Perioral dermatitis

I have a very stubborn case of Perioral dermatitis.  I am a 29 year old male who wasn't using any topical steroid prior to my condition.  I have discontinued use of flouride toothpaste, products with SLS and harsh soaps.  My condition is primaraly focused aroud my eyes and lower forehead, but exist mildly around my mouth.  I started to see results with Minocycline, but began to break out in hives after about 3 weeks.  My Dr then switched me to Ampicyllin (sp?) but I saw no results.  I recommended we try Erythromycin and began to see immediate results 3-5 days that have slowed since.  I have been on Erythromycin now for 4 weeks and have started to once again develop hives.  I don't want to discontinue the treatment because I am running out of options, but I don't know how severe the reaction can become if I continue.  I am currently taken 500 mg, three times per day.  I would say my condition is about 70% cured from the time I began treatment.

Some of the topical I have tried are; Locoid (sp?), Rosex, Protopic, Cortisone.

Should I switch to a topical Erythromycin?  Should I continue with the oral and just deal with the hives?  I am very frustrated and concearned that I am running out of options.

Bryan

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[Alan Rockoff, MD]

I am not sure that what you have is not perioral dermatitis but rather plain old acne.  I don't recall seeing perioral dermatitis on the lower forehead.

Either way, treatment takes 4-8 weeks to see results, sometimes more.  You can't tell at this point what will happen unless you stay on the medication.  I am a little perplexed by your repeated "hives"--I haven't seen hives come from either minocycline or eryhtromycin, and while anything is possible, these medications are unrelated to each other.  Perhaps these are just regular hives that people get who aren't on anything, or else maybe they aren't even hives.

My advice is to stay the course and stay in touch with your doctor about hives and other symptoms.  Clearing this up may take several months, but please rest assured that there are plenty of other options for you to access if needed.

Take care.

Dr. Rockoff