treatment for perioral dermatitis

[9magnolia]

Dear Dr.,

I'm female, 25, and have been having a nasty skin rash (redness and red bumps) under my nose for the past 10 weeks and I finally went to see a dermatologist who told me that I have perioral dermatitis.
She prescribed gen-minocycline (pills) for three weeks and an acne cream neo-medrol.
My question is: Is three weeks of antibiotics long enough?? I did some research on the internet and it said almost everywhere that 1-2 months of anticbiotics is required, otherwise the rash will come back or not disappear at all.
Also I was wondering why my dermatologist prescribed an acne cream. The rash is still as red as ever. If it's not acne but perioral dermatitis, why an acne cream?  
Is there anything else I can do in terms of my lifestyle that might help the condition? e.g. I've been on the contraceptive pill for the past 8 years. Should I stop taking the pill?

Thank you very much for your help. I'm very depressed about this. I've always had clear skin and the rash is very noticable.

A.

[loiloi]

Hi. Peri-oral dermatitis responds well to a 12 weeks course of either minocycline or oxytetracycline. The best contraceptive pill to take is Diane35 (also called Dianette) which contains an oestrogen and cyproterone acetate. If your doctor feels you warrant both the pill and oral antibiotics use a condom as there is a theorectical risk that tetracyclines will reduce contraceptive effectiveness of the pill.
Do not use a steriod cream as although this will initially settle the redness it will aggreviate acne and rosacea.
Eloise.

[Alan Rockoff, MD]

No reason to be depressed.  You should be pleased that you have a condition that should be able to be knocked out in relatively short order.  Having said that, I agree that 3 weeks is a bit short.  It usually takes a month, or perhaps 6 weeks.  If it's not clear by then, you might need a refill of the antibiotic.  As to the cream, we use acne and rosacea (perioral dermatitis is a form of that) interchangeably, though it's the oral component of therapy that's most important.  I am perplexed, however, at the choice of neo-medrol, which sounds as though it contains a steroid, and steroids perpetuate perioral dermatitis.  I think you should check with your dermatologist both about the duration of minocycline and the choice of cream.  At the end of the day, you should be completely clear, though.

Best.

Dr. Rockoff