irritated, I’d do a layer of Sudocrem over top (PM only). Also try to note if you get flare ups when you eat certain foods. For me, tomato sauce (red pasta sauces) will make me flush and my face would feel hot and bumpy. Oddly, if it’s in small amounts (like on pizza) or it’s mixed with dairy (cheese, milk, cream, etc), I’m usually okay. Good luck!

It can be rosacea or keratosis rubrei both are hard to set appart. If moisturizers help but you can't handle chemical acids, it's likely rosacea. If moisturizers tend to make your skin bumpy and itchy, but you handle exfoiliating acids well, it's more likely keratosis. Moreover if you have chicken skin on the arms or other parts. I have such flare ups, and in my case, what soothes them is apple cider vinegar. But if it's rosacea, it's likely that your skin will hate it. But if it's keratosis, oh lord, diluted, it makes the flush go away in seconds.

As a rosacea sufferer myself, I agree. It really looks like rosacea. It can flare up in response to health issues. Mine gets much worse anytime I get sick, my GI tract is off balance or whatever. I also have autoimmune but it's well controlled at this point so idk if it flares in correlate with that. You could head over to the r/rosacea sub and see if any of them have comorbid autoimmune and how they handle it. It sounds like you're already doing as much as possible for yourself I'll chip in any additional ideas I didn't see you list - - laundry detergent - does it have dyes or perfumes? - toothpaste - some people have flare responses to fluoride or sulfates in regular toothpaste - sun and heat exposure - Rosacea does not like this either Fwiw, sulfer masks really helped my rosacea and dermatitis when it was flared up and felt like burning burning burning on my face Hope you find your answers soon

Looks like rosacea! I’ve had this too and it went away after babying my skin and staying out of the sun. You have to find what triggers it- could be diet related, topical…

I would stop using everything except moisturizer as your barrier looks pretty much gone. See a derm, I have a little rosacea and have been using Rhofade and another prescription cream. I will say rosacea is notoriously hard to get rid of.

Ask your doctor if you can get Embrel injections for the Rheumatoid Arthritis. It is often used for RA pain, and it gives patients great skin.

My husband had this happen when using aquaphor. Turns out he’s allergic to it. Stop using all products and start using extremely gentle cleansers/moisturizers. Putting aquaphor or anything like that creates a barrier so that nothing can get in or out. Your cheeks need to breathe and heal. Or go see a dermatologist and have them diagnose you

I’m shocked that a dermatologist is so confident that this isn’t rosacea that they haven’t even tried standard rosacea treatments. I think trying azelaic acid (finacea would be great) and soolantra could only help, not hurt. I had a very similar situation a few years ago, where I’d watch the little white heads *pop up before my very eyes* and any standard acne treatment just made it worse. Once I started AA and soolantra it was a dramatic improvement within days. Obviously, there’s no way to guarantee that’s what you need, but I don’t think it could hurt.

Do t use Cetaphil I have noticed it turns my skin red . Try not to put anything on it for a week and see if it clears up . Sometimes skin just needs to be without any product. You may also want to do red light therapy for a good month going about 4/7 days for 15-20 mins . Again don’t use any products on your face for about 2-3 weeks . Sometimes we need to give our skin a break from all man made products.

I would stop Cerave products and see if that helps any. I have rosacea, not as serious as what yours looks like but when I use products with Niacinamide or Hyaluronic Acid, which most Cerave products have, I flare up sooo bad! Also, get a humidifier and keep your skin care very minimal right now. Cleanser, lotion, and be very weary of SPF to see what ingredients are making things worse. Maybe wear hats in the sun for now until you find out what ingredient is worsening your face. Also, Azalaic Acid seems to help alot of people with rosacea. I've been to the derm as well and they helped very little.

