To think this is the wrong treatment for Perioral Dermatitis?

[Ihatephilnholly]

My (adult) daughter recently had a breakout on her face, red scaly itchy skin around her mouth and nose and gradually creeping up towards her eye on one side.

She had the same thing a couple of years ago, not nearly as bad and went after a couple of weeks.

This time it was so bad she went to the gp. Ist visit they prescribed Fucibet, a steroid cream. She used the cream for months but when it didn't clear up and began to get worse she returned to the gp, only to be told by a different doctor that a steroid cream was completely the wrong treatment! They prescribed Duac cream instead. This has been a disaster, causing her skin to crack and flake off like really bad dandruff. She's stopped using it now but is in despair as to how to treat the condition.

Does anyone have any experience of perioral dermatitis, how do you treat it, has it cleared up? Anyone successfully used Duac, if so how long did it take to settle down? Thank you.

Sorry can’t help but watching. Dd given some thick Vaseline type cream from docs but doesn’t really do much.

Yes, i have had this three times. Caused by oily foundation 2nd time and retinol the third time.

I didn't use any medication and this is how I cleared it up the last 2 times-

Whilst there are small "pustules" (bumps) DO NOT MOISTURISE. in my experience any form of moisturiser just made it worse and lengthened how long it took to clear up. Flaking is the skin healing. She needs to let it all dry out.

Foundation - beautifully matt no7. Good to to cover up but also has a drying effect. Does cause skin to flake off. Speeded up healing time.

Only when there are no pustules left, only then, then moisturise with something simple and thick like nivea creme in the blue tin.

Also used teatree to help dry up the pustules.

Honestly I really think you just need to get through the flakey stage. I was glad to be wearing a covid mask everywhere last time as it makes you so self conscious.

Good luck to her

There is also a useful Facebook group with thousands of members. Worth joining if just to check what she really has is perioral derm as it cash be misdiagnosed.

Is it definitely perioral dermatitis? I had a similar, awful rash that had weeping spots, that went from my mouth, over my cheeks and up my nose and between my eyebrows. The doctor questioned if it was shingles at first, so did 3 courses of antibiotics. I was eventually diagnosed with rosacea and use rozex gel.

Steroid creams are a definite no on the face. It was a really miserable time and took a long time for mine to heal. I do occasionally have small breakouts but the rozex seems to help. Although I do have redness in the area (probably only noticeable by me).

I had this (happy to send a pic). It was plain old acne and antibiotics + spironolactone sorted it

Perioral dermatitis is a poorly understood condition and can be stubborn to treat, even if you see a good dermatologist it can unfortunately involve trial and error.
I’d agree with the Doctor that steroid creams are known to worsen perioral dermatitis!

Sometimes antibiotics or azelaic acid can help. Also, less is more with skincare products for perioral dermatitis - my skin can’t tolerate anything too occlusive or too many products. My skin has never fully returned back to normal once I developed it (as in if I use too many products or something occlusive I can flare up).

DS had this when he was very small. He ended up seeing a specialist at GOSH. He was prescribed a long course of antibiotics and a topical cream called cetraben. We were advised the steroids the GP prescribed had exacerbated the problem.

Lymecycline capsules, 408mg x 2 a day for a month (408mg is a weird weight but I am reading it off the packet right now!) and topical zineryt. Ask the doctor for either of these things but ideally both together!

Lymecycline worked for me. Have had it several times, lymecycline worked every time.

Steroid cream can cause PD, probably the only thing that will get rid of it is tetracycline antibiotics (there are several others that can be used) for approx 4- 12 wks. There is a chance the steroid cream she has been using may cause TSW (steroid withdrawal) for a little while in which case her skin may cycle thro flairs of burning red rash which then flakes but it should go after a time. Go back to drs and ask for the oral antibiotics, she should be able to moisturise as usual if on them - if they push back advise it’s affecting mental health - I wish her all the best with it 💐

Steroids made it better for me for a couple of days, then much worse. Only antibiotics cleared it up. Definitely push for them.

Mine cleared up instantly when I changed toothpaste to one the dermatologist recommended.

Rosex cream ( metronidazole) clears up my personal dermatitis and keeps it at bay as long as I use it regularly.

Lymecycline is the only thing that definitely works for me. I can do anything to my skin in terms of make up brands etc (I have used retinols for 10 years) as long as I take this occasionally. It started sometime after my first pregnancy 20 odd years ago.

I suspect mine is from dermadex mites. A certain amount on skin are normal but too many are now suspected of disrupting skin condition. There is a belief that peri-oral dermatitis and rosacea are linked to the skin mites (I’ve read a lot, who knows…). Either way oral antibiotics work for me every time. Sadly (but understandably ) they are not readily prescribed. The first gp gave me a repeat prescription for two years, it was heaven. My skin was perfect.

It takes 6 weeks to kick in, for me, and it looks a lot worse for the first few weeks so you have to stick with it for 4 to 6 weeks to be sure it’s working.

Steroids make it worse. Fungicide does nada. Tea tree oil may work but the drying effect was so bad I gave up after a week (maybe putting on less would work).

