Perioral Dermatitis - Eczema, Meet Acne

By Sarah Villafranco, MD
Posted in Blog, on April 18, 2014

I have a lot of medical words in my brain, but few have been on my mind as consistently over the last several years as perioral dermatitis. Having suffered with it myself, I have done extensive research, both didactic and practical, often with myself as the guinea pig, and I am happy to share what I have learned.

What is it?

Perioral dermatitis (PD) is a very common condition of the facial skin (perioral = around the mouth), especially in women of menstruating age. It is frequently undiagnosed or misdiagnosed, and acts like a cross between acne and eczema. The fact that these two diseases behave very differently may, in part, explain why it is so poorly understood, and so troublesome to treat.  With continued research, and after talking to many people who suffer with the condition, I actually believe that PD is an endpoint that arises from a unique, fluctuating set of circumstances and predispositions in each patient.   As with a mathematical equation, different numerical combinations can add up to the same sum.  This is true of PD as well.  In some cases, it is clear cut, and directly linked to to a particular cause.  But in most patients, the causes are multiple, uniquely combined,  and ever-changing  (making it even more difficult to treat!).

It varies in severity. In mild cases, it consists of patches of slightly bumpy, red or irritated looking skin, often with some mild flaking of the skin around the mouth, chin, and nose. (Some women experience symptoms near the outer corners of the eyes as well, though this is a less common location.) In more severe cases, the skin becomes very inflamed and angry looking in those areas, with flakes or scabs that can bleed or become infected.

Why does it happen?

There are many theories about the cause of perioral dermatitis, none of which are definitive. The most commonly proposed cause is the use of steroid facial creams, which are prescribed ubiquitously by western dermatologists. Other possible causes include fluoride toothpaste and sodium laureth sulfate. Exacerbating factors may include heavy creams or oils, cinnamon flavor/scent, and exposure to cold and sun.  I think we will probably learn in the future that there is a large hormonal component to the condition, as well.  It tends to resolve on its own as we age; it is fairly rare to see it over age 50, when our hormones simmer down and even out a bit.

My Story

I began having trouble with PD at age 36, a fairly typical age for women to have symptoms (generally age 20 to 45). My symptoms were also typical, and included redness, small bumps, and flaking of the skin around the chin, mouth, and nose.

When I first started studying natural skincare, especially with regard to this issue, I experimented a LOT on my own face. From yogurt masks to apple cider vinegar to nourishing oils to heavy creams, I explored options. None seemed to help consistently, and some (oils and heavy creams) made things worse. Hormone fluctuation definitely affected my symptoms, which were unfailingly worse in the days before my period.

I went to a local dermatologist after about 4 months. I told her I had perioral dermatitis. She agreed, and prescribed a topical antibiotic. As she wrote the prescription, I asked her if she had any experience with natural remedies, such as green tea extract, probiotics, and apple cider vinegar. She told me she was unfamiliar with homeopathy.  

I tried the antibiotic lotion for four days, and my symptoms got so much worse that I decided to be a bad patient and stop the medication. That’s when I got serious about figuring out a plan. Granted, this was not a randomized, controlled experiment. I made a bunch of changes at once, and could not tell you which one made the difference in my skin.

But here are the things I changed:

 

  • I stopped fluoride toothpaste (I switched to this one, which is also free of sodium laureth sulfate- Seafresh Toothpaste by Jason)
  • I stopped using sodium laureth sulfate in my hair care products.
  • I started evening primrose oil supplements (I like these - Barlean's Evening Primrose Oil. They also helped moderate my PMS symptoms, and who can complain about that?)
  • I took a less-is-more approach with my skin, which I continue to follow. I use this soap once or twice a day - Osmia Organics Black Clay Facial Soap - and I limit exfoliation in the perioral region (counter-intuitive, I know). After cleansing, I follow with this water-based serum -Osmia Organics Active Gel Toner. I leave the serum on for 30 seconds, and then follow with this cream - Osmia Organics Purely Simple Face Cream - applied sparingly around the mouth and chin.

