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Is Pregnancy Advisable When Undergoing Steroid Treatment For Perioral Dermatitis?
Question: I am writing this seeking your help with my condition described below, I would really appreciate giving me your medical opinion/advice about it.
Since May 2014, I noticed some tiny spots around my T-zone, they were not red or anything.
I went to a dermotolgist in the UK, where I am studying and he said that I have seborrheic dermatitis and he advised me to use Nizoral shampoo as a face wash and a shampoo. Unfortunately, my skin did not improved.
Just to let you know that my face and particularly my T-zone was the only affected area of my whole body, there was not any symptoms in my hair or scalp.
I wen back home for the summer vacation, I wen there and saw a couple of other dermatologists.
First dermatologist: (June 2014)
- Same diagnoses
-Prescription given: Sporanox tablets + cream with 1% Hydrocrtozone & 1% Nizoral.
-Result: was not effective.
Second dermatologist: (July 2014)
-Same diagnoses
-Prescription give:
1- Gupisone (Corticosteroid 5 mg) 2 tablets a day for 30 days.
2- Locoid Lipocream 0.1% (hydrocortsone 17-butyrate 1 mg per g)
Result: It made wonders to my face, my face was 100% clear and even better than before!
At that time, I got married and after coming back from my honeymoon, I was noticing that the symptoms are starting to come back and worse than before!
I went back to the same second dermatologist hoping that he can help me after his magical first prescription!
(September 2014)
- Prescription given: Betnovate, a topical corticosteroid
- Result: It did help in calming up the flare up and the redness of my skin but it wasn't as the first result, I decided at that point to stop the treatment, and I stopped it gradually because I was aware of the rebound affect of the steroid creams.
(October 2014)
Came back from home to the UK to start university after summer vacation, I went to the same first dermatologist I saw first.
- He was surprised that I was given strong and potent steroid creams and he said that it made it much worse than the first time I saw him.
- He prescribed me a Protopic Ointment cream (non-steroid based cream) for a duration of four weeks.
- Result was satisfying at first but my skin started to flare out at end to treatment duration.
I went back to follow back with him with frustration, he was suggesting to take isotretinoin (Viitman A) for three months. I read a lot about this medicine and that its given to sever cases where nothing responds but I was so anxious to take it because I was told that I cannot get pregnant even after stopping the treatment for at least 1 month, and I know that patients who take this medicine should do a regular blood test every four weeks to check that the level of the lipids and liver enzymes are ok, otherwise, the medicine should be stopped and continued when everything is back to normal. And this going to take for ever + I didn't think that my skin reached that level of severity to take isotretinoin.
(November 2014)
I have decided to go a different dermatologist, a dermatologist who is specializing in complex medical dermatology.
His description and diagnosis was: " On examination there was monomorphic micro papular rash affecting her forhead, medial cheeks and chin. Tiny micro-pustuls were evident under magnification. There was fine scaling in places. The scalp was spared and there was no involvement of her ears".
He was suspecting that the rash represents perioral dermatitis, possibly with an element of sebhorrhoeic dermatitis.
Treatment given:
- Lymecycline 408 mg daily
- Elidal cream ( twice a day for only two weeks).
Result so far: my skin started to return to normal by time, and now after a month of taking the tablets, my skin is almost back to normal only 15% left to get there. I am happy about that but I am still worried that I need to be on these tablets for a long time, especially that I can not be pregnant during the treatment. Me and my partner want to have a baby soon and I am just worried that if I stop the treatment, I might got the same skin problem during pregnancy. I have read that there are safer alternative medicines such as erythromycin tablets, clarithro-mycin, oral metronidazole. I am worried that they might not be affective to solve the problem in case i get pregnant, which I am hoping to!
From my early childhood, I used to get red checks whenever I play or under the son or even when I feel shy, but I did not feel any kind of burning sensation at the time, it was just a red color on my cheeks But in my teens, i started to feel my checks … and sometimes it feels like burning. However, my skin was clear and I rarely get spots!
I have been reading a lot in the internet, I became obsessed about my skin, I red about steroid induced rosaceslike dermatitis, I think I probably have this condition because if i compare my skin back in May 2014, when I started seeing my skin being changed, my skin was not as bad as after using all the steroid based treatments. In addition to this, this is the first time in my entire life that my skin gets bad as this!
