Perioral dermatitis; questions!?

[bluesky]

Okay, so I think in general there could very well be an entire forum dedicated to perioral dermatits, as overall info is just scattered everywhere, and it seems most people who have it are either totally confused, overwhelmed, as nothing they try helps, or they don't know what products to use how to use them etc. OR they take antibiotics and it just goes away forever. I so wish I was apart of the second group! Anyway, I think it'd be helpful if all those with perioral dermatits now or in the past could post the products they use or found helpful, how they use them, and what helped/cleared the dermatits.

Firstly I have a question, for those of you out there do you apply moisturizer on your dermatitis areas just like you would elsewhere on your face??

My primary area is my upper lip and at times I wonder if by not moisturizing it like I do the rest of my face it worsens it, but then at the same time I get worried that the moisturizer on the rest of my face migrates to my upper lip during sleep etc. and worsens it! Its so confusing and very frustrating!! Also, do you cleanse the area w/ cleanser just like the rest of your face?? I normally don't because again I'm really scared of aggravating it with products. Also, how do you all remove your makeup?? I hate doing things that cause irritation to my face in general because again feel like it's worsening it.


Okay, so as far as the "products" I use-

toothpaste- jasons powersmile, although sls and fluoride free, I wouldn't suggest it, it has a VERY intense mint flavor that is potentially irritating to the POD, and I'm intending to switch to Toms of main clean & gentle, sls free toothpaste, SPEARMINT flavor (the other flavor isn't fluoride free) which is reported to be much milder tasting.

P.S- This is on sale right now; its better to buy it cheap here or from vitacost.com etc. as my local health food store charges 8$$ for this toothpaste

http://www.drugstore.com/products/pr...BUY-PLST-0-CAT


cleanser- I use presently skinmedica cleanser which is nice, but does have sulphates in it, even if not SLS, also because I'm on accutane it's not as gentle as I'd like but it does it's job. I'm still on the hunt for a nondrying gentle completely sulphate free cleanser.

moisturizers- I use presently cetaphil cream which the petroleum in it makes me nervous so I'm still on the hunt for this too, considering emu oil or md forte replenishing cream which is petroleum free

makeup remover- presently i have to use olive oil, going to try jojoba though as olive is just way too thick and leaves a very heavy film.

makeup- still hunting for this too, my skins too dry for most everything so

Also- I have not cleared my dermatitis yet, I'm on accutane so while 85% cleared (it was VERY bad before though) its still not gone, I'm thinking I may need to take a round of antibiotics when I get off accutane. It stinks though, I thought accutane would clear it up!

[JennaB]

This is a great idea bluesky. I can understand being overwhelmed with PD. I know I sure am at times. Honestly seems more reactive than my rosacea flushing at times

I had to stop using sunscreen because that seemed to provoke it. Going to try to find a better sunscreen...so right now no sunscreen. But I avoid the sun like the plauge anyways

I just recently started introducing a cleanser again after a couple months. I am using Eminence sweet red rose cleanser. Feels like silk going on and afterwards my skin just looks more balanced. Around my PD areas (mainly my nasal folds and chin I barely use any cleanser) This cleanser seems to work perfectly so far. But I alternate between just using this and luke warm water.

I always use a microfiber cloth now too and my face just feels cleaner with this.

For moisturizer I have been using pure virgin coconut oil (I do not put this at all on my chin, I keep all sorts of moisturizers of the chin area because I can get really bad acne there, like one or two huge bumpies every week or so! But since I stopped moisturizing there it has cleared, I also think the meds have helped with it too) But put it everywhere else and it seems to work wonders (I have been using this for over 5 months now) I also use it on my body and I rarely get itchy legs anymore. I used to get itchy so bad on my legs that I would sratch myself until I bled. I know disgusting right? Just couldn't help it Maybe it is eczema on my legs or something but all I know is this coconut oil has been a God send. Use it in my hair too sclap treatment twice a day and my hair looks amazing! Ok that is enough about coconut oil! I also use a couple Eminence moisturizers for my face that I use when I do not feel like using the coconut oil. I use the eight greens whip moisturizer and mango night cream. My skin seems to love it so no complaints. PD doesn't act up and neither does my rosacea beast!

For toothpaste I am using this all natural organic one which is sls and fluoride free and it is green apple flavour because my PD does not seem to like mint.