 

While I make no claims about whether these steps will work for a person with PD, these minimally invasive changes have improved my symptoms dramatically. It took about 6 months (less invasive measures often require more patience), and I occasionally have symptoms around my cycle, when the dermatitis is visible up close in a mirror. Most of the time, people squint and stare when I tell them I have the condition, which tells me it is not usually noticeable. Wearing makeup (even a dab of powder, as I don’t wear any foundation) will make the dermatitis more visible, as well. 

With any of the lifestyle changes or products mentioned above, results may not be visible for 3-6 weeks - it is a condition that takes a long time to change, and requires patience and committment on your part.  

How should I treat?

Dermatologists will treat this condition with topical or systemic (oral) antibiotics, over a course of 6-12 weeks. There is a moderate success rate with this course, as well as a relatively high relapse rate.   Avoid steroid creams at all cost, as they are suspected of having a causative relationship to PD. I have found, whether antibiotics are involved or not, that relapse is very likely without lifestyle modifications.

The first two changes I suggest are eliminating fluoride in toothpaste, and sodium laureth sulfate (SLS) in oral, facial, and hair care products. A healthy, plant-based diet, with appropriate supplements, such as evening primrose oil, and attention to beneficial fats and grain or legume-based proteins will make a positive change in almost any skin type. And, sufficient water intake (spring water is the best) will help maintain intracellular water levels in the skin, as well.

As for skin care, I choose my products because I love my products, and I know who made them and with what ingredients. But, the point is that you need to RESIST the urge to scrub your face and heap products on it. Perioral dermatitis wants to be left ALONE. It does not like heavy creams or oil-based serums. It wants water-based, simple products, and some peace and quiet.  

I can't promise you our products will work for you!  But, we have had a LOT of people say their symptoms have decreased substantially (if not dramatically).  Whether you purchase product from us or not, I am available by email for questions any time, and will do my best to respond to them within a week or so.  And, if you've purchased our products and want to touch base about how they're working for you, we are here to listen, and help you make adjustments if necessary.

Remember, above all – do less.  And, for your own sanity, keep track of the things you do, and try to think of them as pieces of a management strategy for PD, rather than looking for one "miracle cure".  It will likely be a condition that does not fully go away until it is good and ready, so it can feel more frustrating than it needs to if you are out to CURE it, rather than decrease the symptoms and render them manageable.  Make sense?

And, now that you've read the basics, maybe our blog post about PD Frequently Asked Questions will help with any other questions you may have - thanks for reading!

 

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Comments

Hi- I have self-diagnosed perioral dermatitis. I have a doctor appointment next week. I have already noticed a difference since I’ve switched toothpaste and hair care products. My face is also much less “angry” and irritated when there is nothing on it. It’s less red. the dryness really looks unattractive, though. Looking forward to trying some of your products.
My question is this: I’ve read that this condition is linked to candida. Makes sense since I am prone to yeast infections. I cannot take birth control for this reason. What concerns me is being put on an antibiotic to fight the skin issue,. We all know that antibiotics can (and most likely for me) cause yeast infections. Sounds counterintuitive to me. Any thoughts on this? Thanks!!

Brandy on May 21, 2015

Hi Sarah,

Thank you so much for sharing all of this information with us, this post is God-sent! I’m 28 and have been dealing with PD for a few years now and have been feeling quite hopeless! I will be ordering a sample pack of the soap, toner and face cream and cannot wait to try them! I am 4 months pregnant right now, so I just want to confirm that these three specific products are safe during pregnancy? Thanks so much! – Jessica

Jessica on May 19, 2015

During the dry winter this year I developed terribly dry skin and PD around my nose & chin. It got worse at the times of my cycle. Oils, moisturiser etc did not help at all. I was desperate, & could not figure out why this was happening as I was using the same skin products for 2 years. I tried out some different skin products from the same brand aimed at sensitive skin and it changed literally overnight! I have no trace of PD left on my face! The game changer proved to be my cleanser. My new cleanser has no Sodium Lauryl Sulphate, and contains soothing, non stripping ingredients. For those who have tried everything else with no success, I used Paula’s Choice Skin Recover cleanser. Hope you all find success!

Faye on May 18, 2015

Hi Sara, my son (10years old) was “diagnosed” with seborrheic dermatitis in early 2014, but the rash started around his nose in late 2013. They prescribed prescription strength hydrocortisone and athlete’s foot cream mixed together. He also recommended to use Head & Shoulders to wash the area. That seems to help a little bit. It never really went away and then he would get flare ups. Then the beginning of this year it spread to around his eyes. Dr. said it’s the same thing and prescribed tacrolimus. It won’t go away at all. He has had many flare ups. I’ve started to keep track of what he eats and the other day after playing with puppies his face was really bad. That had never happened before. My parents are visiting family in Florida and they talked to my cousin who is a pediatrician and he said it could be perioral dermatitis. When I looked it up, it really sounds like what he has and not the seborrheic dermatitis. It’s so frustrating. He has this sweet and cute face and now this crap is all over it. His shampoo, cleansers and lotions don’t have the SLS. I’ve used Aveeno Baby before and now an organic/hypoallergenic cleanser and Vanicream facial wash. He’s allergic to sunblocks, so we’ve been using Vanicream sunscreen since he was 3. We went back to see his allergist and have an appt. this week to do some skin testing. If nothing comes out of that appt. we will go see a holistic doctor. This post has been eye opening and helpful. I will try the black clay soap and praying it helps. Thank you for the information.

Patsy Prough on May 09, 2015

Wow! Never have I come across so many comments which convey EXACTLY how I feel about my skin! Thank you so much Sarah for your advice, and for sharing your story. I dealt with PO back when I was in highschool, doctor gave me some cream, it went away and I never worried about it again. This was about 9 years ago. Now all of a sudden, since around the middle of last year I have been cursed with this damn disgusting skin around the base of my nose and my mouth. This morning was the first time I looked at myself in the mirror and literally started crying – I’ve always been lucky to have very clear skin. Thank you for your advice. I’ll be giving all of these options a go – SOMETHING has got to give :) :) x

Alison on May 08, 2015

All winter I had a recurring tiny bump or set of bumps beside each side of my mouth…..it was driving me insane and I couldn’t figure out why. It looked like a cold sore which made me feel very self conscious. Then it became a huge crack that took weeks to heal. This I found out was angular cheilitis….which in my opinion is way worse than a cold sore….it would crack open daily. So for six months I’ve pretty much had a red scar, open cut or section of bumps and had no idea why. Then I found this thread. I took toothpaste away and just use baking soda and some coconut oil to brush my teeth. I only use either the green blistex or coconut oil as Chapstick. I really do not eat sugars or dairy and that seems to leave my face very clear except for that area. I chewed a piece of gum the other day and within ten minutes had bumps on each side of my mouth. I was sooooooo irritated. So my miracle cure for these bumps….and I’m talking within an hour …and for sure gone within a day. …..Listerine. ….the Listerine Zero mint flavor specifically. I apply listerine to the bumps with a q tip. I also apply that to any pimples or bumps I get now and it makes them go away almost immediately. I assume it has something to do with it being antibacterial. I also always apply coconut oil or olive oil….mixed with a little water…to my face before I put make up on….it seems to prevent any make up from penetrating and giving me a breakout.
I’m looking forward to a summer free of bumps and without toting my concealer everywhere just in case.

Andrea on May 07, 2015

Hi. My son just turned 13yrs. He has history of eczema and has used steroid creams in the past. Hes recent one left him with PD. I took him to a local doctor who finally realised this is nto eczema we are dealing with. She’s precribed him to use a Nizarol shampoo and use the suds to wash his face and petrolium jelly (Vaseline) for the dryness. have you heard of these treatment method before. After reading this blog im unsure what to do. I am after reading this going to invest in SLS free toothpaste and shampoos Thanks

Amy Haley on May 05, 2015

During the dry winter this year I developed terribly dry skin and PD around my nose & chin. It got worse at the times of my cycle. Oils, moisturiser etc did not help at all. I was desperate, & could not figure out why this was happening as I was using the same skin products for 2 years. I tried out some different skin products from the same brand aimed at sensitive skin and it changed literally overnight! I have no trace of PD left on my face! The game changer proved to be my cleanser. My new cleanser has no Sodium Lauryl Sulphate, and contains soothing, non stripping ingredients. For those who have tried everything else with no success, I used Paula’s Choice Skin Recover cleanser. Hope you all find success!

Faye on April 29, 2015

I am beginning to lose faith in western medicine.. ;( I started getting crazy skin flare ups at 44 years old… I thought almond allergy. I went to the derm and he prescribed steroid cream which in turn I believe has now given me PD. UGH… Really? I just purchased the starter set. It appears after I ditched the steroid cream – everything natural I have been doing – is prob making this worse (coconut oil, EOs). I know you state less is more – but the dryness is killing me. I am afraid to try anything at this point! I did start some new probiotics… I’m guessing I should ditch those too till this calms. Yes? Will your cream be safe to apply to offset this dryness/pain?

Dani Trees on April 28, 2015

@Charlotte – So sorry for your struggles. I have found that coconut oil makes my skin feel dry and my PD symptoms flare, at least used by itself. You might try a very simple face cream if you’re still feeling dry.
@Shanna – I think all cinnamon and derivatives of cinnamon can exacerbate PD, although there are certainly no official studies to support that! I guess I would stay away from it for a while and see if you notice a change. Double check your toothpaste for SLS also – that’s a tricky hiding place that occasionally gets missed. Good luck!

Love to you both – Sarah.

Sarah Villafranco, MD on April 23, 2015

Hi Sarah, thanks so much for sharing your thoughts and knowledge on PD. I’ve battled an outbreak for 5 months now. Mine started to go away during a cleanse, and was almost completely gone yesterday morning, but now it’s slowly creeping back up. Ugh. I’m wondering about cinnamon. You mention to stay away from cinnamon flavoring, but have you found that cinnamon in general can be a problem? I realize I need to test it out for myself, but curious if others have had issues with it, or if it’s just cinnamon flavoring. I’m using the Black Clay soap (love it) and just order samples of the gel toner and face cream. Can’t wait to try them out on my face!

Shanna on April 23, 2015

HI there, I have had one bout of PD which was cleared up by a course of oxytetracycline tablets. But… it’s back. I have switched back to flouride free toothpaste, and am putting honey (raw) on the spots. Part of it has cleared up and the ones round my eyes are taking a little longer. But, defintely better after the honey. Apart from being a bit sticky (not good when all the dust outside sticks to it) my biggest concern is that my face feels very dry. I am relenting and putting organic cocnut oil on – but I suspect that is slowing down the healing process.

Charlotte on April 13, 2015

@Sherry – We actually hear from quite a few people in their 60s and even 70s who have PD! It seems so unfair to have to deal with skin problems in those decades, but it’s not uncommon. It sounds like you have made all the right changes so far, and I hope with time and patience, you will start to see some improvement. Feel free to email us on the site if you have specific questions. Sending my best, Sarah.

@Krissy – You are so right that PD is different in every case. You have done a great job so far trying to figure out your triggers, and eliminating them. It takes time, a gentle attitude, and a heap of patience to make your symptoms decrease in a long-term way. You should be proud of yourself for the role you are playing in your skin’s recovery. Please let us know via email if you have other questions, and keep up the good work! Sarah.

Sarah Villafranco, MD on April 10, 2015

Dr. Sarah after reading everyone’s comments and although I haven’t officially been diagnosed It appears that what I have is PD….my question is this…can this possibly be? I am 66 years old and have never had skin problems. This mess around my mouth and nose is driving me crazy! I ordered samples of your soothing skin care set and am experiencing some relief I know you said this all takes time. I also changed my toothpaste, hair care and bath soap as you suggested. It seems everyone else with this problem is so much younger. My skin has always been very dry but clear and I thought perhaps I might be over processing it?