I am so worried, I have red that these conditions are chronic and they might be with me all my life and I might need to be on a regulated does of tablets all my life!
I am worried about this and how it is going to restrict me in planing my future family .. I am currently taking folic acid supplements because I am hoping to get pregnant soon.
Do you think I should be waiting till I become sure that my skin is not going to flare up after stopping lymecyline or shall I not restrict my self from getting pregnant?
Since May 2014, I noticed some tiny spots around my T-zone, they were not red or anything.
I went to a dermotolgist in the UK, where I am studying and he said that I have seborrheic dermatitis and he advised me to use Nizoral shampoo as a face wash and a shampoo. Unfortunately, my skin did not improved.
Just to let you know that my face and particularly my T-zone was the only affected area of my whole body, there was not any symptoms in my hair or scalp.
I wen back home for the summer vacation, I wen there and saw a couple of other dermatologists.
First dermatologist: (June 2014)
- Same diagnoses
-Prescription given: Sporanox tablets + cream with 1% Hydrocrtozone & 1% Nizoral.
-Result: was not effective.
Second dermatologist: (July 2014)
-Same diagnoses
-Prescription give:
1- Gupisone (Corticosteroid 5 mg) 2 tablets a day for 30 days.
2- Locoid Lipocream 0.1% (hydrocortsone 17-butyrate 1 mg per g)
Result: It made wonders to my face, my face was 100% clear and even better than before!
At that time, I got married and after coming back from my honeymoon, I was noticing that the symptoms are starting to come back and worse than before!
I went back to the same second dermatologist hoping that he can help me after his magical first prescription!
(September 2014)
- Prescription given: Betnovate, a topical corticosteroid
- Result: It did help in calming up the flare up and the redness of my skin but it wasn't as the first result, I decided at that point to stop the treatment, and I stopped it gradually because I was aware of the rebound affect of the steroid creams.
(October 2014)
Came back from home to the UK to start university after summer vacation, I went to the same first dermatologist I saw first.
- He was surprised that I was given strong and potent steroid creams and he said that it made it much worse than the first time I saw him.
- He prescribed me a Protopic Ointment cream (non-steroid based cream) for a duration of four weeks.
- Result was satisfying at first but my skin started to flare out at end to treatment duration.
I went back to follow back with him with frustration, he was suggesting to take isotretinoin (Viitman A) for three months. I read a lot about this medicine and that its given to sever cases where nothing responds but I was so anxious to take it because I was told that I cannot get pregnant even after stopping the treatment for at least 1 month, and I know that patients who take this medicine should do a regular blood test every four weeks to check that the level of the lipids and liver enzymes are ok, otherwise, the medicine should be stopped and continued when everything is back to normal. And this going to take for ever + I didn't think that my skin reached that level of severity to take isotretinoin.
(November 2014)
I have decided to go a different dermatologist, a dermatologist who is specializing in complex medical dermatology.
His description and diagnosis was: " On examination there was monomorphic micro papular rash affecting her forhead, medial cheeks and chin. Tiny micro-pustuls were evident under magnification. There was fine scaling in places. The scalp was spared and there was no involvement of her ears".
He was suspecting that the rash represents perioral dermatitis, possibly with an element of sebhorrhoeic dermatitis.
Treatment given:
- Lymecycline 408 mg daily
- Elidal cream ( twice a day for only two weeks).
Result so far: my skin started to return to normal by time, and now after a month of taking the tablets, my skin is almost back to normal only 15% left to get there. I am happy about that but I am still worried that I need to be on these tablets for a long time, especially that I can not be pregnant during the treatment. Me and my partner want to have a baby soon and I am just worried that if I stop the treatment, I might got the same skin problem during pregnancy. I have read that there are safer alternative medicines such as erythromycin tablets, clarithro-mycin, oral metronidazole. I am worried that they might not be affective to solve the problem in case i get pregnant, which I am hoping to!
From my early childhood, I used to get red checks whenever I play or under the son or even when I feel shy, but I did not feel any kind of burning sensation at the time, it was just a red color on my cheeks But in my teens, i started to feel my checks … and sometimes it feels like burning. However, my skin was clear and I rarely get spots!
