Perioral dermatitis and possible bacterial infection

[SamK7]

Hello, I'm a seventeen-year-old female, very prone to atopical dermatitis, and I've had problems with what I assume is perioral dermatitis for almost two years. One doctor told me that it MIGHT be perioral because then it seemed mild, though he never prescribed me antibiotics just gave me one cream that didn't really help. Anyway, the area around my mouth is always dry if I don't use a moisturizer, and it seems it lost the ability to regenerate itself normally, and yes, I used corticosteroids around my mouth before this condition appeared which I stopped using about 7 months ago. Also, very often the lesions will appear around my mouth just like that, especially during night, which is definitely my biggest problem (just like in the photo I posted). Are these lesions typical for perioral? Given that it usually worsenes during night, I suppose it can be from chemicals from saliva or bacteria, no? Because, I don't touch my face, it doesn't itch.

http://img211.imageshack.us/img211/2779/dsc07355z.jpg

SECOND: From a recent skin analysis, they found that I have staphylococcus aureus on the very same place. I know staphylococcus lives on skin even in regular conditions but I also know I've had impetigo when I was younger. These lesions that I have now are so less troublesome; they don't spread on other parts of my body and they easily disappear too, but they eventually always return.

So, the condition around my mouth: can it be just bacterial or just perioral or BOTH? Both - because the skin is prone to bacterial infections in patients with perioral, right?

And third: a month ago, the skin on my neck, on forehead and eyes worsened too. I'm prone to eczema in those places. Sometimes, it awefully itchs unlike my mouth. Now the thing is, the lymph nodes in my neck have been swollen for over a month, and the last time I visited my doctor, he said it was probably because of that eczema-like thing on my neck. But, can that possibly have something to do with staphylococcus aureus too or it's just a normal eczema?  

http://img27.imageshack.us/img27/1499/dsc07357x.jpg

Tomorrow, I'll be visinting the doctor again.

[ghent96]

Yes, Elidel and certain other creams to treat eczema, psoriasis, etc suppress the immune system locally and/or regulate turnover rate of the skin.

[SamK7]

Thanks. Just one more question: can perioral dermatitis be provoked by prolonged use of Elidel cream?

[Bhupinder Kaur, MD]

Hello,
The treatment of perioral dermatitis 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. For seborrheic dermatitis, topical antifungals and mild steroids are the usual treatment and combination of the two can be used to treat stubborn patches. Oral antifungal drugs and immunomodulators such as tacrolimus and pimecrolimus are used in very severe cases. You can use the antibiotics prescribed by your doctor and if the symptoms persist then please consult these treatment options with your dermatologist.

I hope it helps. Take care and regards.

[SamK7]

Thanks for the reply. I visited the doctor yesterday and he wanted to give me corticosteroids to treat my eyes and forehead but I refused because my skin's gotten so thin and I seriously don't need more steroid addiction, so he just gave me garamycin cream for EYES to use around my mouth (don't quite understand why, haha) and oral cephalexin for swollen lymph nodes and a possible bacterial infection.

As for forehead, he said it was probably atopic dermatitis. Now, is there a way to determine the type of dermatitis other than just having a dermatologist make an evaluation by looking at it? Some tests maybe?

[Bhupinder Kaur, MD]

Hello,
From the symptoms and pictures it looks like perioral dermatitis and seborrheic dermatitis on the forehead. Seborrheic dermatitis is a common skin condition that causes flaky,dry, white to yellowish scales to form on oily areas esp. under the nose or anywhere on face.
My sincere advice is to consult a dermatologist and get it evaluated. Diagnosis has to be confirmed first.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[SamK7]

Anyone, help? Please?