perioral dermatitis - thoughts and suggestions please!
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free skin care · Tue Jan 15, 2008 6:04 am

jjb wrote:

Wow, how happy I was to see this thread - I've been so out of it since getting pregnant that I haven't been on the forum in months! Very Happy

Ironically, the last time I was on here, I was suffering from a major bad case of dermatitis and was totally depressed about it. I went to the derm and he also prescibed Elidel, which worked really well. Now however, I can't use it since I'm pregnant and I have the worst case of dermatitis I've ever had! It's ALL OVER my chin and forhead and is spreading to my cheeks. I'm going to a different derm on Monday to see what I can do until I finally have the baby next month, then I'm going to see about Metrogel or possibly an oral antibiotic if it is safe during breastfeeding - I am sooooo miserable right now! After doing some research, I think that my dermatitis has turned into a skin infection since it is so irritated.

As for any of you that are using Elidel, just be careful not to use it too long - it was required to carry an FDA black label warning in 2006 so I am wary of going back on it unless I really get desperate...

From the Elidel website:

What does the boxed warning in the ELIDEL label say? What are the other changes to the label for ELIDEL?
The boxed warning, which is located in the Warning section of the product label, states:

Long-term Safety of Topical Calcineurin Inhibitors Has Not Been Established

Although a causal relationship has not been established, rare cases of malignancy (e.g. skin and lymphoma) have been reported in patients treated with topical calcineurin inhibitors, including ELIDEL Cream.

Therefore:
Continuous long-term use of topical calcineurin inhibitors, including ELIDEL Cream, in any age group should be avoided, and application limited to areas of involvement with atopic dermatitis.
ELIDEL Cream is not indicated for use in children less than 2 years of age.

Changes were also made to other sections of the label, including the wording of the indication as well as the addition of a Warning's section.

What is a boxed (or "black box") warning?

A boxed warning is included in a product label. It is used when the FDA believes there is a need to highlight a significant safety concern.

I was diagnosed with POD three years ago and my derm had me on antibiotics but my POD was very stubborn and didn't seem to be responding to treatment. I was very frustrated! Despite feeling so ugly, I went for a facial and the aesthetician told me that to her, my rash looked a fungus, but to check back with my derm before using an antifungal. After I left the spa, I immediately drove to CVS and bought some antifungal cream and to my relief, it cleared it up almost immediately. If you are able to use topical antifungals while pregnant, it might be worth a try.

I remember reading back then that fluoride in toothpaste has been implicated as a culprit in POD -- might be best to use one with fluoride (at least until you are better) and to avoid getting toothpaste on your face when you are brushing your teeth.

-cathy

free skin care · Tue Jan 15, 2008 9:06 am

Doxycycline has almost cleared up the slight case of POD on the side of my chin. Which leads me to think that, at least in my case, the problem was bacterial.

Thanks for the warning about Elidel!

--avalange

free skin care · Tue Jan 15, 2008 10:55 am

cathy_jean wrote:

jjb wrote:

Wow, how happy I was to see this thread - I've been so out of it since getting pregnant that I haven't been on the forum in months! Very Happy

Ironically, the last time I was on here, I was suffering from a major bad case of dermatitis and was totally depressed about it. I went to the derm and he also prescibed Elidel, which worked really well. Now however, I can't use it since I'm pregnant and I have the worst case of dermatitis I've ever had! It's ALL OVER my chin and forhead and is spreading to my cheeks. I'm going to a different derm on Monday to see what I can do until I finally have the baby next month, then I'm going to see about Metrogel or possibly an oral antibiotic if it is safe during breastfeeding - I am sooooo miserable right now! After doing some research, I think that my dermatitis has turned into a skin infection since it is so irritated.

As for any of you that are using Elidel, just be careful not to use it too long - it was required to carry an FDA black label warning in 2006 so I am wary of going back on it unless I really get desperate...

From the Elidel website:

What does the boxed warning in the ELIDEL label say? What are the other changes to the label for ELIDEL?
The boxed warning, which is located in the Warning section of the product label, states:

Long-term Safety of Topical Calcineurin Inhibitors Has Not Been Established

Although a causal relationship has not been established, rare cases of malignancy (e.g. skin and lymphoma) have been reported in patients treated with topical calcineurin inhibitors, including ELIDEL Cream.

