Thursday, June 25, 2009

Perioral Dermatitis - from Comments

Got this comment from Lauren about Perioral Dermatitis:

Aimee, I found your site while looking for a possible link between discontinuing Flovent and my son's rash around his mouth appearing a day later. Your blog entry and the comments by others were the only information I could find about perioral dermatitis caused by flovent or stopping flovent. Have you had any more experiences with it since your post?

The pediatrician and the allergist both had never experienced anything like it. He got a topical antibiotic cream and I suspected it wouldn't work after reading your blog, but gave the doctor the benefit of the doubt. It actually mostly cleared up with the cream, but then rebounded quickly as soon as he stopped using it. He's now back to using the cream plus on an oral antibiotic. I'm wondering if we should be reporting this to the drug company (GSK) since it seems to be an undocumented side effect that doctors have no idea about.

So, yeah - periorial dermatitis can DEFINITELY be caused by Flovent, or any inhaled steroid. I'm surprised that more pulmonologists don't talk about it!! #1 son had it so bad, it was terrible. It made him so sad - it looked like had terrible acne. And we had to go to several doctors before received an accurate diagnosis and treatment. One doctor referred to it as "steroid acne," which I think is accurate - but didn't prescribe a strong enough treatment.

Ultimately, it required a three-week course of SERIOUS oral antibiotics and a topical antibiotic gel. It's pretty serious stuff.

Lauren - I'm in support of your approaching GSK with this one. It should be listed as a side effect.

Thanks for bringing the topic back up. I'm sure there are plenty of other moms out there who could use this info

22 comments:

Anonymous said...

I'm glad to be reading your post. I have a 4 year old son who last November presented with a very small rash around his nose. A few months later he was placed on Flovent (inhaler with mask and chamber) by BOTH a pulmonologist and allergist (to my surprise). The dermatologist ONLY prescribes Noritate ointment twice a day. My husband and I were thinking allergies because of bowel issues (which began after milk intro) but are no longer on that thought. I came across your post after the second trip to the dermatologist revealed that steroids should not be used (but his use of flovent was made aware to doc). I came home and searched flovent and perioral dermatitis. My docs here tell me to continue flovent (which husband and I have never seen breathing issues on my son)and use the Noritate cream. His POD is now completely around his mouth, nose, and working its way around his eyes. It's horrible. I'm trying to find another dermatologist that specializes in children. I think this is such a new occurance with this medication that the docs (here atleast) honestly do not know the relationship.

Anne

Aimee said...

Perioral Dermatitis is both caused *and* suppressed by Flovent. I always found it presented in a single pustule if we missed even one dose of Flovent, and then came out full force when we went off for the summer.

Any dermatologist should be able to treat this. It requires a long course of oral antibiotics along with a topical cream or ointment.

As far as the Flovent for asthma/allergies...if both doctors recommended the Flovent, chances are your child is wheezing. Interestingly, pediatric asthma is not always audible, but a trained ear can hear it through a stethoscope.

BTW, my oldest had horrible poops after milk was introduced. And he is asthmatic. We put him on soy, and the bowel issues resolved immediately. Our doc was OK with this choice, as long as we bought calcium fortified soy and/or OJ.

Brenna said...

POD cannot be controlled with antibiotics or conventional medicines. I have been dealing with this condition for 18 months and the only thing I have found that has helped is Apple Cider Vinegar, both used topically and ingested (good luck getting small children to ingest the sour taste though) check out this website. It should help you out.

http://www.earthclinic.com/CURES/dermatitis.html

Aimee said...

Thanks, Brenna. That's a great suggestion. I respectfully disagree with the point that POD cannot be controlled with antibiotics - it absolutely can be, although the course is long and probably unpleasant. My son's was cleared up over a three-week course.

While I would rather have used vinegar, believe me, I wasn't aware of this option.

Regardless, perioral dermatitis is a medical condition, so before trying Brenna's suggestion of cider vinegar or any other treatment, please speak to your doctor.

