Beware the bugs in old makeup
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London - Gazing into the bathroom mirror, my heart sinks. I’d hoped for an overnight miracle but if anything my skin looks even worse than it did yesterday.
I’m in my mid-40s, but I’m still plagued by acne and this is a particularly bad bout. Across the lower half of my jaw and around my nose, tiny red bumps have joined together to form a livid rash.
It’s horribly unsightly and all I can do is slather foundation on my skin to hide my outbreak. I’ve suffered with acne for more than 20 years, but usually the spots subside after an uncomfortable fortnight.
However, this eruption has lasted well over six weeks. I simply can’t bear it any longer.
Once my make-up comes off, my skin looks inflamed, red and raw. The spots are smaller than usual, but they look angrier and they seem to be spreading across my cheeks.
So finally, in despair, I visit a dermatologist. He takes one look at my face and announces that these spots aren’t acne at all.
“That’s perioral dermatitis,” he says, writing out a prescription for a medicated facewash and an antibiotic cream, which I am to apply twice a day to the affected areas. Perioral dermatitis is a relatively common skin condition, and my dermatologist, Dr Sunil Chopra, believes I developed it as a result of my make-up - from using foundation I’d kept for too long and transferring the bacteria from it to my skin.
The bacteria originate on our hands in the first place. When we dip our fingers in facial products, such as skin foundation, we transfer it to the product.
Over time, the bacteria will multiply and grow. Thereafter, when we use the products we are simply putting bacteria back on to our faces.
But it’s not just cosmetics that can cause problems. Steroid creams - a staple treatment for eczema as well as other conditions such as psoriasis - can also trigger the angry rash associated with perioral dermatitis.
Saqib Bashir, consultant dermatologist at King’s College Hospital in London, says: “In most of the cases I see, perioral dermatitis is linked to eczema and the use of topical steroid creams on the face.
“Many of my patients have continued putting steroid creams on their faces because they believe the rash is linked to eczema. Instead, the steroid cream is feeding the perioral dermatitis.”
There is no definitive explanation as to why steroid creams can trigger perioral dermatitis but Dr Chopra, who works at the London Dermatology Centre, suspects it is because steroids suppress the immune system where it is applied and bacteria are therefore more likely to flourish.
“In these cases, it has nothing to do with the age of the cream. The remedy is to stop using steroid cream on the face,” he explains.
However, in products such as make-up, sun block, and even creams and moisturisers, age does matter.
The longer you keep them, the more the bacteria build up, and when we transfer that bacteria to our skin it can result in perioral dermatitis.
Dr Chopra adds that although most manufacturers now put anti-bacterial agents in their creams, it is unwise to hang on to products for longer than six months as this gives time for bacteria to build to a critical mass.
Far more women - around one in 100 - than men suffer from the condition, but Dr Chopra says that the true figure is probably three times higher. “We only have figures for people seeking treatment. Most sufferers simply soldier on with the condition believing it is acne. And because acne can be hard to treat they simply put up with it,” he says. Even not removing your make-up properly at night can cause problems, adds Dr Chopra.
“It’s vital that all cosmetics and any creams, like sunscreen, are always removed properly. If they aren’t, bacteria can flourish, particularly in the folds of the skin, where perioral dermatitis is most likely to manifest.”
Luckily, perioral dermatitis - unlike acne - tends to respond very quickly to medication. The hypothesis is that perioral dermatitis is caused by bacteria.
Acne on the other hand is usually the result of a blockage of the sebaceous glands. Once the sebaceous glands are blocked, a secondary bacterial infection, propionibacterium acnes, can develop in acne sufferers.
Although antibiotics are used to treat acne it can be stubbornly resistant to them. However, unlike acne, perioral dermatitis is not caused by this bacteria and is not thought to be hormonal.
Furthermore, whereas acne affects the deeper layers of the skin, perioral dermatitis affects only the upper layers, making it easier to treat.
Experts believe this infection in the upper layers causes the eruption of a distinctive red rash of small spots that almost always appear around the jaw and nose and, in severe cases, around the eyes as well.
Oddly, given the ease with which perioral dermatitis can be treated, the actual bacteria causing the condition have never been successfully isolated.
“We are convinced perioral dermatitis is caused by a bacteria because it responds so well to antibiotics like erythromycin and tetracyline,” explains Dr Chopra.
Dr Bashir, who sees about one case of perioral dermatitis a month, usually treats his patients using an oral antibiotic for six weeks and then an anti-flammatory cream such as Elidel. This is not an antibiotic but calms and soothes inflamed skin and is available on prescription.
Although more women than men have historically suffered perioral dermatitis, Dr Chopra is seeing an increasing number of male patients with the condition.
“It’s because men are using more skincare products. If bacteria get into the surface of the skin, then it is very easy to transfer bacteria to the product and re-infect your face every time you use it,” he explains.
For the first few days after I began treatment, the patches of perioral dermatitis appeared to get even redder and more inflamed. But after a week my skin calmed down and now, three weeks on, it’s spot-free.
I’ve thrown away all my old make-up, my cleanser and moisturiser and replaced them with new ones.
It’s been expensive but spots rob me of my self-esteem, making me feel horribly ugly and self-conscious. Thanks to treatment, this eruption of perioral dermatitis has subsided and I feel I can face the world again.
Of course, my old foe acne will no doubt re-appear. But for now at least, I can leave the house without cover-up. - Daily Mail