calling all acne detectives....is this really acne?

I had a new client, a 26-year-old woman in yesterday for an acne facial. I don't think she had acne. She tells me her break outs began as a senior in high school. She was on Yaz birth control for a few years, which she says helped, but has gone off it in the last few months, and says her skin has gotten worse. It's the pattern of her "acne" that makes me suspicious. Except for a very few minor open and closed comedones on her forehead, she has clear skin - except for a ring of a large number of closely-spaced inflamed lesions that surround her mouth. None had pus heads. A few were dry and flaky on top. Those that had healed had left reddish-purple spots in their wake; this in the skin of a true Fitzpatrick type one - red hair, blue eyes, pale skin. Her pores are not those of the typical acne-prone person; pretty refined, actually; and her skin was not oily. She tells me this has been the pattern of her skin issues since high school.

Any clues what could be going on here?

Thanks so much?

Replies to This Discussion

Permalink Reply by Laura Cooksey on December 23, 2011 at 3:29pm

I'd love to see a picture - can you post on on Flickr and give us a link?

Could be perioral dermatitis - I 'd try some mandelic on it.

Permalink Reply by Heather Capitanich on December 23, 2011 at 3:43pm

I'd say possible perioral dermatitis also. Stubborn stuff to get rid of to!

Permalink Reply by Mary Lou Coleman on December 24, 2011 at 11:54am

http://www.flickr.com/photos/72771207@N06/6565131725/

Above is the link to a photo her mom took. It's not great, but hopefully enough to go on. It shows the only affected area. Other than her chin, her face is essentially clear. I though perioral dermatitis, too, but this would be an extreme case if it is, wouldn't it be?

Thanks for your help!

Permalink Reply by Laura Cooksey on December 28, 2011 at 1:01pm

I would test some Mandelic serum on her and see which one she tolerates and start with just that. See if it makes a difference. I don't know what it is she has but mandelic has so many properties to it that it usually clears up stuff like this.

Permalink Reply by Mary Lou Coleman on December 31, 2011 at 9:23am

She came in yesterday, and will gradually introduce 15% Light to the affected area.

Thanks so much for your help, Laura.

Permalink Reply by Elizabeth Lee Pasko on January 14, 2012 at 1:19am

Just a thought, and I'm no Laura.......

I'd suggest she changes her toothpaste as well. The acne aside, just the redness pattern looks like she could have a sensitivity SLS.

Permalink Reply by Mary Lou Coleman on January 14, 2012 at 8:58am

Hmmm...interesting idea. I'll pass it along. Thanks!

Permalink Reply by Beth Cohen on January 27, 2012 at 7:40am

I would look into what kind of haircare products and makeup she is using. She would be having a reaction to mineral oil in a new lip gloss she's tried (for the comedones around her mouth) which are drying out because of her toothpaste. Does she wear her hair with bangs?... See if she washes her face before or after putting conditioner in it. Just a few thoughts... Hope everything works out well!

Permalink Reply by Mary Lou Coleman on January 27, 2012 at 8:13am

Thanks for your thoughts, Beth. She is doing better with a combination of mandelic serum and neosporin, although it appears she used the neosporin too long, and reacted to it - a common thing - so she's off it now. Actually she didn't have comedones around her mouth, they were papules. I'm not too concerned with something like mineral oil, as it's so low-reactivity, and the lesions were only around her mouth, not at her hair line. We may never know what this really is/was, but my money's on perioral dermatitis.