HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Suggest Treatment For Perioral Dermatitis

Posted on Mon, 23 Mar 2015

Question: Hi there. I was diagnosed with perioral dermatitis about 7 months ago. I started using Oracea 40 mg and washing my face with a soap and cream by Osmia Organics which designed their products for people with pd. I have been clean and free of this tricky rash for about 6 months now. I'm still on the antibiotic but this past week have been seeing signs of it return. I am nervous to use metro gel since I read that if you stop it will return. I would not mind using the gel gor however long I need to. My question for you is, I had my face in s tanning bed and would the uv Rays cause a flare up even though I'm on antibiotics? And I have the metro gel 1 percent as samples, how should I use this? I would hope I can use it just once a day for the flare up for it is not nearly as bad as it used to be. And how fast will this work? Thank you fit your time

Answered by Dr. Hardik Pitroda (34 minutes later)

Brief Answer:
Pictures requested

Detailed Answer:
Hello,
Thank you for posting on HCM.
Oracea contains an antibiotic doxycycline. Though doxycycline is a good option for perioral dermatitis, its usually not indicated for such a long period of time. Secondly, doxycycline is a photosensitive drug i.e it sensitizes your skin to sunlight/uv rays and thus your exposure to tanning bed could have caused photodermatitis.
Your current rash could also be suggestive of another condition called rosacea, which classically exacerbates on sun exposure or uv exposure and it can also closely mimics perioral dermatitis.

Thus for better clarity and management, I would suggest you to post some good clinical picture, so that I can help you in a better way.
You can mail pictures to YYYY@YYYY
with subject titled ' ATTN Dr Hardik Pitroda'.

Thanks
Dr Hardik Pitroda

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Pitroda (8 minutes later)

So is the metro gel good to use? For how long? And if the rash gets better s d I stop the gel will the rash come back?

Also since I'm on Oracea and plan on being on it for a little while longer, if I stop the gel since being on the sbribiotic will I have a higher chance of the rash not coming back if I stop the gel? And do the uv Rays could have def caused a flare up ? How long till the flare up is gone?

I just did a yogurt mask do my cheeks are red. I know one hundred percent I don’t have rosacea do please ignore the cheeks that is from my yogurt mask. But this is what my face looked like right before bed. I haven’t had a flare up like this since I got clean in September. Becoming nervous cuz I don’t want to deal with that pain again

Answered by Dr. Hardik Pitroda (3 hours later)

Brief Answer:
Topical metronidazole and benzoyl peroxide

Detailed Answer:
Hello,
Thank you for the picture.
After careful review, I can say that this does look like a relapse of perioral dermatitis.
Metronidazole gel is a good option for treating perioral dermatitis. I would suggest you mix metronidazole gel with clindamycin gel to apply twice a day . At night apply benzoyl peroxide 2.5 % gel.
Its inherent property of perioral dermatitis to reoccur, thus it has nothing to do with stopping metronidazole gel.
Long term remission can be achieved by proper use of above mentioned medications. For now I would suggest you to follow the above regimen for 3 weeks and then follow up with latest picture.
You may continue oral doxyxyline(Oracea) but I would suggest you to gradually stop it use as long term use of antibiotics can be detrimental.
Also, I would suggest you to take single dose of oral albendazole and ivermectin combination tablet and repeat after 2 weeks.
Avoid fluorinated and chlorinated toothpaste.
Avoid use of cosmetics as far as possible over affected areas.
Since you are on oral doxycycline I would advise you to avoid use of tanning bed for meanwhile.
Hope you got my point here.
Do follow up after 3 weeks.
Thanks
Take care
Dr Hardik Pitroda

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Pitroda (2 hours later)

Thank you for your response. I will see my derm and ask what the proper creams that should be used. I'm very skeptical about putting more creams like these on my face, for in the past I have had bad experiences. If I have any further questions I will ask. Thank you

Answered by Dr. Hardik Pitroda (13 hours later)

Brief Answer:
Wish you best of health

Detailed Answer:
You are welcome and take care.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Hardik Pitroda (16 hours later)

Another quick question. So I'm going to use metro gel 1% once a day hit the first week then twice a day for three weeks then once a day again when things subside. They already look so much better. If my face is too drying can I just use the gel once a day at night and during the morning/day put my face cream in that's a natural product for pd that I've been using for months now which helped get rid of the rash last time? Just don't want my face to be too dry

Answered by Dr. Hardik Pitroda (16 hours later)

Brief Answer:
Do follow up after 3 weekd

Detailed Answer:
Okay you may decrease the frequency of metronidazole gel ince lesions are in resolution but dont stop it completely without my advise.
Make sure you use a good quality hypoallergic moisturiser for dryness.
Post follow up pictures after 3 weeks for further management.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Pitroda (6 hours later)

My face stings a bit from the use of the metro gel. What shoukd I decrease my use to so that I won't feel the sting. Would every other day or every other two days help it not sting as bad? It's a very light sting, but still bothers me a bit

And sorry for the constant question. I just want to note that my face has completely cleared up. I want to still use metro gel just want to know what's the least amount I csn use it so that it still works but won't cause my face to sting a bit. I've been using the gel since Wednesday every night.

Answered by Dr. Hardik Pitroda (15 hours later)

Brief Answer:
Mix with moisturiser to decrease stinging

Detailed Answer:
Hello,
To prevent stinging you can mix Metrogyl gel in 1:1 ratio with water-based moisturiser like Emolene.
The quantity should be just enough to cover affected areas eith thin film of mediaction and make sure you apply the gel without any pressure and rubbing.
Thanks and take care

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar