Saturday, April 28, 2012

Perioral dermatitis diary

My perioral dermatitis journey began almost exactly one year ago, right in the midst of first-year vet school exams. It started with a dime-sized reddish raised oval patch on my chin that looked almost, but not quite like acne. It waxed and waned over the next two months but never completely disappeared. A family member gave me some of his high-strength topical steroid cream and let me beg you now to never, never, never take prescription drugs from anyone other than your doctor even if you think you have the exact same condition. As it turns out, this was the absolute worst thing I could do.

Over the summer and autumn, the steroids kept the rash more or less at bay, and in addition to this I went off birth control and had to deal with the resulting acne. Starting around Christmas, I found that if I went more than a day or two without applying the steroids, the rash would come back and eventually it started to spread to both sides of my chin, then to around my nostrils, and in the lines between my nose and mouth. I started to use the steroids every day as prophylaxis, even if my skin was clear. In February I decided I had enough of the break-outs and went back on the pill, which cleared up the pimples but did nothing for the rash. I became concerned about this chronic steroid usage, as I knew that it could be damaging long-term and could lead to skin thinning amongst other bad things. I started to look up some more information about facial rashes, which is when I came across photos of people who had perioral dermatitis - and they looked exactly like me.

As it turns out, perioral dermatitis can either be caused by or at least exacerbated by topical or oral steroid usage. I don't think I was using steroids a year ago when my rash first started so I'm not sure exactly what caused it - some people also blame a sensitivity to sodium lauryl sulfates in soaps and shampoos or fluoride in toothpaste, and others claim it is an overgrowth of either bacteria, Candida yeast, or Demodex parasites. Who knows? Of course, the steroids I started using eventually did not help at all. I'm keeping track of my progress here for anyone else suffering from perioral dermatitis who may be interested!

Day 0: A week ago, the day of my last exam for second-year, I stopped the steroid cream cold turkey. By that point, it was starting to lose its effectiveness anyway - there were persistent red patches on my chin and around my nostrils that refused to clear.

Day 1: The next morning, I looked a mess - the red patch had spread to cover my entire chin and below and around my nose. I even had some bumps on my eyelids.

Day 2: By Sunday, the red patches became a mass of tiny, zit-like pustules which were filled with a clear, serous fluid as opposed to the white, purulent junk like you normally find in pimples (and you can thank my veterinary gross pathology class for these awesome descriptions). We drove from Guelph to Montreal to spend a few weeks with Davis's family before heading to my family and summer jobs in Vancouver. I kept hoping it would clear up before I needed to start my job.

Day 3: The pustules were angry angry angry, slightly oozy and itchy, sore, and painful. I hid in my bedroom most of the day, only venturing out of the house to buy sodium lauryl sulfate-free replacements for all my soaps and shampoos. I settled on Kiss My Face shampoo, Green Beaver conditioner and toothpaste, a Druide soap bar, and DermaMed face wash. I was looking for the simplest ingredient lists possible - the shorter and more natural, the better. I also bought probiotics, based on some suggestions I'd read online. That evening, I started taking the probiotics, salmon oil pills (for the anti-inflammatory benefits), and two tablespoons of raw organic apple cider vinegar, again on an internet recommendation. I also put a 1:1 dilution of the apple cider vinegar on the rash, which some people claim is a miracle worker. I also iced my rash for a few hours, which brought temporary relief. Starting this morning, I had also resolved to cut out a lot of crap from my diet - no refined sugar, no pasta, no bread - this stuff is supposed to feed the yeast, if that is indeed the causative agent. Of course I wouldn't follow this perfectly, but I figured a reduction was a good start at least for my overall health if not the rash specifically.

Day 4: Little change. Of course, I know nothing happens instantly but I was hoping for at least some relief from the soreness. I couldn't even blow my nose without pain, as both my nostrils were crusted and inflamed. I continued morning and night to take the probiotics and salmon oil, as well as drinking the apple cider vinegar and putting it on my face. Desperate for relief, I went out to try and find calendula cream, which is also supposed to be anti-inflammatory and another potential miracle. Sadly, the health food store wouldn't have it in stock for another week, so I bought a calendula tincture and went home. The tincture was probably not the greatest idea - I don't think it made things worse, but it was alcohol-based so it stung like a bitch. By evening, some of the pustules had started to dry out.