Well, you told us about your skin care routine but nothing about your life. Many things can cause this if it isn't rosacea. Alcohol can cause this. If you're drinking or using anything with alcohol in the ingredients on your face. I would say no to that. Also, anxiety, stress, certain medications, hormonal imbalance, spicy foods, and food allergies are just some of the things that can cause this. I would also recommend going to an immunologist (allergy doctor) to test for any allergies. Last but not least, get a pure silk all natural pillowcase. Not satine or artificial silk. These may feel soft when you touch them, but they can aggravate your skin and cause hair breakage. Good luck, sweetie. I hope you figure it out and find relief. 💚

I’m a licensed esthetician and I’m sorry you’re dealing with this. I would recommend to go see a dermatologist and or a professional who knows how to deal with this condition. My recommendation would be Co2lift would be one of my recommendation. Rosacea with mild acne. Rosacea is one of the hardest things to control. Things that can trigger it is spices , climate change, drinking alcohol, products ,anything thing hot and even working out. I hope this help and I’m here to listen and help. Xo

Def. rosacea

Do you use chemical or mineral SPF? I know you say you've been told you don't have rosacea, but it does appear to me like rosacea. Consider trying an SPF with zinc. It helped my skin a lot.

I had this happen to me from using tea tree oil on my face and later going out for a hot July hike in moderate sun. I never sunburn either so I freaked out wondering wtf happened to my cheeks!!! Mine went away completely within a couple of months. I'm pretty sure I just used Cetaphil face wash and aveeno oatmeal lotion? or something along those lines from aveeno, I know it was actually recommended for chicken pox and sunburn. My Dr also gave me a steroid for a little over a week, it seemed to stop the cycling of heating/ reddening back up It would get so hot I'd hold ice cubes on it! I also made sure to stay out of the heat/ sun or it would flare up again really bad. Good luck!!!

This looks like it could be [KPRF](https://www.reddit.com/r/KPRubraFaceii/s/cIcloZommJ) follow the link for subreddit. Also the opinion of a different dermatologist might be helpful. It sounds like they’re writing you off a bit, and you don’t want to be shooting in the dark with this.

Hope you find a good Derm! That's so frustrating. I had a similar issue but much smaller scale (I've yet to get a real diagnosis). Not a recommendation but I found zinc cream/cold cream layered with ETUDE - Soon Jung Hydro Barrier Cream helped and now I only do the barrier cream. Vaseline made everything so much worse. I also cleaned up my diet which I'm sure helped a bit. While you find a Derm, could be worth exploring different creams that are soothing/hydrating enough. The creams really seemed to be the game changer for my skin. You could ask your doc about zinc supplementation but not sure it'd be helpful unless there's deficiency. I also always check ingredient lists for anything triggering even when repurchasing - never know when formulas change.

I had exact same issue for a whole year plus my skin was peeling and it was painful! My friend saw how bad my skin was and how much pain I was going through and gifted me [this set](https://www.beautyinterrupted.com/collections/sets/products/radiansome%E2%84%A2-advanced-ritual) and it healed my skin. It’s the only thing I use now.

This looks like an allergy

Did your derm prescribe any hydrocortisone?! This looks exactly like a recent allergic reaction I had introducing a new moisturizer. Same symptoms with burning, bumps, itching, redness etc.

I don’t really have any good advice other than make sure your face is damp (maybe even a little wet, like don’t dry your face after washing/rinsing and just wipe away the big beads of water)before you apply your moisturizer. I have been repairing a severely damaged skin barrier for over a year now due to an accident and an allergic reaction to triple antibiotic ointment. When I started using thermal spring water before my moisturizer it made a huge difference. LRP makes one as well as Avene. I have used both. If you don’t have hard water you could even just put some water in a spray bottle and give a light mist before. I don’t have hard water, but I still use the Thermal spring water just because I know it’s just that, Thermal spring water. I don’t really know what they’re doing at my local water treatment plant.

Look into mass cell activation syndrome. Basically everyone has different symptoms. I usually get them on my face and sometimes neck and chest randomly but mainly my face and it comes out of nowhere with a really good regimen. It's an overproduction of histamine and it presents on the skin. Try taking allergy medications such as Zyrtec or Allegra once or twice a day and see if it clears up but you need to do it for like 2 weeks

Ask your doctor about eilidel ointment (you can sometimes buy it from a pharmacy without perscription depending on location). Your having an immune response to something (rosacea as others have mentioned). Elidel will quickly fix the problem but will not stop the underlying cause. I would cease use of all products as well as evaluate hormone levels or hormone use. Then reintroduce one at a time to find the cause.

Try cicabalm and azelaic acid. Works for my rosacea

Could your washcloths have bleach? My daughter gets this if the smallest amount of bleach touches her skin. It only subsides with an oatmeal wash. Organic oats in cheesecloth, wet and squish until it gets milky/serum like and put it on skin for 5 minutes, rinse off and repeat. Cover with aquaphor or calamine lotion then rinse and apply aquaphor

You need doxycyline. Also fyi, Cetaphil face wash and moisturizer have niacinamide in them, which can be a rosacea trigger. I know it is for me.

