Perioral Dermatitis Case #1

 

 

 

Perioral Dermatitis

This case reviews a 28 year old female successfully treated for Perioral Dermatitis with Chinese Herbal Medicine over a 4 month period. The initial two months involved stopping the active lesions and the following two months we focused on consolidating the treatment to prevent a flare up while also treating and successfully clearing the post-inflammatory hyperpigmentation that resulted from the previously active perioral dermatitis. 

Perioral Dermatitis (and Periorbital when it appears around the eyes) is an inflammatory condition of the skin consisting of a rash usually with red bumps around the mouth and jaw line. It can often be mistaken for acne or rosacea, with a defining feature being the presence of micro pustules, very fine pinpoint projections of pus which differ from the typical acne pustules which are much larger. 

Initial Visit Intake

At the initial visit the patient presented with a rash around the mouth and jaw line consisting of papules (bumps), many of which were erythematous (red) some of which had or previously had micro pustules (very small thin projections of pus in the middle). In addition, the patient’s forehead had many papules, mostly flesh colored and not erythematous, some with micro pustules. 

The patient reported just over a 2 month history of perioral dermatitis. The patient reported that initially her outbreak was misdiagnosed by her doctor. Once properly diagnosed, the patient reports receiving a “steroid injection” in her glute which she reports seem to aggravate the perioral dermatitis. Consequently the patient reports being placed on topical antibiotics and topical Tacrolimus. Tacrolimus is an immunomodulator originally used internally during and after organ transplants it is now also used topically to treat various forms of dermatitis/eczema. The patient stated that she experienced very little benefit from the antibiotics and decided to stop after two months. At the time of the initial visit the patient reported that since stopping antibiotics that the perioral dermatitis was progressively worsening. 

First Visit Key Findings:

-Stress – the patient reported high levels of stress and unhappiness surrounding work. Pt reported a history of unrelated anxiety/depression.

The patient was observed sighing often and trying to take a deep breath.

-Heat – pt reports that she always felt very hot, even since a young child. 

-Digestive Upset – The patient reported frequent acid reflux accompanied by loose stools. Pt reports dairy was a major trigger. 

TCM Pulse Qualities: Wiry, Thin. 3rd positions absent

Tongue: Rigid, moderately thick white coat

 

Dx: Perioral Dermatitis due to Liver Qi Stagnation and blood stasis with Stomach Damp-Heat with Toxin

Initial Txt: 10 days of granulated herb extracts (5:1 concentration ratio), daily dosage as follows:

Chai Hu                  1.5g

Chi Shao                   2g 

Mu Dan Pi                 3g

Bo He                        1g

Sheng Ma                  2g

Yi Yi Ren                    3g

Chen Pi                      2g

Huo Xiang (10:1)       1g

Shi Gao                   3.5g

Zhi Zi (10:1)                1g

Huang Qin                  2g

Ye Ju Hua                  2g

Bai Hua She She Cao 3g

Gan Cao                     1g

 

Results and Further Course Of Treatment

The patient reported significant improvement at the first visit, most noticeably resolution of the lesions on her forehead. A topical ointment, Wu Shi Gao (Five Stone Ointment) was added to the regimen. The patient was treated with various versions of the same formula throughout. Huang Qin was substituted for Huang Lian to help with acid reflux which resolved early on in treatment. Huang Qi and He Huan Hua were added to Tonify the Qi as the patient also had mentioned some emotionally related fatigue with the patient noting a difference in energy levels. Herbs that nourish and move the blood and open the collaterals were added in the second half of treatment to help clear the post inflammatory hyperpigmentation from the healed lesions. 

I communicated with the patient a few months later and there was no mention of any flare up.

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