How Is Perioral Dermatitis Diagnosed
Perioral dermatitis is usually diagnosed by a dermatologist looking at its appearance, the location and distribution on the skin and by asking a few pertinent history questions, says Dr. Schlesinger.
He says that in taking a history, dermatologists can sometimes help patients identify their personal triggers, whether it be certain foods , medications , makeup, or fluoridated toothpaste.
Another common association is with chronic topical steroid use and it has also been reported after the use of nasal steroids or inhalers, says Dr. Schlesinger.
Topical And Oral Antibiotics
According to Zamani, first line treatments for perioral dermatitis often include one of the below options:
- ‘Topical antibiotics are helpful for their anti-inflammatory properties and can include metronidazole, clindamycin, and erythromycin.’
- ‘Topical sulphur preparations and azelaic acid gel.’ Several studies have found that azelaic acid is effective in treating inflammation.
- ‘Topical calcineurin inhibitors like tacrolimus ointment or pimecrolimus cream can be effective.’ A calcineurin inhibitor works with the immune system to block the chemicals that can contribute to a perioral dermatitis flare-up.
‘If topical therapies do not resolve perioral dermatitis, oral antibiotics can be added daily for an extended period of time,’ says Zamani. Patience is key, however, as topical therapies may not show peak efficacy for three months of daily use. ‘Oral antibiotics can be used for three months or longer if the symptoms are not controlled with topical therapies,’ adds Zamani.
What Are The Treatment Options For Perioral Dermatitis
A number of treatment options exists for perioral dermatitis depending on the severity of the condition. Eliminating exposure to possible triggers is usually the first step, followed by a 6 to 12 week course of antibiotics, usually doxycycline or minocycline. For mild cases of perioral dermatitis topical antibiotic creams are usually sufficient while oral antibiotics may be needed for moderate to severe cases. In cases that appear to have been triggered by topical steroid usage, a non-steroidal anti-inflammatory cream such as pimecrolimus or tacrolimus is particularly effective.
If you are looking for a dermatologist to treat perioral dermatitis in the San Diego area, call Dr. Melanie Palm at 858.792.SKIN to schedule an appointment to discuss your treatment options.
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What Causes Periorificial Dermatitis
The exact cause is not understood. A suggested mechanism proposes epidermaldysfunction as the primary disturbance, resulting in:
- Increased penetration of exogenous agents through the stratum corneum, triggering an irritation reaction
- Enhancing trans-epidermal water loss resulting in tightness and dryness, causing patients to increase use of topical products, leading to further irritation.
What Is The Outcome For Periorificial Dermatitis
Periorificial dermatitis, including CGPD, often runs a chronic variable course that may last months to years without treatment. Usually, there is no scarring or disturbance to skin pigmentation except in severe and lupoid cases.
With treatment, most patients recover well. If POD recurs when antibiotics are discontinued, or in the future, the same treatment can be used again.
What Does Perioral Dermatitis Look Like
Perioral dermatitis can initially present as small red pustules on the face, most often occurring around the mouth and nose, though patches of perioral dermatitis can be found around the eyes, elsewhere on the face, and even on the genitals. When the rash expands beyond the lower half of the face, it is then referred to as periorificial dermatitis. As the condition worsens, the affected skin appears red, dry and flaky.
What Questions Should I Ask My Healthcare Provider About Perioral Dermatitis
- Why do I have perioral dermatitis?
- Do I have perioral dermatitis or another type of dermatitis?
- Do you think this will go away on its own, or do I need treatment?
- What medications should I stop taking?
- What over-the-counter products should I stop using?
- Do I need to see a dermatologist?
- Are there any other specialists I should see?
- What treatment would be best?
A note from Cleveland Clinic
There are many types of dermatitis. Some have an obvious cause while others, like perioral dermatitis, are unclear. It can be frustrating to have a rash and not know for sure where it comes from. Although topical steroids is thought to be the most likely cause, there are a variety of other theories. Work with your healthcare provider to narrow down what the cause might be. This will help you and your healthcare provider determine a treatment plan.
