Perioral Dermatitis

I've been seeing a Derm for the last 6 months for a rash around my mouth.  I was using Elocon off and on for years in the crease of my chin.  1st she said POD due to Elocon, I stoppped using Elocon and tried tetracyclince.  2 months of that, rash was still present, although not as pimply. 2nd visit she said POD is now gone can start using Elocon & Protopic @ night, put me on doxycyclince also.  2 months rash got worse, pimples cames back.  3rd visit she said stop using Elocon, still on doxycycline.  I now Have been off Elocon for 54 days.  Rash has 0 pimples, have been testing with Cleocin T & Metrolotion.  Metrolotion burns my rash & makes it worse, Cleocin seems to work better.  Before using Metro, the rash was light pink, and looking better.  Tried Metrolotion 1 night, two days ago and rash is red again.  Last visit to derm, she is convinced it is not POD, but does not know what the rash is.  
Symtoms (symptoms): Red rash on chin, no itching, some drying, no pimples, a little bit of the rash is above my lip as well.
1) What should I put in it now, being that it is red/inflamed from the Metrolotion?
2) If the Rash is corticosteroid induced, how long before it gets better?
3) Can it be POD with no pimples?
4) I've been on doxycycline for 3 months, should I stop?
5) Food allegy? My derm said it would itch if it was.

My derm has given up on me, she said I may just have to live with it??  Where can I go from here?

[Alan Rockoff, MD]

Perioral dermatitis is a pimply eruption around the mouth and sometimes the eyes too.  This can arise spontaneously in women, or be promoted by cortisone creams like Elocon in both women and men.  Despite your continuing feeling of "irritation," I think you should avoid using any steroid creams.

While I can't say what's going on with certainty, I suspect that all you have left is residual skin sensitivity from all the stuff you've been using.  Three months of doxycycline should indeed be enough.  And if something as inert as Metrolotion appears to "irritate," perhaps the best approach is to stop all active medication for a period of a month or two.  Wash with something bland, like Cetaphil, and use only a simple moisturizer, like Cetaphil, Neutrogena, etc.  Often, redness like that which you say you have just needs to be left alone for a while, so it can subside on its own.

If it pimples up or worsens, see your skin doctor (or another one.)

Best.

Dr. Rockoff

[Guy88]

One more question....
It sounds as though men only get this condition through overuse of topical steriods.  Is a mans perioral skin different than a womens?

[czz]

I am a 43yr old woman - i have been dealing with a rash that appears frequently on my face - mostly downward from the corners of my mouth, sometimes around the outer nose/nostril, and now between the top of my nose and my left eye.

I have been on tetracyline for 2 months last oct-dec.  while the redness subsided - on and off - it continues to return -
I have also been prescribed cleocin and Locioid cream - nothing is working - sometimes the patches are bright red - and very very dry and flaky - sometimes the redness and dry skin subside for a brief period.

What is this?  My dermatologist mentioned that perhaps my toothpaste was dripping from my mouth - however that is out of the question.  

Is this perioiral dermatitis? as you mentioned it could happen spontaneously in women.  Coincidentally, my boss - a 44 yr-old woman has them same condition currently.

I have stopped all medication for a number of weeks.  

Also, someone mentioned that this could possibly be caused by an overdose of niacin?  Both myself and my boss have been taking Vit B supplements recently and both of us have had major flair ups.

Thanks for your help.

[MarianneStebbins]

As I understand it, men's skin is not as thin, and has some other different properties.  My guess is that men also don't use nearly as many skin products which irritate skin.

[Europa]

I am a 20 year old male and have been seeing a dermatologist three months for a slightly bumpy fairly red area on my chin.  She diagnosed this case as POD and put me on Dynacin 100mg twice a day, and both Metrolotion and DesOwen lotion twice a day.  Previous to my seeing the dermatologist I was treating acne for a year with Benzamycin and Minocycline 100mg twice a day.  I stopped the Benzamycin on my own a month previous to seeing my dermatologist due to the irritation and redness it caused my skin, especially around my chin.  Since I started my treatment givin by my dermatologist, and doing the usual changing of toothpase and such, I have seen a slight improvement in the color on my chin but not really on the bumps.  I believe that perhaps, since I have been using an oral antibiotic 100mg for so long that the Dynacin 100mg I am currently using has very little effect on the 'POD', if it even is that.  Could it even be that I simply need to stop topical treatment all together?  I also find it ironic how many reports link POD with exposure to Sodium Lauryl Sulfate, and Cetaphil non-soap cleanser is reccomended for POD when it actually contains Sodium Lauryl Sulfate.  Im just looking for opinions from anyone who feels they might beable to help.