Perioral Dermatitis

I have been diagnosed with perioral dermatitis.  I went to the dermatologist and was prescribed a steriod cream called Cutivate 0.05% and an antibiotic cream called Clindamycin Phosphate Lotion 1%.  I have been on the antibiotic cream for 2 weeks and used the steroid cream for only the first week of my treatment.  I was very happy after the first week of treatment because the rash appeared to have totally disappeared.  However after I stopped the steroid cream, the rash came back MUCH  worse than it had been before I applied it.  I called the derm. and they said to continue using the steroid cream along with the Clindamycin for 6 weeks, but to alternate the steroid cream, one week on one week off.  I am very afraid to do this since I believe this is what has made my rash so much worse.  I called them and asked if I could start using an oral antibiotic because I had heard that this may help more than the topical one, but they said they wanted to wait and I should continue using the steroid cream and the antibiotic cream together.  I am not going to reapply the steroid cream to my face.   Do you have any idea of how long this could take to go away with just using the antibiotic cream and would you also suggest what they said and use the steroid cream in alterations?  I have also just had a baby 6 months ago and have been nursing her.  I thought maybe this could be part of the whole problem since I did not have this problem up until I had her.  I had a period for one week and it totally went away, so I thought hormones may be the culprit.  Also, do you know if it is okay to apply shea butter (Karite Gold Shea Butter) to the face while using the antibiotic cream?  Sorry this is so long winded I just don't know what I should do at all.  Thanks for your time.  Any help would be GREATLY appreciated.

[Alan Rockoff, MD]

If you indeed have perioral dermatitis, then I don't agree with your using a steroid cream.  Steroid creams make this condition temporarily better, but then it flares up as soon as you stop, which seems to be what you say is happening.  The best treatment for perioral dermatitis is oral antibiotics, but use of these is severely limited in nursing or pregnant women.  I would advise you to not use steroid creams, to just use the antibiotic cream, and to get another opinion either from your current dermatologist or from a different one.  Hormones and pregnancy typically do not affect perioral dermatitis, and successful treatment doesn't require hormone modification.  In the end, however, you should be totally clear, with no scarring.

Take care.

Dr. Rockoff