Perioral dermatitis is common, and there are effective treatments. Dont hesitate to ask questions, follow your healthcare providers instructions and remember that your rash might get worse before it gets better.
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Diet And Lifestyle Modifications
Gluten intolerance is a known cause of flare-ups of Perioral Dermatitis.
To control and prevent recurrences, your diet needs more of:
- Quinoa and millets
- Excessively spicy and salty food
In your personal hygiene and lifestyle habits, you should:
- Avoid OTC steroid creams like hydrocortisone.
- Wash bath and bed linen like towels, bed sheets and pillow covers in hot water weekly.
- Not use cleansers with artificial fragrances or rough and granulated face scrubs.
- Shower with warm water, not too hot or cold.
- Not use too many oil based and heavy creams opt for water-based ones instead.
- Minimise the use of cosmetics, sunscreen and make-up items.
- Wash your face with a hypoallergenic and gentle soap only.
- Use foaming shampoos that contain sodium laureth sulphate
- Not scrub your face too hard.
Face Washes And Moisturisers
Use face washes that are non-foaming and free of sodium laureth sulphate. Moisturisers that are water based, lanolin-free and fragrance-free are best in this condition.
Studies show that squalane oil is an ideal moisturiser for sensitive, inflamed skin. The oil’s molecular size is identical to that of the skins sebum molecules. Thus, it is absorbed better and is also antibacterial and antifungal in nature.
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Deterrence And Patient Education
As previously stated, patients with perioral dermatitis should be made aware of the role of topical steroids in their disease process. In addition to the discontinuation of topical steroids or other triggering agents, patients should also be instructed to stop using all topical products except for their prescribed medication regimen. It is also important to impress upon the patient the time frame for treatment to remission, which could be weeks to months. The likelihood of chronic symptoms should also be discussed in detail.
How To Cure Perioral Dermatitis Fast With Antibiotics
I was 35 years old when I noticed a cluster of tiny pimples forming around my nose. I treated those little zits as I would any breakoutby exfoliating and slathering my face in creams.
The next day, the entire area was red and raw. In the weeks that followed, everything I attempted to clear my skinfrom facials to steroid creamsonly made the situation worse.
With the help of Google, I eventually diagnosed myself withperioral dermatitis , an inflammatory skin condition my doctor eventually told me could be common for women of a certain age. The small bumps I had mistaken for pimples early on turned out to be pustules. As they popped, these pustules spread the red rash and left my skin dry, red, and flaking.
For seven months, I searched the internet for natural remedies for perioral dermatitisessential oils, apple cider vinegar, an anti-inflammatory diet, switching to a non-fluoride toothpaste, tossing out my favorite skincare products, eliminating makeup completelynone of it worked. In fact, the rash just got worse, spreading around my nose and mouth and even up to my eyes.
That was when I knew ridding my face of this rash would require more drastic measures. I learned how to cure perioral dermatitis fast by swapping steroids and harsh acne treatments with antibiotics and an anti-inflammatory diet.
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When To See A Doctor
Before changing your skin care routine, its important to get a proper diagnosis of your facial skin rash.
A dermatologist can identify perioral dermatitis with a physical exam and provide treatment advice. Dont stop taking prescribed topical or oral medications unless your doctor tells you to.
Once you start treatment for perioral dermatitis, its important to stick with your treatment plan, even if you dont see results right away. However, if you see new or worsening symptoms after several weeks, call your dermatologist. Examples include:
The Most Effective Perioral Dermatitis Treatment
After a few weeks of tending to the issue in my normal manner of bathing my face in salicylic acid, I had come to the conclusion that this angry rash had only gotten worse. I took to Google and concluded that I had somehow contracted ring worm of the face. My solution? Athletes Foot cream. Yes, slathering Lamisil on the inflamed skin twice a day did lend a bit of relief. But then the rash just migrated to a slightly different location as if it was moving steadily toward the borders of my chin.
