Atopic dermatitis (eczema)

Perioral-nasal-ocular dermatitis (PONOD) is associated with the use of various types of creams on the facial area. Most patients with Perioral-nasal-ocular dermatitis are using multiple different types of cosmetic and medicinal creams. The use of corticosteroid containing creams over extended periods are especially strongly linked to the development of Perioral-nasal-ocular dermatitis.One of the most important aspects of the longer term treatment of Perioral-nasal-ocular dermatitis is therefore the gradual cessation of the use of all creams on the face, except for a simple moisturizer.

Depending on the severity of the Perioral-nasal-ocular dermatitis the above process is started while taking an oral Tetracycline antibiotic, like Minocycline 100mg/day. Normally this antibiotic must be continued for at least 3 months (or until the rash has disappeared) and is then tapered off over a 2 month period.

Paradoxically, the early phases of the treatment of Perioral-nasal-ocular dermatitis involves using a topical corticosteroid cream on the face to calm down the active redness and inflammation. The most commonly used corticosteroid cream contains Mometasone furoate. This is initially applied daily until the redness subsides and then tapered off as soon as possible.

The tapering off process of the corticosteroid cream normally occurs over a few weeks. The average patient will use the corticosteroid cream daily for about 5 days, on alternate days for about 4 days, twice a week for about 2 weeks and after that maybe once or twice a month. There is however considerable variation, but this regime will give to the general idea.

All the while the oral antibiotic is continued until the rash has been absent for at least a month. Only then is the oral antibiotic also tapered off. It is extremely important that during this treatment period all facial creams (yes all!), except one moisturizer must be gradually stopped. If this is not entirely possible then try to eliminate as many creams and lotions as possible. Once all have been stopped they can gradually be reintroduced one by one if necessary.

Perioral-nasal-ocular dermatitis is normally quite responsive to the above treatment regime and most patients will experience a marked improvement in only a few days to weeks.