12.10.2017

Metronidazole + Doxycycline Review :: Perioral Dermatitis Fiesta

MetroGel + Doxycycline Review :: Perioral Dermatitis Fiesta

I don't want to brag or anything, but face rashes and I go way back. I've had perioral dermatitis (POD) for over 5 year, which makes me a particularly ancient breed of witch. Also, when I was a kid, I had a persistent rash along the sides of my nose, making me a particularly precocious breed of teen witch. I eventually "grew out of it," but based on I what know now, I think that nose rash was POD as well.

About 6 months after I started on 0.05% Retin-A, I finally got in to talk to my doctor about the perioral dermatitis. I came to the appointment armed with lots of Internet research and many deeply intrenched notions, because I know doctors love it when you do this. I planned this moment in my mind for years, and came into the appointment ready to battle.

When my doctor told me that I needed to try treating the rash with a low-dose steroid cream, my pupils constricted. I said, Doctor. Steroids make this worse. And she told me to only use a tiny bit. Like a dot on the pinky worth, and only on the affected area. And I said, But doc, I'm supposed to get an antibiotic for this. And she said that I had the rash for too long, antibiotics do not make sense, try the steroid cream for two weeks, then let her know what happens.

So I did.

Hydrocortisone Cream 0.5% :: Perioral Dermatitis Fiesta

And this is what happened:

Hydrocortisone Triggered Chin Perioral Dermatitis :: CrappyCandle.com  Hydrocortisone Triggered Lower Eyelid Perioccular Dermatitis :: CrappyCandle.com

I emailed my doc the evidence, and that my friends is how I go my first proper dermatology referral in a decade. So I guess the steroid cream did its job.

Dermatologist Office :: Perioral Dermatitis Fiesta
This is the dermatologist's office. While you cannot see me in the pic, I can assure you I was beaming.
At the dermatologist, I explained my rash history and the steroid cream dabbling, and showed her my pics, and she said, yes you have perioral dermatitis. Let's treat this with an oral antibiotic. I was wary due to past experiences (there were so many butt zits, guys), but she said that the chin variety of perioral dermatitis tends to require a more aggressive, systemic approach. I agreed to everything she suggested because I was dangerously close to losing my health insurance and had no time for conservative treatment. She prescribed me doxycycline, 0.75% metronidazole gel, and 0.1% tretinoin for my acne (I'll have to review the tretinoin at a later date, lovies).

INGREDIENTS:
  • Metronidazole Gel 0.75% (MetroGel) (active: metroidazole / gel: carbomer 940, edetate disodium, propylene glycol, purified water, sodium hydroxide / preservatives: methylparaben, propylparaben)
  • Doxycycline Hyclate 100Mg Capsules (active: doxycycline hyclate / inactive: lactose monohydrate, microcrystalline celllulose, magnesium stearate, gelatin, diacetylated monoglycerides, acetic acid, sodium lauryl sulfate, silicon dioxide, titanium dioxide, ferrosoferric oxide, butyl alcohol, propylene glycol, alcohol, fd&c blue no. 2, fd&c red no. 40, fd&c blue no. 1, d&c yellow no. 10)
  • Doxycycline Hyclate 50Mg Capsules (active: doxycycline hyclate / inactive: magnesium stearate, microcrystalline cellulose, FD&C Blue No. 1, gelatin, silicon dioxide, sodium lauryl sulfate, titanium dioxide)
  • Hydrocortisone Cream 0.5% (active: hydrocortisone / inactive: benzyl alcohol, glycerin, glyceryl monostearate, isopropyl palmitate, lactic acid, paraffin, polyoxyl 40 stearate, potassium sorbate, purified water, sorbitan monostearate, stearyl alcohol)
  • Jojoba Oil / Tea Tree Oil (10:1 ratio)
  • Aztec Clay Mask (as needed) (see my review + instructions here