I broke down on my birthday and went to the dermatologist after six weeks of dealing with the rash. She immediately concluded it was Perioral Dermatitis, a mysterious rash with no known cause or cure . The doctor prescribed Clindamycin, a topical antibiotic, with no guarantees.
After several weeks using this rather expensive prescription lotion, I was not seeing any improvement so once again I looked to the interwebs for advice. Solutions varied widely. Many concluded that this rando rash was a reaction to a product. In order to find out which one, you would have to try the zero method and eliminate all products from your routine. Obviously, I would NEVER subscribe to such an insane method. But I did cut back on everything but the most basic: my ever-so-gentle Avene Hyper-Sensitive Face Wash and Moisturizer, the antibiotic lotion, and of course my makeup de rigueur. But the rash persisted.
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When Should You See A Doctor
If you suspect you have perioral dermatitis you should stop putting all ointments and creams on your face. This alone may improve the condition. However, it’s best to see a GP as soon as the rash starts in case it’s one of the other conditions mentioned above. Also, your doctor may want to prescribe antibiotics or another type of perioral dermatitis treatment.
Organic Olivia Parapro Formula
The supplements were originally formulated for the founder to clear her chronic cystic acne and to clean out any lurking pathogenic bacteria. Luckily, the cleanse felt mild. After 30 days, my gut felt re-balanced and my skin was still clear, flare-up free, and I definitely had more energy.
Then, I began exploring a new diet to keep my PD away. Miller recommended I change to an eating protocol of cooling, anti-inflammatory foods, as well as adding herbs to support my skin and blood, which she said are intrinsically related. I was desperate for my skin to stay clear, so I was game for anything.
diet should include a lot of leafy greens, broccoli sprouts, light grains, such as quinoa, sourced locally and organically. Unfortunately, with a leafier program, I also had to cut back on some of my favorites: alcohol, sugar, dairy, and processed foods.
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How To Cure Perioral Dermatitis Fast
Perioral dermatitis is a type of rash that can develop on your face, particularly around your mouth. Like eczema, this inflammatory skin disease may be long-term, or chronic. It also tends to recur without treatment.
The key to treating and preventing this red, bumpy, and sometimes painful rash is to use the right treatments. Prescription medications are the foundation of fast perioral dermatitis treatment. A dermatologist may also recommend stopping other medications and adopting a new skin care routine.
Keep in mind that this rash is treated gradually, with complete resolution expected between a few weeks and a few months.
Talk with a doctor or dermatologist about which of the following treatment methods may work best for your perioral dermatitis.
Oral antibiotics are considered the most reliable treatment for perioral dermatitis. These help to clear up any underlying infections that may be contributing to this rash.
To avoid antibiotic resistance, your dermatologist will likely recommend decreasing doses as part of your treatment plan.
An alternative to oral antibiotics for perioral dermatitis are topical versions. These take several months to clear up your rash but may reduce the possible risks and side effects associated with taking antibiotics by mouth.
Topical antibiotics may be prescribed in either cream or lotion form.
Granulomatous Perioral Dermatitis In Children
In otherwise healthy prepubertal children, a profusion of grouped papules may develop on the perioral, periocular, and perinasal areas . Eight of the initial 59 reported patients also had generalized lesions. Besides extremity and truncal lesions, several girls had dramatic lesions of the labia majora. Both genders are affected equally. Children with skin of color dominate the reports, but white patients are also susceptible. Because the histologic appearance is granulomatous, sarcoidosis is often considered. Topical corticosteroids, however, may worsen the condition, and systemic involvement is not present. Topical metronidazole, ivermectin, erythromycin, sulfacetamide-sulfur combinations, and an oral macrolide or tetracycline-type antibiotic all are often effective. In some patients, the combination of prednisone and dapsone has proved beneficial.
