follow up question--treatment of perioral dermatitis--neo-medrol

Dear Dr.,

Re: “I am perplexed, however, at the choice of neo-medrol, which sounds as though it contains a steroid”

Thank you very much for your response. I spoke to my dermatologist and I have a more detailed question now for you. She  is always  in a rush and I feel that it might be good to get a second opinion.

As I said last time, she prescribed gen-minocycline (pills) and a cream called Neo-Medrol which does indeed contain a steroid. She refuses to prescribe me any other cream. After all I've read about steroids, I'm really not sure if I should follow her advice and use the cream. She said the steroid is  mild/the quantity is low and that's why it's ok to use it even for several weeks. What would you recommend? Should I use the cream at all or just stick with the oral antibiotic minocyline? Is there any other cream you know of that I don't need a prescription for? I'm really not sure about Neo-Medrol. I know what happened last time when I used  a hydrocortisone cream...

Here are the specfic ingredients of neo-medrol. Please let me know what you think. Thanks a lot!:

Methylprednisolone acetate 2,5 mg (0.25 %)
Neomycin sulphate
(equivalent to 1,75 mg neomycin base) 2,5 mg
Aluminium chlorhydroxide complex 100 mg
Sulphur 50 mg
Preservatives:
Methylparaben 0,2% m/v

Butylparaben 0,3% m/v

Thanks very much!!
A.

[Alan Rockoff, MD]

If your diagnosis is indeed perioral dermatitis, my opinion is that a cream containing a steroid should not be used.  Topical antibiotic creams (metronidazole, azelaic acid, clindamycin) are usually prescribed as adjuncts to oral antibiotics, but I'm frankly not sure they add much.  Certainly oral antibiotics are the most important part of treatment.  Cream containing steroids are likely to perpetuate the problem.  You might be better off just using the pills.  That's the most I can say without having seen and diagnosed you myself.

Take care.

Dr. Rockoff