Now since I developed the PD and the rosacea, I stopped all my make up use! Now I am just starting to venture my way into these waters again. Which I am terrified of because my skin is just reactive it seems to most anything but I went to Sephora the other day and got some samples of Laura Mercier tinted moisturizer and the primer. Haven't tried them yet because I am a terrified baby I am thinking this weekend will give them a try. I'll tell you how it goes. I also use under eye concelor and brow powder by benefit. That is it for make up. I like to keep it simple.

I also am taking minocycline 100 mg a day. Almost for 2 months. I am going to go off of it though pretty quick because I just feel things are in control. I guess we will see how it goes.

I really hope other people respond to this thread! Because PD is so scary and I am constantly questioning myself over things...like moisturize? not moisturize? Cleanse? not cleanse? sunscreen? no....well you get the point!

Hope we can help each other!
Jenna

[Erikson]

STOP using toothpaste with flouride!!! It has worked for me, no more bumps around my mouth!!

[JennaB]

We both have stopped using toothpaste with fluoride and sls in it. Wish it was that simple.

[bluesky]

Same here Jenna, if only it was as simple as discontinuing w/ SLS & fluoride toothpaste, mine would of been gone months ago! Your lucky Erickson!

Oh- jenna, thanks alot for your reply, I hope in time we can build this thread up and hopefully others will contribute to it as well.

I know exactly what you mean btw when you said "Because PD is so scary and I am constantly questioning myself over things...like moisturize? not moisturize? Cleanse? not cleanse? sunscreen? no....well you get the point!" this is a daily thing for me!! LOL!

From what I gathered from your post btw you apply cleanser to your affected areas but not much?? And thanks for listing all your products, are you in the USA as most of them look unfamiliar to me. Oh- what about your upper lip btw (area above the lip) do you apply your moisturizers there??

You're right to say mint is aggravating to POD, which is why I can't wait to switch out my toothpaste, I might test out a kids SLS and fluoride free one too if I find this other toothpaste too intense a flavor!

Makeup is so hard for me too! Let me know how you get on with the tinted moisturizer and the primer. Is it the moisturizing primer?? I'm actually thinking of trying some Laura mercier silk creme foundation in the future but it's scary and I need to get a sample of it at sephora.

Would you say so far the minocycline has helped the POD alot?? I think accutane has helped mine quite a bit but like I said in my previous post its still not 100% gone, more like 80-90% depending on the day but its so aggravating that I'm still getting this stupid rash and bumps all over my upper lip, I just want it gone!! Rosacea is enough on its own!!

[JennaB]

I am just so happy to be conversing with another person who has PD! So you are just going to have to excuse my extreme excitement lol.

The cleanser that I mentioned to you (the sweet red rose by eminence) you can find on dermstore.com but other than that you can only get them at spas that sell the Eminence line. The line is expensive but it is the only thing that hasn't affected by rosacea/PD/extreme sesitivity/God knows what else I have wrong with me (totally just kidding a round but that is how I feel some days with my freak skin) It is all organic and natural. I would recommend checking out a spa and going there and explaing your skin and your problems and how you would love to try some samples. This is what I did and one of the facial ladies gave me like a ton of samples. Make sure you explain about the mint aggrivating things too. Also, what is great about this line is the samples last because you have to dilute everything with water. But yes I only apply the tinest amount of cleanser to my PD areas.

With Moisturizer I do apply only a little in the upper area of my lip just below my nose. Like I will apply the moisturizer everywhere else on my face and then usually I will just pat with my fingertips whatever is left on them over my PD areas (I hope that makes sense )

Well the mino has sure helped with most of the bumpies! But I am sure by many people's opinions I didn't have it bad but I noticed it and they just wouldn't stop. I couldn't get it under control. But yes I feel like the mino has helped with those bumps that just look like these tiny patches of rash! So annoying. I still get one or two tiny pin sized spots here and there in my PD areas but I am learning to accept them because I just think they are going to be kicking it here on my face for awhile.

Oh the makeup issue I went into Sephora and talked to one of the nice helpers but I explained how I wanted the oil-free version but she thought I should go with the regular version. Not too sure how I feel about this. I am thinking I should have really pushed the oil-free version. Please tell me what you think!! Oh and yes the primer is the hydrating one Are you familiar with it? I just seriously don't like putting lots on my face....do you think the primer is really necassary? Are you wearing makeup or anything on your face currently? Or since developing PD?