I have been reading a lot in the internet, I became obsessed about my skin, I red about steroid induced rosaceslike dermatitis, I think I probably have this condition because if i compare my skin back in May 2014, when I started seeing my skin being changed, my skin was not as bad as after using all the steroid based treatments. In addition to this, this is the first time in my entire life that my skin gets bad as this!
I am so worried, I have red that these conditions are chronic and they might be with me all my life and I might need to be on a regulated does of tablets all my life!
I am worried about this and how it is going to restrict me in planing my future family .. I am currently taking folic acid supplements because I am hoping to get pregnant soon.
Do you think I should be waiting till I become sure that my skin is not going to flare up after stopping lymecyline or shall I not restrict my self from getting pregnant?
Brief Answer:
Could be either perioral dermatitis or rosacea
Detailed Answer:
Hello. Thank you for writing to us at healthcaremagic
I have gone through your query very patiently and I have understood it.
It would help me greatly if you can upload an Image so that I am able to have a better opinion about the diagnosis.
Judging from the description and distribution of the rash that it affects central T zone and also based on the response to treatments tried I will keep a possibility of either perioral dermatitis (snuffles) Or Rosacea, probably made worse after using potent topical steroids.
Seborrheic dermatitis is a possibility too.
All three of these conditions would respond to topical steroid initially but all three would get worse on continued use.
All three of them are chronic with remitting and relapsing courses.
Seborrheic dermatitis classically affects the side of the nose with an itchy, scaly/flaky rash.
Perioral dermatitis or snuffles also affects almost the same area i.e perinasal, nasolabial folds, perioral area as well as chin. There is background erythema along with monomorphic, minute bumps which may be red, slightly scaly, may develop into fluid filled as well as pustular lesions. There may be associated itching or burning sensation.
Perioral dermatitis may develop in response to potent topical flourinated steroids, cosmetics like sunscreens, toothpaste, sunlight exposure etc
Rocasea and perioral dermatitis are closely related conditions and treatments are almost the same.
Treatment is long term and includes oral antibiotics, either
-Tetracyclines like Doxycycline, Tetracycline, Lymecycline Or
-Macrolides like Azithromycin, Roxithromycin Or Erythromycin
-Oral Retinoids like Isotretinoin.
Oral treatment is very effective in perioral dermatitis as well as rosacea. They may required to be given for 3-4 months; after stopping these there may be a relapse which may require a repeat course.
For mild disease, topical treatment alone may be effective and options which can be tried are
-Topical antiacne like clindamycin, benzoyl peroxide Or
-Topical azaleic acid Or
-Immunomodulators like Pimecrolimus etc
Of course if you are planing to be pregnant soon you should stop taking Tetracyclines i.e Lymecycline and Oral Retinoids are not an option for you because hey can have fetal side effects.
In that case it is your personal decision whether to stop or continue taking oral treatment; stopping oral treatment may precipitate a relapse.
It also depends on whether your skin condition is mild enough to be well controlled with just topical's.
Nevertheless, Macrolides like Azithromycin Or Erythromycin are safer in pregnancy and if your skin condition is severe enough to warrant oral treatment and not be able to be controlled with just topical treatment.
You may discuss about changing to one of these oral antibiotics with your treating dermatologist.
You may just use topical's like azaleic acid, clindamycin, pimecrolimus if the disease is mild.
Use a gentle cleanser for face wash e.g cetaphil cleansing lotion and avoid all cosmetics like sunscreens, moisturizers, soaps etc
Regards
Could be either perioral dermatitis or rosacea
Detailed Answer:
Hello. Thank you for writing to us at healthcaremagic
I have gone through your query very patiently and I have understood it.
It would help me greatly if you can upload an Image so that I am able to have a better opinion about the diagnosis.
Judging from the description and distribution of the rash that it affects central T zone and also based on the response to treatments tried I will keep a possibility of either perioral dermatitis (snuffles) Or Rosacea, probably made worse after using potent topical steroids.
Seborrheic dermatitis is a possibility too.
All three of these conditions would respond to topical steroid initially but all three would get worse on continued use.
All three of them are chronic with remitting and relapsing courses.
