small red spots under mouth

I had a red spot pop up just under the corner of my mouth that was followed by some more. They have no texture; there is no burning or itching, and no dryness. After this, the area around my nose became quite dry and bumpy as well as the skin between my nose and mouth but I still didn't experience any sensations other than dryness. These dry areas weren't red, they were slightly pink but basically skin colored.

I went to several different doctors and they all told me I have Peri oral Dermatitis. I was prescribed Metronidazole at first and with no luck. The dryness slowly got worse and the red spots were not going away. I used Phisioderm to wash my wash my face and the dryness disappeared in a few days but then came back just as quick.

After seeing a dermatologist he prescribed me Doxycycline for 1 month and an ointment made of Clindamycin 2%, HC 1% in 80% h20 and 20% isopropanol. This ointment took away the red spots before I even started the anti biotics but once I ran out, the spots came back again... After this, I started Doxycycline and the dry spots disappeared but it made my face break out and a few days after finishing this treatment, the small red dots below my mouth are returning and it's always in the same area!

What is this and how do I get rid of it!?

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum!

Bilateral (almost symmetric) discrete erythema (redness), accompanied with dryness and papules (small “bumps”) in perioral and perinasal region is most likely Periorificial dermatitis. Potential differential diagnoses include Acne rosacea, Seborrhoic dermatitis, Contact dermatitis, Lip-licking dermatitis, etc.

The main thing to know about Periorificial (perioral) dermatitis is that it can be caused, and is always aggravated, by the use of topical corticosteroids. So, use of corticosteroids is contraindicated.

Also important, and quite encouraging, is the fact that perioral dermatitis is mostly a self-limiting disease that evolves during several weeks and resolves over several months, rarely longer.

In regards to treatment, first line of therapy would be topical metronidazole concurrently with oral tetracycline, or doxycycline or minocycline for 2,5 – 3 months. Systemic erythromycin is recommended in children, pregnant and nursing mothers and tetracycline-allergic patients. Second line of topical therapy could be erythromycin, clindamycin, azalaic acid or sulfur preparations.

In addition, it is recommended to reduce use of cosmetics and make-up and avoid introduction of new skin care and oral care products. The goal is not to irritate skin, trigger allergic reaction or simply prevent further damage of skin barrier function and consequent dryness and sensitivity.

Wishing You Optimal Health,
Dr. Jasmina Jankicevic

[lynnragle]

I have the exact same thing on my face and as soon as a I a couple days break from the scaly bumpy rash it comes right back again. It is embarrassing