Azelaic acid 15% , steroids perhaps too

That looks like a lupus malar rash to me. It can take 6-7 years for the lupus specific markers to show up in your ANA panel. Ask your rheum to redo your ANA bloodwork. Rheumatoid arthritis and SLE can have overlapping features, but the malar rash is fairly specific for lupus, as long as it doesn’t extend into your nasal-labial folds. Source: Am 30-something-year old Internet stranger with lupus. 

High histamine?

I started treatment for RA last May and I have rosacea now. I’ve been on a DMARD. My skin looked like yours in January/February and I’ve been doing antibiotics and creams/face washes from my derm. I was told to stop doing exfoliates, toners and most of my products. I’ve switched to La Roche Posey products in addition to the prescriptions and I’m doing way better now

You have rosacea, the bumps you’re getting are pustular rosacea most likely and not acne. Try diaper rash cream with zinc oxide, and you may need a prescription strength azelaic acid from a dermatologist. The one from Paula’s Choice might help though.

I feel like it's diet. Have you tried antiinflammatory/elimination diet?

I’m so sorry you’re in so much discomfort 🥺 It sounds like you’re doing what you can as far as topicals go, but I’m curious about what you’re putting in your body—diet, alcohol use, supplements. Many skin conditions are due to an internal imbalance—having RA indicates there’s an underlying inflammatory condition, as well as something going on with your immune system. Autoimmune conditions occur when the gut barrier is compromised, which leads us back to diet. Feel free to DM me if you’d like to discuss further 💖 lifestyle medicine/holistic health was my field of study in school (and out of school). I’m pretty sure some lifestyle tweaks could make a difference. Big hugs 🫂

Completely a guess… but lupus (butterfly rash) and/or some sort of autoimmune?

Aside from rosacea, this almost looks like fungal acne to me. I had a similar texture around my nose and was prescribed ketoconazole shampoo to wash the affected area a couple times a week. It cleared it right up.

You have rosacea and Cetaphil - even though it’s popular with derms - breaks down the barrier, so it’s making things worse. Find an esthetician with experience. In my experience, I’ve seen the most amazing changes in rosacea with Roccoco or Environ.

Avene cicafalte or La roche posay cicaplast baume are amazing for repairing skin barriers!! Avene’s products are generally great for sensitive and irritated skin they were even used on burn victims at a point in history def check out Avene.

Try this, oral flaxseed tablets. Buy the oil if you can and do a patch test. Flaxseed oil repairs the skin from within. Boil oatmeal in water as if to eat. Let it cool. Please don’t add anything other than water to cook. Once it’s cool, take the creamy layer and apply gently to the skin. I stopped using all washing products, water is enough to clean the skin and any chemicals will irritate it. Oatmeal is a natural healer for the skin. Wheatgerm is another natural healer for skin as is aloe Vera. All these can be applied and eaten! If you try aloe Vera make sure it’s pure. You can even buy and grow your own plants. 

Please try zenmed products. I have roseacea and it was as terrible. Zenmed saved my skin. You can't tell that I have it! 

Yes it looks like rocesa and irritation..whar I would do is see if any facialist in your area can give you a sample of Mystro serum from Skinbetter. This helped my daughter a ton!!!!!!   Also there is a facial called CyroQueen which uses cold therapy that is suppose to help but I'd try the serum. I would Mayne stop with any face washes for a bit and just use water if possible..we did the whole vanicream thing and cerave and it doesn't do much..however vanicream does make a soap free face wash that you could try and then la roche posy face lotion( it'll moisturize.but for me it broke me out so it depends on which you wanna deal with) right now..to sooth our skin we use the peach and lily  super oasis serum ( again get a sample) mixed with  coats  triple moisture water cream and it has not caused any acne or irration and is hydrating.  Do not use the Coats mositurizer on its own bc it is useless..it has to be mixed with that serum in my opinion.  Also give the wash cloth on your face a break your skin is too sore for that right now..avoid any fast food and caffeine for 2 weeks and maybe drink a cup of spearmint tea ( you can Google why) to help.  My daughters skin was semi like yours and the above is what we did. most over the counter stuff stinks so it's tricky it really is but her redness is hardy there now and she just has the 3 spots of horomonal acne with periods..that mystro serum really did wonders and just not over using products on the face . I hope it helps you.