Sherry on April 08, 2015

My PD started in the fall of 2014. I have been dealing with this unsuccessfully since then. It is progressively getting worse :(
I have done a lot of research and talking to my Dr. about PD. I too opted out of using the antibiotics or using any steroid creams. After all the extensive research and talking to my Dr, PD is cured differently for everyone.
For me I feel like my diet (which was a lot of sugar & breads) is my trigger.
I have started out my new lifestyle change by eliminating fluoride toothpaste and shampoos and conditioners with SLS in them. I also found that my hand lotion contained SLS, which I did eliminate that too. I have also made a conscious effort to eat clean 90% of the time, I cut coffee out of my diet. I do however drink a coconut green tea and I add a tsp of coconut oil to it in the morning. I do let it cool, since I have read the heat does effect the PD.
PD has made me very self conscious and depressed.
I am going to try the sample starter set. You said not to put it around the mouth or the chin. Do you put it on the PD? Mine is more on the sides of my nose and in my laugh lines (which haven’t been used a lot lately because of PD).

Krissy on March 31, 2015

@Julianne – I am so sorry for your frustration, and can tell that you are at your wit’s end about your skin. I know that feeling so well. But, having lost my mom to cancer, I am also here to remind you that it is not cancer, and that you are not doomed. It will take a bit of time and patience to sort out why your skin is misbehaving, but if you approach it like a research project, you will figure out what makes things worse or better for you. Be sure to read the other blog post about PD on our site – the FAQs – and take some notes about what you’re eating/doing. Focus first on eliminating all SLS and fluoride, and on eating well and managing stress. With a small baby, and being a teacher, I’m sure you have a lot on your plate. You need to nurture yourself and get to a calm place about your skin, or it won’t get better for you. I have heard some people say that Cerave products work for their skin – they are not natural, but they are less expensive. And, as for your middle schoolers, I would take the time to say to them: “Kids, I have a problem with my skin, and it’s called perioral dermatitis. I’m not sure what causes it, and I’m trying to help it get better, but I’m really sensitive and upset about it. So, I would be grateful if you would be kind, and remember that your words can hurt people.” They may surprise you with their empathy when you just speak to them from the heart. Sending good luck and deep breaths – Sarah.

@Orla – You have done a great job figuring out what works to heal yourself, and I’m so glad your skin is better after eliminating gluten. It can be a painstakingly slow process, but you are exactly right when you say: “And remember, we are all unique, what works for one, might not work for others so be open to finding your own path.” Words of wisdom, indeed. Thanks for sharing – Sarah.

Sarah Villafranco, MD on March 29, 2015

I never had a name for this until recently. I used to call it this Acne/dermatitis, that was mainly around my mouth but would sometimes stretch up into my eyes as well. Fairly unpleasant and mine would weep a lot.

I was treated for several different things, impetigo, herpes and acne – all to no avail and sometimes worsening and causing extreme pain. I asked if it was diet related and was told no.

For me it started early when I was about 17, First I gave up cheese and it went away. Then it came back when I was 19, this time I linked it to milk so I gave that up. In my mid twenties it came back and nothing worked. Finally a doctor prescribed a topical antibiotic and this worked but I had to use it every day to stop to keep it under control.

A few years ago I tried going “Paleo”. I cut out gluten and that was tough! But my skin cleared up. I always had a red tinge around my eyelids – that went away. I had dark circles around my eyes that I thought were age and they disappeared too. I went back to my doctor and told her the news and she said skin complaints like mine were one of the number one symptoms of gluten-intolerance/celiac. I stopped getting every cold that came my way and she explained that my body just wasn’t so inflamed any more so was able to battle colds easier.