Bonus images for this chapter can be found online atexpertconsult.inkling.com
Christine A. Sorkness, Valerie A. Schend, in, 2008
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How Can I Reduce My Risk Of Perioral Dermatitis
Avoid topical steroids and face creams. See your healthcare provider as soon as possible after you notice symptoms of a rash around your mouth, especially if the rash causes itchiness and burning.
After the rash is gone, only use a mild soap or soap substitute when you wash. Dont go back to using products you used before the rash.
How To Prevent Perioral Dermatitis
While similar to perioral dermatitis in its appearance, rosacea differs in that it is a chronic condition with no cure. It may be tempting to treat rosacea with a topical corticosteroid, but there is evidence that use of steroid creams can actually make it worse and lead to corticosteroid-induced rosacea-like dermatitis . Perioral dermatitis can fall into the family of CIRD if topical corticosteroids are its cause. Therefore, it is important to not treat rosacea with a topical corticosteroid.
The management of rosacea is best done by avoiding triggers. Triggers vary for each person, so it is important to pay attention to what causes a rosacea flare-up. Potential triggers include:
- Skin, hair, or makeup products
If I knew the exact cause of my perioral dermatitis, I might be able to prevent flare-ups better. However, once youve had it, there is a strong likelihood it will return at some point. Knock on wood, Ive made it a year and a half without a recurrence so far.
The best thing you can do to prevent perioral dermatitis is to be gentle with your skin. And to see a doctor immediately if you start to notice a recurrence. The only real regret I have is not considering antibiotics for perioral dermatitis, to begin with. I wouldnt have had to hide my face from cameras or feel embarrassed to go outside for half a year.
If it ever does come back, antibiotics will be my very first course of treatment.
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How Long Will It Take To Get Rid Of Perioral Dermatitis
Expect gradual improvement. This rash tends to clear slowly. It may take a few weeks or a few months to clear completely.
If youre having trouble getting rid of a rash, you can find a board-certified dermatologist by going to: Find a dermatologist.
ImagesImage 1: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
Image 2: Getty Images
ReferencesChamlin SL and Lawley LP. Perioral dermatitis. In: Wolff K, et al. Fitzpatricks dermatology in general medicine . McGraw Hill Medical, USA, 2008:709-12.
Nguyen V and Eichenfield LF. Periorificial dermatitis in children and adolescents. J Am Acad Dermatol 2006 55:781-5.
Rodríguez-Martín M, Sáez-Rodríguez M, et al. Case letters: Treatment of perioral dermatitis with topical pimecrolimus. J Am Acad Dermatol 2007 56:529-30.
Whats The Best Way To Prevent Perioral Dermatitis From Coming Back
Even with the right treatment, perioral dermatitis may recur over the course of several months or even years.
Theres no clear reason or cause for perioral dermatitis, so most triggers are unknown. We do know that its more common in women, and researchers think that hormones may play a big role.
To keep perioral dermatitis from coming back, you can try the following strategies to see whether they work for you.
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Noble Formula Zinc Soap
Zinc is an essential mineral that is needed for numerous healthy bodily functions, including boosting the immune system, healing wounds, and assisting in DNA/protein synthesis and growth. Applied topically, it’s shown to aid in wound healing and regeneration as well as protect the skin by deflecting UV rays.
Back to my zinc theory. For me, its an essential supplement to ingest, but Ive also found that it helps my skin topically as well. Cleansing at nighttime during a flare-up with this has a tremendously soothing effect, and it really helps to banish the bumps.
Since I stopped taking antibiotics completely, Ive had a couple of flare-upsmostly during times of excessive travel, product testing, or drinking a little too much and slacking on supplements. For me, stress is definitely a contributing factor, but connecting with fellow PD sufferers helps me maintain composure without exacerbating the flare-up. Also, knowing that I have access to an effective arsenal of natural and store-bought treatments that work for me is comforting on so many levels.