I’m currently trying a topical antibiotic as my gp won’t do oral antibiotics again without me trying an alternative. I’ve used azelaic acid and niacinamide acid, it slowed the reoccurrence but didn’t stop it. Apparently it works for some.

If your daughter can’t afford a dermatologist then try either Skin+me or dermatica. She’ll have to describe her issues (online) and send photos in. They (online dermatologist) will prescribe something with azelaic acid or similar. The subscription will be about £20 a month but you can control how often the tube is sent out. Alternatively try an online pharmacy (Superdrug do it) and order Soolantra - that is meant to work for many people, I plan to try it next if the metronidazole doesn’t work and my gp won’t then prescribe Lymecycline.

Again though - tell her not to give up on something until she’s tried it for 6 weeks.

La Roche Posay and cerave won’t help it but are good brands that I find don’t make mine worse.

Good luck

Mine was toothpaste related as well - I switched to a fluoride free toothpaste and it cleared up in a couple of weeks (after previously being prescribed and trying topical antibiotics). I also can’t use anything harsh on my skin, even azelaic acid which I used to be fine with, so I’d go carefully with trying lots of products. I use a super gentle cleansing balm and moisturiser now, nothing else, and my skin is pretty clear.

Thank you all so much for your replies, I'll pass them on to her.

Sometimes antibiotics or azelaic acid can help.

Both of the treatments the OP's daughter has been prescribed contain antibiotics (fusidic acid in the first and clindamycin in the second). Fusidic acid resistance is quite common, especially in Staphylococcus. Clindamycin resistance is less common but does occur. I'd have thought a bacterial infection that doesn't respond to topical antibiotics would be treated with oral antibiotics, but there's always going to be a problem with clearing infections in areas that are inflamed (hence the steroid with the antibiotic in Fucibet) and repeatedly exposed to microorganisms (hence the antiseptic in Duac).
Unfortunately, she's going to have to keep going back to show the treatments aren't working. I had something similar a few years ago when I had conjunctivitis, which the GP treated first with a steroid and then with an antibiotic, both of which made it worse because it turned out to be a viral infection that cleared up by itself once I was referred to an ophthalmologist who told me to stop putting drugs on it.

The steroid cream didn't touch mine, I was given a month long course of antibiotics - which I thought was crazy at the time,.but 4 years on and I've never had another breakout.

DS15 suffers with Peri Oral Dermatitis, the only thing that clears it up is Timodine prescribed by the GP.

We tried absolutely everything before hand, so DS was over the moon to find something that stops it as soon as it starts.

Azelaic acid clears mine up every time.

Are they absolutely sure it's peri oral? DS (then aged 15) had terrible red, scaly, pustules etc mainly round his mouth and spreading upwards. Was prescribed several combination creams for several months. In the end a different GP (after deciding to refer him) took treatment back the simplest level and prescribed simple clotimazole cream. Cleared it all up in under 2 weeks. It's never come back. Interestingly though he was dx with a different autoimmune disease 2 yrs later.

I have suffered for over ten years with this and the only thing that has cleared it up is a course of anti-biotics. Doxycycline - normally for a month at a time and it gets rid of it. I was told not to take steroid creams as it made it worse.

Echoing other people who have said to be sure that it is actually perioral dermatitis.

It’s interesting that you liken the flakes to dandruff, because my ’perioral dermatitis’ turned out to be seborrheic dermatitis - the same condition that causes dandruff on the scalp. I don’t suffer from dandruff and it was only when I developed matching patches behind my ears that I realised what it was.

I treated mine with a dandruff shampoo containing ketoconazole (I use Nizoral) which I used as a face wash and a non-steroid cream called Sebclair which I still use daily.

Mine responded really quickly, within 24 hours of washing with the ketoconazole shampoo, and has been kept at bay.

Prior to that discover I had some success treating mine with a total amnesty on all make up, moisturisers and skin care products. Once the flakey, dry, itchy stage had passed it would clear up. However it was not a fun few weeks whilst that happened and it would start to creep back as soon as I so much as applied a moisturiser or suncream.

I had BAD perioral dermatitis and nothing the doctor prescribed worked.

But I found a cure! It is Weleda’s Calendula face cream, and/or Weleda’s Calendula nappy cream (applied on the face, obviously). This cleared up my perioral dermatitis completely. The nappy cream was good for caking it on thick at night, and the cream is really more of a salve, which I used in the daytime. You have to keep it on really thick, all the time for a week or so, and it should clear up.

There have been a few times when I’ve been stressed and a bump or two cropped up, but I immediately apply the Weleda’s Calendula cream again and the bumps go away without ever turning into an outbreak.

Please get some today. This cream saved me. I was so devastated by my perioral dermatitis that I was suicidal at one point.

I tried other products containing calendula, but the Weleda face cream and Weleda nappy cream seemed to be the most “pure” form somehow. Maybe there is some other ingredient in it that makes it so effective. In any case, it is inexpensive and cured my p.o.d.

I’ve suffered with this for years. Avoid toothpaste with sodium lauryl sulphate, and hydrocortisones on the face will make it worse.
mine seems to be triggered whenever I go away on holiday and stay somewhere other than home, which is very inconvenient!
I’ve made a note of some of these antibiotics and also bought the cream recommended so thank you previous posters.