Is this Perioral Dermatitis?

http://lr240.tripod.com/skin/index.html (pics)

These pictures are not all taken at the same time, some were taken yesterday, some in 2002. I've pushed my tongue into my mouth to show the texture of the area. I've had this problem now since the end of 1999

The affected area is below my mouth, on the chin and also at the sides of my nose which share the similar symptons. When I first noticed this problem I realised the areas of skin that were affected had a bumpy texture, like tiny goose pimples. The area on my chin is prone to lots of little grease spots, y'know, those when squeezed have little white shoots of goo inside. These are still apparent today.

Over the 4.5 years since I discovered this problem I feel it has gradually improved, but at an 'extremely' slow rate. I also feel the lumpiness has descreased over time. In general it feels alot smoother now than it did 3 years ago for example, but it's far from gone.

The area of 'normal' skin directly under my lip has no lumps/spots on it at all, it feels & looks perfectly fine. There's also an 'oval' shaped area of skin right in the middle of the problem area that too feels completely smooth compared to the areas around it. If you look at the pictures I have marked these areas in yellow. The fact that there's a definite 'divide' between the good and bad areas of the skin seem to magnify the problem and it makes me so self conscious you wouldnt believe. The affected areas have a reddy/orange appearence and seem to have a different densisty to my normal areas of skin. When I stretch my mouth, by laughing for example these areas will become angry & blush. Sometimes they will itch but this is very minor. I don't know whether they tingle because they really are, or it's simply because I know they are there.

When I first went to see my dermatologist he seemed unsure of what is was exactly, over the course of a couple years I've had many creams. Elidel, Elocon, Steroid creams, Doprobase, Healan Ointment, Nizoral Cream. My dermatologist seems to think it's dermatitis. None of these creams seemed to do any good at all. I've also gone through large periods of months where I didn't use anything at all on my face. I would just use pure water to wash to see if this helped, it didn't.

In January of this year I had some phototheropy treatment. This didn't seem to do much either other than give me sunburn. Just recently I have had patch tests to find out if I am allergic to anything, the results came back that I was allergic to 'quanterium 15'. This seems to be the NHS's final diagnosis, to which I am extremely dissapointed. I'm in the position now whereby I am extremely desperate to resolve this problem. Sitting here writing this I don't even know what my problem is exactly, is dermatitis the correct diagnosis?. I know it must be something but no-one yet has been able to help me. I've got to the stage now where I'm willing to try  *anything*. I'm currently considering green peel treatment.

[Alan Rockoff, MD]

Unfortunately, I cannot access the pictures at the site you give.

I haven't any idea what you have.  Perioral dermatitis causes red pimples, not the tiny bumps you describe.

It's hard for me to avoid the sense when I read your meticulous, almost obsessive description that you are looking at your skin far too closely.  Of course, I am not seeing it.

You can get other opinions, I suppose.  But getting a diagnosis that will satisfy you seems unlikely, given what you say the people who examined you have said.

If you're that self-conscious, you may have to consider either cosmetic cover-up or counseling to come to terms with your appearance.

I know these observations will not satisfy you, but what you describe does not match any skin disease I have seen or heard of.

Take care.

Dr. Rockoff

[__m]

I wish you could see the pictures. You just have to copy this following line:

http://lr240.tripod.com/skin/index.html

or try this one

http://tinyurl.com/3so85

and paste it into your browser address bar and click enter. I am not delusional. I find it really hard to desscribe the symptons, hence the reasons for the pictures. Please could you have another try at viewing the pics?

kind regards

[Alan Rockoff, MD]

OK, I saw them.  The little bumps you have are normal anatomy--they are small follicles often seen in this area.  They are not a disease.  There is no medication for them.  Facials can make them less prominent, though only temporarily.  If you poke and prod them, the skin can get red.  

Seeing them makes me reiterate my recommendation that you learn to deal with them, because you basically have to and because there's no reason you shouldn't . . .

Dr. Rockoff

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