Topical Steriod Use and Acne

[reesew]

I apologize in advance for the novel I'm about to write!  I've always had moderately problematic skin: blackheads, whiteheads, & papules,& I see a derm.  In an attempt to try a different avenue, I went to an aethestician in April & I allowed her to do a "mild" chemical peel on my face (20% glycolic acid).  As a result, I got contact dermititis on my neck & was prescribed Bethamethasone Valerate .1%.  It cleared up the problem in 2 days, & I thought it was great.  I also had a similar angry red rash on my temples.  I asked my college health center nurse (where I had gotten the BV) if I could use it on those areas.  She said yes.  I had NO idea it was a potent steriod,& I proceeded to use a tiny amount on each temple 1x/day for 3.5 months. The ointment reduced the redness & my skin looked normal, but I noticed that if I skipped a night, the rash would immediately re-appear.  Because the rash mimicked what my skin looked like after the peel, I assumed the peel was the cause of the flare-ups, not the med.  I know now it was a reaction to the lack of having the steriod,& I could just die knowing what I was doing to my skin, which is incredibly (& unusually) sensitive as it is.
At this point, it has been 1 month since I stopped the BV, after I finally alterted my derm to the problem. He put me on triamcinolone cream to wean me off the BV, & now the skin around my temple areas is very red, irritated, and breaking out in whiteheads & larger zits,& it's is even spreading a little in surface area (it had never been a problem area before using the med).  My dr said that my skin is withdrawing from the steriod & this is to be expected.  He also said he noticed slight atrophy (although not "observable to the untrained eye").  In addition to the triam cream, he recommended I continue to use differin all over my face, including my temples, which seems to be irritating this area more(I've been using that med for over a year for my regular skin problems). In addition, other areas of my face, 1 side of my nose & my entire chin area are now breaking out in large pus-filled nodules.  It is out of control.
Now for my questions: Have I done permanent damage to my skin because of the length of time I used the BV? Isn't 3 mos a long time? If it's not permanent, what time frame am I looking at? Could I have systemic effects?  Are the breakouts on my nose and chin caused by the BV even tho it wasn't used there (I did put it on @ night & could it have possibly spread as I slept)?  I know you recommend doxcycline, but I'm allergic to tetra and minocycline so I assume I'm allergic to that(I get hives). I've been on tablet erythromycin since June, w/ no improvement at all, but the dr tells me to keep taking it.  I also have heard about metronidazole.  Is better than clindamycin, as that's what I am taking now, but my dr hasn't told me to put it on my temples.
I'm very sorry for the length of this inquiry but I am miserable and desperate.  
Thank you so much for your time.

[Alan Rockoff, MD]

In the hierarchy of steroids, Valisone isn't that strong.  No need for misery and desperation.  Metronidazole is a good idea.  I'd get off the steroids as soon as you can, if you haven't already.  

I have rarely if ever seen true allergy to minocycline and tetracycline--are you really sure about that?  Even if you are, doxycycline is a different animal.  Also, other antibiotics like amoxicillin may help.  Oral medication will speed up your healing by a lot, and you shouldn't need to use it more than 4-6 weeks, if that.  So don't rule it out, is my advice.

Best.

Dr. Rockoff