Therefore:
Continuous long-term use of topical calcineurin inhibitors, including ELIDEL Cream, in any age group should be avoided, and application limited to areas of involvement with atopic dermatitis.
ELIDEL Cream is not indicated for use in children less than 2 years of age.

Changes were also made to other sections of the label, including the wording of the indication as well as the addition of a Warning's section.

What is a boxed (or "black box") warning?

A boxed warning is included in a product label. It is used when the FDA believes there is a need to highlight a significant safety concern.

I was diagnosed with POD three years ago and my derm had me on antibiotics but my POD was very stubborn and didn't seem to be responding to treatment. I was very frustrated! Despite feeling so ugly, I went for a facial and the aesthetician told me that to her, my rash looked a fungus, but to check back with my derm before using an antifungal. After I left the spa, I immediately drove to CVS and bought some antifungal cream and to my relief, it cleared it up almost immediately. If you are able to use topical antifungals while pregnant, it might be worth a try.

I remember reading back then that fluoride in toothpaste has been implicated as a culprit in POD -- might be best to use one with fluoride (at least until you are better) and to avoid getting toothpaste on your face when you are brushing your teeth.

-cathy

That's interesting because I've started to wonder if I have a fungal infection as well since nothing "antibacterial" (OTC) is really having any affect this time - in the past, antibacterial soap seemed to help calm things down, but this time it's not doing anything! Do you happen to remember which antifungal creme you tried?

free skin care · Tue Jan 15, 2008 11:55 am

The derm rxes Elidel for my 10 yr old son to use for 3-4 mos, but after reading the product insert I didn't use it. I then talked to my pediatrician, and he said (according to a ped derm who gave a lecture about it for continuing ed) that the doses of Elidel given to rats were exponentially greater than what you'd use on human skin. Don't know if that helps or not, but I felt ok (not great) about using it this once for a couple of mos. If my son's PD comes back, I'd probably choose a different course of therapy.

Regarding the antifungal cream, you could even try washing your face w/ a dandruff shampoo (and your body, too) to help w/ the fungal infection. HTH Smile

free skin care · Tue Jan 15, 2008 12:15 pm

jjb-

I used the Lamisil cream that comes in a tube, and they sell it in the footcare aisle for athlete's foot and jock itch.

I hope this works for you, and that your skin heals up soon. POD is no fun, I know!

-cathy

free skin care · Tue Jan 15, 2008 12:18 pm

tsjmom wrote:

The derm rxes Elidel for my 10 yr old son to use for 3-4 mos, but after reading the product insert I didn't use it. I then talked to my pediatrician, and he said (according to a ped derm who gave a lecture about it for continuing ed) that the doses of Elidel given to rats were exponentially greater than what you'd use on human skin. Don't know if that helps or not, but I felt ok (not great) about using it this once for a couple of mos. If my son's PD comes back, I'd probably choose a different course of therapy.

Regarding the antifungal cream, you could even try washing your face w/ a dandruff shampoo (and your body, too) to help w/ the fungal infection. HTH Smile

Thanks for the advice Very Happy

! I was thinking of trying Nizoral or something like that, so that is what I'll do. Elidel worked really well for me before I was pregnant too, so I may end up trying it again for a short period of time after I stop breastfeeding if I get desperate, but I'm going to ask about alternatives too.

free skin care · Tue Jan 15, 2008 12:19 pm

cathy_jean wrote:

jjb-

I used the Lamisil cream that comes in a tube, and they sell it in the footcare aisle for athlete's foot and jock itch.

I hope this works for you, and that your skin heals up soon. POD is no fun, I know!

-cathy

Thanks! I actually have some so maybe I'll do a little patch test and see how it goes.

free skin care · Tue Jan 15, 2008 3:30 pm

I only used elidel for a month and a half so I should be ok...still though, I wouldn't use it again if I can help it!

