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