Day 5: The pustules were mostly dry and crusty but still painful and so itchy. I stopped drinking the apple cider vinegar, since it was making me nauseous but I still continued with the probiotics and salmon oil. I longed for some kind of lotion or salve to put on the dry skin, but I was too afraid to try anything. My boyfriend suggested aloe - pure aloe, since we have a plant. We cut off a leaf and I rubbed the juice into my rash every few hours. I didn't notice any improvement this day, the rash was still dry and itchy but I figured the aloe couldn't be hurting. I also put a yogurt mask on twice, but didn't notice any relief or change. If anything, it made the itching worse as it dried.

Day 6: I stopped using apple cider vinegar on my face. For one, it burned and itched in a way that did not seem healing to me. Also, it stank. And it was not a good stink... it smelled like rotting and decay, and I couldn't stomach my face smelling that way even if that is the natural smell of the vinegar. It was making me depressed and I had a nightmare of my face turning black and necrotic and collapsing into my skull. I also quit using the calendula tincture, and continued to put aloe vera on my rash every couple of hours. I was fortunate because I had a few weeks off between the end of classes and the start of my summer job - I slept 8 to 10 hours a day plus naps and refused to feel guilty - my mother has always taught me that the body needs sleep to repair itself. That afternoon, my mother-in-law went out and bought me some pure vitamin E oil, which was a huge relief. The pustules were all gone by this point and all that was left was a red patch of dragon-like dry skin. I put vitamin E oil on my face every couple of hours - as soon as it was dry again, I reapplied it until it absorbed. That night I tried a honey mask on half my face, but it didn't seem to have any effect good or bad.

Day 7: No topical treatments other than alternating aloe vera goop and vitamin E oil. Some of the dry dead skin is starting to slough and I'm trying not to pick at it. I'm feeling less depressed, and less inclined to curl up in bed with a book all day. Boyfriend says rash looks better but it's hard for me to see.

Day 8: Woke up with a thumb-sized patch of normal (if still red) skin on my chin. Actually, the entire patch of rash is still obviously reddened, but the dragon-scale texture is receding. I'll continue with the aloe vera and vitamin E all day. Also ate a crapload of sugar today. :(

Day 10: Things are looking much better. There are some new red bumps, but the background redness is still shrinking. I may be able to go out in public soon! Still just using aloe vera plant juice and vitamin E oil, and still taking 4 salmon oil caplets a day plus probiotics.

Day 12: Dermatologist today! I was probably in with him for less than 5 minutes, long enough for him to pronounce it officially as perioral dermatitis and hand me a prescription for oral minocycline and topical clindamycin and metronidazole. I'm usually a proponent of preventing disease naturally as opposed to loading yourself with drugs, but in this case, I just want to get rid of this thing and live normally and the fact of the matter is that for the majority of people, the drugs do the job. I also bought some Desert Essence moisturizer because although the vitamin E oil felt great, I felt like my skin needed something that would sink in a little more. This stuff seems pretty natural and has jojoba oil, sesame oil, and aloe vera so it seems like it should be good. I also bought some Kiss My Face lipbalm, because I just really like their stuff now. :) Will keep updating about the meds.

Day 16: Well, no adverse effects from the drugs yet, which was one of my main concerns since I had read so many online accounts of the antibiotics (especially topicals) actually making the rash worse. I don't see a lot of improvement yet, but it can take 2-3 weeks to see any changes. Boyfriend thinks the rash on my chin is getting better, but unfortunately my 'mustache' rash (so sexy) is still red as ever. We're driving to Vancouver in a couple of days, meeting up with some friends in Seattle, and then I start my new job in two weeks, so it would be REALLY nice if my face looked better by then. We'll see...

Day 42: Sorry I haven't been updating - the past few weeks have been crazy busy! Well, the drugs did do magic - the redness on my chin started fading within a week of starting the drugs and is now totally normal. My 'mustache' redness took a little while longer to fade, and it's still a little darker even now, but it's nothing that can't be mostly hidden with foundation, and I don't even think anyone would notice unless I pointed it out. I never had any side effects from the medications, and they've even cleared up the small amount of acne I had before the dermatitis. I still have a few more days of the oral antibiotics to go, and I'll keep using the topical creams for a while yet to prevent recurrences, but I was telling my boyfriend yesterday that it was the first time I actually felt pretty in almost a year! I stopped using the probiotics while I was on the antibiotics, but I'll probably start those up again with the salmon oil once the antibiotics are finished. I also started using some different shampoos from Lush that are a little more chemically than Kiss My Face, but so far no reaction. I also accidentally used some fluoride toothpaste a couple of times and that seemed okay too, so I'm not sure what exactly it was that I was sensitive to in the first place. In any case, I will still try to stick to products with short, natural ingredient lists because it can't hurt!

