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My education in defense against dermatitis

August 14, 2011 Reviewed by Copley 17 Comments
I just had to take an extended hiatus from Truth in Aging. I wish I could say that I was vacationing on another continent, but instead I was in hiding because of a skincare disaster of epic proportions. It all started with some inoffensive redness under the corners of my mouth. A little over a month ago, this flushed skin became inexplicably dry, flaky, and uncomfortable. The red patches then became raised and developed bumps. Suddenly, my face fell into the throes of a full-fledged breakout, as unsightly blemishes sprouted all over my chin and even branched north onto my cheeks. The discomfort became so severe that I began to lose sleep at night and avoid social settings. By the end of this saga, my skin resembled the state of the U.S. economy.

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.

Lessons learned:
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!
  • April 21, 2017

    by Sam

    What was the concealer you used?

  • July 17, 2016

    by Ingrid

    Thank you all for writing about your experience with PD.... it means a lot to know that I am not alone. None of my friends or family had ever heard of such a thing,so I felt very alone.
    Everyone assumes I am suffering from "Adult acne" and suggest various acne treatments, my doctor didn't even know what it was and that made me mad because when I showed her the rash it was very minimal, til she told me to use
    Cortisone cream, then I woke up to the PD all over my lower face and into my nostrils. Thanks Doc!
    Thank you all for the tips...

  • December 13, 2015

    by Anya

    I recently came down with a case of PD and after trying a few things and becoming quite frustrated, I have decided to try the "zero therapy" approach and put literally nothing on my skin. No cleanser, no moisturizer, no make-up...nothing. Just rinsing with lukewarm water followed by cold water. I even switched to a fluoride-free toothpaste. I am wondering, for those who have tried "zero therapy," what was the recovery process like? Since I started (about 5 days ago) my skin has been flaky where the PD used to be. Is this normal? If so, when does it stop?

  • June 27, 2015

    by Stella

    I have just had a flare up of the dreaded PD, after about 4/5 blissful years without it! It began when I was 17/18 and was prescribed a steroid cream to help with cracks on the side of my mouth. But I overused the cream as I was unaware of the harm it can do, and then the PD around my mouth began. I saw a dermatologist who put me on a course of doxycycline and zero therapy...which was almost impossible for a teenage girl to adhere to! from the ages of 17 to about 21 I suffered from it on and off, and have been without it since, now aged 26.

    The past month I have been very sick with a cold/sinus infection, and had to blow my nose constantly all day, and so my nose and the skin under it above my lip became red, cracked and irritated so I began using Lucas' Pawpaw cream on it and Avene restorative skin cream (both things I thought were ok for sensitive skin)...and then bam! PD was back.

    So disappointing and frustrating! Was on a course of antibiotics to kick the sinus issues, ironically doxycycline, and have a repeat so will take that...perhaps that will help a little? and will attempt to put nothing on it, which is difficult when it gets very flaky and dry and I have to go to work/leave the house. And it's just so uncomfortable and itchy :(

    Not sure what to do now, besides get a referral to see a dermatologist again asap, but I feel like I already know what they will say and there certainly won't be any super quick fix. I'm scared to put any prescribed creams on it at all, but I'd love to know what the anti-inflammatory gel composed of azelic acid was that you used Copley.

    My usual Daily moisturiser for the past few years has just been a Dermaveen one, do you think that would be ok to use on the PD occasionally?

    Not sure if anyone will read this, but found this post/thread very useful when doing a manic Google search of PD. It's nice to know you're not the only sufferer even if it feels like it!

  • June 2, 2015

    by Cassy K

    I also suffered with perioral dermatitis - I turned 37 and that was it - skin disaster time! It sounds ridiculous and vain but I started to feel anxious about leaving the house. I live in the UK and at the first sight of rain I'd panic because I feared my foundation would wash off! I spent most of autumn and winter wrapped up with a scarf across my lower face! I tried hiding it with foundation cream but I had to plaster the stuff on because the rash was so angry and bumpy. I used steroid cream to try to get rid of it. Good grief this was the worst thing I could have done. Please, please don't do this! It was a disastrous decision that took long, painful months to reverse.

    I ended up with an angry, pustulating rash all over my chin, upper lip, both corners of my lips - it was a bumpy, painful, red mess that wouldn't budge. Crikey, it was nightmarish and was marching across my face. I'm really pale skinned and it was like my skin was red raw. So painful. I got so fed up of being told by my doctor that it would clear up if I took this course of meds or used that cream and after months of following their advice it only got worse so I took matters into my own hands.

    I did a load of research and read forums like this one and they helped make me feel less alone. Thank you ladies :) I then started trying the Dead Sea salt cream, the Nelson herbal remedy gels, slippery elm root, expensive face creams, tea tree oil, facial scrubs, even sulphur tablets, but they all made it worse or did nothing to help. Suddenly I realised, as I sat smothered in sulphur cream trying not to breathe the noxious stench in, that the only thing I hadn't tried was common sense. I was really scared but I decided to throw everything away - all my exotic face creams, my steroid creams, foundation, everything. It was frightening to wake up the next day and know I wasn't able to hide behind those things anymore. An angry rash greeted me and it annoyed me so much I decided it was time to do some serious facial battle.

    I tried to think what would work for me and this is what I did and still do. I use simple dove cream soap to wash my face - the neutral ph really works for my skin, and I have a strict E45 lotion only rule for my moisturiser because it's light, instantly absorbed by my skin and I feel it's feeding the skin what it needs to heal. I don't tend to use E45 cream though because I find it too heavy. So that's what I did and I found that within a month or two of only doing this and applying the E45 lotion three times a day I was completely clear of perioral dermatitis. I had a small amount of pink left over where the rash was worse but that's gone now too.

    I've been following this albeit slightly boring skin routine for 9 months now and fingers crossed it's working consistently without any flare ups. I don't use foundation at all, I avoid all creams other than this lotion. I've started to experiment with adding 1 drop of Tamanu oil in with the E45 lotion but this is a new experiment - if it's a disaster I'll let you know. It's supposed to regenerate skin and I'm sort of hoping I've found my answer to an anti-ageing solution without using the chemicals found in the usual creams. I'm 39 soon and the wrinkles are beginning to peep out.

    So my advice for what it's worth - be brave, ditch the junk and return to basic skin care routines suitable for your skin type and really give it a chance to work. It's not an over night cure so it will take dedication and time but it's worth a try. Don't give up hope that you'll find the answer that's right for you. Good luck.

  • May 12, 2015

    by Terri

    Susan, you may want to try CV Skinlab products. They are designed for compromised skin. You can read some reviews here at TIA.

  • May 8, 2015

    by Susan

    I have been suffering with peri-oral dermatitis for about 17 years now. Following posts from other sufferers and once speaking to an interested doctor, I use the following products.

    Sunsense daily face SPF 50 tinted moisturiser
    Dr Brommers Baby mild soap
    JASON Aloe vera shampoo and conditioner (SLS free)
    Sarakan toothpaste and mouthwash (SLS free)

    I went about a 8 months using these products and not taking Doxycycline antibiotics and skin was great. Got to winter and PD became really bad so now taking antibiotics again.

    I try not to let PD get me down but the redness on my face is noticeable and I would love to hear from others if there is a suitable product which would help?

    I really feel that less is more when dealing with this condition so want to keep the number of products I use to the minimum.

    Hope this information is of help.

  • March 31, 2015

    by jo

    I started with perioral dermatitis a few weeks ago.I am sure it is a result of having used different antiacne products on my face and over washing.Also I typically thought it was eczma so applied a mild steroid cream.Having self diagnosed I stopped the steroid cream and as i expected my skin got 10 times worse.I took advice whilst waiting for a doctors appointment.I stoped all my skin products and threw away my foundations and moisturizers.I used the newborn water baby wipes and water to wash my face and applied aveena lotion just once per day.My skin has improved significantly and the doctor has given me a course of tetracycline so hopefully it will clear up.I have a wedding at the weekend so need to find a decent hypoallergenic foundation just for the day.Having always worn foundation i am having to take a leap of faith and only wear it when needed.Been kind to your skin must be the best solution.

  • May 17, 2013

    by a

    it is so difficult to have all in all skin.may be seboreic sicca.seboreic dermatisis but oily in deep,causes dry skin form.still have so much hard.dehydration,dryness,clogged pores,accepting no toners,cant find any sunscreen because high ppd and spf looking for but all are drying,alcohol,mineral or somehow.chemicals are sensitizing.they say antiaging dont use but then no result.you are well giving advices but most of products you advise arent sold in my country so as I dont buy on net.peah.by the way you never givepeopleanwer on youtube I wonder why.thanks

  • January 19, 2013

    by Angela

    Just an afterthought, You need to research how to pick the best essential oils so that you are getting 100% pure. I ordered from Ananda Apothocary. They have detailed explanations on each oil and their healing properties along with how to mix them. I woke up this morning and aside from some dryness, there is no bumps or redness. It is almost my old chin again.

  • January 19, 2013

    by Angela

    Hi Copley,
    I have PD and I am not one who trusts traditional medicine. I did some research and came across some natural ways to treat it. Some of them worked better than others for sure. What I found that worked best for me was a combination of things. A Zinc supplement, Neem soap, Hydrogen peroxide, sulfur, Kollagen Intensiv Renewal or Canandula Cream and essential oils.

    I first would cleanse my face with the Neem soap. Then I would douse the area with the Hydrogen Peroxide (I used it undiluted but it's quite painful and probably should be diluted with water). Then I would apply the sulfur and rinse, followed by the essential oils and Kollagen Intensiv or Canandula Cream.

    As far as the essential oils go, I used the following:

    Carrier oils: Tamanu, Hemp, Borage,Primrose, Pomegranate seed.