If you are suffering from something like this try eliminating the more common causes of inflammation from your diet. Try one thing at a time though. If you add a supplement, use a new skin product or eliminate a food type all together you wont know what caused the change. You could have a really expensive regimen on you hands and not know which one really helps. In my case its complete elimination of Gluten but for others it might be adding something in. Now I can eat all dairy just not milk so that is a great addition to my diet that I thought was gone. Keep an eye on “Auto-immune Protocols” as to what might be a culprit in your case. And remember, we are all unique, what works for one, might not work for others so be open to finding your own path.

Orla on March 29, 2015

Dr. Sarah – I am going to be totally candid in my comments here. I started getting PD in December of 2014. After reading about others experiences, I now feel like I am doomed to have this for the next 10-15 years as I am only 31. It sounds like once you get it, you have it for good until you reach an age for it to go away. I feel like its almost like a ‘cancer’ that if you are unlucky enough to get, you are stuck with. What the heck!?!? How is there no cure? How did I get this stupid stuff? I want RID of it.

I am a middle school teacher. Having PD is embarrassing and the kids are EXTREMELY unforgiving. I also went to a dermatologist who, of course, gave me topical steroids. Needless to say, it got so much worse. I have been through 5 different prescriptions at this point but will not take oral antibiotics because I am breastfeeding. I will not ‘pump and dump’ because my baby is more important than looks. But…. I can’t do this. My face is horrible. There has to be something better than this for the next 15 years. HELP!

I wear MaryKay makeup and have been a consultant for about 6 years. Now I only use powder on the top part of my face as well as eye makeup. I don’t put makeup on the bottom part of my face but I NEED to cover this stuff up. Its awful.

Also, I would love to try to the products but am unable to afford them. Are there cheaper brands that won’t break the bank?

Again… I feel doomed and stuck. Why did I get it after 31 years of NOT having it? Now I’ve got it for 10+ years to come. What the heck!?!?!

Julianne on March 25, 2015

@Jen – Check out our PD FAQ blog post for more info, but here are my best makeup tips (I don’t wear foundation, so I can’t attest personally to any of these – sorry!) “Ideally, you should not use any makeup while your skin is angry and red. Almost all foundation and pressed powder will irritate it further. But, if you have an important occasion and need to use something, certain brands may upset things less. W3LL People is an incredible brand, founded by incredible people – I have tried a few of their products and just love them. For eyes and lips, Kjaer-Weiss is a boutique brand with a great reputation, as are Vapour Organic Beauty and RMS Beauty. Ingredients to avoid in makeup over the affected skin are bismuth (in many mineral foundations and powders), talc, parabens, petroleum, and possibly beeswax (it forms a heavy layer on the skin and can be too occlusive).” Good luck, and I hope your skin settles down soon. -Sarah.

Sarah Villafranco, MD on March 23, 2015

Hi Sarah,
I was wondering if you could recommend makeup for someone suffering with PD. Mine is so bad that I HAVE to use something to cover it up when I go out in public or I feel like a horrible monster, but I don’t want to further exacerbate my PD. Any reccomendations would be greatly appreciated! Thanks so much.

Jen on March 22, 2015

@Lori – Totally understand about feeling unattractive – it’s very hard to remember that your beauty is more than skin deep when your skin is misbehaving! PD can affect the lips, but sometimes you may be dealing with a second problem there. I hope things have improved by now, but eliminating SLS and fluoride in all personal care products (double check toothpaste for SLS, not just fluoride) is a huge step. Please feel free to email us on the site if things don’t settle down soon. Best, Sarah.

@Melody – It’s so unfair when your skin switches from zero-maintenance to high-maintenance – ARGH! To answer your questions, both stress and essential oils can exacerbate PD. We use VERY small percentages of EOs in the formulas we recommend for PD (less than half a percent). But, occasionally, when my skin is super angry (rarely, thank goodness), I try to use unscented everything. As for petroleum jelly, I don’t love it on the skin of the face, where I think it really interferes with the function of the skin. That said, and petroleum-related issues aside, I do think it can help the skin heal when all else fails and the skin is raw and angry and red. For daily use on mild symptoms, thought, I think it could be exacerbating things. As for a mild cream suggestion, you can try ordering a sample of our Purely Simple Face Cream on our site to see if it works for your skin. Cetaphil doesn’t work for a lot of PD patients – not sure why so many docs keep recommending it. Healing wishes your way – Sarah.

