perioral dermatitis - thoughts and suggestions please!
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free skin care · Sat Nov 10, 2007 7:29 am

Hi everyone

I posted on here about a year ago, for a wicked case of acne on my chin that seemingly developed out of nowhere, and finally one year and 3 dermatologists later I was diagnosed with perioral dermatitis.

I've been on metrogel (for the rash) and neo medrol (for the acne) for three weeks now, and things seem to be clearing up for the most part.

my concern now, is helping to prevent it from flaring up again! i'm not sure if my derm will keep me on these meds forever, and I'm hoping for some input from everyone who has had a bout with PD...

what products/ingredients do you find helpful at keeping PD at bay?

what products/ingredients do you find contributes to your flair ups?

anyone use any SA/GA without causing a reaction? (I desperately miss my green apple peel! - i've got a lot of red marks left over on my chin that i'm hoping to address once i've got my PD under control fully)

any other tricks or tips you have for me would be greatly appreciated!

Thanks for your input everyone!

free skin care · Sat Nov 10, 2007 6:14 pm

Hi there! I was just diagnosed with peroial dermatits around my eye area. It's quite a mild case though. My dermatologist perscribed me a topical cream called elidel and gave me a mild moisturizing cleanser, both of which I have to use for two weeks. I can't use any other products during that time(cellcosmet withdrawl has already set in!!). She said that it should clear up by then...I can give you more info in 10 days time when I go back. I've heard that more severe cases can take six to twelve weeks to resolve. My dermatologist is going to have me reintroduce each one of my beauty products one by one to see if any of them are the cause. However, I'm not sure I'll do this because I am almost positive I know the cause. I started noticing little red bumps around my eye contour area about a year and a half ago. The red bumps occurred a couple weeks after I switched my beauty regime to Trilogy rosehip oil, cream cleanser, and vital moisturizer. I used the rosehip oil all around my eye area. As good as the oil was...I am almost %100 sure that this was the cause. There have been many good reviews about rosehip oil and I would def. recommend it to anyone who can handle it. I think it was just too rich for me. Anyway, I'll keep you posted on how things are going. BTW, I've been using the elidel for three days now and the infection is almost gone.

free skin care · Sat Nov 10, 2007 6:18 pm

Can peorial dermatitis clear up on its own?

free skin care · Sun Nov 11, 2007 4:41 am

I had a small breakout of POD a couple of years ago, probably due to overuse of hydrocortisone. I only had a small area close to my nose that was affected, and my skin is otherwise dry and clear. I got the advice on a board to put on a gel with salisylic acid, of the type otherwise used on pimples, and while it burnt like $#%& Embarassed

, it really helped. Afterwards, I haven't had anything of the type again.

free skin care · Sun Nov 11, 2007 9:45 am

How long did you use the salicylic acid on the affected area?

free skin care · Sun Nov 11, 2007 10:33 am

blackmamba wrote:

How long did you use the salicylic acid on the affected area?

I don't really remember, but it wasn't that long, maybe a week? It makes the rash dry up, and then disappear. I would try on a tiny area first, because your skin seems much more affected by the POD than mine was.

free skin care · Sun Nov 11, 2007 3:19 pm

I get perioral dermatitis every so often, all around my nose and chin. The important thing is to get it completely cleared up -- it can fade quite a bit, but until it's cleared up it can just keep coming back. oral antibiotics are the only thing that's worked for me, but I haven't tried metrogel.

as far as triggering it goes, for me it's cold weather and the heavier creams I use in the winter. hard to avoid unfortunately. I use tazorac,salicylic acid, and glycolics with no problem though.

free skin care · Sun Nov 11, 2007 8:59 pm

How come dermatologists recommend not using any beauty products during the treatment of dermatitis. I'm almost 100% sure that none of the products I'm currently using have caused it. I think the dermatitis was caused by the rosehip oil and then never cleared because of the steroid cream I was using.

free skin care · Sun Nov 11, 2007 11:16 pm

blackmamba wrote:

How come dermatologists recommend not using any beauty products during the treatment of dermatitis. I'm almost 100% sure that none of the products I'm currently using have caused it. I think the dermatitis was caused by the rosehip oil and then never cleared because of the steroid cream I was using.

use of heavy moisturizers is associated with perioral dermatitis, so your doctor is probably recommending that you stay away just in case.

As far as the steroids go, they are associated with PD, but it is generally a reaction that occurs when a person has been using them for a long time and then quits.

my derm says that PD generally will not clear on its own -- the symptoms will just come and go. he said that topicals are not very effective in treating it. I know that my derm is not the word of god, but whatever antibiotics he gives me clears it up completely within a week and doesn't come back for at least a year (I'm pretty prone to it).

free skin care · Mon Nov 12, 2007 9:56 am

Well, I've been using elidel now for four days and my eyes have never looked better in fact! Theres not even the slightest trace of dermatitis! I'll keep using it till the two weeks are up though.

free skin care · Mon Nov 12, 2007 4:59 pm

Can perioral dermatitis get worse over time? Just wondering because my case is soooo mild. It's hardly noticeable.

free skin care · Mon Nov 12, 2007 9:32 pm

blackmamba wrote:

Can perioral dermatitis get worse over time? Just wondering because my case is soooo mild. It's hardly noticeable.

mine gets worse if I don't treat it...but I've never had it on the eyes and I've never heard of elidel as a treatment (that's a steroid for eczema usually, right?) so it's not too comparable.

free skin care · Mon Nov 12, 2007 9:53 pm

so strange... i was just diagnosed with this by my doctor. i normally have perfectly fine skin, and i actually think ocm with castor oil did this to me. lots of little hard bumps on either side of my chin, wouldn't go away for many months and some of which flared up into horrible zits. i thought it was just a readjustment phase since i moved back to the u.s. from france, but i went and had a facial and had all of them extracted... only to be horrified that they came back three days later in the exact same place, and with a vengeance. i had ignored them for several months, but then i wanted these bumps 'off' my skin.

i am on an extremely high dosage of erythromycin, and they are actually going away now (cross my fingers). like others on this forum have said, no more ocm with castor oil for me! i have been using all my other products with no problem. i agree with waffle that oral antibiotics work.

--avalange

free skin care · Tue Nov 13, 2007 8:00 am

Are these pumps itchy or painful for any of you? I ask because almost all of the scarring on my cheeks came from what I call a "freak" breakout; I've had every kind of breakout imaginable but nothing like this before or since. I tried to self treat but they got worse and became so painful I had to go to the derm. It looked very similar to some of the pictures of PD, a ton of pumps clustered together. The derm didn't know what it was, told me "nature was picking on me", and gave me oral antibiotics. Luckily the antibiotics worked! I've been searching for what afflicted me since then because I never want to relive that. Off to do more research on this! Thnx Smile

free skin care · Tue Nov 13, 2007 9:34 am

All I know is this elidel stuff is really good! I only had a few bumps on either side of my eyes though. They've been gone three days now and I still have a week on elidel to go! I think it depends on how severe the case is. my deramtologist told me that she treats the more severe cases with oral antibiotics.

free skin care · Wed Nov 14, 2007 7:09 pm

avalange - your situation sounds exactly how mine started/is! I wasn't sure what caused the development of all these bumps... at the time I was new to EDS and I also hoped on the OCM (with castor oil) bandwagon, as well as tried Dr. H CC and mineral makeup all within a month, and I was never able to pinpoint the culprit. things on my face started to settle down after a round of antibiotics from my 1st derm (was for acne though), but then I started OCMing again, and all my bumps came back... I didn't make that connection though!

waffle - glad to hear that you can still use your retinol and acids! gives me hope!

thanks for your input everyone else too! it's not a pretty thing to go through, and it's interesting how differently it can manifest itself on each person... looks like antibiotics is the route to take though for the most part!

glad to hear yours is clearing up with the elidel blackmamba!

free skin care · Wed Nov 14, 2007 8:15 pm

Thanks Lulabelle!! That's interesting about the Castor oil...well, good luck everyone! I see the dermatologist again in less than a week now...Oh! And I also figured something out. It WAS the rosehip oil!!! Apparently rosehip oil contains a really high dosage of vit c, something my skin isn't good at handling. At least I know how to prevent a future outbreak. Rolling Eyes

Thanks everyone!! BTW, for anyone who's interested in the vit c theory, there's a post somewhere on EDS about people who can't use vit c. Turns out a lot of them suffer from tiny red bumps!

free skin care · Wed Nov 14, 2007 8:22 pm

hi dear waffle!

what oral antibiotics are you taking, might i ask, for this? i am almost done with my round of erythromycin and whereas it has completely cleared up on one side of my face, there are still about 5 bumps on the other side. i am scared that they will not clear up and that it will all come back (again) with a vengeance, like you intimated. i want to know what to ask my physician for... because i really don't want to have to go to a derm after all this. do you think topical antibiotic might work?

thanks!

