I'm a 58 year old male. In the summer of 2002 a patch of red skin
about one inch square appeared on my right lower cheek, about 2 inches
away from, and inline with my mouth. There were some raised bumps on
the red patch. At about the same time, the skin on the back of my
right ear, stretching from the skin on my face at the base of my right
ear to the top of my ear (mostly on the back of my ear but slightly
creeping over the rim of my ear to encroach slightly on the front rim
of my ear too) started to itch and burn very very painfully. I saw a
dermatologist who said I either had discoid lupus or rosacea. He said
the only way to find out was to have a biopsy for which he would
charge me $500. When I baulked at the cost he said the best thing to
do then was to assume it was rosacea and to take a 3 month course of
antibiotics. He gave me a prescription for the antibiotics. But I left
there not really happy with anything that had happened. For a start,
this guy is supposedly a specialist dermatologist, (supposedly dealing
with some contact dermatological problems), yet I crossed both the
previous patient and the following patient in the doorway of his
surgery, and the doctor definitely touched my own skin condition quite
liberally while I was there, yet he never washed his hands while I was
in his presence. How do I know the patient before me didn't have a
contact dermatological disease? On top of that, I didn't feel like
going on a 3 month course of antibiotics in the 'hope' that that
diagnosis may be right.
So, a couple of weeks later I went to see another specialist
dermatologist, at the same private practice. He didn't wash his hands
either. He asked me what the other doctor thought it was. I said he
thought it was rosacea, I didn't mention the alternative that the
other doctor had suggested, discoid lupus. He immediately also said
that what I have is rosacea, and he said how good it was to hear that
another doctor shared his diagnosis - but he only said that after he'd
asked me what the other doctor thought it was. I was suspicious of
them both then, so I can't go back to either of them now, as I have no
confidence in either of them now.
In between seeing the two specialists I asked my GP if it would be OK
to try TRIADCORTYL on my skin as it was getting more and more painful
and unsightly. (I had some TRIADCORTYL at home as I used to use it for
another skin condition and it seemed to alleviate that quite well). He
said it was OK, so I did, and it suppressed the ugly appearance of the
red patch on the back of my ear, and slightly suppressed the bumps on
the patch on my face, though the redness was still present on my face.
But now I was getting a powerful ache going from my shoulder right up
my neck, then behind my ear and under my skull, and it was giving me
headaches. For a while I put this down to the TRIADCORTYL because on
the leaflet it says it shouldn't be used for more than 5 days on the
face and it could be damaging to the inner ear and eyes. I started
scanning rosacea websites but none of them mentioned the type of pain
I'm feeling. It's now 4 months since I first saw the first
dermatologist and now the pain in my shoulder/neck/back of my ear/base
of my skull region is like a 'thing' inside me and I'm worried it
could be something serious like cancer or something.
My trouble is that I don't know where to start going to look for an
answer now.
I wonder if I should go and see another dermatologist, but now I think
that the effects on the skin are just the visible signs of a much
worse thing below the skin, and a dermatologist won't catch what's
going on under the skin. I don't know that is a fact, I'm just
guessing.
Also, because of my 2 previous experiences with the 'specilaist'
dermatologists I've got serious doubts about a) their cleanliness and
b) their skills, that I can't overcome.
Would I be best to get a scan?
I'm pretty depressed by all this as I'm now frozen with fear and
unable to act. I'm also afraid of a) what it is and b) I may not
believe what a dermatologist tells me now if that's what you suggest
as a first step to finding out. I feel that those two dermatologists
that I saw were just interested in taking my money rather than
worrying about getting the diagnoses correct. The first one especially
made me think this, when he suggested I go on antibiotics for rosacea
for 3 months, just because I baulked at the cost of a biopsy.
My question is;- is this cancer? If you think it is, how do I find
out, who do I go to see without seeing a dermatologist who doesn't
wash his hands? (I'm assuming it's dermatologists who discover that
there is cancer in, or just under a person's skin). Is that right?
Also, is it normal practice for dermatologists to not wash their hands
between touching patients. If so, how come thay don't go down with all
the contact diseases thay come into contact with?
My GP is a sincere man but he is as much in the dark as to what it is
as I am.
Please help me if you can.

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Request for Question Clarification by kevinmd-ga on 23 Feb 2003 13:27 PST

Hello - thanks for asking your question.

I am an internal medicine physician and not a dermatologist.  Without
seeing your lesion, I'm sure you can understand that I cannot diagnose
you over the internet.

However, I can give a pretty detailed discussion on skin cancer and
how to diganose it as well as relevant websites.

Please let me know if this is acceptable.

Thanks,
Kevin, M.D.

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Clarification of Question by worried888-ga on 23 Feb 2003 15:02 PST

Hi Kevin,
Thanks for your quick response.
I would be grateful for anything that could help but I cannot diagnose
this myself so I don't know whether or not skin cancer is the relevant
path to go down. I simply have no idea what this is, whether it's
rosacea, cancer or something else.
I mentioned cancer because it feels bad and that is my worst fear but
I have no idea of whether that idea is relevant or not.
I feel like I have a 'thing' inside my neck that's creeping it's way
towards my brain. Some of that feeling may be illogical terror, but I
feel pressured as it gets worse every day and I have no idea where to
go next to seek help.

