Perioral Dermatitis, help please, wits end.

Hi there, I was finally diagnosed with perioral dermatitis three months ago, after years of on/off topical steroid abuse. My GP prescribed me a course of Tetralysal, and a complete ban on all steroid creams. 7 weeks on and still no let up on the horrible burning all down the sides of my nose and under nostrils too. He then prescribed me a gel called Duac when it flared up particularly bad, which made me actually almost insane with the pain! The only thing that calmed it was Canesten, and after a week of just applying Canesten, my skin was clear, for the first time in months, hurrah! Or so I thought... The PD came back, bit by bit I began to feel the awful burning and horrible redness coming back. Another trip to my GP and he prescribed me Minocin instead of the Tetralysal, and Rosex (metronidizole cream). The Rosex has made things even worse, and I'm not sure if it's connected to having stopped the Tetralysal, but after 5 days of taking the Minocin, with no improvement, I'm just about to give up to be honest. Please can someone offer me some advice about what to do next. The burning is driving me round the bend. Thanks for your time.

[Bhupinder Kaur, MD]

Hello,
Perioral dermatitis like acne is a chronic papulopustular and eczematous facial dermatitis. It mostly effects women and appear around the nose, mouth and eyes. Treatment consists of oral antibiotics and anti-inflammatory drugs. A mild soap or soap substitute, such as Dove or Cetaphil should be used for washing. Scrubbing should be avoided.
Doxycycline is the preferred antibiotic for perioral dermatitis but minocycline can also be used. In unresponsive and granulomatous forms, oral isoterinoin may also be considered. Pimecrolimus cream can also be used. I suggest you to consult a dermatologist and discuss these treatment options with your dermatologist.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.