perioral dermatitis, eczema or what?

[desperate1]

I have an area on my face on the right side only that is red, itchy and flaky. It seems to start as small red bumps that spread from one area of my face and infect just the same localized area to remain red itchy and flaky. It effects the area of skin beneath my nose and around the side of my face but not my chin. This is the same area that I was prescribed lidex to use. I only used it a few times and that was 5 months ago. I used it on my neck.Since then I used erythromycine topically for 6 wks and it seemed to make it redder and peel. doxycycline oral tablets produced extreme flaking and was discountinued after 10 days.I was told to use ecurin soap and moisterizer and broke out in a rash so severe all over my face and neck I was given predisone for 10 days. It cleared everything up until the last day. The bumps appearred and the cycle repeated. I used nothing and suffered until my skin looked purple and I went to my derm again. I was given in the last month floucinolone acetonide ointment .025. This seems to lessen the itching and lessen the redness but the patches remain discolored. I used this for a week. Then stopped, then have used it for a few days with roughly a week between uses. It still doesn't totally clear it up. I was presribed with perioral dermatitis and have been on tetracycline 500mg.once a day for 3 weeks and 3 weeks at 250mg. Is this a super infection caused by the erythromycin, is it eczema. The area on my face is larger than my fist. I am so worried I am being mis-diagnosed. I see no end in sight. I did patch testing and I am allergic to molds, grasses, NEOMYCIN which was given to me initially in several medications and baslam of peru.That is why the ONLY medication that has given me some type of relief was the fluocinolone because it has fewer ingregients for me to react to.My neck has the same problem but does not get bumpy, just red but does not peel.I have tried every lotion under the sun and aveeno baby moisturizer for eczema seems to work until the bumps and redness start then nothing can give me relief from the redness, itching and spreading. I use zyrtex and quit all other forms of medication 3 months ago including birth control pills, rhino cort, advair and I use albuterol maye twice a month. My symptoms started around the same time I was first prescribed rhinocort. The only other thing that relates is close to the same area that this originally started on my face I plucked my facial hair by my lip in that same area. It has spread from that original site and seems to start in the same area first and spread to surrounding areas. I think each medication used topically has only made it worst. Elidel set my face on fire, same with pramosone and even plain hydrocortisone.
Any advice would be greatly received.

[Alan Rockoff, MD]

You will do fine.  It sounds as though you have steroid-induced perioral dermatitis.  When you use strong stroids on your face, they seem to help, which makes you want to keep using them.  Then as soon as you stop, your skin gets much worse.  I'm pretty sure that's what happened with doxycycline, because that drug does not "produce extreme flaking."  Anyhow, tetracycline should work too, but it often takes 4-6 weeks.  So please stay the course and please don't use any more steroids on your face, weak or strong.  Ask your doctor about considering the addition if tacrolimus ointment, a non-steroid.  But you should clear up anyway, and once you do, you should stay clear, since perioral dermatitis is not a recurring condition most of the time.

Take care.

Dr. Rockoff