Perioral dermatitis - desperate for help!

Hi DR

I really hope you can help me! I will try and keep this story brief:


I started getting red blotches on my face around Dec 06 went to the doc’s later in Jan 07 and she told me I had Eczema and I was to treat it with Elecon and Hydrocortisone cream. I did this right up until  beginning of September 07 and  went back to the doc’s as it just came back within 2 days after using the creams. She then told me on September 7th  I had POD and gave me Daktacort and a weeks worth of anti B’s. It all seemed to clear up, slowly, but was a 99.9% improvement so I did not complain. I decided to stop using the Dakracort cream 13th October as I thought it was a short term problem I had. Anyway to cut a long story my face basically exploded into a bright red rash with the white heads and it seemed to increase to around my left eye area as well as all around my mouth.

I have been given Doxycycline antibiotics which I started exactly a week ago today and am applying Daktacort VERY thinly once a day (reluctant to use Daktacort as I am worried of skin thinning and my skin growing immune to it). So it is a week on and yes my rash is not as big but it is definitely still there and just as red. I have been given Doxycycline Capsules 50mg per day for one month. I have been to my GP several times and who I really don’t think they know anything about the condition as I was initially given thrush cream and put on the yasmin contraceptive pill.

My questions to you are:

1. do you think I have been give the right dose of Doxycycline and for the correct duration
2. is the Dakacort the appropriate cream to be using
3. And finally I am absolutely worried sick that I am going to be stuck with this for life (I am in sales and it is severely affecting my work performance!)

If these antibiotics don’t work and I need to see a dermatologist in London is there anyone you recommend?

I really look forward to hearing from you.

[Alan Rockoff, MD]

It does sound as though you have perioral dermatitis.  This is a form of rosacea, which in some cases--yours, for instance--is aggravated and perpetuated by the use of steroids.  I recommend that you take doxycycline 100 milligrams twice a day and that you discontinue Daktacort, which as a steroid quiets down the inflammation but at a cost of lengthening the healing.  When you stop the Daktacort, your rash will get substantially worse, but only for a time.  This rash is not permanent and will not result in lasting damage of any sort.  You ought to get a dermatology opinion to support my educated but long-distance suggestions.  Any competent dermatologist will do, as this is not an exotic condition.  It is unpleasant, but curable.

Best.

Dr. Rockoff

[vc338]

Hi

Many thanks for your response. I am waiting to see a dermatologist but have a four week wait. In the mean time is there any other cream I should be using as well as the Doxycycline?

Regards

Victoria