Day 100+: I don't even know how many days it has been. Day 0 was in April, and it's now mid-September. I've sort of stopped using the topical clindamycin and metronidazone, and my dermatitis has been pretty quiet - I may have had a minor flare-up a couple of weeks ago, or it may have just been acne. I used the topicals for a couple of days, and it went away, but left some wicked dry skin in its place (may have been the drugs...) I rubbed in jojoba oil every chance I got, and that seemed to take care of it. Stopped the topicals again. Skin is great. I've been cheating and using 'bad' products full of crap, and it doesn't seem to have much effect. NOT saying there's any reason to go off of limited-ingredient stuff... but if you slip up, it MAY not be the end of the world.

One year later: happy to report that I've had no flare-ups since the last time I updated this entry, not even a peep. I still pack my topical creams when I travel, just in case, but I just went through an extremely stressful 4-week final exam period AND I was eating like crap AND not sleeping AND using all sorts of random face/hair products and my skin has been behaving itself wonderfully. There is hope!

Some perioral dermatitis resources
- violet extract?
- variety of natural remedy suggestions
- MedScape reference
- Ack! I've Got Perioral Dermatitis
- EarthClinic POD forum (lots of suggestions, but critical thinking suggested)
- another forum on POD
- article from Canadian Family Physicians
- calendula and other ideas


  1. Oh you poor thing, sorry to hear about this.

    Isn't it annoying that dermatologists are so difficult to get in to see, I have to set up my annual appointment 3 months in advance and who knows what will be happening when the appointment date finally arrives :(

    Sounds like you have tried a lot of stuff, I'm sure the stress of this and finals is not helping.

    Hope it continues to get better and yes, be very wary of using anyone else's presciptions esp. steroids.

    Take Care, have a lovely summer, T. :)

    1. Good sharing, yes, apple cider vinegar (ACV) helps to boost metabolism, blocks the body’s storage of dietary fat plus breaks down and dissolves existing body fat. A study at Australia’s University of Sydney in which subjects who consumed two tablespoon of ACV daily experienced fewer surges and crashes in blood sugar levels. Read more at:

  2. I'm sorry to read you're going through this!! It sounds like you are doing some fantastic and useful things to help clear it up though ~ apple cider vinegar, vitamin E, aloe and natural face lotion are exactly what I would do too. Also, nettle tea, extract or supplements (I use the drops) are supposed to be extremely effective in clearing up skin conditions/allergies. My husband just started taking it for dry skin areas and allergies. You might try that ~ I think Whole Foods carries it. Good luck and I hope it all clears up soon!

  3. Thank you for the comments and support ladies! Brooke, after reading your comment yesterday I actually had a dream that I was looking for nettle tea in a department store of all places. :) I will see if I can find some though, I am a huge tea drinker so it would be easy to incorporate into my routine!

  4. This comment has been removed by the author.

    1. Hey there,

      Sorry to hear you have this too. :( It's a real shot to your self-esteem, isn't it?

      It's been 8 months since I had any obvious PD, so I'm trying to remember what it was like. I think initially it was kind of moist and itchy and bumpy, and a few days later it became more dry and flaky. I had it in the same places you did, I think those are the most common places to see this type of rash.

      I would say the rash cleared up within 2 weeks of starting the oral and topical antibiotics. By the time my oral course was done (4 weeks) all you could see was a slight pigmentation in the area of the rash. After another 4 weeks I discontinued the topical drugs.

      I had a couple of flare-ups since then, but really only tiny ones, and they never got very far. Basically when I exercised sometimes, there would be some tinglyness, redness, and roughness in a tiny patch on my chin. I would just reapply the metronidazole/clindamycin for a few days and it would go away. I haven't had anything more than that, and it maybe happened twice.

      I hope the drugs take care of it for you this time! I think the clindamycin might have been more effective than metronidazole for me, so it might be worth a shot! Also, if you don't think the minocycline is working, you could always talk to your derm... I remember mine gave me three refills of it, and said if it came back after that to see him again and we'd try another drug.

      Good luck!!

  5. Thank you so much for writing about your experience. It's given me hope and I'm sure many others.
    My experience has started pretty much the same as yours... including the steroid cream - and I can't agree with you more about what you said. NEVER USE THAT STUFF!

    I was put on tetracycline about 11 days ago. I keep thinking that because it's not all better now, something is wrong. But then I remind myself to be patient. I also heard that if you use steroids, it takes longer to heal.