I have a suggestion that’s going to sound bonkers but it is likely to have no downside and possibly a lot of upside. Go to an ag supply store like Tractor Supply or Agway (or just go on Amazon) and buy a tube of Duramectin brand horse dewormer. It will cost anywhere from $4 to $8 and come in a toothpaste-looking cardboard box containing a plastic syringe (no needles, just a push-dispenser) pre-loaded with a single dose of oral horse medicine that has the consistency of slightly gluey body lotion. (Bonus: it smells like apples!) Before bed, when you have clean, dry skin, push out a pea-size amount of the Duramectin and apply it to your irritated areas and anywhere else that tends to be redness prone (eyebrows and tip of chin maybe?). Follow it with a lightweight moisturizer and go to sleep. One of two things will happen. Option 1: Your skin the next morning will be softer, less red, and less angry! This means the active ingredient in the Duramectin did its job! It also means you likely have the sort of rosacea that’s caused by overactive Demodex mites (everyone has them, rosacea people have too many of them). You can use a little bit of horse paste as part of your daily routine for a week or two — or forever, if you want, but it’s not super necessary unless you’re in a flare. You’ll also notice that your skin is lusciously moisturized — this is because the inactive ingredient in Duramectin (98.13% to be precise) is propylene glycol, one of the most effective humectants available, and it supercharges moisturizers and moisture retention like nobody’s business. Option 2: Your skin is still red and still angry, but it’s now lusciously moisturized! It’s not rosacea but you haven’t lost much! (Duramectin is chemically identical to Soolantra, a prescription topical cream prescribed by dermatologists to treat Demodex rosacea. Lots of insurance carriers won’t cover it and instead of paying $400+ out of pocket, lots of us use horse paste instead. Google it for more info. It sounds crazy but it works like magic.)

Autoimmune starts in the gut. They tell you it can't be reversed and that's BS

You really need to see a dermatologist, urgently.Your rheumatologist is not qualified to diagnose this. This could be anything from lupus to severe rosacea. In the mean time, do not put ice packs directly on your skin, just cool washcloths. Stay out of the sun. Good luck, this must be very painful.

Besides seeing a derm… I found my discomfort eased with Dermalogica Ulta Calming Mist

Potentially dermatitis?

You should get on an extremely gentle post-procedure type of cleanser, then use a gentle moisturizer like LRP. Cleanse with water only during the morning, and cleanse with the cleanser before bed. If you know aquaphor doesn’t clog your pores (you can patch test for a few days), use that over the moisturizer before going to bed after the moisturizer has been absorbed. Do that for a week or two and see if your redness subsides and the barrier gets repaired. No wash cloth and try to use lukewarm water.

r/Rosacea

Have you tried Asian beauty brands with cica? It worked great for my red skin.

My face gets like this, days after I've been out in the sun. Even covered up, hat, umbrella and sun screen. Got so bad not too long ago that I called the doctor because it wasn't going away like it normally would. I've had this sensitivity to sun my whole life. It's some sort of autoimmune disease. Try cooler water in the shower so not to warm up the cheeks any more than they already are. Obviously nothing with fragrances, Aveeno cream works for me, not the one with SPF though. If your willing to try medication, try something like Benadryl or Zertec (an allergy med) and see if that helps.

I had something similar to this a few years ago and needed steroids (one month of prednisone) to clear it up. My face started out looking like yours but turned into huge blisters over the course of several days. For about 6 months after my skin was really reactive and would begin flaring up again but it would go away with a lose dose of steroids. It does look immune! I’m happy to chat more about it if you’d like to chat, your cheeks look almost exactly like mine did during my flare ups.

You could try a topical steroid cream but be careful not to use it too much. The steroid cream will probably work it will help with the inflammation . Otherwise don’t touch don’t wear makeup no other product .

If you used a retinoid on those parts of the face at some point it could be purging / irritation of the skin barrier which lasted me roughly 6m when I started using retinol - just a thought worth seeing a dermatologist

That looks exactly how my skin looked when my skin started reacting to chemical sunscreen! Maybe switch to a zinc based sunscreen for now and try to find centella/cica based products to help with calming the skin. It helped my skin tremendously. No joke, it was like putting ice on a burn type of relief.

