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Have Perioral Dermatitis, Mild Enzymatic Exfoliation. Using Topical Hydrocortisone. Wean Off It?
I am an esthetician and have a client who has been using a topical hydrocortisone twice daily for may months. I advised her of the negative side effects of the continued use of hydrocortisone and she discontinued. She now has many papules and a few pustules around her mouth and along her jawline. Seems like perioral dermatitis except that there is no redness or flaking and aside form the breakout, the rest of her skin is healthy. The papules unfortunatley are starting to look slightly cystic and are uncomfortable for her. She has started using the hydrocortisone again to calm down the breakout. How can I safely wean her off the hydrocortisone ad alleviate the breakouts? I can tell her skin is thinning as she peeled slightly after a very mild enzymatic exfoliation.
Wed, 25 Sep 2013
hi,
Thanks for writing to us.
Firstly it has to be seen whether she has developed acne lesions over area of application or it is steroid induced perioral dermatitis.
As lesions are more of pustular and cystic type, start the patient on doxycycline and give her benzoyl peroxide and adapalene for application. Do not stop hydrocortisone abruptly, ask your patient to use it twice in a day on alternate days in first week then once in a day on alternate days in second week. In third week she may use it for two non consecutive days and then stop. Pimecrolimus is said to work well for steroid induced perioral dermatitis as diagnosis is not confirmed, treat her empirically with doxycycline, adapalene and benzoyl peroxide.
Take care
Thanks for writing to us.
Firstly it has to be seen whether she has developed acne lesions over area of application or it is steroid induced perioral dermatitis.
As lesions are more of pustular and cystic type, start the patient on doxycycline and give her benzoyl peroxide and adapalene for application. Do not stop hydrocortisone abruptly, ask your patient to use it twice in a day on alternate days in first week then once in a day on alternate days in second week. In third week she may use it for two non consecutive days and then stop. Pimecrolimus is said to work well for steroid induced perioral dermatitis as diagnosis is not confirmed, treat her empirically with doxycycline, adapalene and benzoyl peroxide.
Take care
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