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Dr. Ravoof
Dr. Ravoof, Doctor
Category: Medical
Satisfied Customers: 12247
Experience:  Experienced Physician in the field of Medicine and Surgery.
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I have had eczema for my whole life. In May 2019 I began

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I have had eczema for my whole life. In May 2019 I began suffering from dry lips that became irritated easily. In January the skin became very inflamed above my top lip and often cracked and weeped. My GP diagnosed me with perioral dermatitis in March. I tried 2 weeks of Fusidic avid which initially helped it to heal but then it got worse again. I have been on Lymecycline since mid March (1 per day).The painful cracking of my skin around my mouth has gone. However my skin is extremely tight and dry around my mouth and down my jaw. The skin between my lip and nose often flares up and becomes itchy and flaky. I have inflamed red patches on my neck and jaw that are itchy and flaky. Since around 3 weeks ago I also now have red and itchy eyelids that are becoming very puffy and sore.
Around my mouth, neck and eyelids I am using doublebase cream and also La Roche Posay lipid replenishing balm. I use plain Vaseline on my lips. I have started taking cetirizine hydrochloride to calm the itching. I have not seen a dermatologist about this yet. I am wary of using steroid creams as my GP said this can make the issue worse.What else can I do?
Customer: replied 1 year ago.
Photos as of yesterday
Customer: replied 1 year ago.
File attached (1V6MZMG)

Dear Customer.

Thank you for your question.

I am currently reviewing your concern. Please note that all phone call requests are auto-generated. I have no control over them. You may ignore these requests.

Communicating through chat is just fine with me.

Do you have any other symptoms? like

Any other past illness?

Like recurrent allergic rhinitis?

Bronchial Asthma in the lower respiratory tract?

Are you on any other regular medicine like TCA which could exacerbate your condition?

Thank you for your patience.

Customer: replied 1 year ago.
I have had no other illnesses. Approximately 10 years ago I had a patch test after a large allergic reaction that tested positive for cobalt chloride. My eczema has been mild-severe on my hands over the past year. The only other medication I am on is Sertraline.

Thank you for your reply.

You would require to use a mild steroid cream such as 1% Hydrocortisone. This is available over the counter.

Emollients and moisturizers are not very effective generally in your condition.

Latest and effective drugs, which you may discuss with your doctor include.

a) Crisaborole-phosphodiesterase 4 inhibitor. Very effective and available as topical Cream.

b) Dupilumab- Acts as level Interleukin 4.

I hope that helps.

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Giving a positive reply does not complete our conversation, you can continue any questions, you may have.

A bonus would be appreciated.

Thank You.

Dr. Ravoof and 3 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
Thanks very much for your time!

You're welcome.

Thank you for positive rating.

Dear Customer,

I would like to recommend daily lifestyle changes which would further help in your eczema care.

I hope you would find it useful.

Since no permanent cure is available as it is a chronic skin condition, following measures should be incorporated.

It is good to watch out for the triggers which exacerbate your condition, they are unique to the patient.

Avoid scratching, it creates micro-tears and precipitates a flare-up

There are general measures which would be helpful. Links to various products given towards the end.

1) Use fatted cleanser (not soap) to clean like Dove, Basis, Camay. Avoid hot water.

2) Moisturize regularly with Vaniply and Cerave (ceramide cream). Especially after short (NOT LONG) showers with lukewarm water(NOT HOT).

3) Evening Primrose Oil 1000mg twice a day is helpful.

4) At night apply AMlactin cream.

5) Avoid excessive exposure to sunlight. Some exposure of 15 -20 minutes helps. If it is required use Aveeno positively mineral sunscreen.

6) Zinc supplements 25mg twice daily help.

7) If itching is severe- apply a cold compress and keep a good anti-itch cream like Sarna (Camphor+Menthol) in the refrigerator and apply it cool, feels much better.

8) Elimination diets have no role in the treatment of eczema.

9) Allergy to contact material like nickel, dyes in the fabric can cause a flare-up. Wool and Synthetic fabrics are well-known triggers. Cotton is the best.

10) Wash clothes in mild fragrance-free mild detergent. Avoid fabric softeners, they irritate eczema.

11) Avoid stressful situations as much as possible. Ensure a good night's sleep of 8 hours. They are well-known triggers.

12) After exercise or strenuous activity take a short shower to remove sweat which can trigger a flare-up.

The links of various products are as follows.

Moisturizers (thick & greasy)

http://amzn.to/2lm1FlC

http://amzn.to/2lKkUWT

Moisturizers (light)

http://amzn.to/2m6l2R0

Moisturizers for chapped hands & lips

http://amzn.to/2lEn4Hf

http://amzn.to/2lJZdWM

Soaps/body wash

http://amzn.to/2lKhROx

http://amzn.to/2mkfnTA

Detergents

http://amzn.to/2l6sRlJ

http://amzn.to/2mkrG2d

Anti-itch creams

http://amzn.to/2lEhlAW

Shampoo

http://amzn.to/2mkcW3q

With these measures, you would get good results.

But, if the symptoms are not resolved with the above measures to your satisfaction, you may consider using an immunosuppressant like Elidel (Pimecrolimus). But like discussed before topical steroids like Hydrocortisone cream may be tried first. It does not cause major side effects if used for a short duration and low strength of 1%.

I wish you all the best in life and happiness.

Take care.

Customer: replied 1 year ago.
Thank you ever so much for the advice. It’s very kind of you.

You're most welcome.

Glad to help.