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Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8203
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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I have a red burning rash around my mouth and down under my

Resolved Question:

I have a red burning rash around my mouth and down under my chin. I also have patches of irritated inside my elbows and on my wrists. I saw an allergist for the issue and he believes the issue with my face is perioral dermatis, and my arms are eczema. I was prescribed metrogel for my face and steroid cream for my arms. It has been 2 weeks since I started the treatment, and my face is as bad as it ever was and he wants to switch me to desonide for my face but my reading online indicates that steroids can exacterbate perioral dermatitis, Need advice on how to proceed.
Submitted: 2 years ago.
Category: Dermatology
Expert:  Dr. Nair replied 2 years ago.
Hi,

Can you take a photograph of the affected area?
Customer: replied 2 years ago.
Here you gographicgraphic
Expert:  Dr. Nair replied 2 years ago.
Thank you for the photograph. Tell me did the rash on the face and your arms start at about the same time? Does that rash look similar to the facial rash?

Do you have any trouble with scalp dandruff?

Were there any pimple like bumps or small pus filled lesions around the mouth when the rash started or did it always look dry and scaly?
Customer: replied 2 years ago.
The rash on my face started about 3-4 weeks before I noticed the rash on my arms.

The rashes look similar when they first appear, there is generalized redness, but the rash on my face gets dry and peels while the rashes on my arms do not. The rashes on my arms also get a more pebbly apperance then I noticed on my face.

I do not have any problems with scalp dandruff.

I do not recall having any pimple like bumps when the rash started as far as I remember it just started off with generalized redness, and a deep within the skin tingling itch.
Expert:  Dr. Nair replied 2 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

Thank you for the information. Though perioral dermatitis is a possible diagnosis the lack of acne like bumps or pustules in the affected area, occurrence of a somewhat similar rash in the arm flexures and the lack of response to doxycycline are all factors against the diagnosis.

I think all your symptoms can be explained by seborrheic dermatitis (seb derm) which is a type of endogenous eczema. I would recommend trying the desonide cream mixed with 1% clotrimazole on the perioral area (twice a day). This works quite well in seb derm. The same mixture or something stronger (e.g mometasone cream instead of the desonide cream) can be used on the arm rashes. Treatment is required for 14-21 days to see maximum benefit.

Regarding the outside possibility that the facial rash is indeed perioral dermatitis desonide cream is still okay since this is a non-fluorinated steroid and it is mainly the fluorinated steroid creams like Fluticasone which have been implicated in worsening or triggering perioral dermatitis.

Hope this helps, please feel free to ask if you have any queries.
Customer: replied 2 years ago.
If it is seborrheic dermatitis, will the treatment with desonide and clotrimazole likely to clear up the rash for an extended period of time or no?
Expert:  Dr. Nair replied 2 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

That's always a hard question to answer. Many patients do clear up for prolonged periods of time (years sometimes) while other can have recurrences during periods of stress, season change, winter etc. However the recurrences do tend to be milder as time goes on for many patients.
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8203
Experience: MBBS, MD (Dermatology, Venereology & Leprology)
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