---

Request for Question Clarification by kevinmd-ga on 23 Feb 2003 17:22 PST

Hello,
Reading your description, I can gather the following symptoms:
- facial rash (i.e. ear rash)
- headache
- shoulder pain/mass
- neck pain/mass

I can offer possible diseases that can present with these symptoms. 
You can then take this information to your personal physician for
further discussion.  However, for something definitive, I would
suggest seeing your primary care physician - without examining or
seeing your symptoms, I cannot diagnose anyone over the internet.

Let me know if there are any other symptoms that I am missing.

Thanks,
Kevin, M.D.

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Clarification of Question by worried888-ga on 23 Feb 2003 22:51 PST

Hi Kevin,
There are no other symptoms other than those I mentioned.
By "primary care physician" I'm assuming you mean my General
Practitioner (GP) which is the term we use for the family doctor here
in the UK.
In the UK there are only 2 kinds of doctors, GP's which are free, and
specialists which are expensive. However, my first experience with the
specialists mentioned above has made me wary of just running around
and consulting just anyone. I'm looking for a distinct pointer to a
distinct problem and then doing some research to find the best and
most appropriate specialist.
Unfortunately, my GP has no idea of what it is, nor of which kind of
specialist to recommend I go see, since he is as much in the dark as I
am as to what it is.
This is the crux of my dilemma - what specialist do I go to see to get
a line on what this is?
I was hoping that my detailed description would leap off the page and
immediately tell a specialist what is wrong with me but it seems
that's not going to be.
Thanks for your attempt to help, I appreciate it, but I think I'll
wait a little longer to see if anyone else can point me straight where
to go.

---

Request for Question Clarification by kevinmd-ga on 24 Feb 2003 14:41 PST

Hello,
I entered the following symptoms into a program that provides
diagnoses (to be complete):
- male
- elderly,
- neck pain
- shoulder pain
- facial rash
- headache
- chronic

Here's what it came up with:
polymyalgia rhematica
cervical spondylosis
seborrheic dermatits
rhematoid arthritis
throacic outlet syndrome

Would you be interested in a brief discussion of these diseases?

Thanks,
Kevin, M.D.

A few years ago, my nose took on a reddish glow and I consulted my
doctor.

He referred me to a specialist who, simply by inspection, diagnosed
rosacea and prescribed metronidazole 0.8%

It worked fast.

Thanks probonopublico-ga,
I asked my GP for metronidazole after reading about it on various
rosacea websites and he prescribed it for me but it inflamed my
condition quite seriously which was just another pointer that led me
away from the idea that what I have is rosacea.
But thanks for your interest.

I do not understand why you had to see these dermatologists as a
private patient. Since your GP admits he is clueless about this
matter, he should give you an NHS referral to a specialist, so that a
full investigation can be made without you having to worry about the
cost. A biopsy would clarify a lot. It would exclude a number of
conditions and might also permit a full diagnosis. Your experience
with the metronidazole could simply mean that you are allergic to that
drug, and not necessarily say anything about whether or not you have
rosacea.

Thanks tehuti-ga,
My GP did refer me to a dermatologiacal specialist but I went private
because I couldn't be seen by the specialist for 6-12 months if I
pursued the matter through the NHS. Ironically, when I phoned the only
local private practice for an appointment to see their dermatological
specialist I found out I would be seeing the same specialist privately
as I would have been seeing on the NHS, the only difference being that
I would get to see him within a week if I went privately instead of
the 6-12 months I would have to wait to see him on the NHS.
I do want a biopsy, but unfortunately for me I've now seen the only 2
dermatological specialists in my area and as mentioned above, I
couldn't now go back to either of them because of their unhygienic
practices.
I'm going to have to raise the money to go private and find someone
outside my area who at the very least washes his/her hands between
patients.
Thanks for the pointer about the metronidazole, I hadn't previously
thought that I might be allergic to it, and that has helped me to
understand things a bit better now, having been told that. Thanks.

Yes, NHS waiting lists are a terrible problem! 

I thought this web site might possibly interest you. It would give you
an opportunity to discuss the matter by email or telephone for a fixed
fee, as well as letting you ask the service to supply a referral to a
specialist outside of your area.  http://www.e-med.co.uk/home.html

NB I have no connection with this E-Med. Also, I cannot vouch for it
since neither I nor anyone I know has tried it.

Thanks tehuti-ga,
I've just been to have a quick look at the e-med site and it does look
interesting.
I'm going to check around on the net and see if I can find any
independent referees who may have used it before. I'm going to have to
spend my money carefully if I'm going to get through this and stay
solvent.
I'll keep you informed of what's happening and thanks again for your
help, I appreciate that.

Hi worried,

I just wanted to note that just because you didn't see them washing
their hands it doesn't mean that they aren't cleaning their hands. 
Several recent studies have shown that the use of alcohol-based hand
cleansers actually decrease the rate of infection compared to the use
of soap-and-water cleaning in medical settings.  A lot of hospitals on
my side of "the pond" are switching over to alcohol-based hand
sanitizers for between-patient contact, as they save time and water (a
big issue last summer in our drought!).  "Scrubbing" may only be used,
in many places, during surgical preparations.  Obviously I don't know
if the two dermatologists you saw were using non-water based
cleansers, but it is a possibility.  One way to check might be to call
their office and ask a secretary or nurse...

- librariankt