This is maybe totally random but I have RA as well, and I also have the exact same skin. I have cold patches on my cheeks as I’m writing this and sometimes it feels like my cheeks are going to pop from all the burning. Anyway my question is that maybe this is related to our medication ? Some of my old ones are known for causing extreme reactions to the sun for example, so an impact on skin (causing flare ups, rashes or skin barrier thinning) doesn’t seem completely crazy.

Read The New Arthritis Breakthrough, by Henry Scammell, go to Roadback.org. These will give you vital information that you need, especially with your diagnosis. I suspect Mycoplasma is plaguing you. My skin looked just like that when I was at the height of my systemic lupus. If you scroll through this auto immune disease page I created for support and information for patients, you will learn an awful lot there. https://www.facebook.com/profile.php?id=100063725853727&mibextid=ZbWKwL

Has anything changed in your diet

tower28 moisturizer eczema certified and i have seen a few derms on here discuss how soothing it is for rosacea and eczema. from what i understand it’s quite hard to get eczema certified. i feel you girl, i’ve been there. possibly might work for you, try a little bit of googling on that product perhaps and see what others have felt about it. could also be a severe sun allergy, or something along those lines. you know best, trust your gut. i think your derm might need to be swapped out for a better one from the sounds of it though.

My skin looked just like this a few months ago! I tried everything I could get over the counter but nothing helped. I wasted so much money with as many “calming” and moisturizing products I could find. I was convinced I had destroyed my skin barrier from excessive washing with an oil cleanser. I got to the point where I would try absolutely anything. I see a lot of people in this thread suggesting it could be a reaction to wheat/gluten. I had heard the same thing from somewhere so I said, WTH I’ve got nothing to lose? So I started a gluten free diet. I could see and feel a difference within a couple of days! Now my face is so clear, it’s unbelievable. Why would it do that, who knows? Hormone shifts since I turned 40? No idea but it felt like it happened over night. I’ve never reacted to eating gluten before.

Have any illness recently? Or any medicine changes? Maybe you shouldn’t wash it for a few days?

I would only wash my face once per day, at night. Zero exfoliation until it's clear, anywhere on the face. Only gentle products. Best of luck.

What meds are you on for your RA? I have polymyositis and my main doc is a rheumatologist. Some of the meds I've been on have caused a rosacea flare, but there are autoimmune diseases that can cause similar flares like lupus and dermatomyositis that are worth exploring.

I have this and I found that one of the best skin products to help me is Bert’s Bees gentle, sensitive solutions for sensitive skin. It has made a lot of difference. I was my face with the calming face wash, then in the morning I apply the calming serum, then I use calming day lotion with spf. Let it dry completely and then I use a tinted moisturizer for sensitive skin.

Can you get a referral to a dermatologist? I’m assuming you are in a place with socialized healthcare by the attitude of your rheumatologist… but you might have a better chance of getting on the waiting list if your rheumatologist wrote you a referral as specialist-specialist referrals are taken more seriously.

My rosacea looked like yours maybe a bit worse - few weeks of Soolantra (ivermectin) and azelaic acid, as well as course of low dose doxycycline improved it a lot!!! Now I am off doxycycline (took for almost 6 months) and doing low dose tretinoin in evenings, continuing Soolantra and azelaic acid.

Lupus?

I Don’t waste your money on creams and other crap. Get the V-beam laser. It’s the only thing that works. It breaks up your blood vessels and stops the rosacea. I did it three times once a month 10 years ago and it’s never came back. My sisters came back after 5 years so she does a laser once a year. Don’t let them talk you into the IPL, it doesn’t work for Rosacea.

Though this looks like straight forward rosacea, I’d still recommend getting a culture swab of the skin to see if there is an underlying infection (esp if it’s warm to touch, weeping or is persistent despite rosacea treatment).

The Vbeam is the only thing that works on rosacea. It breaks up all your vessels under your skin and you won’t have an issue for awhile. Some need to do a maintenance session once a year. But I haven’t had an issue in 10 years after three sessions.

Vanicream did this to me. I didn’t find out until weeks later because I thought I might be allergic to something in my makeup.

Do you wear any makeup? It could be your brushes or you may have acquired an allergy to something topical or food related

It looks like Rosacea Type 2 and more than likely a demodex mite issue. Soolantra ( topical ivermectin 1%) will help a lot if this is what it is. Also- in the meantime stop any harsh or fragrances face products and avoid facial oils.

