A stubborn case of perioral dermatitis that just would not quit

I had this client come in about nine months ago with what looked like a simple rash around her mouth. She'd been using a new toothpaste, so we thought it was a contact thing. I gave her a gentle routine, cut out actives, the whole deal. It cleared for a week, then came back worse. I mean, we tried everything I could think of: switching to a zinc soap, fungal acne protocols, even cutting out all oils. It took me six full months of tweaking her home care, trying different calming serums, and finally getting her to a derm for a short course of prescription cream to really get it under control. I've never had a skin condition take that long to pin down before. Has anyone else dealt with a perioral dermatitis case that just seemed to laugh at your usual fixes?

4 comments

4 Comments

uma_reed262mo ago

What did the derm end up prescribing for her? I've seen a few cases where the usual calming stuff just makes it angrier, like the skin barrier is totally shot and needs that medical nudge to reset.

dakotawells20d ago

Oh man, yeah I've been there! My derm had me on this super low dose steroid for two weeks, just enough to calm the redness without wrecking my barrier more. But the real game changer was when she added a prescription barrier repair cream with like, ceramides and cholesterol in it. Turns out my skin was so busy reacting it couldn't even hold moisture, so the steroid just stopped the freakout and the repair cream did the heavy lifting. If your friend's skin is getting mad at normal calming stuff, maybe suggest asking about a barrier-support script instead of just a steroid alone.

noahcampbell2mo ago

Honestly, they gave her this super gentle steroid cream, like the weakest one they make. My skin would probably laugh at it and ask for something stronger, I've messed my barrier up so many times trying every product under the sun. I once used a "calming" mask that made me look like I had a bad sunburn for a week. So yeah, I get needing that medical reset for sure.

dylan_green5820d ago

My derm put me on 1% hydrocortisone for five days, but that barely touched it. So she switched me to a short course of desonide, which is a bit stronger but still gentle enough for the face. The real trick was pairing it with a prescription azelaic acid foam, that stuff calmed the redness way better than any greasy cream I tried. After the two week taper, I went straight to a simple routine of just the foam and a mineral sunscreen. My skin basically needed that medical reset to stop the cycle of irritation. Did she get a steroid or something non-steroidal instead?