    Essential oils: Rosehip, blue German Chamomile, Helichrysum, Canandula, Sea Buckthorn, Tumeric, Litsea Cubeba among others.

    Now the carrier oils make up the bulk of the mixture and I mixed and matched them until I found the best ratio for what my skin was doing at the time. I think the Tamanu and Pomegranate seed made up most of my carrier oil mixtures with maybe one other oil added. Tamanu has great healing properties indeed.

    The essential oils were added sparingly at a 1-5% ratio of the mixture. There are books and websites with info on the best way to get the best results. You do have to use caution not to apply certain oils undiluted to the skin so it is important to research this before you cause sensitization to certain oils or further skin irritation. Again, I mixed and matched until I saw the results I was after. I applied the mixtures with a q-tip either straight or mixed with Kollagen Intensiv or in a Canandula Cream.

    Now it is not completely gone but I only started this last week and it has greatly improved. The redness is gone, the bumps are gone for the most part or barely visible and it is no longer painful unless I scratch at it. There is some dryness but the oils really help with that. I'm going to continue to use this system and see what happens. Good luck

  • September 12, 2011

    by Junko

    Copley, What sunscreen did you use while you were healing?

  • August 22, 2011

    by kim

    Hi Copley,

    Sorry it took me a little to get back to you. As far as AHAs go, my skin no longer reacts badly to them - since it's gotten so much stronger and healthy over the past few years. Back when I was still battling with random flare ups I really didn't use any AHAs, so I'm not sure if there were gentler better quality ones that would have been ok. It sounds like your derm really understands the problem. My derm didn't really give me any of that advice. I was also told to see if I could connect the outbreaks to food, but I didn't find a connection. I think the thinking is that it's too much heat in the skin(inflamation) so perhaps spicy foods will irritate... not the case for me. However, I do think sugar wasn't very helpful. So when my skin was irritated I tried to stay away.

    Hope this helps!!
    Kim

  • August 17, 2011

    by copley

    Thank you all for your kind words of encouragement! It's reassuring to hear that these types of skin conditions aren't usually permanent. Here's hoping it's just a "phase"!

    Kim- I feel the exact same way about my magic Rx cream! It's like a band-aid that hides the problem but doesn't do any real healing beneath the surface. I also agree with you that all-natural is the way to go when trying to put out a fire on your face and keep it at bay. I've been extremely careful about picking gentle products since this incident started. The one exception is a glycolic toner that my dermatologist recommended I use in place of my regular cleanser. I like the results I see now, but only time will tell if they keep up. Did your skin have a bad reaction to AHA products, and how strong were they? Thanks so much for sharing your insights!

  • August 15, 2011

    by Julie Kay

    Copley- this would unnerve me beyond belief! I suffer perioral dermatitis, as well, but it's always been a patch in my hair, or on my neck (in the back) or in my ear. Nothing like yours, thankfully. It does pass, but usually to another location. As consolation I offer that it dissipates w age... AND I've never suffered it twice in the same location. You are beautiful and will be beautiful for your wedding. ~jk

  • August 14, 2011

    by Kim

    Copley,

    I went through the EXACT same thing as you several years back. I think I'm a few years older than you. In my case, I too ended up going to the derm and was prescribed a cream that worked magic. I felt however, that for some reason the cream - while it always cleared up my rash in a matter of days - was making my skin weaker. It was almost as if it was pushing the rash under the skin, but not really healing it. Anyway, it was obviously incredibly tempting to use it whenever a random case of dermatitis popped up (in the same areas as you get it). Eventually I found Arcona skin care. After using it for several month I realized my dermatitis wasn't coming back. I'm not sure Arcona had any magical properties other than it was gentle and natural. For me, keeping dermatitis at bay meant not using ANY harsh skincare (basically nothing from any major store), nothing with chemicals, no AHAs, no exfoliation (that was the worst), definitely no sun, and minimizing stress. My skin has gotten soooo much stronger and healthy, on a deep level. And I haven't had any dermatitis for a couple years now.

    So I think this skin phase of your will totally pass. And if you can try to avoid using the prescribed meds, once you get your skin nice and clear, I think it'll help you build up the health of your skin in that area - on a much deeper level. Oh and one other thing, if you are taking anti-biotics, definitely take a pro-biotic, which is also super important for your skin.

    I hope this helps!!! And trust me, I totally feel for you Copley. But I really think it will pass.
    xoxo
    kim

  • August 14, 2011

    by Jennifer

    Wow, Copley! A mighty frightening experience for you! I believe that tetracycline can also make your skin susceptible to the sun, so be careful! When I was in high school, we gals would share cheap makeup constantly. Once, after using a particularly strong Jean Nate toner (10-0-6?), the entire right side of my face broke out in a horrible scabby rash. Now, as an early 50's gal, that side of my face has had problems with little broken capillaries & rosacea (not sure if that's what it is)...sins of the past, presenting themselves? Perhaps.

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