Anonymous said...

I'm glad I found mom's talking about Perioral dermatitis. My eight year old had what looked to be "poison ivy" on his face, as diagnosed by our pediatrician. Despite my asking her why if it was Poison Ivy, why wasn't he itching or why hasn't it spread, she prescribed hydrocortisone and prednisone. After what seemed like much worse skin conditions, I took him straight to my dermatologist, who is now giving him liquid antibiotics and some sort of cream to put around his eyes, because they are also affected and seem to swell sometimes.
Anyway, I bought Cetaphil antibacterial soap for him because I read something about bacteria being a cause. Do any of you know what moisturizing cream I can use on his face, just because it looks so dry, that won't make the condition worse? It looks dry, but I am afraid to use anything on his face these days.THanks

Susan said...

Does anyone know what moisturizer is safe to use on an eight year old boy with Perioral dermatitis, because I can't stand the sight of what looks like dry skin, but don't want to use anything to disturb the condition more. He is currently on oral liquid antibiotics from my dermatologist. His pediatrician said he had poison ivy on his face, and put him on prednisone and hydrocortison, which I am wondering now if that is why we are having this problem. I wish I could find a fast solution to this.Thanks

Aimee said...

It still amazes me how little information there seems to be on Perioral Dermatitis caused by asthma meds!!

For us, the cure was several weeks of oral antibiotics and topical Metrogel.

In response to the recent comment, I think washing with Cetaphil is a GREAT idea, although we use just water and soft washcloth most of the time, and Cetaphil only when needed, even today. I would check with a dermatologist before using any moisturizer, but I imagine any gentle, hypoallergenic, fragrance-free lotion will be OK. Or something like Aquaphor, assuming your child is too young for acne.

Anonymous said...

To Susan I myself have been battling with PD. I at first trusted the doctors as well and took the steroid cream and it cleared, then returned, worse. Repeated with the pills, minocycline. Then I was prego so I couldn't take it anymore. I have now done a heavy amount of reading on the subject of skin diseases in general. Since the PD has returned. I'm not going to go that route again. I decided to attack from within! First of all. Virgin Coconut Oil. Buy it online or locally at health food stores or an indian market. It is pricey but since I've bought it I use it for EVERYTHING. and it last along time. Moisturizer, bath, makeup remover, frying, ringworm, diaper rash etc ect. the list on this stuff is amazing! Makes me wonder why we have so many products? Plus, the benefits are amazing. It is anti-fungal, and also powerful anti-oxidant. It will stop the bacteria from multiplying as well as moisturize, and promote healing. I am using a combination of natural remedies. The idea is to treat the person not the illness or the symptoms. Include Immune boosting foods in the diet. 2 -3 tablespoons daily recommended for adults and children. Mix into a smoothie is great, fry in it( it doesn't turn into hydrogenated fat) bake with it, salad dressings etc.
I also have been taking Oregano OIl. The oil directly is quite potent( it burns, I think because it is killing the bacteria or human demodex the parasite that cause acne and other skin diseases) MIx it with the coconut oil or olive to dilute. Oregano Oil is known to have very strong anti-biotic and anti-innflamatory effects. ( Another miracle substance I couldn't LIVE without) Also YOU could put a few drops into the bath. There are capsules you can take as well. Tea tree oil. Again diluted with water or oil and can be also added to the bath. Then I also Use Aloe Vera. Further promotes healing. The last thing I do is to drink seabuckthorn juice. Excellent for the skin ladies! I very much encourage you all to try these items. It is not a quick fix, it takesd time to remove the toxins that causes this in the first place and time to boost your immune systems to fight it. You'll find these items can replace many of the you use in your home without the price of being possibly unsafe. Think of all the unnecessary chemicals in all of our products. The pharmicuetical companies do know about these extra side effect that aren't listed, but say that can't be proved. The truth is it pays better if we are sick. I question everything I am prescribed now and do my own research. I encourage you to do your own research as well. Hope this helped. Remember, coconut oil, aloe vera, Oregano oil, tea tree oil, seabuckthorn.

