Suffering for 10+ years. Sub derm? Perioral dermatitis? Help me puzzle this one out.

[cleocatra]

This might get a bit long winded and I apologize, but there's a lot of information for me to get out.

In 1998 or so I had issues with flushing and was diagnosed with a mild form of rosacea. I was prescribed Metrogel which seemed to help a lot. About six months later I began to have issues with a rash that would appear primarily around my nose but occasionally on my chin. They were tiny red papules that never seemed to come to a head. They didn't itch or particularly hurt. I was confused and kept trying to dry them out with astringent - obviously didn't work...just made me a flaky nightmare. My dermatologist diagnosed me with seb derm and I was prescribed a cream for it. (I can't recall the name of it currently, but I'm requesting a copy of my medical records so that I can keep all of this stuff straight.)

They eventually switched me over to Elidel, which I've been on until now. I've been able to manage my condition reasonably well but I do have flare-ups pretty frequently. (Especially in winter months.) I am terrified of putting anything on my face because I don't know how it will react - therefore I just do a quick wash with toner at night and moisturize sparingly - I feel like my skin will suffer from this in the long run. In addition, I recently read that Elidel holds a black box warning and that it can weaken the immune system. I had a physical a few weeks ago and was told by my doctor that my white blood cell count was low and that Elidel could potentially be responsible for it. I don't really feel like I'm in a great position right now.

In the past two weeks my skin has gotten worse. I don't know if it's due to the stress of worrying about this condition and the constant googling/my quest for "the cure"... but either way, my skin is suffering for it. I have the same rash on my nose and chin but the papules are developing into larger blemishes. I'm also breaking out on my forehead in tiny zits - this is the first time on record that's happened for me. I finally caved and went to a dermatologist yesterday. She spent about four minutes in the room with me, barely looked at my face, and then prescribed me with Clindamycin Phosphate swabs for my forehead and chin and told me to continue using Elidel on the rest of my problem areas. I'm pretty confused. The issue with my chin started off as the same ol' rash I always get but has gotten worse... is that veering into acne treatment territory? Should I be applying that stuff to my chin? Ugh, I have no idea, you guys be the judge.

Another dermatologist informed me a few months ago that I might have perioral dermatitis. I had never heard that before. I cut sls/fluoride toothpaste out of my life but never saw any real improvement.

skin_1.jpgskin_2.jpg
The first photo is from a few days ago. The one on the right is from today. (After moisturizing a bit, I'm not really all that glossy.) I'd appreciate any input you have regarding my condition and what you think it may be. I have a consultation with another derm scheduled next week but who knows if they'll be any more helpful. Any pointers you have on treatment would also be appreciated. I just ordered raw honey and coconut oil. I have a zinc pyrithione soap that doesn't seem very effective. I've tried ketoconazole in the past with little to no success.

(I know my condition is not as severe as other cases I have seen. I try to keep a level head about it but unfortunately I've also suffered from pretty bad social anxiety in the past in regards to my appearance. Feeling people stare at my face when I have these flare-ups going on is pretty disheartening...)

Thank you all in advance!

[flying_er]

Hi cleocatra and welcome to the forum.

I think one of the important things to remember is it can be a fine line between rosacea, seb derm, perioral dermatitis and acne. And often a person suffers from more than one of these issues. I think it's important to work with a doctor and not try to do too much self diagnosis. Often the doctors are not even sure so they try different topicals to see what will hopefully work. It can be a long and tiring process but most people eventually find something that helps. From the pictures you condition looks treatable, it doesn't seem all that bad so hopefully you can get it under control soon.

Hang in there and don't get down on yourself, things will get better. But remember these conditions tend to go up and down with periods of good skin and then breakouts so don't get too worried about the breakouts, they tend to clear.

-Dave-

[cleocatra]

Hello Dave,

I appreciate your kind words more than you know. I try to put things in perspective but it's difficult when it comes to one's face, as I'm sure many people here can empathize with. My issue stems from having so many diagnoses that it isn't clear what I should be focusing on. It makes sense what you say (and what I've read) that a lot of these conditions are interlinked.

Do you (or anyone else here) know if treating my chin with the Clindamycin Phosphate swabs could potentially be more harm than good? Everything I've read about seb derm indicates that ingesting antibiotics is a bad idea. Does this include topical swabs? So many burning questions!

I agree that I should probably quit with the home remedy/diagnosis and am in the process of hunting down a better doctor. My recent derm was pretty dismissive of any questions/concerns I raised. That's why I came here... you all seem incredibly knowledgeable and helpful.