What is the treatment for bumps on chin and forehead?

Question

Hi doctor,

I am an 18-year-old, and I have dry skin. I get breakouts on my forehead, and I get an occasional breakout on my chin. Other than that, I have good smooth skin. Around six months ago, I started to get these red bumps around my mouth and eyes that I had never had before. I started researching and thought I had perioral dermatitis, so I started treating it like that. The bumps went away. I talked to a family member who is a doctor, and they thought I had a minor gluten allergy because of the rash and a few other symptoms. So I went two weeks without gluten, and they completely went away, but today when I washed my face, I noticed that they were back and ten times worse than ever. They are all around my mouth and reach up to my nose. Some bumps have also formed on my cheeks, which have never been there before, and I do not have any around my eyes. I need a dermatologist opinion on this because I am stressed out and tired of trying random things that are not working. Please help me figure out what I have and how to fix it.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I have reviewed your attached images (attachments removed to protect the patient's identity). Perioral dermatitis is a common skin problem with itchy or tender small red bumps. The papules usually occur around the mouth, nose, eyes, and occasionally in the genital area. The probable causes:

1. Activation of the innate immune (genetically determined) system.

2. Epidermal barrier dysfunction.

3. Altered cutaneous microflora due to the application of multiple medicinal products like topical steroids, steroid inhalers, cosmetics, and fluorinated toothpaste.

4. Neglecting to wash the face and hormonal changes.

Differential diagnosis include:

1. Steroid rosacea.

2. Perioral dermatitis.

The probable diagnosis is perioral dermatitis.

Treatment plan:

1. Taper the topical steroid cream if you are taking it. Also, stop using other cosmetics and sunscreens.

2. Do not stop the steroid cream suddenly, as it may lead to a flare up. So, replace it with a less potent cream.

3. After tapering the topical steroids, I suggest liquid or gel sunscreen.

4. I suggest a capsule of Doxycycline 100 mg once daily for four weeks and applying topical 0.03 % Tacrolimus once at night.

5. Do not use soap. Instead, wash your face with warm water to clean the face while the rash is present.

Preventive measures is avoidance of topical steroids and occlusive face creams.