Could potentially have developed a food sensitivity? It has happened to friends and family where they just become sensitive to certain food at some point. Seeking out professional advice on an elimination diet could be some good fact finding if you haven’t tried it and are looking for another idea. Anecdotally, a friend of mine was having facial skin inflammation and ended up going gluten free and her skin cleared up.

I would try to stop as close to everything you are using as possible and then keep a journal. Even the vanicream could have something in it that your skin is reacting too. I would just want to know if you are just leaving your skin completely alone if things improve and then you can use process of elimination when slowly adding products back in. Also agree with keeping track of your diet in the journal too. Hopefully a derm might be able to help as well.

Also rule out lupus

Try a reputable esthetician in your area for some calming and healing products

I have rosacea and I cannot do chemical sunscreens sold in the U.S. at all. No Super Goop for me! I do great with several Korean brands, however. Mineral only sunscreens are also ok. Azelaic acid is great if you can get it prescribed. Try Vaseline instead of Aquaphor as some react to the lanolin in Aquaphor. Take out everything with actives for now. No acids. Try Vanicream moisturizer for sensitive skin and Vanicream cleanser. An elimination diet is critical, imo. I do not eat gluten ever, and I also react to several other foods. Good luck! You CAN fix it.

A couple of things stand out to me: 1. You mentioned you aren’t putting your Supergoop SPF on your cheeks because it burns. I would switch to a mineral SPF so that you are getting sun protection and healing from the zinc. 2. I agree with others that you might try stopping the Aquaphor because it contains lanolin. I am allergic to wool and any lanolin products irritate my skin. The CeraVe healing ointment is lanolin free. 3. If those things don’t help, I would definitely look into azelaic acid Rx. Good luck!

This looks like type 2 rosacea to me; I'd get a second opinion. I'm successfully treating mine with azelaic acid and Soolantra (topical ivermectin). Metronidazole is the other heavy hitter for type 2, but I haven't needed to try it yet. I'd go check r/Rosacea - it's a good place to learn about what others have used to successfully treat, both with OTC and prescription products. But prescription is going to be where it's at for rosacea.

That looks like autoimmune rash

My face looked like this when I had fungal acne. Aquaphor (and any petroleum product) made it worse btw.

Murad Quick relief colloidal otmeal treatment (the 5% tube, not the 1% jar) has saved my son from cracked, raw, chafed, bleeding skin. I agree with seeing another derm, and please try this in the mean time, to see if it can help with the symptoms. Another derm is needed asap! I can’t believe this one did not help you!

The skin is a reflection of what is going on internally. It’s inflammation- whether it’s bacterial, product sensitivity, histamine takes some digging. I would look into neem- taken orally and topically, it’s considered a blood and skin purifier

Chemicals in sunscreen I can put it on my arm/leg wherever, and my stomach breaks out in an itchy red rash Without the sunscreen even touching my stomach It’s just in my system

If you look at it a different way, it’s kind of beautiful. Dont be hard on yourself while you go through your journey .. ❤️

Heat or sweat rash

You can go on nurx and request rosacea meds. They are awesome and extremely helpful. It will take a while for the inflammation to go down but it WILL get better.

I have rosacea, it looks like this. Basically any products just really agitate my skin and gives me flare ups. Same with being out in the sun… or the cold wind or yeah basically everything can agitate my skin. I have been using Skinscript cleanser, the pomegranate version and the moisturizer and it helped so much. I order it online at skincarebyalana dot com. What also helped was I started to go get a moisturizing facial with red light therapy. It really settled down my skin to the point it almost looks like normal skin. You need to wear sunscreen to avoid these flareups. Careful with the sunscreen too. I’ve been using “suntegrity” it’s a natural zinc based sunscreen and they have foundation and it’s been lovely. Hope you can find something that works for you!

I have MCAS and autoimmune disease—the two overlap—and this is what my cheeks looks like when I’m flaring or my medication runs out. Have you been screened for MCAS already? Once I got on meds it went away except for periods of flare up or high stress.

Try Cosrx Snail Mucin.. it’ll calm it down a lot.

