Need help identifying the redness of my skin

Posted in r/Rosacea

Sorry for the long post but I wanted to provide as much information as possible. The first picture is what I consider my own "high flareups". It doesn’t happen very often but there don’t seem to be any significant triggers that I know of. I’m 29 years old but I’ve had redness all my life (as well as redness / discoloration on my arms and legs).

I went to a dermatologist but didn’t get any good pictures or explanations of the size of my redness, frequency, or triggers. He diagnosed me with rosacea and prescribed Soolantra but my insurance doesn’t cover it so I will be paying out of pocket if I go that route. I really don’t have the money to pay for that medicine out of pocket. he also recommended laser treatment as an option.

I’m not a medical professional and it’s hard to diagnose, but I started looking into the possibility that I have Cutaneous Lupus Erythematous (acute skin lupus – only affects the skin). I got blood work done at the clinic to check for ANA (anti-nuclear antibody) and it came back negative. But people on the lupus subreddit say it’s possible there were side effects from that test and they still have lupus. They say laser treatment for skin lupus will cause it to flare up so I’ll want to make sure I have rosacea and not skin lupus before I try something like that.

I’m posting here before going back to the dermatologist for a second opinion (this time I have more information to give them).

Areas affected:

face (except chin, forehead, and nose), neck, and upper chest. Possibly unrelated but noticeable – I have redness / red color on my legs, arms. and hands (could be keratosis pilaris?). I have had red skin on my face since I was very young (maybe 5 years old or so).

General information – possibly unrelated:

1. I have had redness issues all my life with varying amounts of severity. It seems like it was worse when I was younger and overweight (for my age).
2. redness mainly seems to be based on the trigger. It doesn’t seem to cycle with any significant frequency – some rosacea is caused by dermodex worms but I’ve never had week long periods where I’m at least red.
3. My skin is itchy and dry. My skin has no bumps and is mostly smooth. I don’t grow much facial hair in hot climates but I know whether that is genetic or not. When I break out my face can be warm/hot to the touch but sometimes my face can feel hot (like it’s going to be red) but when I look at it it’s a little red.
4. I am especially good in sunlight. With sunscreen I don’t have more redness. I’m bald so I have to put sunscreen on the top of my head but I can go without sunscreen on my face for hours and be fine.

Details of redness / triggers:

• Waking up in the morning – very gentle. About as non-red as I can get.
• Alcohol – medium to high redness.
• Alcohol with a small meal in the stomach – high to high.
• Fear / shyness – talking to the most important people in the company, interviews, giving a speech, placement – medium to high intensity.
• Sex – medium to high intensity.
• More caffeine than usual – moderate intensity.
• Coughing is equal, or laughing loudly – high intensity that fades.
• Stress – moderate to high pressure.
• Hot food – medium to high pressure.
• Shaving the back of the neck or face – medium intensity (done on the shaved area)
• Exercise – low (although heart rate is elevated)
• Hot shower – low to moderate intensity but goes away within 30 minutes to an hour

High intensity flareup – before

High burn – side view

High intensity flareup – another side view

Medium intensity flareup – side

Medium intensity flareup – on the other hand

How I usually look – some redness but not too bad.