Problem: I can't seem to get rid of
these red, swollen, sometimes crusty bumps around my lips
and at the sides of my nose. Nothing seems to help, including
over-the-counter acne products and cortisone creams. What
can I do?
Solutions: What you describe sounds
like an almost classic case of perioral dermatitis. According
to the American Academy of Dermatology (http://www.aad.org)
"Perioral dermatitis [POD] is a common skin problem
that mostly affects young women [20 to 45 years of age].
Occasionally men or children are affected. Perioral refers
to the area around the mouth, and dermatitis indicates
redness of the skin. In addition to redness, there are
usually small red bumps or even pus bumps and mild peeling.
The disease can look a lot like acne. The areas most affected
are the areas from the nose to the sides of the lips,
and the chin... . Sometimes there is mild itching and/or
burning."
POD is actually quite common and, according to most dermatologists,
is increasing in incidence (Source: Australasian Journal
of Dermatology, February 2000, pages 34–38). While little
is known about what causes this disorder, there are theories
that overuse of topical cortisone creams, fluoridated
toothpaste, or heavy or occlusive skin-care ointments
and creams (especially those with a petrolatum or thick
wax base) and foundations may be responsible. Exposure
to sunlight, heat, and wind can also make matters worse
(Source: eMedicine Journal, August 1, 2001, volume 2,
number 8).
You can experiment by stopping the use of any of the
potentially problematic products mentioned above. You
should also discontinue the use of topical cortisone creams,
but be aware that this can initially make matters worse.
That can feel self-defeating, but be patient for a few
weeks to see if the condition improves.
It would also be helpful to find out if fluoridated toothpaste
is the source of the problem. You can try brushing with
fluoride-free toothpaste such as Tom's of Maine Natural
Fluoride-Free Toothpaste ($2.99 for 4 ounces) and see
if that makes a significant difference. If fluoride-free
toothpaste turns out to be the solution, check with your
dentist to see how this will affect your dental health.
If these experiments lead you to suspect POD is indeed
the cause of the bumps around your mouth and nose, it
is best to see a dermatologist because there are no cosmetics
or over-the-counter medications that can treat the condition.
A dermatologist can prescribe topical metronidazole (MetroGel,
MetroLotion, or MetroCream), alone or in combination with
either oral tetracycline or erythromycin. Even though
topical cortisone creams may be the cause of POD, you
may be prescribed a low-potency cortisone cream to reduce
the inflammation and to help you wean off the stronger
topical cortisone cream you may have been using (Source:
Seminars in Cutaneous Medical Surgery, September 1999,
pages 206–209). For more information on POD, visit http://www.aad.org/pamphlets/Perioral.html
(this URL is case-sensitive).