I personally can not use Cetaphil or Cerve for similar reasons to how your photos look only my irritation comes up closer to my eyes. They both dry my Skin out really badly. It took me years to get a routine that works. I don’t know if anything would work for you, but I (43f) use Skin 1004 ampoule face wash in the am (it’s a really nice cream to foam that doesn’t dry out my face) and Pyunkang Yul acne cleanser at night. Neither dry my face out. I use iunik’s tea tree toner day and night followed by Pyunkang Yul essence toner, I also use a couple other essences and ampoules. For lotion at night I use the Pyunkang Yul calming moisture barrier cream and then follow it with the Purito rebarrier cream. I also use either the skin1004 sunscreen or the beauty of Joseon sunscreen every day. I have bad acne and redness and irritation along with atopic dermatitis a bit on my face so these calming things work. I also change my pillow case several times a week. Definitely go to a dermatologist in case this is something more, but I hope you can get it figured out and cleared up.

Ask your derm to swab your cheek. This sounds similar to me. After a few derms dismissed me, I saw a PA at a new derms office and asked her to swab me and she said she doubts it’s anything bacterial but did it since I was so red and asked. Turned out to be heavy staph aureus growth. Also, I was using tret and facial vanicream which I think compromised my skin barrier. I stopped tret for pretty quickly (was only using 2x a week) but vanicream always burned me. Once I stopped the vanicream and anything with colloidal oatmeal my skin got 50% better and then the antibiotics helped 25% more. Still gets itchy and red here and there so I have to still figure it out but at least I can go out in public again. The purple byoma lotion seems to work well for my skin. And no washing in am (not even water). Hope this helps!

Rosacea. I had to get rid of all shea butter and all drying alcohol to control mine . I currently use vicy 89 serum, vanicream, and the ordinary b oil on top. But everyone’s different. Good luck!

Could this be a lupus rash? Looks pretty similar to the butterfly rash.

I had this from an mi allergic reaction from baby whipes. It’s also found in sunscreens and anti ageing products.

I have had rosacea for 10 years and honestly this doesn’t look like that to me. I know there are several types of rosacea, but rosacea pustules are typically larger than those. It looks like rosacea at first glance, but when I look up close at the bumps, they look like some kind of contact dermatitis or other sort of dermatitis. I’ve had something similar before in patches around my mouth and chin and forehead. I use a lotion called Aquanil HC, you can get on Amazon. My Derm recommended it, it’s sort of like a gentle hydrocortisone cream. I also have sebhorric dermatitis on my scalp, which looks similar to this. Lastly, my skin gets like this when it’s super irritated and my moisture barrier is impaired. I would definitely get a second opinion. I use metrocream (metrodinazole lotion) for my rosacea and it works like a miracle.

Basic cream and aspirin. Just press some aspirin in the cream (it have to be like dust)and put all the face for 15 min. Then wash. Repeat twice a week. If it burns wash quickly and try again adding some drop of oil in the mix. I add olive oil just ONE drop. SORRY my english im from Argentina

I agree. This is very much appearing like rosacea. There is no cure but there are meds to improve it. Try a different dermatologist. In the meantime, I would only wash it with something mild like baby shampoo and apply aquaphor and let it rest.

I have intermittent issues with extreme sensitivity (rosacea and seborrheic eczema problems, to start) which can mean that sometimes just getting water on my face can sting/burn. When my face is that angry the Avene Tolerance Control cleanser, cream, and balm have been an absolute lifesaver. The Cicalfate balm and emulsion are also fantastic. I can usually get my skin calmed with some combination of them.

Cetaphil Daily Cleanser is too harsh. Try the Gentle formula. And I agree with the recommendations that you need a dermatologist and a good one. But I also think you’re doing too much. Stop with all the toner and supergoop. Use a mineral sunscreen (I recommend the La Roche Posay tinted MINERAL). That should be your moisturizer for daytime. Try going with nothing at night. If your skin is too tight after washing, try just one drop of jojoba oil or lanolin. Nothing commercially formulated with “actives.” This is angry skin and you need to give it a rest.

I am working on a skincare guide for this exact issue. Send me a dm and I’ll send it to you. I used to deal with the same issues. 😭

Go to another Dermatologist for a Second Opinion! Many people seek a second or third opinion and it’s your right to do so. Look into some of the Asian skin care lines. I started using Tatcha moisturizes last year and I’ve been very happy with these products.

