Pustules around lips - can these be ingrown hairs?

[sean113]

Doctor,

I am a 24 year-old male. For the past 7 years, I have been experiencing whiteheads around my mouth, especially along the vermilion border. Blood tests have consistently come back negative for HSV-1 and 2, as well as all other STDs. I experience a new outbreak (usually an individual lesion on some part of the vermilion border) every two weeks or so.

After seeing several dermatologists and trying all sorts of topical creams/ointments (metrogel, elidel, clindomycin, etc.) and various tetracycline antiboidics (tetra, mino, and doxy), my current dermatologist diagnosed me with perioral dermatitis and prescribed Sulfacet-R, which basically made these pustules cease for about 18 months.

This past winter, the medicine suddenly stopped working, my refills were of a different version of sulfacet-r (it is now more of a clear ointment in a tube, whereas before it was a tinted cream) and I cannot get the old Sulfacet-R back, as my pharmacy said it has been discontinued. Further, the new Sulfacet-R is extremely drying on my skin, and I cannot continue treatment with it (the skin cracks/begins to pus).

Consequently, I am again experiencing the outbreaks. I am wondering, is it possible what I am experiencing is in fact a reaction to shaving? Could these pustules be ingrown hairs? They certainly look like them, as they are whiteheads that often grow a single hair out of them when fully formed. If so, how long might I have to go without shaving to notice a result?

[Candyland0103]

Ask to add an antifungal (oral pill RX only) to ur regiment- after 10-20 Days, I bet you'll be jumping for joy

[Dr J Singh]

Hello,
Perioral dermatitis like acne is a chronic papulopustular and eczematous facial dermatitis. It mostly effects women and appear around the nose, mouth and eyes. Treatment consists of oral antibiotics and anti-inflammatory drugs. A mild soap or soap substitute, such as Dove or Cetaphil should be used for washing. Scrubbing should be avoided.
Doxycycline is the preferred antibiotic for perioral dermatitis but minocycline can also be used. In unresponsive and granulomatous forms, oral isoterinoin may also be considered. Pimecrolimus cream can also be used. I suggest you to consult a dermatologist and discuss these treatment options with your dermatologist.
I hope it helps. Take care and regards.

[Silverdiog]

I have the same thing and have tried all those antibiotics, creams, and liquid roller acne fighters. Nothing has worked. I've been to four dermatologists and all of them prescribe the antibiotics first and then all of the creams and oitments... now what? Thanks

[sean113]

I have not considered electrolysis, though I would certainly be open to laser hair removal or any other removal of the hair follicles along the vermillion border.

My hair is not very curly. I am a white male, and my hair is thick and dark.

I do try to steam my face once in a while, though I just place my face above a pot of boiling water so as to open the pores. I am apprehensive about using a compress, as I don't want to have a wash cloth or anything else directly on my face. I suppose I'm just nervous about any bacteria that might be spread around that way.

The pimples vary in size, but they typically turn into whiteheads which become quite large before popping (in the shower, or by me with a sterilized needle). I would say that on average, they are about 1/3 the size of a pencil eraser. (I don't have a more precise measurement) I have had the popped lesions cultured, and every test comes back negative/inconclusive. I really don't think this is viral, and the previous efficacy of Sulfacet-R antibiotic lotion on the face suggests that the ailment is in fact bacterial.

Based on what little I know, it seems like it would be folliculitis. I do get these whiteheads on other parts of my mouth, though they are primarily along my lips.

Thank you for your help.

[NurseCEE]

Have you thought about having electrolysis in the area, removing that hair shaft so if ingrown hairs then--voila--taken care of. Have you tried temovate for folliculitis? basically that sounds like what you have, but I am not a physician, and I do not diagnose, I can only give advice as a nurse. Do u have curly, coarse hair? What about your face/ any folluculitis like around your lips?  I am brainstorming here. What about facial/go to spa for treatment, steam room, steam those plugged pores open around that verm area so the hair can make it way to surface without irritating inflammation---even steam from really warm cloth over the area every couple nights. Are the little pimples hard? Soft? How large?? Sounds like that gel as too much drying alcohol in formula. Have you had the fluid in the vescicle  cultured? Viral as well as bacterial? There is an old med called Kenalog comes to mind for some reason, a relative had similar problem and used kenalog ointment, it is beige/tannish brown, sounds like the ointment contains similar ingredients to what you used.  I love dermatology, hate those little irritating bumplets (my word) that tend to make me feel less than beautiful or in your case HANDSOME. We all deal with such in one way or the other, as only complexions in MAGAZINES ARE AIRBRUSHED PERFECTLY.  See another dermatologist until you get it right. I will do some quick research in my books and get back to you on this also. Do answer my questions--so I can find some answers for us.