Anonymous said...

I have PD, Coconut oil is great. Include it in his diet. 2-3 tablespoons a day. It goes great in Smoothies. You'll find you can use it for everything! Treat the problem from inside rather than out. There isn't a quick fix. No cure they say. That is because they prefer to treat us rather than cure. There is no money in a cure. DO RESEARCH. Coconut oil, tea tree oil, oregano oil, aloe vera and seabuckthorn juice or oil. Apply the coconut oil directly, eat it, put it in his bath(or yours) There is a parasite that causes these skin conditions. Antibiotic treatment only makes it worse. Oregano oil and tea tree oil should be diluted. Oregano oil also comes in capsules. WE have been using these plants for centuries so we know a lot more about them, than some stuff a company made out of chemicals in order to make obscene amounts of money. Also look into why and elliminate the sources. Flouride, and SLS,ALS as well as steroids as you know have been linked. Research the human demodex as well. HOPE THIS HELPS.

Anonymous said...

I am so glad I found this website. I am 33 years old and dealing with asthma and COPD. I do daily breathing treatments which consist of albuterol and ipratropium. I also use my rescue inhaler of albuterol daily. (On other meds for my breathing too) About 6 months ago I started developing really dry flaky skin around my mouth and chin. It pretty much is exactly where my mask goes. I have tried everything from aveeno wash with eucerin moisturizer to more water and vitamins. My sister is a physician and I kept telling her I thought it was from my breathing treatments, but I thought it was a fungus kind of like thrush. I have no health insurance right now so I can't go to my pulmonary physician. I'm seeing my sister tomorrow to show her how bad it has become. It has started to spread up my left cheek and nose. It is quite embarrassing and making me feel quite self conscious. I even had a lady at the mall trying to sell facial cleansers tell me I need to exfoliate my chin. I wanted to punch her. (Did I mention she approached me?) So thank you for having this, now I can mention it to my sister and hopefully she can prescribe me something for this before I go insane.

Aimee said...

I can't believe this is still an issue. You'd think by now more doctors would have caught on!

Anonymous said...

Just found this while searching for my 3 y.o. daughter, who is on Flovent and has had a horrible rash for more than 6 months. I started making the connection to the start of the rash and the switch to Flovent from Pulmicort - and the fact that she's on the mask, and it was right around that area. I presented this idea to her ped, who thought it was worth exploring. Switched her to a different mouthpiece and did Lotrimin. It got worse - which now makes sense, since we removed the steroid spray from hitting her skin. Just heard back from the ped, and she agreed to start oral and topical antibiotics. She hadn't heard of the POD caused by Flovent, either. Fortunately, she listened. Also have a pediatric derm app't in 4 weeks. So, yeah, still a problem.

Anonymous said...

My daughter has been on Flovent for mnay months now to control her asthma and for a couple months now she she has developed red and sometimes purple-ish rashes around her mouth. It was very mind boggling because we thought for a long while that it was food allergy but we couldn't really figure which food. The red/purple rash comes and goes very randomly her mouth area. It also gets more purple when she is cold or swimming or sucking a popsicle! Anyway, just yesterday I thoguht aybe it was her asthma meds (either the Flovent or Ventolin) as the rash is only around her mouth. Sure enough. Did a little googling and found other families with this same problem. Our rash goes away when not using Flovent.

The suggestions I got was to make sure to rinse their mouth and to use wet warm cloth to wipe the mask/face area after each use. Someone else posted the following:

"a treatment with topical clindamycin and an oral erythromycin/sulfa combination cleared it up beautifully. This was after the general pediatrician had tried antifunglals, steroid creams, and antiobiotic ointments to no avail for months.".

Hope this helps.

Anonymous said...