    Also, thanks for telling us what products you used. I think I'll get some aloe gel and try Vit E as well.

    I'm really so happy for you - that it cleared. I know how traumatizing it is to go through.


  6. I've been getting annual POD Flare ups for 3 yrs now .The flare ups usually last 2-4 mnths. It all started after ceasing a prolonged period of corticosteroid use.
    The first time it acted up i used antibiotics which seemed to help. The second time i got a POD Flare up i opted for Arzelaic acid instead of Antibiotics. The Arzelaic acid was very effective though one has to bite through the insane burning and itching upon application.
    I used the arzelaic acid before bedtime and within 2 wks the POD had disappeared.I must mention that as the POD subsided i started having breakouts which i then treated with prescription retinoid.

    This february i got another flare up. This time i was determined to find the culprit and a natural remedy...I tried every thing from ACV to castor oil. I alternatively omitted certain foods in my diet and tried different oils on my face.
    3 mnths down the line i decided to cut off Quark ( cottage cheese/ sour cream variant in Europe).
    I'd been taking Quark daily for my protein intake. Quark is to some extent probiotic.
    At the same time i applied yoghurt masks daily and only used grape seed oil as a moisturizer . Within 4 days my POD has drastically reduced....So my conclusion, atleast in my case i think certain foods trigger the POD....
    And all in all our bodies send signals which we should be glad for...

  7. Hi there,
    I've had POD at age 20 and now again at 34. Awesome. I was given topical Clindamycin first and now the Metronidazole to use instead. Did you use them at the same time? I took Doxycycline for a month and then stopped. How long did you take your antibiotics. It's just not going away. I use 100% aloe gel and feel like it helps. Did you use any moisturizer on top of all the Rx creams and aloe?
    I'd love to know a bit more....

  8. Dermatologist in delhi will take care of your skin related related issues. You just need to mention your troubles and get the best services from the our experts.

  9. Hi I am dealing with the same problem for almost a year now :( I have tried a few different things but none seem to help. I started with being prescribed hydrocortisone an dalican solution to apply twice a day as needed, it worked for about 2 months then didn't seem to do much after that point. Then I was prescribed fucidin cream which only made things way worse, I stopped use after a couple days because it was growing at a fast rate and was soon red, I started using the hydrocortisone/ dalacin solution again.... I did some research and changed all my make-up, shampoo/ conditioner, body soap, face wash, laundry detergent to all natural limited ingredient products. This helped improve things but still red with bumps.. So I tried lavender and tea tree oil which also seemed to help for awhile. Now I am trying apple cider vinegar and am seeing a slight improvement but I am defiantly loosing my patience I just want my face back to normal already :( I have an appt tomorrow so hopefully I can get something that will help for along period of time forever would be great lol.

    1. I've used the minocylcine previously, and it always clears it up. I'm actually on it again after...I'd say it's been at least 4 years since my last flare-up. It's amazing how quickly the antibiotics clear things up. I've been on them for 2 weeks now and it's like having a different face. It's definitely not a first-resort, but if you've tried other things and it hasn't worked all that well, try minocycline. I have a friend who used Protopic (prescribed by a dermatologist) and she says it works really well for her, but it's another one of those topicals that can either clear it up or make it a lot worse. So much trial-and-error with the POD!

      Since your post was a few weeks ago, I'll just say that I really hope you were able to find something that will work for you! Best of luck.

  10. Reading this was like looking into a mirror of my life over the last 8 or 9 months! As an eczema sufferer, I thought what I had on my face initially was a run of the mill case and proceeded to self diagnose and treat with topical steroids, followed by myriad home "remedies" when that only made things worse. It wasn't until I finally went to a dr. and dermatologist that I went on topical antibiotics (erythromycin) and it started to get better. I am very careful about the products I use on my face now but still have lingering redness/discolouration around my smile lines, nose and up to between my eyebrows. I have a question for you on how long you continued the use of your topical meds - did you wait until all the redness was gone or stop just after the initial peeling/flaking and inflammation was gone? I'm just not sure how to get rid of this scarring so that I can be complete PD-free but worried about over-medicating. Any further insights would be great!

  11. Hi! I am having my first experience with PD (the past month). I need advice and help. Everything I have tried is backfiring and not working. I opened a blog and have photos- any type of advice would be appreciated!!

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  14. This is exactly what I'm currently dealing with. I started oral tetracycline yesterday and am currently dealing with the burning pain, but the itchiness is pretty much gone. As embarrassing as it looks, the pain is the worst thing right now. I'm hopeful with your story that this will clear up soon!