Seborrheic dermatitis classically affects the side of the nose with an itchy, scaly/flaky rash.
Perioral dermatitis or snuffles also affects almost the same area i.e perinasal, nasolabial folds, perioral area as well as chin. There is background erythema along with monomorphic, minute bumps which may be red, slightly scaly, may develop into fluid filled as well as pustular lesions. There may be associated itching or burning sensation.
Perioral dermatitis may develop in response to potent topical flourinated steroids, cosmetics like sunscreens, toothpaste, sunlight exposure etc
Rocasea and perioral dermatitis are closely related conditions and treatments are almost the same.
Treatment is long term and includes oral antibiotics, either
-Tetracyclines like Doxycycline, Tetracycline, Lymecycline Or
-Macrolides like Azithromycin, Roxithromycin Or Erythromycin
-Oral Retinoids like Isotretinoin.
Oral treatment is very effective in perioral dermatitis as well as rosacea. They may required to be given for 3-4 months; after stopping these there may be a relapse which may require a repeat course.
For mild disease, topical treatment alone may be effective and options which can be tried are
-Topical antiacne like clindamycin, benzoyl peroxide Or
-Topical azaleic acid Or
-Immunomodulators like Pimecrolimus etc
Of course if you are planing to be pregnant soon you should stop taking Tetracyclines i.e Lymecycline and Oral Retinoids are not an option for you because hey can have fetal side effects.
In that case it is your personal decision whether to stop or continue taking oral treatment; stopping oral treatment may precipitate a relapse.
It also depends on whether your skin condition is mild enough to be well controlled with just topical's.
Nevertheless, Macrolides like Azithromycin Or Erythromycin are safer in pregnancy and if your skin condition is severe enough to warrant oral treatment and not be able to be controlled with just topical treatment.
You may discuss about changing to one of these oral antibiotics with your treating dermatologist.
You may just use topical's like azaleic acid, clindamycin, pimecrolimus if the disease is mild.
Use a gentle cleanser for face wash e.g cetaphil cleansing lotion and avoid all cosmetics like sunscreens, moisturizers, soaps etc
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello doctor,
Thanks for your response.
How can I upload the pictures?
I don't want my pictures to be on the website or anywhere in the internet, can you insure that?
Thank you,
XXXX
Thanks for your response.
How can I upload the pictures?
I don't want my pictures to be on the website or anywhere in the internet, can you insure that?
Thank you,
XXXX
Brief Answer:
Upload pictures
Detailed Answer:
Hi.
To upload the pictures you may either go to the "Reports Section" and upload Or else you may mail them to " YYYY@YYYY " with the subject line as Attn Dr. kakkar.
The pictures are confidential and are not shared with anybody else Or on internet. So please feel safe.
Regards
Upload pictures
Detailed Answer:
Hi.
To upload the pictures you may either go to the "Reports Section" and upload Or else you may mail them to " YYYY@YYYY " with the subject line as Attn Dr. kakkar.
The pictures are confidential and are not shared with anybody else Or on internet. So please feel safe.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for reassuring that, I will send them by email now.
Thanks,
Thanks,
Brief Answer:
This is most likely a perioral dermatitis
Detailed Answer:
Hi.
I have reviewed the Images.
Even I think that it is perioral dermatitis. This is neither seborrheic dermatitis nor is it rosacea.
You had a severe eruption even extending on to the glabella as forehead probably as a rebound after using potent topical steroids i.e betamethasone butyrate
Your present skin condition is significantly better as compared to what it was a 2 months back.
I think you can continue with the same treatment for 2 more weeks (lymecycline and pimecrolimus). Thereafter you may use just topical's i.e pimecrolimus, twice daily.
I would suggest you to try metronidazole 1% gel.
Discuss this with your treating doctor before trying.
Regards
This is most likely a perioral dermatitis
Detailed Answer:
Hi.
I have reviewed the Images.
Even I think that it is perioral dermatitis. This is neither seborrheic dermatitis nor is it rosacea.
You had a severe eruption even extending on to the glabella as forehead probably as a rebound after using potent topical steroids i.e betamethasone butyrate
Your present skin condition is significantly better as compared to what it was a 2 months back.
