perioral dermatitis

[steph]

I am totally convinced I have perioral dermatitis along with my rosacea. I looked at some pictures someone posted on this forum and it's in the same location as my bumps. I've been on doxycycline since November and it has reduced my bumps about 40-50% but not totally elimatating my outbreaks. Does anyone else know of other treatments for perioral dermatitis? I think it's hormonal because it comes and goes with my cycle. Help please!

[Canada Dude]

I recall reading in Dr Nase's book that IPL was a great way to treat it along with the rosacea. So you can treat both at once, shoudl help with the redness.

[claudia]

I found some very interesting info at the following site. I think I had a bit of this too as I was using Flonase (nasal steroid spray) constantly for about 4 years. Interestingly my nasal stuffiness totally went away after starting Bactrim...which my derm perscribed for my hormonal cystic acne that I have along with rosacea. I was using doxy like you but it didn't clear up the residual rashy bumpiness around my mouth and chin...only the Bactrim did this and in just a few days! Also interesting is that perioral dermatitis can evolve into rosacea!

http://www.aocd.org/skin/dermatologic_diseases/perioral_dermatiti.html

Perioral Dermatitis

Perioral dermatitis is a facial rash that tends to occur around the mouth. Most often it is red and slightly scaly or bumpy. Any itching or burning is mild. It may spread up around the nose, and occasionally the eyes while avoiding the skin adjacent to the lips. It is more rare in men and children. Perioral dermatitis may come and go for months or years

There may be more than one cause of perioral dermatitis. One of the most common factors is prolonged use of topical steroid creams and inhaled prescription steroid sprays used in the nose and the mouth. Overuse of heavy face creams and moisturizers are another common cause. Other causes include skin irritations, fluorinated toothpastes, and rosacea.

A dermatologist diagnoses perioral dermatitis by examination. No other tests are usually done. The first step in treating perioral dermatitis is to discontinue all topical steroid creams, even non-prescription hydrocortisone. Once the steroid cream is discontinued, the rash appears and feels worse for days to weeks before it starts to improve. Heavy face creams should also be stopped. One must resist the temptation to apply any of these creams to the face when this happens. Think of the face as a cream junkie that needs a "fix"- one needs to go "cold-turkey".

A mild soap or soap substitute, such as Dove or Cetaphil should be used for washing. Scrubbing should be avoided. Try stopping fluorinated toothpaste for stubborn cases. Non-fluorinated toothpaste is available at a health food store. The most reliably effective treatment is oral antibiotics. These are taken in decreasing doses for three to twelve weeks. Topical antibacterial creams and lotions may also be used for faster relief. These can be continued for several months in order to prevent recurrences.

Even after successful treatment, perioral dermatitis sometimes comes back later. Usually, the same type treatment will again be effective. Many cases that come back eventually turn into rosacea. Perioral dermatitis is a common skin problem, but fortunately most people do very well with proper treatment.

CV

[steph]

Claudia,
So is the Bactrim still working pretty good? I can get my skin looking pretty good for about 10 days then the bumps start all over again. Hormones. I'm just curious from your experience if Bactrim is better than Doxycycline. How long have you been on Bactrim? I haven't read of too many rosacea suffers that use Bactrim. Even just plain old acne suffers aren't prescribed Bactrim. I do know of a couple though. Thanks for your replies.

[claudia]

I used doxy for several months...low dose to start and then upped to reg dose. My skin seemed to be clearing at first but still had overall redness, whiteheads and bumpies all over chin, mouth and forehead. Then after a few months skin got really bumpy and flared angry red with deep inflammed cystic acne (yuch) :oops: . That's when derm tried regular dose without success. To give her credit...she had wanted me to start on the reg dose but I wanted to try the smaller 40 mg/day dose to start...I may have created my own resistance to doxy :cry:

Since I'd already tried minocycline without much success my derm put me on Bactrim 800/160mg 2x/day. I'm totally amazed with the results...redness and cystic acne stopped in 2 days (yes - 2 days!), whiteheads and residual bumpiness gone in less than a week and I haven't flared since then. Have been on Bactrim for a month. Doxy didn't even come close to the smooth clear calm skin I have now.

Now my derm wants to try and lower the dose to 1x/day and see if I can maintain. She says some patients maintain on 1x/day 3 days/wk.

Maybe reason Bactrim is not usually prescribed is because it's a sulfa drug and more people are sensitive to sulfa drugs and may have a negative reaction. There have been some cases of people dying on this drug when they ignored rashy side-effects. But if you're not allergic then it's a godsend.

And rosaceans may not be prescribed Bactrim because it's generally used for people with resistant cystic or hormonal acne. I just happen to be blessed with a charming combo of rosacea + cystic acne...lucky me!

FYI --- I think my derm would've put me on low dose accutane but her office is no longer prescribing it due to all the legal hassles. However, she says that Bactrim is safer overall than accutane and if you're not allergic it's actually more gentle on the system than minocycline or doxy and can be used long term with less problems!

Hope this helps!

CV

[steph]

Claudia,
Thanks for all the information and your history. I'm really glad you are doing better. I might ask my derm about Bactrim at my appointment next week. Thanks again. steph