  15. 35 yrs old. Been suffering with Periorificial Dermatitis off and on for 6+ yrs. Around the nasolabial folds, chin and eyelids. If you don't want case info, skip to the bottom for what cured it for me.
    Never took hormones. Social drinker. Crappy diet but no fast food or really processed stuff. Never took supplements or did much skincare beyond washing with Bronner's soap and moisturization with oils. Skin leans toward dry, but I live in a tropical climate and it can become greasy. Not acne prone, not even blackheads. I use regular toothpaste and in my shampoo there are SLSs. I've never been one for taking pills I can't remember the last time I took antibiotics, and I haven't had any regular prescriptions ever.
    After much online research and misery, below is what I've done and it's been months of clear after months of rash.
    40% zinc oxide cream applied before bed and once during the day. Beaudreaux's Butt Paste.
    Violet extract applied multiple times in a 24 hour period. Herb farm flowering top.
    25 mg of zinc every day via supplement pill.
    10 billion CFU of acidophilus lactobacillus per day. Walgreens.
    Began cleansing my face with coconut oil with a few drops of carrot seed EO mixed in. When the rash was finally gone I cut down the applications of zinc and Violet to just once per day.
    And that's it, I haven't changed my diet or my toothpaste or my shampoo and I have not stopped drinking. I did not visit a dermatologist or doctor or take any antibiotics. I don't wear much make up but when I do I am able to without having a flare up, providing I keep my routine going.
    Good luck everyone.

  16. I feel your pain. I had PD a few weeks ago and it was just aweful! It burned and itched and I had pus coming out like crazy. I got rid of it in like three days though using natural treatments. I swore that if it worked I would write about it. So here is my blog where I hope to help others who are struggling with PD!

  17. Calendula oil can help with soothing the irritation and calming down the spots.

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  19. I'm 36 years old and I've had severe PD for the past two years. It kinda got better when I stopped using fluoride toothpaste, make up, sulfates, moisturizers, etc. but never went away completely. 30 days ago(in the middle of a bad breakout - I had scaley, itchy, painful red blotches over and under my eyes and around my mouth) I started the Whole30 diet. I KID YOU NOT - by day four, there was not a TRACE of PD on my face!!! And now 30 days later, my skin hasn't looked this good in years! If all else has failed you, please, please, please try Whole30 and see if it changes your life like it changed mine. PD is so debilitating and depressing, and I really hope this helps y'all too! I am a happy girl again, praise the Lord!

  20. I had the same experience with steroid topical. I was not properly educated NOT to use it on my face, ugh. I do have to add a recommendation for everyone out there that is looking for a cure....Clotrimazole cream aka antifungal, Lotrimin AF or other brands as long as it ONLY has Clotrimazole 1% as the active ingredient. I found this recommendation in a life saving blog, it has extremely changed my PD struggle. After going off the steroid creme my PD exploded all over my face, I am on day three of only using Clotrimazole, NO makeup, and washing my face with a VERY mild SLS free face wash no more than 1 time a day and ladies my face is healing! The patches have subsided to healing red patches of skin opposed to puss filled bumps. I am hoping that by day 7 I will feel like a normal woman again. I am SO GRATEFUL for this remedy that is not talked about enough. Good luck ladies!


      :) :) :) :)

  21. i had the same problem - luckily i was diagnosed straight away by my doctor - so no steroid cream given (thank goodness) it went away with the use of Apple Cider vinegar and anti fungal cream.


    Now i use that, i wash face with Coconut oil(natural) and also use organic shampoo and conditioner although i don't really need to.
    I have been clear for weeks, not only that but drinking the apple cider vinegar (diluted) before i start my day every morning has made my skin look and feel wonderful.

    i have had nothing come back for months.

  22. I'm not sure if you are still struggling with perioral dermatitis, but I struggled with mine for 3 years. I was able to manage it and only get occasional flare ups, but I could never completely get the redness or bumps to go away! I started using Rodan and Fields Soothe regimen back in September of 2016 and I haven't had any redness or bumps since I started. I loved my results so much that I started selling the products, and now I want to reach out to others with perioral dermatitis because I know how frustrating it can be!!! If you are still looking for answers for how to manage this, let me know! My website is . I hope that everyone reading this is able to find something that works for them, because I know how incredibly frustrating this can be. :( Good luck, everyone!! And please reach out to me if you are interested in trying these products!

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