Sarah Villafranco, MD on March 22, 2015

@Shannon – Thank you for sharing your experience. It sounds like you are actively researching your own skin, and making great, healing choices for yourself. Well done! – Sarah.

@Lisa – Life with a transplant is even more complicated than regular old life, which is pretty darn complicated! You seem to be taking amazing care of yourself, and that “new” kidney is so grateful! As for how long it might take for your PD to clear, I usually advise people that it may always lurk around the corner, and can come cropping back up with stress or too much coffee or with any other trigger specific to your specific case. So, you are doing all the right things, and your most powerful weapon now is patience. Oh, and I have found that coconut oil makes my PD flare – maybe it’s worth an experiment in eliminating it for a bit? Best – Sarah.

Sarah Villafranco, MD on March 22, 2015

Hello, I just recently purchased the black clay facial soap which I like and feel that’s it’s working. I’ve only been using it for a week and just curious how long it takes before my PD is completely clear. I had a kidney transplant 13 years ago and also have rheumatoid arthritis. I’m off all my medicine for RA but can’t come off the anti rejection medicine for my kidney. I tried the primrose oil supplements but I had a reaction from taking them. I have to be careful with supplements because of my kidney and the medicine I take. I take quite a bit of supplements from USANA, eat very healthy, removed sls and fluoride as well. I also use coconut oil, but can the coconut oil be making my PD worse.

Lisa Fredrickson on March 20, 2015

I am 36 and have battled PD since around 30, however I haven’t had an episode in a while, thanks to many mortifying outbreaks and the desperate research for anything to get rid of it! Mine started from using nasal sprays full of steroids, then putting hydrocortisone on those dry patches. My surest trigger was stress (especially emotional) and over exfoliating-this was a hard lesson for me since I am extremely dry and flaky and as a result have acne breakouts from it. Using too much product and switching them too often exacerbated it. Another factor for me was season changes-onset of spring in New England especially would bring a flare up. It is such a trial and error figuring out what works and what makes it worse-and you are so right, Sarah, that it is a temperamental condition that seems to need to go through all the stages in order to clear-and I have found that to be true even while helping it along with something that does work. The stress I felt just over having such ugly chaos on my face (I’m a makeup artist!) seemed to feed it reason to stick around longer-such a cycle!
Some things that I’ve found helpful are: switching to fluoride free toothpaste, diluted ACV toner, plain yogurt masks, bentonite clay masks (sometimes mixed with ACV), probiotic supplement, fragrance free everything, colloidal silver, aloe straight from my plant (a godsend is Natures Path Silver Wings silver aloe tea tree gel-only 3 ingredients!!-must get it for so many uses!!) One thing PD seems to need is to dry out in order to heal, which is so hard not to remove those flakes (trust me, it only prolongs it and creates little crusty scabs!) I try to eliminate sulfates, parabens and fragrance, which seem to aggravate it, and I have become quite a beauty DIYer out of necessity to control ingredients, as I seem to have become sensitive to many things in my 30’s along with it.
My sister introduced me to Osmia (she suffers too) and I loved the samples of black clay soap and rose clay soap-they do last a lot longer than they look like they would if you put them on the soap saver away from the sink) Currently I’m using a silver facial soap and straight aloe leaf after, ACV toner in evening and alternating clay and yogurt masks depending on where I’m at in my cycle. A final suggestion is watch what you use on your hands also, especially creams, as it will transfer to your face-also change your pillow case often! Good luck in your own quests :)

Shannon on March 17, 2015

@Stacy – I have had pretty good luck with Desert Essence unscented shampoo and conditioner. Check out the PD FAQ blog post for other ideas! Good luck, and great job taking care of yourself. -SV

Sarah Villafranco, MD on March 08, 2015

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