I think you can continue with the same treatment for 2 more weeks (lymecycline and pimecrolimus). Thereafter you may use just topical's i.e pimecrolimus, twice daily.
I would suggest you to try metronidazole 1% gel.
Discuss this with your treating doctor before trying.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
DO you think that two weeks of lymcycline would be enough for now?
and since I had this condition suddenly in May, is there a chance that I get it back? Are there any patients who get completely relived from this condition after proper treatment and never get it back again? what do you think my case is?
Do you consider my skin condition now to be mild?
Regarding the pimecrolimus, the doctor advised me to use it twice a day for two weeks and I did that at the beginning of the treatment. Do u still think I need to repeat that? and why?
How is metronidazole 1% gel different from pimecrolimus? Do you think it is better?
And are u suggesting that I use it after stopping from lymecyclin? and whats the frequency and the lengt/quantity of dosage?
Does it have any affect if used during pregnancy?
Looking forward for your response.
Thank you,
XXXX
DO you think that two weeks of lymcycline would be enough for now?
and since I had this condition suddenly in May, is there a chance that I get it back? Are there any patients who get completely relived from this condition after proper treatment and never get it back again? what do you think my case is?
Do you consider my skin condition now to be mild?
Regarding the pimecrolimus, the doctor advised me to use it twice a day for two weeks and I did that at the beginning of the treatment. Do u still think I need to repeat that? and why?
How is metronidazole 1% gel different from pimecrolimus? Do you think it is better?
And are u suggesting that I use it after stopping from lymecyclin? and whats the frequency and the lengt/quantity of dosage?
Does it have any affect if used during pregnancy?
Looking forward for your response.
Thank you,
XXXX
Brief Answer:
Perioral dermatitis
Detailed Answer:
Hi.
Your present condition is significantly better as compared to what it was and i would say it is mild to moderate and I feel that 2 weeks of lymecycline would improve it further.
Perioral dermatitis may relapse and there can be a few relapses but it is not the rule in all patients. Relapses need to be managed similarly.
Perioral dermatitis has a good prognosis overall and most of the patients are ultimately cured.
Pimecrolimus is a topical antiinflammatory just like metronidazole and both of these have beneficial effects in snuffles. Some may respond better to metronidazole and others to pimecrolimus. Just like pimecrolimus, topical metronidazole can also be used twice daily.
You may start using topical pimecrolimus or metronidazole along with oral treatment (lymecycline). Together, topical + oral treatment, produces more improvement as compared to oral treatment alone.
However, some dermatologists prefer to treat perioral dermatitis with just oral antibiotics and take the patient off all topical's including cosmetics, sunscreens etc because in some patients with very sensitive skin any amount of irritation can precipitate a relapse.
You must also discuss this with your treating dermatologist, whether you can restart pimecrolimus.
Lymecycline is contraindicated in pregnancy because it can affect fetal dentition and cause permanent discoloration.
Topical metronidazole and pimecrolimus can be used during pregnancy.
Regards
Perioral dermatitis
Detailed Answer:
Hi.
Your present condition is significantly better as compared to what it was and i would say it is mild to moderate and I feel that 2 weeks of lymecycline would improve it further.
Perioral dermatitis may relapse and there can be a few relapses but it is not the rule in all patients. Relapses need to be managed similarly.
Perioral dermatitis has a good prognosis overall and most of the patients are ultimately cured.
Pimecrolimus is a topical antiinflammatory just like metronidazole and both of these have beneficial effects in snuffles. Some may respond better to metronidazole and others to pimecrolimus. Just like pimecrolimus, topical metronidazole can also be used twice daily.
You may start using topical pimecrolimus or metronidazole along with oral treatment (lymecycline). Together, topical + oral treatment, produces more improvement as compared to oral treatment alone.
However, some dermatologists prefer to treat perioral dermatitis with just oral antibiotics and take the patient off all topical's including cosmetics, sunscreens etc because in some patients with very sensitive skin any amount of irritation can precipitate a relapse.
You must also discuss this with your treating dermatologist, whether you can restart pimecrolimus.
Lymecycline is contraindicated in pregnancy because it can affect fetal dentition and cause permanent discoloration.
Topical metronidazole and pimecrolimus can be used during pregnancy.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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