METHOD:
  1. Wake up, splash face with cool water, and dry.
  2. Apply a thin layer of metronidazole to the affected area (which for me was my chin and below my left eye, but I applied it all over my face because medicine is good). 
  3. Apply some jojoba/tea tree oil as a "moisturizer."
  4. The doxcycline needs to be taken once a day, at the same time each day, with food, but not dairy. (Because breakfast is the meal that I am most willing to abstain from cheese long-term, I opt for morning doxy.)
  5. Decide that a banana is a meal.
  6. Throw up blue banana mush 15 minutes later.
  7. Adjust meal plan accordingly.
  8. Do your normal skincare routine at night, careful to avoid applying anything to the POD areas (except maybe oil).
  9. Repeat daily for as long as you can avoid breakfast cheese.
CONCLUSIONS:

Are you ready for some good news, guys? Well, after about 1 week, the acne on my forehead and cheeks cleared. My doctor said that the doxy would take about a month and a half to start affecting anything, so this was a just freaking treat, y'all. I was using the 0.1% tretinoin at the same time, so that might have had something to do with it.

Metronidazole + Doxycycline Antibiotic Before and After :: Perioral Dermatitis Fiesta

From the time I started treatment until my follow-up appointment at month 3, I did not experience any new perioral dermatitis flares. I wasn't applying anything to the POD areas except oil and the metronidazole during this time. At this point, my doctor recommended I stay on a lower dose (50mg) doxycycline for 6 more months, and that I can start easing in Retin-A on my chin, once per week.

After a few weeks on the lower dose doxy, my acne starts to get a bit worse, although I'm not sure if it's because of the antibiotic or due to other products I was testing concurrently. My chin doesn't seem to tolerate the Retin-A yet, so I stopped applying it there.

Toward the end of my lower dose doxy supply (60 pills), my skin is looked a bit smoother. I started using the clay mask once a week on days I wasn't using Retin-A. I also became very lazy with my pill popping. At the time, I told myself I was weaning off the doxy, when in actuality I missed my breakfast cheeses. I decided to not refill the prescription after the bottle ran out. In all, it was about 5 months of oral antibiotic treatment, which means I only did 55% the prescribed regimen. I'm a very bad patient, do not be me. I'm still using the metronidazole though, so that's gottta count for something.

Metronidazole + Doxy Antibiotic Before and After :: Perioral Dermatitis Fiesta

Note: These pics only go to month 4 because I wanted to show the actual progress I saw. I started using other products during month 5 (MONTH FIVE IS TAINTED Y'ALL), so I will be posting those pics on their own with their appropriate product review.

Perioral Dermatitis Before and After :: Metronidazole + Doxycycline Antibiotics

Ultimately, I'd say this trial was worth it. Although I was not immediately able to apply whatever products I wanted to the POD affected areas, I haven't really had major problems since the doxy. And, bonus side effect, my acne improved drastically. I also have a proper protocol whenever my POD is being a PITA:
  • Jojoba/tea tree oil 1-2 times per day (after I wash or rinse my face)
  • Metronidazole every other day, or every day if it's flaring.
  • Periodic clay/ACV masks on bad days (calms a flare almost immediately for me)
UP NEXT:  La Roche-Posay Toleriane Hydrating Gentle Cleanser

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PS: As I was putting this review together, I finally realized that my lip balm addiction could also be triggering POD flare-ups. I gradually weened myself off lip balm over the course of about three weeks. I did this by switching to a non-wax, non-petroleum based balm, then reduced the frequency of applying that. I'm now at the point where I apply lip products whenever, but I don't feel compelled to reapply every few hours like I was doing before. Although I didn't properly test this, I feel like it has been helpful for curbing my perioral dermatitis.

This is Part 3 of my 3 part Perioral Dermatitis Series:

Part 1:  Guide to Perioral Dermatitis Part 1 - The Basics
Part 2:  Guide to Perioral Dermatitis Part 2 - Treatments
Part 3:  MetroGel + Doxycycline Review


And for the Acne Peeps: Visit The Acne Experiment MOTHER HUB

5 Month MetroGel + Doxycycline Review :: Perioral Dermatitis Fiesta
MetroGel + Doxycycline Review :: Perioral Dermatitis Fiesta
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