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Please Help - 5 Months And No Diagnosis (Pic)

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Edit: Attached a zoomed-in pic to better illustrate the constant whiteheads.

Hi all, it's been five months of derm visits and rxs, and I still am not sure exactly what I have. I was initially diagnosed with perioral dermatitis over 2 years ago, and my (stupid) derm gave me a lotion that contained hydrocortisone and metro. I used it for nearly two years, and it worked. Upon realizing how bad cortisone use is, I stopped it -- and my face flared dramatically.

The flare phase has passed, but mini-eruptions have not. A more recent derm thought I might have demodex/rosacea, but ivermectrin + oral anti-parasitics did nothing. I've also tried finacea and antibiotics, to no avail.

Here's what my condition is like: every day, I get a handful of small, fluid (not pus)-filled bumps. They appear around my mouth and nose, and to be honest, they aren't even inflamed most of the time. I can literally scratch them off (no popping needed, since they are so superficial), and while the area becomes red for a while, if I put some sulfur on it, it's back to normal the next day.

I'm washing with a black soap, which I feel at least keeps my skin healthy, but it is not preventing the small pimples (?). Has anyone heard of this? The bumps, which I get EVERY day, are never deep -- just small, whitehead-looking things that if smothered with sulfur, are almost always gone in 24 hours.

My derm seems to be puzzled and wants me to go on Accutane, and to be honest, I'm sick of dealing with this and will likely do it. I just don't like not knowing what the problem is -- what if I go on Accutane, and it doesn't knock it out? It doesnt help that the last two times I've gone in, I haven't had a fluid-filled bump to show her.

I would really appreciate any help that can be given. I'm at my wit's end.

*pic: if you look closely, several of those bumps have a small whitehead. Since using the soap the larger, non-whitehead bumps have diminished. All it takes is a slight scratch to pop them, and again, they are totally superficial.

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Anyone? This is the rosacea forum -- do any of you guys get small whitehead-like bumps? I'm just not convinced it's rosacea... but I'm also not sure what the heck it is (or how to best treat it).

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In my opinion this is a steroid- induced perioreal dermatitis. For some people it produces little fluid filles pustules, rather than just skin redness. The skin barrier has beed destroyed by the use of topical steroids, and now thos is the result.

Guess why I know that...well....as I live an ocean away from you I am pretty sure we did not see the same dermatologist, but: they both had the same crazy idea to ├╝rescribe steroids for the face:)

Treatment is a zero diet for your skin. Zero meaning nothing at all in that area, no cleanser, no toners, no moisturizers. Just pure water, but no rubbing. In some cases Doctors prescribe doxicycline for it to calm down the inflammation. Or metro cream.


Successfully on "the regimen" from age 12 to 33 for cystic acne

Now:

100mg spironolactone since 08/13

Paula's Choice BHA 2%,

Green Cream 6 Retinol

Acne free and already almost free of hyperpigmentation, discolorations and wrinkles


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Thanks so much for the reply, Calumma. I'm sorry to hear you are struggling with the same thing. So no treatment, huh? Is that what you've been doing? I'd hate to use nothing, since a dollop of sulfur typically dries the spots out. I stopped the cortisone use in May of this year... is the idea just to let the skin barrier repair itself? And if so, any idea how long that usually takes? I hope the use of sulfur does not delay the healing....

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Yes, but also Doxy pills. And Black tea pads ( really strong ). This is a very common advice ( even my new derm gave it to me) for POD and first it sounded kind of weird, but it worked really well.


Successfully on "the regimen" from age 12 to 33 for cystic acne

Now:

100mg spironolactone since 08/13

Paula's Choice BHA 2%,

Green Cream 6 Retinol

Acne free and already almost free of hyperpigmentation, discolorations and wrinkles


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