My daughter gets the same rash within 48 hours of each time we need to start Flovent. We use an antifungal called Ertaczo (Sertaconazole). It is gentle and does not iritate her skin. She's 2. It keeps it at bay. It is formulary (no generic) so its expensive. Before we found the Ertaczo, she had the rash for almost two months. It was ALL over her face including both eyes. The pediatrician and dermatologists tried anitbiotics both orally and topically and another antifungal. All worked temporarily but the rash came back with a vengance.

I am glad we found the Ertaczo. Without it, we wouldn't be able to keep up the Pulmicort or Flovent. The rash got so bad.

Anonymous said...

My son has PD so badly right now. Tried everything and nothing's worked. I believe it is due to the use of flovent. Noticed the PD started popping up after a few months of using flovent. Didn't put two and two together until I stumbled upon this post. Not sure how to proceed. His skin is so raw. It's painful looking and it pains me as a mother to see my baby suffering form this. Any advice would be helpful.

Aimee said...

Hi, Anonymous! Not sure where you live, but you need to find a physician who is aware of the links between inhaled corticosteroids and PD. B had to be on both topical and oral antibiotics for a LONG TIME - weeks - to get rid of it.



Best of luck - keep us posted on how it goes!!

Aimee said...
This comment has been removed by the author.
Aimee said...

Hi, Anonymous! Not sure where you live, but you need to find a physician who is aware of the links between inhaled corticosteroids and PD. B had to be on both topical and oral antibiotics for a LONG TIME - weeks - to get rid of it.



A doctor unfamiliar with the connection will prescribe topical steroids, which will only make things worse. Antibiotics are the only way to address, based on my experience.



Best of luck - keep us posted on how it goes!!

Anonymous said...

I am a 35 year old male and have been experiencing Perioral dermatitis for several years now. More recently I have been having anxiety and nervousness problems as well which is not like me. I had gone to the dermatologist several times over the past two years but found no real cure. I have taken a topical steroid which keeps the redness down and doesn't allow for a breakout. I started trying to understand what can cause anxiety and found it can be caused by your thyroid gland. I then started reading about thyroid issues and found that some sinus medications can cause thyroid problems. I then thought to myself that I have been on a nasal spray called Fluticasone Proprionate for roughly the same amount of time. I've been reading a lot of posts just like the ones listed here saying how nasal sprays can cause POD. I stopped using the nose spray today so we will see how the POD reacts. I would really love to see it go away. Mine has for the most part stayed on the right side of my face near my right nostril and upper lip area.

Aimee said...

Anonymous - you should NOT be given a steroid for perioral dermatitis. That's what causes it! It may temporarily suppress the reaction, but it won't cure it. You need antibiotics, and you'll need to be on them for a WHILE, unfortunately, so get yourself some probiotics, too. And please see a different doctor.

Anonymous said...

My 6 year old son has been on flovent inhaler for the past 8 months. A few months ago he developed a rash around his mouth. His primary care physician believes it has nothing to do with the inhaler, although I think it does. I have gotten 2 different opinions from two different doctors who diagnosed him with "typical peri oral dermatitis " both doctors told me to let it run its corse, and to never apply any steroid or cream of any sort to the area. I am so confused because his inhaler is a steroid and I feel that the rash is linked to the flovent use! I finally convinced his primary care provider to change his inhaler to a chewable pill to treat his asthma. I guarantee we will see results soon. I'm so frustrated about this random rash that he got and all they can ever tell me is that it is "typical peri oral dermatitis ". I will update you all when I find a resolution to this ongoing issue!

Aimee said...

Hi, anonymous - perioral dermatitis is both caused by AND suppressed by steroids. It's super-weird. See if you can find a doctor who'll treat if it persists. Obviously, our kids need to breathe, and sometimes we need steroids to make that happen. But, walking around with an acne-like rash is an awful thing to have to deal with as a kid. It broke my heart to see B like that for so long. The treatment was fairly awful in and of itself (for the love of GOD, buy a probiotic if you have to do what we did!!) but it worked.