Where are your main problems with PD? Just the area above your lip now? Moisturizing is such a tricky thing because if I don't moisturize my skin get dry and start peeling on my cheeks. Plus PD can get flakey too at least when the bumps dry up and just disappear (is it like that for you too?) Too right you are with the rosacea being enough on its own...then through this gorgeous bumpy rash into the picture!

I am from Canada actually! Really glad you responded back! I too hope that more people with come join this thread and offer their advice, opinions and support!

Hoping to hear from you again
Jenna

[Erikson]

Sorry u didn't see any results, I hope u find something that works 4 u!

[Brady Barrows]

Periorol Dermatitis is a rosacea mimic and is considered in a differential diagnosis of rosacea. "Perioral” refers to the area around the mouth, and “dermatitis” indicates a rash or irritation of the skin. Usually Periorol Dermatitis is characterized by tiny red papules (bumps) around the mouth. The areas most affected by perioral dermatitis are the facial lines from the nose to the sides and borders of the lips, and the chin. The areas around the nose, eyes, and cheeks can also be affected. There are small red bumps, mild peeling, mild itching, and sometimes burning associated with perioral dermatitis. When the bumps are the most obvious feature, the disease can look like acne.

Compare images of acne, rosacea, perioral dermatitis and other similar rosacea mimics. DermIS 27 Images.

A research paper in 2004 said, "However, it remains disputed as to whether PD is an individual skin disease or a subtype of rosacea in atopic patients." source

A dermatologist diagnoses perioral dermatitis by examination. No other tests are usually done. Sometimes, scraping or a biopsy of the skin is done. Occasionally, blood tests are ordered to eliminate other conditions that can look similar. A culture for bacteria may sometimes be needed to eliminate the possibility of infection.

Perioral dermatitis is a facial rash that tends to occur around the mouth. Most often it is red and slightly scaly or bumpy. Any itching or burning is mild. It may spread up around the nose, and occasionally the eyes while avoiding the skin adjacent to the lips. It is more rare in men and children. Perioral dermatitis may come and go for months or years. One of the most common factors is prolonged use of topical steroid creams and inhaled prescription steroid sprays used in the nose and the mouth. Overuse of heavy face creams and moisturizers are another common factor. Other factors include skin irritations, fluorinated toothpastes, or other dental fluorinated products. Some dermatologists believe it is a form of rosacea or sunlight-worsened seborrheic dermatitis.

Why perioral dermatitis occurs more frequently in young women is a quandary. However, it may sporadically affect men. Its exact cause is unknown. Perioral dermatitis is a difficult condition to treat effectively, often requiring several months of treatment.

"...A low-potency topical steroid may also be used to suppress the inflammation and to wean off the strong steroid. Perioral dermatitis in childhood is probably a juvenile form of rosacea..." source

Generally steroid use should be carefully monitored by you physician and not for long term use since this may lead to steroid induced rosacea.

Apparently the following study suggests that topical steroid use increases demodex mite density in perioral dermatitis

Density of Demodex folliculorum in perioral dermatitis.
Dolenc-Voljc M, Pohar M, Lunder T.
Department of Dermatovenereology, University Medical Centre Ljublana, Zaloska 2, SI-1525 Ljublana, Slovenia.

The role of Demodex folliculorum in perioral dermatitis is not satisfactory explained. Our purpose was to assess the density of D. folliculorum in perioral dermatitis and evaluate the relationship of the mite count to previous therapy with topical steroids. A standardized skin surface biopsy of the chin was performed in 82 female patients with perioral dermatitis and in 70 control female subjects. Patients who received previous topical steroid therapy had a significantly higher mite density than the patients who had received no topical steroids (p<0.001). In the latter group of patients, the mite density did not differ significantly from that of the control group (p=0.629). Mite density increased significantly with the length of treatment with topical steroids (p<0.001). Our results suggest that increased density of D. folliculorum in perioral dermatitis is a secondary phenomenon, associated with topical steroid therapy.
source

"Tacrolimus ointment is increasingly used for anti-inflammatory treatment of sensitive areas such as the face, and recent observations indicate that the treatment is effective in steroid-aggravated rosacea and perioral dermatitis." source

"Perioral dermatitis was diagnosed in 329 patients....In 80 patients demodex was discovered....Treatment with liquid nitrogen gives good results..." source

Besides perioral dermatitis there are many other rosacea mimics.

Sources

AAD
Dermnet NZ
AOCD
MedlinePlus


Perioral dermatitis in children.
Laude TA, Salvemini JN.
Department of Dermatology, State University of New York, Health Science Center at Brooklyn, 11203, USA.

Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis.
Dirschka T, Tronnier H, Folster-Holst R.
Dermatological Practice Centre, Wuppertal, Germany 2004

Perioral dermatitis (rosacea-like dermatitis)--adverse effects of externally applied steroid preparations
Urabe H. - 1978

The treatment of steroid-induced rosacea and perioral dermatitis.
Sneddon IB. - 1976

Perioral dermatitis and rosacea-like dermatitis: clinical features and treatment.
Urabe H, Koda H. 1976

Rosacea-like dermatitis of the face. "Perioral dermatitis"
Steigleder GK, Strempel A. - 1968

[bluesky]

Thanks Brady- I am well aware of all the technical info about perioral dermatitis- have had this condition for going on 9+ months so trust me I know way more than I ever want to know about it. LOL!

Jenna- I know what you mean about being happy to connect w/ another person who has perioral dermatits- I always feel like I'm the only one out there! I mean I know there are other people as I read posts from them but like I said everything I've read from people it's just scattered all over the internet and nothing is "community" based where you can ask people questions and talk etc!

I'm so glad the minocycline has helped you! What dose have you been taking and how long? I know it's annoying to still have traces of it though, I just want it gone!! I hate waking up every morning being scared to walk into the bathroom fearing that it will have exploded all over my face again!! Thankyou also for taking the time to answer all my questions, that's very much appreciated. I hope this info can potentially help someone out there too.

I looked into the cleanser you mentioned and your right it is pricey lol, but very pretty packaging! I can't seem to locate any spa etc. around here that carries it as I think it's a canada based product so my hunt continues. Overall I'm OK w/ my cleanser, it's probly the best I've used yet far but I would prefer something completely sulphate free, although it is SLS free.

I know what you mean when you talk about the moisturizer, Idk my skin seems to just flare so bad whenever I put moisturizer on my top lip vicinity even if only a little tiny bit, ! So I guess it's better for me to just avoid that area it seems, but it is confusing as I'm always like you going back and forth in my mind... cleanse, not to cleanse, moisturize not to moisturize! It drives me crazy!!! I was curious also as to what toothpaste you use btw, brand wise?? Also- do you use mouthwash ever??

Oh- and two other things I wanted to ask you just out of curiosity and interest as this is my first time conversing w/ another PD victim did your PD burn at all?? Mine burned REALLY bad, on a scale of 1 to 10 probably a 7. It was horrible! Sometimes it would tingle too but most of the time it just burned so badly! Okay- and last question- was your PD more like a rash or just little pimple like bumps?? Mine was more like a bad bad rash that also had little red bumps, but not really pimple like bumps if you understand what I mean? Lol!

Well, hope your doing good Jenna! Talk to you soon I hope!

best wishes!

[size2stilettos]

Hey girls sorry its been so long! Ive been crazy busy with uni work and have also been trying out some treatments and giving them enough time so I can report something back.

Ok so I STILL have P/D. No where near as bad as it was in October but if I use anything to oily/moisterising the redness and small red lumps all come back. I've been left with a really horrid facial burn that is mainly on my forehead and nose but can move around whenever it wants. I have been on Cymbalta since Christmas for this, starting at 30mgs and moving up to 60mgs in Feb. Unfortunately Im still getting some breakthrough pain so looks like I will have to go back to the Dr. I refuse to go back on Gabapentin as I put on a shed load of weight with it. Not cool Really dont know where to go next.

I have been on antibiotics for 3 months and it looks as though I will have to do a full 6 month. Scared ****less that when I stop it will all fly back on to my face. Since this begun I have only been using water or an emollient to wash in and only now have I been able to introduce Dove Sensitive cream bar in to my routine. However if I use it for example 3 days in a row my skin gets tight and the P/D starts up again. So I just use it when I really want a good lather.

Makeup touch wood hasnt been a problem. I started using it again since December but only mineral. I have also had to change my toothpaste, hairdye and I now le my face air dry instead of patting with a towel.

Triggers seem to be the cold. Im pretty fine in warm rooms etc but if theres a big change then it starts to burn all over again. Sunlight is also aking me very sensitive however that could be due to the antibiotics. Another thing which set me off a few weeks back was a fluid eye makeup remover so again I just use an emollient.

How's things doing with you guys?? Hope its alot better since last time!!! Any advice for me would be much appreciated. Also does yours burn still fromtime to time?? I cant belive I have been dealing with this for 7 months already. 6-12 weeks on antibiotics to clear my ass!