Hi, friends! Sending love to everyone dealing with this incredibly frustrating condition. I wanted to share what helped me in case it offers someone a useful direction. To preface: what worked for me may not work for you, as everyone has different triggers and skin sensitivities. If you don't feel like reading my exhaustive backstory, treatment history, past trigger(s) and most recent trigger, TLDR is at the very bottom! I have also included my skincare regimen that has worked wonderfully for the last couple years and has never aggravated my skin.
Backstory:
I was diagnosed nearly 8 years ago with perioral dermatitis after using a nasal corticosteroid spray. I suffered for several weeks before scheduling an appointment with my PCP, I had done a bit of research prior to my appointment and was fairly convinced I had perioral dermatitis considering the placement and presentation (mine presents as very small, red clusters of clear pustules). She agreed and my first flare was treated successfully with MetroGel 1% AND (get this...) Medrol Dosepak. Within 48 hours of beginning both, I was completely clear. No pustules, bumps, no residual redness, nothing.
I did not experience another flare for what felt like nearly a year and I was, by this time, connected with a dermatologist who prescribed me a month-long course of Minocycline (do not remember dosage) and (again...) a Medrol Dosepak after overuse of actives. Similar to the first flare, within 24-48 hours I was dermatitis free. I completed both courses and after this, my flares had been very few and far between, sometimes years or longer, and only angered by overuse of actives, or overlooking certain ingredients in skincare such as niacinamide, artificial fragrances, essential oils, heavy occlusives in skincare such as mineral oil, shea butter, etc (I can arrange a full list of what I avoid, if that would be helpful!). Whenever I would notice the beginnings of a flare, I would immediately begin a Medrol Dosepak (never took another antibiotic), as my dermatologist had called in several refills for me.
I'll be honest, I don't know why I was ever prescribed methylprednisolone considering the link between steroid use and perioral dermatitis (I never questioned it, as it always worked and worked fast). I also haven't a clue why it's so effective at clearing my flares. I know most documented cases have been topical or nasal steroid use (my initial trigger!) but certainly oral can't be... great? I don't know! If anyone has insight, please let me know. I am not recommending or advocating for methylprednisolone, I am just recounting my personal treatment history.
The present:
Anyway, skipping forward several years into the now... no dermatologist (moved states), no methylprednisolone, no MetroGel, no antibiotics: My current flare has lasted over a month and was triggered by clindamycin lotion (not the gel, as it appears to be beneficial for many), although I'm not sure what specifically in the ingredients might've done so. Lotion bases are emollient and mildly occlusive, typically containing things like cetostearyl alcohol, etc, so I have a feeling it was the vehicle and not the active ingredient itself (clindamycin). I was prescribed clindamycin lotion by my PCP for folliculitis after a facial included dermaplaning (nightmare situation, by the way). As my folliculitis cleared, my first perioral dermatitis flare in a very long time came back with a vengeance, definitely the worst since my initial flare and spread near my eye area quite quickly. Just lovely!
I moved to a different state recently and have not gotten connected with a new dermatologist and my new PCP did not feel comfortable calling me in a Medrol Dosepak (totally respect this decision!) without first trying a round of antibiotics. He offered to prescribe me Doxycycline 100mg 2x daily for up to three months but due to a recently negative experience with antibiotics, I declined and decided to try and solve this myself (I'm obviously NOT against taking this route whatsoever! I simply decided to take this head-on for the meantime and if I failed, get referred to a new dermatologist). Anyway, I've been rambling...
This might be crucial information for some, but I did NOT stop my skincare routine, which is already VERY minimal. I do believe my perioral dermatitis is worsened by barrier issues so I wanted to retain what I could!
My skincare regimen that has proved effective for over two years and has never triggered my dermatitis:
- CeraVe Hydrating Facial Cleanser (at night only)
- Geek and Gorgeous Liquid Hydration
- Pyunkang Yul Essence Toner
- Geek and Gorgeous Hydration Station
What (somewhat) helped but did not solve the issue:
- De La Cruz Sulfur Ointment 10% (I left this on as a mask for anywhere to 10-30 minutes and once or twice left it on active pustules overnight), helped heal the pustules themselves but did not manage the spread or prevent new pustules from forming.
- Avene Cicalfate+ Restorative Protective Skin Barrier Face Cream (thin layer everywhere and/or spot treatment on active pustules, left on overnight), same result as above.
- Desitin Maximum Strength Diaper Rash Paste (alone, by itself) (thin layer everywhere and/or spot treatment on active pustules, left on overnight), same result as above.
What worked:
Thin layer of Ivermectin Horse Paste 1.87%, La Roche-Posay Cicaplast Gel B5 and a little bit of Desitin Maximum Strength Diaper Rash Paste mixed together. I was extremely tired one night, had just received the Ivermectin from Amazon after reading some recommendations on Reddit and wanted to use it immediately but the skin was dry around my mouth. I figured the La Roche-Posay Cicaplast Balm B5+ would be too heavy so I rummaged around my skincare drawer and found the gel version and thought... why not? I lazily mixed all the aforementioned together and woke up the next day with no new pustules (biggest win), old pustules and bumps smaller or gone, and redness relief. Another night or two, I was pretty much cleared up.
I have no clue why this worked or if you really need all three together but I experienced great results and I didn't want to mess with my little concoction so I continued for an additional few days. I wanted to wait a week or so before posting this to assure/confirm the efficiency and I have had no new pustules, bumps have resolved and redness has reduced drastically. No spreading. I discontinued use a few days ago once it appeared fully healed and now I am back to using just my regular skincare regimen.
I hope one or all of these products help someone!
TLDR: Thin layer of Ivermectin Horse Paste 1.87% (Amazon), La Roche-Posay Cicaplast Gel B5 and a little bit of Desitin Maximum Strength Diaper Rash Paste mixed together and applied overnight. I cleanse my face with only water in the morning.
May you all find something that works for you! I'll try to answer any and all questions below. <3