Should people with perioral dermatitis stay away from products with oil in it?

free skin care · Tue Jan 22, 2008 3:22 pm

so is it safe to say that if the perioral dermatitis is coming back four months after I stopped using the trilogy's rosehip oil, that it actually might not have been the rosehip oil after all? This is important as I do miss using it.

free skin care · Tue Jan 22, 2008 3:40 pm

Also, I'm thinking it may not be perioral dermatitis after all...does perioral dermatitis flake like dry skin sometimes? Mayebe it's excema? Oh I don't know!!! But I am sick of tihs!! I'd love to start using my rosehip oil though!

free skin care · Wed Jan 23, 2008 8:06 am

Blackmamba - if you're not sure what it is, definitiley go to a derm if you haven't already done so. It will end up saving you frustration and $ in the end.

free skin care · Wed Jan 23, 2008 9:34 am

I've already been to the derm. she gave me elidel. it went away for about a month and now it's back.

free skin care · Wed Jan 23, 2008 12:14 pm

blackmamba wrote:

Also, I'm thinking it may not be perioral dermatitis after all...does perioral dermatitis flake like dry skin sometimes? Mayebe it's excema? Oh I don't know!!! But I am sick of tihs!! I'd love to start using my rosehip oil though!

When I had it, the skin looked inflammed and had small red bumps and also some flaking. It was localized to the nasolabial area.

Here are some images I found on line: http://www.dermis.net/dermisroot/en/30893/diagnose.htm

free skin care · Wed Jan 23, 2008 12:23 pm

could some ingredients in my eyeshadow be causing it? Like maybe bismuth or silica? That's the only thing I can think of. I thought it was the rosehip oil, but I haven't used that for four months now...and it still came back!

free skin care · Wed Jan 23, 2008 12:47 pm

blackmamba wrote:

could some ingredients in my eyeshadow be causing it? Like maybe bismuth or silica? That's the only thing I can think of. I thought it was the rosehip oil, but I haven't used that for four months now...and it still came back!

Bismuth causes breakout reactions in a lot of people, including me.

Untreated POD can turn into rosacea -- in my case, I already had mild rosacea which I believe made me more susceptible.

Have you had any hormonal changes recently? I think my outbreak was as triggered by a change in birth control pills. I've been on the Pill for 30 years now, and have switched many times, but the only problem I had was when I tried Seasonale ... it was so great only to have 4 periods a year, but I got the POD and my hair also started falling out (fortunately, I have a lot of hair and didn't miss it -- just made a lot of hair to clean out of the tub each day, and also around the bathroom from blowdrying). I struggled with the Seasonale for a year, and then gave up and had my doctor Rx something else (he gave me Yaz).

Of course, creams, oils, fluorinated toothpaste, and steroid nose sprays (like Flonase) are also thought to cause it.

free skin care · Wed Jan 23, 2008 3:01 pm

Thanks cathy_jean. My derm told me to stay away from oils just in case. So for a while I was using cellcosmet (it has hydrogenated vegetable oil in it) and I was fine. I was fine when I added my mascara to the routine, but once I added eyeliner and eyeshadow...it came back. That's why I think it's the eyeshadow? Could it have been the cream or the oil though? I was fine using it for around three weeks. Then, like I said, a few days after I started using eyeshadow, it came back a little.

BTW, how do you tell the difference between perioral dermatitis and face fungus?

free skin care · Wed Jan 23, 2008 3:12 pm

Also, I've noticed that some days it is worse than others...Sometimes I can hardly notice it and other days it's a bit red. And, it's only on my eye area especially my right. I don't have any around the nose or mouth area. In fact, that area doesn't have any bumps, or pimples (maybe around that time of month I'll get one or two), no white heads, nothing.

free skin care · Wed Jan 23, 2008 4:15 pm

Quote:

BTW, how do you tell the difference between perioral dermatitis and face fungus?

I think fungus often has a circular pattern (my POD didn't). I believe it is possible sometimes to do a culture.

I was seen by my derm at least four times for my rash, and just by looking at me,he always diagnosed POD, not fungus. However, it's been suggested that there's a possible link between rosacea and fungus, and there also appears to be a link between POD and rosacea. It was an antifungal that ultimately cleared it up for me (and happily, I haven't had a reoccurence) -- my skin is clear and healthy looking, with no trace that the wicked rash was ever there. Very Happy

Could it be that your skin, although it seemed like it was healed, is still in a reactive state? I know that when I had my POD, my skin was just so angry and I had to be so very very careful about what I put on it ... things that ordinarily wouldn't bother my skin caused it to flare up much worse. Of course, I desperately wanted to try to hide it under some cover up, and really couldn't, because my skin reacted violently to everything.

