Hi Dr. Bailey,
Do you have any advice how to get rid of perioral dermatitis with clotrimazole? I am dealing with gluten/allergy and leaky gut issues and take supplements for that, because I’m sure they are related. Also, is it common to get it not only around the mouth, but on the forehead? I get itchy pimples in clusters that won’t go away for anything!
Typically perioral dermatitis happens on the face and involves the perioral and periocular (around the eyes) skin. It can move out from there, but I have not seen it jump to the forehead. That said, an inflammatory rash like this can present differently on every person.
Perioral dermatitis usually manifests as red itchy pimples and little red blisters around the sides of the mouth. The rash may start subtly at first but gradually revs-up. The skin can get really red, inflamed and blotchy-looking. The rash typically extends onto the chin, up the crease to the nose and can move to the skin around the eyes. The pustules and blisters ultimately become very red, large and ‘juicy’ looking. Perioral dermatitis can be mistaken for acne, rosacea and facial dandruff (aka seborrheic dermatitis).
This is unfortunately one of those frustrating and fairly common rash that we don’t understand. Doctors and scientists have no clue about what causes it. There is a link between perioral dermatitis and chloride or fluoride exposure in dental products, strong prescription (halogenated) cortisone creams/ointments and asthma inhalers.
How Do Doctor’s Treat Perioral Dermatitis?
Tetracycline is the usual treatment for perioral dermatitis. In my experience it needs to be used for at least several months, or else the rash comes back quickly.
Supportive topical prescription products help the skin heal faster. I really don’t like putting patients on oral antibiotics and so I also combine a broad topical approach in the hopes that it will allow me to stop the tetracycline as soon as possible. I usually combine the oral treatment with three topical medicines. Patients layer the medicines on their rash. The topical prescriptions I usually recommend include:
- An anti-bacterial topical (metrogel, erythromycin or cleocin topical prescriptions),
- An antifungal such as ketoconazole or clotrimazole creams
- A mild, non-halogenated cortisone cream.
Key points are that all topical medicines need to be non-irritating and all except the cortisone need to be continued for at least a month after the skin has cleared.
I usually also have my perioral dermatitis patients wash with my Calming Zinc Soap. This naturally hydrating and soothing soap contains medicated pyrithione zinc to help control skin yeast germs that may play a role in this rash. For years pyrithione zinc cleanser was only available as a harsh soap called ZNP, or in harsh dandruff shampoos. Now it’s available in this hydrating, naturally anti-inflammatory bar soap. I have my perioral dermatitis patients use Calming Zinc indefinitely because I find that it helps prevent recurrences too.
Also, continued exposure to fluoride and chloride containing medicines and products needs to be avoided.
There is a high relapse rate with perioral and periocular dermatitis. Patience is important and if medicines are stopped too soon the rash comes right back. In my experience, patients who are prone to perioral dermatitis typically go through a ‘spell’ where they get it several times over a 2 to 5 year period. To help heal the skin I also incorporate Green Tea Antioxidant Skin Therapy into their complete skin care routine. Moisturizer is also important to use because dry skin has reduced barrier integrity. I have my patients layer Daily Face Cream on top of the Green Tea as part of maintenance.
The routine looks like this:
Layered prescription medicines if being used
Ideally broad spectrum mineral zinc oxide sunscreen such as EltaMD Daily SPF 40 is applied on top to prevent hyperpigmentation.
I hope that helps. Please remember I can talk generally about perioral dermatitis but, of course you need to follow up with your dermatologist regarding your diagnosis; I cannot in any way make a diagnosis or give specific advice for your particular treatment over the internet. Take this information into your treating dermatologist to be sure you have the correct diagnosis because your description is not classic for perioral dermatitis.
Cynthia Bailey MD, Dermatologist
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