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Acne, Rosacea, Periorifical Dermatitis


What causes acne?

There are four main causes of acne. These are genetically sticky pores, abnormal keratinization, P. Acnes bacteria, and oil gland production controlled by your hormones. Patients with abnormal keratinization struggle with the rate of their skin cell turnover, so they may have dry dead skin that gets stuck in their pores. Oil gland production can be the cause of acne for patients who would describe their skin as oily. The excess oil can create more bacteria in the hair follicles resulting in acne.

There are 2 types of acne:

The “little bumps” or comedonal acne are your white heads and black heads. This type of acne can typically be managed by topical therapies whether that be a medication facial wash or a topical cream or gel. The average cycle of skin proliferation is 3-4 months, so it may take this long to achieve your skin goals; however, you will see improvements during that time.

The “big bumps” or pustules and nodules are better treated with systemic therapies. These can be oral antibiotics, spironolactone, or Accutane.

Acne can leave scarring and hyperpigmentation. Acne affects more than just teenagers and is common throughout the lifespan. Acne treatments can be tailored to your goals. There are topical treatments for acne such as clindmaycin gel, tretinoin, salicylic acid, etc. If topical treatments do not work you can move to systemic treatments such as doxycycline, minocycline, sarecycline, spironolactone, and Accutane. Here at Moksha Derm in Cincinnati we want to help you achieve your skin care goals, so we will work with you to create a skincare routine that fits with your lifestyle to help you feel comfortable and confident in your skin.


What is rosacea?

Rosacea is a sun-sensitive disease where the blood vessels under the skin dilate due to triggers. Some of the most common triggers are the sun, spicy foods, and alcohol.
Rosacea can happen to anyone. Both males and females are affected by rosacea.

Types of Rosacea:

  1. Rhinophyma is an overproduction of the sebaceous oil glands typically presenting on the nose. It presents with a red nose that has grown thicker.
  2. Ocular rosacea presents as a sandy feeling in your eyes with tearing and red conjunctiva.
  3. Erythrotelangiectasia rosacea is due to blood vessels under the skin dilating. It commonly is described as a flushed feeling.
  4. Inflammatory or pustular rosacea is typically seen on the cheeks and forehead sparing under the eyes and in the skin folds due to limited sun exposure in those areas. This type of rosacea can commonly be misdiagnosed as acne.

Treatment for Rosacea is dependent on the type and can range from daily antibiotics to laser therapies to topical gels. For rhinophyma, patients need to have laser procedures to remove the excess skin build up. For ocular rosacea, patients can receive benefits from doxycycline. for erythrotelangiectasia rosacea, patients number one preventative treatment is a mineral based sunscreen. The importance of mineral based sunscreens versus traditional sunscreens is that mineral sunscreens reflect sun off of the skin, preventing UVA and UVB rays from getting to the skin. These patients may also benefit from laser therapies. There are also topical gels that can help prevent the redness seen with rosacea, these are Mirvaso and RhoFade. Here at Moksha Derm in Cincinnati we tailor your treatment to the type of rosacea you have and the severity of your rosacea. If you currently struggle with rosacea, please come and see us at Moksha. We want to help you look and feel your best in your skin and have access to any additional therapies you may need beyond the typical medications. One thing for you to do at home for your rosacea is to wear a zinc-based sunscreen that reflects the UV rays off of your skin preventing further progression of your rosacea from sun damage.


What is periorificial or perioral dermatitis?

Periorificial or perioral dermatitis is tender, itchy, grouped papules typically presenting either around the mouth, nose, or eyes. It is very commonly seen in middle aged women and can be mistaken for acne or another type of dermatitis. Perioral dermatitis can be seen in children as well but is not to be confused with lip licker dermatitis seen in children. It is exacerbated by cosmetics and topical or inhaled steroids.

Frequently providers prescribe topical steroids for this; however, after use of steroids periorificial or perioral dermatitis gets worse.

The first thing we can do to help treat periorificial or perioral dermatitis is to stop the use of topical steroids and limit inhaled steroids. For patients with mild periorificial dermatitis topical treatments like metronidazole, erythromycin, elidel and protic can help stop the process of periorificial dermatitis. For severe cases, patients may require oral antibiotics like doxycycline or erythromycin.

Depending on the severity of your periorificial or perioral dermatitis, we can tailor a treatment approach to manage your condition. For severe periorificial or perioral dermatitis, oral antibiotics may be needed in conjunction with topical medication to help achieve some calming effects quicker. For mild periorificial or perioral dermatitis topical therapies can effectively manage symptoms. Having personally suffered periorificial or perioral dermatitis, I know that it can affect not only your skin but also your confidence. Please come and see us at Moksha Derm in Cincinnati so we can help you look and feel your best.