Chronic Facial Redness and Rash with No Clear Trigger 无明显诱因的慢性面部红斑和皮疹

Case Report

A patient presented with a three-month history of persistent facial redness and rash with no identifiable trigger. The rash was not associated with fever, recent medication or supplement use, or sun exposure, and the patient had no family history of atopic or autoimmune conditions.

On examination, a smooth, red macular rash with a butterfly distribution was observed across the cheeks and nose, more pronounced on the left side. The rash was accompanied by itchiness, warmth, and a stinging sensation, but notably, there was no scaling, crusting, blistering, or significant pain.

After discussing potential differential diagnoses, the patient opted to first explore Traditional Chinese Medicine (TCM) to observe the response. If symptoms did not improve, the patient expressed willingness to proceed with a skin biopsy and antinuclear antibody (ANA) testing for further evaluation.

 

The patient was advised to monitor for new systemic symptoms, such as joint pain or fever, which could indicate autoimmune progression. Meanwhile, a tailored herbal treatment regimen was prescribed, administered twice daily.

Outcome

Over a three-month period, the patient showed significant improvement:
Baseline: Red macular rash with a butterfly distribution and uneven texture, and likely itchiness.
Month 1: Decrease in lesion size, redness, and inflammation, with smoother skin and reduced itchiness.
Month 3: Rash nearly resolved, leaving minimal redness, no inflammation or scaling, and a smooth complexion, suggesting the holistic effectiveness of TCM in managing the condition.

Discussion

Given the chronicity of the rash (now persisting for three months) and absence of systemic symptoms, the condition appeared benign or slowly progressive. However, due to persistent discomfort, further evaluation remained warranted. Conventional medical management would typically involve topical corticosteroids or calcineurin inhibitors for presumed inflammatory dermatitis, with referral to a dermatologist for biopsy or patch testing if the condition did not resolve. Additionally, given the butterfly pattern, repeat ANA or autoantibody testing (e.g., anti-dsDNA, anti-Smith) could be considered to rule out underlying autoimmune conditions.

Differential Diagnoses Considered

  • Rosacea: Possible, though the butterfly distribution is atypical.
  • Seborrheic Dermatitis: Unlikely due to lack of scaling.
  • Systemic Lupus Erythematosus (SLE): Consider in conjunction with the antinuclear antibody (ANA) test.
  • Subacute Cutaneous Lupus Erythematosus (SCLE) or Dermatomyositis: Possible, though muscle symptoms were absent.
  • Contact Dermatitis or Drug-Induced Photosensitivity: Deemed unlikely due to no recent exposures or vesicles.
  • Burning Face Syndrome or Facial Erythrodysesthesia: Could explain stinging and warmth but are less commonly associated with a visible rash.

In conclusion, the patient’s positive response to TCM suggests that a holistic approach may be beneficial for similar chronic, non-systemic facial dermatoses. However, long-term monitoring remains necessary to rule out potential autoimmune evolution.

Privacy

In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.