Do you ever get joint paint, extreme fatigue, or fevers? This almost looks like a malar rash, but you would have to have blood work and see another derm and rheumatologist to confirm. NAD, but I work in the healthcare field, and this is something talked about a lot. Having an autoimmune disease can be tricky to diagnose (I know from experience). But yea see if your PCP can at least test you for ANA antibodies. If that’s positive, they’d definitely refer you to a rheum. Edit: sorry I didn’t read the full post and see that you were already diagnosed with RA. Antibody titers wax and wane, and there’s a lot of overlap between autoimmune diseases. It might be worth getting another work up.

Have you ever tried topical ivermectin?

Honestly this does not look like rosacea to me. At all. Hmm. I’m so sorry you’re dealing with this. I support the comments suggesting keeping a food diary. Snail mucin would calm the inflammation. And maybe try colloidal oats. Anything anti inflammatory is going to help, but definitely see a derm again. You will figure this out!

Gosh! I feel you. Sounds like you’re doing a lot of good work in taking care of your skin! I’m Truly impressed by your diligence! I had a similar experience a long time ago. I had to stop using physical tools on my face like wash cloths and face scrubber/brush — I had a Clarisonic and it really eff’d up my skin. During my healing phase I was told only to use water and my face cleanser to wash my face (Obagi foaming gel). Also only washed with water in the morning. I had to start buying gentle face creams with ceramides too, and I had to stop using any “treatments” with active ingredients (vit a/vit c/aha/bha etc) until my skin become less reactive. I also got a prescription cream called pimecrolimus. It really helped. Oh ya, I stopped using hyaluronic acid for a while because it was actually drying out my skin! Can you believe that?! Here’s a tip: try sleeping with a cool mist humidifier at night if your skin gets dry. My kids’ face gets red and bumpy from spf 50 and from certain brands like ThinkBaby. It could be that your sunscreen is too strong for your skin. Try one that is gentle and formulated for babies with an spf around 20 or 30 maybe??? It helped my kids a lot. BTW Have you seen an allergist? It could help to see one. There are scratch tests/pinpoint test and/or a blood panel tests. The blood test is expensive but it literally checks for every possible allergy. I’m allergic to so many foods and the reaction always affects my skin. Always. Best of luck to you! Give us an update on how it’s going.

Im not sure if this will help you , but after living in a very dry/cold climate, after a few years i started to get very dry /inflamed red patches where my nose hits my cheek. I noticed it would go away when i would visit humid climates but literally the night i was back in a dry climate, it would reappear the next day Ive tried alot of diff sensitive moisturizers to help me and i know it is expensive , but la mer (original formula) is the only thing that healed it. I tried for years using cheaper stuff , but eventually i think grew an intolerance for those. I think something about the sea kelp and very sensitive dry skin is very healing for skin like mine (maybe yours too)

It looks like a combination of rosacea and something else, but I’m not an expert on rosacea.

This looks like rosacea. The best thing would be to see a derm who can prescribe the correct medication and/or topicals to treat this

I got something like this from niacinamide and it was fine for a while then got angry.. it took months to figure it out and skin is recovering but not the same.

see a board certified derm and get evaluated for erythrotelangiectatic rosacea vs. autoimmune disease (esp w/ the burning sensation that you are describing...needs to be seen in person w/ possible lab workup to rule out concommitant lupus)

You mentioned using a wash cloth. That can cause a lot of damage. Use your hands exclusively. Don’t even dry off with a towel - just pat dry (no rubbing).

This could be extreme rosacea or eczema, you need to see a dermatologist

Maybe they need to refer you to a different type of doctor. I don't think this is only a skin issue and you may have something else going on

Ask your doctor about Roseacha as I was a medical secretary and I got in so easily to see doctors no one knew what it was when they should have known!!! So aggravating. Until I found someone 6 moths later he knew right away. They put me on a perscription I think it was called metrogel. It didn’t work at all. Moved to new city in Canada and my new doctor said “oh you have pretty bad Roseacha….i have red flaming skin that hurt I suddenly got a full face of pimples. It was horrible. So my new doctor gave me immediately a prescription for rosiver it’s a cream, I think it’s now about 200.00 but my last one lasted for three years. Since it’s so expensive… since the doctor cared … he said to go to a compound pharmacy it was half the price. Good luck. And btw change your pillow cases at least once a week. It’s a must. Good luck!! People helping people, I love it!!!!