White itchy spots around the lips, below the nose, and on the chin. What could it be?

Question

Hello doctor,

Our 12-year aged daughter has a problem with the skin around the lips, below the nose, and on her chin. It started before seven months, and the skin in those places is red with little white spots and often very itchy. We visited many general physicians a few times, but they cannot determine what it was.

They suspected it to be some bacterial infection, acne or something else. She has tried different creams and ointments such as Hydrocortisone, Hydrocortisonum Oceanic, Bactroban 2 %, Freederm, Duac, Virupos, Fusidic Acid, Oilatum, and even Elocom. And Elocom seemed to work but just for a few days.

Without any cream, it gets worse very fast, and changes are visible in hours. She had eczema and some skin allergies, but it was not so severe and long-lasting. The condition at this moment is, so severe and she needs a quick help.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

This condition is known as perioral dermatitis, which usually results from the use of topical steroids. One feels better when they use topical steroids like Elocon (Mometasone), but it gets worse as soon as it is stopped. You need to stop using steroids and start taking following medications

A. Pimecrolimus, 1 % Cream, apply once at night.

B. Metronidazole gel 0.75 % apply once in the morning.

C. Use sunscreen every three hours during day time.

D. Capsule Doxycycline 40 mg once a day.

E. Tablet Fexofenadine 120 mg once a day.

Do this for 20 days and then follow-up. Please stop using topical steroids for this.

I hope this helps.

Thank you.