Unlike eyeshadow and eyeliner, your mascara isn't applied directly to the skin. Maybe your skin is just letting you know it still needs some more time just to settle down?

free skin care · Wed Jan 23, 2008 9:24 pm

aw cathy_jean that's really good advice. It is possible that it hasn't calmed down yet. Needless to say I've stopped eyeshadow for a little. The bumps are already almost gone again!

Mon Jan 17, 2011 8:06 pm

I've dealt with perioral dermatitis off and on for over ten years. For me, the only thing that worked was oral antibiotics. My skin would be OK for awhile, but I usually had a flare-up within a few months each time I tried to come off of them. This last time around, I ended up being on them for well over three years.

I had to stop b/c we were trying to have a baby, and oddly enough, I went over a year without a flare. It showed up again after I started trying the OCM, and I was afraid I was going to be stuck with it throughout my pregnancy. Calendula cream as well as being VERY gentle with my skin cleared it up, though! Now I'm just hoping it'll stay that way till the baby comes. Smile

Thu Apr 21, 2011 5:02 pm

I’m a guy that had perioral dermatitis for over 2 years, and it’s been so bad that I chose to use my wife’s foundation makeup. Several months ago it started itching badly, and not knowing it was PD at the time, I scratched my face like there was no tomorrow. Well, the PD spread horrifically all over my face. It wasn’t until that point I started investigating what was wrong with me. Up until that point I just assumed I had poor skin genetics - dumb!

Thank god for sites like this and earth clinic and all of you because it has started a wonderful journey of discovery and appreciation for nutrition. I wanted to share my experience and return the favor…

The first thing I discovered was that the commonly prescribed treatment for PD is tetracycline, which has dangerous long-term side effects, and the PD always returns. I never saw a dermatoligist for PD - I self-diagnosed myself by researching the problem, checking out photos and comparing my symptoms.

After much research and dealing with this problem I now believe I know the cause and what I need to do to CURE PD. I started my natural treatment a little more than 2 months ago. After 2 weeks my severe PD symptoms disappeared. Since then I’ve had to stick to a few strict regimens, but I completely stopped using my wife’s makeup or any embarrassing signs of PD for over 2 months now.

From my research and experience I have determined that the cause of PD is an overgrowth of Candida in the body. In order to CURE the disease you have to kill the candida overgrowth, but this is very hard to do. Here’s what works for me to get rid of the symptoms…

Before you do the following, remove all toxic chemicals that contain sodium lauryl sulfate and flouride from your home. Buy a new toothpaste without flouride, remove all soap, shampoo, body wash, dish soap, household cleaner, and laundry detergent that contains sodium lauryl sulfate. Natural food stores have natural cleaners without these harmful chemicals that actually do a better job! You need to stop wearing makeup and using ANY creams on the face until your PD symptoms disapear. Once your PD clears up, you can experiment and see what makes the candida thrive. Also, throw out any old makeup - this is filled with bad bacteria that feeds candida, and for some of you it may have caused the candida overgrowth in the first place. After you’ve done this, you’re ready to start fighting the candida overgrowth that causes PD by doing the following regimen….

1. Apple Cider Vinegar on Face - This must be organic and unfiltered with the mother (it will say “with the mother” on the label). Use cotton balls to liberally apply the ACV all over your face. No need to dilute it with water! It will sting, but that’s a sign it is doing its job. The pain will reduce after a few days. Do this once in the morning and once at night.
2. Apple Cider Vinegar Ingested - Every morning and every night you need to drink a shot of ACV. This is very important because it attacks Candida in the body.
3. Apply an organic plain yogurt mask before bed. The yogurt needs to be organic with live cultures. Have at it, stick your whole hand in the yogurt and slop it on your face and leave overnight. I’m serious - the live cultures in the yogurt fight candida.

These 3 things alone had great effects on clearing up pretty much all of my PD symptoms in less than 2 weeks. This is not a cure, however, because it does not completely kill the Candida overgrowth in the body. If I stop this regimen the PD returns. Also, your diet will determine how effective steps 1-3 are. To get even better results and work towards CURING your PD, add the following….