--avalange

waffle wrote:

I get perioral dermatitis every so often, all around my nose and chin. The important thing is to get it completely cleared up -- it can fade quite a bit, but until it's cleared up it can just keep coming back. oral antibiotics are the only thing that's worked for me, but I haven't tried metrogel.

as far as triggering it goes, for me it's cold weather and the heavier creams I use in the winter. hard to avoid unfortunately. I use tazorac,salicylic acid, and glycolics with no problem though.

free skin care · Fri Nov 16, 2007 12:32 pm

miss avalange --

I don't know what they give me, actually. Last time I got it I went to the undergrad clinic on campus and the PA there had no idea what I was talking about...so she just looked it up in some rash book and prescribed whatever was recommended in that. I bet you could find it by googling 'perioral dermatitis treatment dosage' and you can usually find prescribing info. One thing I do remember is that I have to take them for a month. I think you should probably keep going until it is totally cleared up.

my derm said topicals don't work so well, so I don't know if you want to bother with that.

free skin care · Fri Nov 16, 2007 12:49 pm

well, i went through an entire round of this crazy antibiotic and now the doc is prescibing me topical erythromycin--also an antibiotic. yikes. will update...

--avalange

waffle wrote:

miss avalange --

I don't know what they give me, actually. Last time I got it I went to the undergrad clinic on campus and the PA there had no idea what I was talking about...so she just looked it up in some rash book and prescribed whatever was recommended in that. I bet you could find it by googling 'perioral dermatitis treatment dosage' and you can usually find prescribing info. One thing I do remember is that I have to take them for a month. I think you should probably keep going until it is totally cleared up.

my derm said topicals don't work so well, so I don't know if you want to bother with that.

free skin care · Fri Nov 16, 2007 3:12 pm

Hi everyone,

I had a bout with this several years ago as well. The worst part is that my derm also misdiagnosed me and put me on a topical steroid. Steroids actually allow the dermatitis to cultivate and so after six months of using steroids my skin was so sore I could hardly smile/eat. It just so happened that when I was at my OBGYN for my annual physical I mentioned this and she new exactly what it was. She said that it is commonly misdiagnosed and prescribed me some metrogel. She said that once it clears up it typically will not return. Sure enough the metrogel did the trick for me and I haven't had it since.

Avalange - you might want to try the metrogel if the oral antibiotics aren't working. This cleared mine up almost immediately and was very soothing on my tender skin.

HTH!

free skin care · Fri Nov 16, 2007 4:14 pm

hi tamgirl!

this thread is like a reunion of my favorite EDS posters!

maybe i will try metrogel after the topical she prescribed... thanks so much for your input, glad to hear that you are well! Wink

--avalange

TAMgirl99 wrote:

Hi everyone,

I had a bout with this several years ago as well. The worst part is that my derm also misdiagnosed me and put me on a topical steroid. Steroids actually allow the dermatitis to cultivate and so after six months of using steroids my skin was so sore I could hardly smile/eat. It just so happened that when I was at my OBGYN for my annual physical I mentioned this and she new exactly what it was. She said that it is commonly misdiagnosed and prescribed me some metrogel. She said that once it clears up it typically will not return. Sure enough the metrogel did the trick for me and I haven't had it since.

Avalange - you might want to try the metrogel if the oral antibiotics aren't working. This cleared mine up almost immediately and was very soothing on my tender skin.

HTH!

free skin care · Sat Nov 17, 2007 4:11 pm

avalange wrote:

hi tamgirl!

this thread is like a reunion of my favorite EDS posters!

maybe i will try metrogel after the topical she prescribed... thanks so much for your input, glad to hear that you are well! Wink

--avalange

Thanks avalange! It's nice to be able to stop in and catch up with everyone. I've been so busy the last few months that I haven't even been on EDS until I wrote this response. I'm glad to see you're still around as I always enjoy your insight. I hope the metrogel will help you as easily as it helped me.

Well, I'm off to a wedding but will hopefully be back on EDS more often now. Have a wonderful night!

free skin care · Sun Nov 18, 2007 7:44 am

avalange - my derm told me that he would prescribe me penicilin if the metrogel doesn't work. He said that he would prefer to prescribe me Minocin, but it really messed with my bloodpressure last time, so I requested not to have that again.

I go see my derm this wednesday, and while most of my rash has cleared up not, i'm still getting some pimples, so i'm not sure if he'll prescribe penicilin for that or something else. i'll post about it though!

free skin care · Mon Jan 14, 2008 11:32 pm

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.

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