Recurring Perioral Dermatitis...What is your advice?

[justin2001]

I am a 23 year old male and have been suffering from recurring perioral dermatitis for the past 4 months.  I went into a local walk-in clinic with a dry, red, inflamed rash near the right corner of my mouth in early April of this year.  The doctor told me I had “impetigo” and gave me two small sample tubes of Topicort 0.25% and some pills to treat it with.  My skin quickly healed with the cream and pills.  

A few weeks later the same rash returned, this time a bit on the other side of my mouth area as well.  I used what was left of the Topicort and it healed again.  A few more flare-ups and treatments of Topicort after a return visit to the doctor and I was hoping to have this problem solved.

However, this past Monday morning I awoke to the worst flare up I have experienced to date and again immediately went to the Topciort.  However, becoming very frustrated I decided to start doing some research online and it turns out that one of the causes of perioral dermatitis is topical steroids, the very medicine I was using to use to heal it.  Many trusted online medical websites state topical steroids as one of the main causes of perioral dermatitis, so I immediately stopped using it.  I went back to the clinic and told the doctor my findings and he referred me to a dermatologist friend of his.  At this point he again stated that the rash was perioral dermatitis so this is not in question at this point.

I saw the dermatologist today and he prescribed me a 1-month dosage of Minocycline HCl 100 mg and a topical cream....Fucidin H Cream.  Multiple trusted websites state that Fucidin H Cream should NOT be used on “Inflammatory rash around the mouth (perioral dermatitis)” and now I am very disappointed and discouraged that this will be a chronic problem I will not be able to get rid of, with doctors who seem to be unaware of cautions on the drugs they prescribe. Please advise me on your opinion and advice of how I should proceed with treating this problem.

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum! Please do not be discouraged. Perioral dermatitis is treatable.

Oral tetracyclines such as minocycline (100mg per day) or doxycyxline (500mg per day or 1000mg per day in severe cases) have been used successfully in treatment of  perioral dermatitis. Topical metronidazole, or erythromycin or clyndamicin are effective alternatives.

In many patients, topical corticosteroids have precipitated or aggravated the condition. They should be completely avoided.  

FYI - Fucidin H cream contains two active ingredients, hydrocortisone acetate (corticosteroid with low potency which, theoretically, should not cause perioral dermatitis or rebound effect) and fusidic acid (antibiotic). It is not in the first line of contemporary treatment of perioral dermatitis but some physicians still do prescribe it.


Wishing You Optimal Health,
Dr. Jasmina Jankicevic

[Hoots28]

A related discussion, This might help? was started.

[justin2001]

Thank you for your response.  I very much appreciate the help.

If possible I would like to ask a few follow-up questions.

I actually used Fucidin H Cream for a 1 week period earlier this summer as prescribed by my general practitioner and it did not help my condition at all, at which point I switched back to the Tropicort, which cleared it up quite quickly, only to come back again of course.  Using the Fucidin H Cream again for the past week as prescribed by my dermatologist, again I have experienced seemingly no help from the cream, and it actually seems to make it slightly worse.

You mentioned Fucidin H Cream is not the first line of treatment today and since the cream is not working for me, is there a specific cream you might recommend for me?  I have read that Pimecrolimus cream seems to be most effective in steroid-induced perioral dermatitis, should I ask my doctor to prescribe me this cream or something else you might suggest?

Also, I have a very important public fundraising event that I created and am running for 400 people that is set for next weekend.  I know the Topicort would clear the dermatitis up by then, or at least to a more comfortable level for myself, and was wondering if using the cream one more time would pose any further risk other than another rebound at which point I would completely stop using Topicort and follow the proper plan?

Lastly, I have also read that photo-dynamic therapy (PDT) has shown to be very helpful in perioral dermatitis although there hasn't been very many studies to back that up.  Do you know anything about the safety/effeciency of this treatment for this condition?

Thank you so much for your help, I can't tell you how grateful I am of this service!

[justin2001]

One thing I forgot to mention is after the first eruption I saw a different doctor at the clinic who diagnosed me with perioral dermatitis at the time.  Whether the first rash was impetigo I suppose I will never know, although it was the same as I have had repeatedly.

Thank you for your help.  It is truly appreciated!