4. Make sure you maintain great oral health. Scrape all that white stuff off your tongue (which is candida) and gargle twice a day with 3% hydrogen peroxide.
5. Candida overgrowth is believed to begin in the intestinal tract. Acidophilus is a good bacteria that does a great job killing candida in the gut. Get an Acidophilus supplement and take 2x/day. This is also called a probiotic.
6. DIET! - What you eat will determine whether the candida is thriving or getting obliterated, which has a direct result on the quality of your skin. Stop eating sugar, all processed foods, and bread. Try to minimize meats and dairy products. I know, it’s hard. The most important thing is sugar. My PD showed no symptoms, and then I ate 3 big bags of chips, a jar of nutella and a loaf of French bread. The PD started coming back even though I was on the regimen. Then, after eating a ton of vegetables and eliminating sugar, it cleared right up after 3 days and now stays clear as long as I don’t eat much sugar. Sugar = more candida.
7. Amalgam fillings - Amalgam fillings release mercury (a serious toxic poison) into your body every time you grind your teeth. Low level mercury toxicity suppresses the immune system, which allows yeast to proliferate. It is also believed that candida thrives on mercury. Unfortunately I have A LOT of amalgam fillings in my mouth. I’m currently saving money to have them all taken out. If you do have them taken out, you need to have it done at a holistic dentists office, where they understand the dangers of mercury poisoning. After removing your amalgam fillings you need to detox your body of the metal poisoning. You can find natural products that remove heavy metals from your local natural food store. Also, cilantro is great for removing mercury.

I strongly believe that once this mercury poisoning is out of my body, I will be able to starve and kill the candida overgrowth through a strict diet, and actually CURE my PD. My goal is to no longer need this regimen. If you are healthy, there shouldn’t be symptoms like PD. Imagine going to bed and waking up without having to put anything on your face - that sounds awesome.

Good luck, and whenever I get the fillings removed, I’ll give you an update.

free skin care · Thu Apr 21, 2011 7:43 pm

I learned about a product a few years back on EDS that helped me quite a bit.

It seems to help both acne and fungal problems. Its active ingredient is pyrithione zinc, which is the same active in Head n Shoulders and some other dandruff shampoos.

It's called DermaZinc. I ordered it from Dermstore, which also sells a harsher similar soap from the Stiefel company, and a cleanser with the same active called Born to Be Mild, From Audrey Kunin's line. It's not quite as pricey as other DermaDoctor stuff, and you use only a little at a time, and the tube you get is big. It leaves a slight oiliness, like when you wash with EpiDermxII, perhaps, but it might be better if you don't want to use soaps.

If your order is big enough, you get to choose samples, so you can try the Born to Be Mild that way too.

I won't run out to the BTBM for a long time, but the thing I never ever want to be out of is the DermaZinc soap, even though I don't use it every single day.

free skin care · Fri Apr 22, 2011 12:09 am

avalange wrote:

Doxycycline has almost cleared up the slight case of POD on the side of my chin. Which leads me to think that, at least in my case, the problem was bacterial.

Thanks for the warning about Elidel!

--avalange

My friend gets it when she is stressed and she takes doxy (twice daily) with good results too. It's the only thing that helps for her, but luckily she only gets it once or twice a year.

free skin care · Fri Apr 22, 2011 10:28 am

I believe that its bacterial too. I have found a very well formulated beta hydroxy acid to cure my problems, blemish or otherwise; at one time I did experience pyroreal (sorry for the spelling) dermatitis too and 2% BHA liquid cleared it up once and for all. Guess what? It never came back! Theres a good article at cosmetic cop website that discusses this too.

Sat Jun 25, 2011 9:15 am

Try Azo Yeast pills. I started taking them as a treatment for my yeast infections due to my monthly cycle and my perioral dermatitis cleared up as well. All I do is take one Azo Yeast pill a day and it helps the rash stay away. If I skip the Azo pill for a few days my rash begins to appear again but once I start taking it again, the rash goes away. It's not a cure but it certainly has helped. As long as I take it you can't see or feel the rash. It may take a few days for you to see a difference (if you do) but it should eventually clear up like mine did. You might want to start off by taking a couple of pills at first and then decrease the pill to one a day or however as needed. The pills are natural so they're safe. I don't know if it'll work for anyone else but it's certainly worth a try! You can buy the pills at WalMart for less than 7 bucks. You really should try it!

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