My education in defense against dermatitis
My skin's metamorphosis was equal parts frightening and frustrating. Frightening might sound melodramatic, but my wedding date is quickly approaching, and naturally, I need to look perfect. It was frustrating because not a single remedy I tried seemed to help the situation, and I figured that my years of training at TIA should have made me capable of self-diagnosis and treatment. I was baffled by the fact that the problem skin was localized on the lower half of my face, especially since the chin isn’t typically an oily or acne-prone zone. And I was inconsolable that this mystery condition got progressively worse with each attempt to mitigate it.
My first solution was to work with some masks to restore my skin’s balance. An old stand-by for healing inflammation, gloTherapeutics gloConditioning Restorative Mask made my face feel refreshed but made no difference in the scaly patches around my mouth. When the dry skin evolved into what looked like acne, I tried a more targeted approach. I applied Walker’s Apothecary Chamomile Soothing Gel Mask all over my chin area and rinsed it off before bed each night. I then dabbed my face with L’uvalla Eucalyptus Toner to make sure that all grime and residue from the day had been removed. Again, the problem skin persisted without any noticeable improvement. It was time for drastic measures.
In 2009, a dermatologist prescribed me Desonide lotion to treat dry skin that cropped up on my chin (hmm, sound familiar?). At the time, it worked like a charm, and I kept a bottle on reserve in case of emergencies. I thought that crusty, flaky skin qualified as an emergency, so I dabbed the Desonide on my red, dry areas every morning before following up with a thick coating of concealer. Little did I know that this type of lotion was one of the worst possible treatments for my condition. Instead of being soothed by the prescription lotion as before, my skin rebelled against it and made a hobby out of collecting clogged pores.
In a last-ditch effort to heal my skin without submitting to a dreaded doctor’s visit, I confided in a few girlfriends about my predicament (though all it took was one look at my chin to see that something was seriously amiss). One friend said that she had the exact same type of rash in her cleavage area last year and that a miracle cream from Japan cleared it up in no time. She still had some cream leftover from that episode and offered to lend it to me. After just a few days of application, this foreign potion spawned a bumpy, flaming red rash that snowballed into a hideous breakout. My skin had reached rock bottom.
Finally, I threw in the towel and made an appointment with a dermatologist. After being cross-examined about my cosmetic habits and history leading up to the five alarm fire on my face, I learned a few things. The good news is that I did not have a disfiguring disease or a fungal infection caused by poor hygiene. (If that were the case, I might be less inclined to share with the world at large). My skin problem had a name that I had come across many times but had never met in person: Dermatitis.
Dermatitis can take on many forms, from atopic (eczema) to seborrheic (often on the scalp resulting in dandruff). It is a general term used to describe an inflammation of the skin, typically accompanied by redness, swelling, and itchiness. The particular strain that decided to afflict me was perioral dermatitis, which simply means that it affects the area around the mouth, though it can also extend to the nose, cheeks, and eyes. I am an ideal candidate for this type of dermatitis because it most typically afflicts young women around my age.
Perioral dermatitis can flare up as a result of hormones, stress, and any number of environmental factors that leave the skin vulnerable. Cosmetic abuse is common among people with perioral dermatitis. I was guilty of testing out different masks, drying out the skin with toner, treating the area with all manners of medicines, and covering the damage with makeup. Considering the onslaught of chemicals and questionable products that I was layering over my rash, it is no surprise that my condition worsened.
The etiology of perioral dermatitis suggests that overusing topical steriods often precedes the manifestation of the rash, though there is no clear correlation with the strength of the steroid and the duration of the abuse. My attempt to soothe the skin with Desonide lotion clearly was a bad idea. Other offending products include creams and ointments containing a petrolatum or paraffin base. The comedogenic oil isopropyl myristate is also linked to perioral dermatitis. A 2000 Australian study found that applying foundation in addition to moisturizer and night cream led to a 13-fold increased risk for perioral dermatitis. Though I never use foundation, I am sure that several occlusive makeup products I was using with my day moisturizer put me at risk for the tell-tale rash.
Even certain toothpaste ingredients, such as harsh abrasives, stinging flavors, and irritating tartar control agents can trigger inflammation. While perusing a skincare-related message board, I saw a recommendation for Squigle Enamel Saver Toothpaste, which is formulated with ingredients to prevent not only cavities, halitosis, and plaque, but also canker sores, chapped lips, and perioral dermatitis. I might splurge for this (rather expensive) toothpaste if my dermatitis makes a comeback. If I can avoid a flare-up by simply switching toothpaste brands, it’s a no-brainer. Unfortunately, the way skin behaves is rarely that simple.
Because of the severity of my condition and the urgency of my situation (with the wedding around the corner), the dermatologist prescribed me a two-pronged approach to clear up my skin the quickest way possible. First, I began a six-week course of a tetracycline antibiotic, an oral medicine used to treat inflammatory acne and bumps. The second part of the regimen involved applying an anti-inflammatory gel composed of azelic acid, which helps skin to renew itself more quickly, kills acne-causing bacteria, and clears up bumps and swelling.
Those medications were only part of my immediate treatment. For the long term, the doctor prescribed a list of changes to my daily habits. Instead of using a liquid face wash and exfoliating a few times per week with a scrub or Clarisonic brush, the derm said I should go back to basics with a gentle cleansing bar and a very specific glycolic toner (review on that to come). I should steer clear of creamy sunscreens and use a gel or light milk sunscreen on my face, making sure to cover up before exposing my skin to the sun, since perioral dermatitis is aggravated by UV light. With the exception of sunscreen, I should adhere to a program of “zero-therapy” on the bottom half of my face, eliminating all cosmetics. My only cosmetic allowance was my (extremely necessary) non-comedogenic concealer. As my comedic derm put it, "We wouldn't want to scare off small children."
Two days into this treatment, my luck turned around. The bumps started to deflate and the blemishes made a retreat. Soon after, the inflamed rash subsided, along with my desire to live like a hermit. I am now two weeks clean, with only a faint pink tint to my skin as a lingering reminder. Once I finish my course of oral antibiotics, the perioral dermatitis could recur at any time since it is a chronic condition. For now at least, I have closed that chapter of my skin sagas and have achieved enough distance from the horror show that once was my chin to learn from my mistakes.
1) Do not self-medicate. Using an unsuitable treatment can exacerbate the problem.
2) Try giving the affected area a breather from cosmetics.
3) Visit the doctor before slipping into a downward spiral. Consult a dermatologist as soon as the condition worsens or gets in the way of routine activities.
4) Adjust daily habits as needed until skin is back to normal.
5) Always be prepared for another flare-up.
If you've ever fought a similar battle with your skin, I'm interested to hear how you overcame it!