Autoimmune Thyroid Disease

An Unfortunate and Lengthy Adventure in Misdiagnosis

Perioral dermatitis and hypothyroidism

with 7 comments

I’ve had a form of facial eczema, perioral dermatitis, for about six years now, ever since my thyroid problems began in earnest. Eczema is associated with thyroid problems, and this was one of the reasons I used to think I was hypothyroid a long time ago, before my “normal” basal body temperature measurements, and numerous bad reactions to various herbal “thyroid support” formulas, teas, and coconut oils, all put me off the trail of hypothyroidism.

The first treatment my then-doctor prescribed me was a hydrocortisone antifungal cream that made my skin considerably worse. The correct treatment for perioral dermatitis, which is thought to be bacterial, is a three month course of erythromycin or another tetracycline. As erythromycin makes me throw up at night, my next doctor (who was not embarrassed to look up the correct treatment in his handbook), prescribed me a clindamycin lotion. Clindamycin, or the benzoate it is preserved with, gives me back ache and a foggy head, but it definitely improves the eczema, though it doesn’t get rid of it. I have to be careful not to drink when I use clindamycin lotion, as if I do I will throw up at night.

People with perioral dermatitis, which usually affects women in the 20-30 year old age group, have to be extremely careful not to use any cosmetics or moisturisers or lotions on their skin, and there are even recommendations not to use fluoride toothpaste, as virtually everything will make the eczema flare up worse. One should not even use plain fats on the skin, as some skin bacteria thrive by consuming fats. The only two things I am able to use on my face are pure vitamin E, and pure glycerine, which is sold as a sore throat medicine. I currently use glycerine as it feels much lighter on the skin than vitamin E. Glycerine is the second ingredient in any regular commercial moisturiser, the first ingredient being water.

The most dramatic improvement I saw in my skin was after I went on the failsafe diet, when my eczema virtually cleared up from being all around my face and below my eyes, to having perhaps one small spot next to my mouth.

My skin reacts negatively to supplementation with a wide variety of vitamins, particularly methyl donors (e.g. betaine, folate), zinc, and pantothenic acid. Vitamins that my skin reacts positively to are: vitamin E (which reduces inflammatory leukotrines), vitamin A (which increases skin cell turnover), vitamin C (anti-inflammatory, but a mixed reaction, that can sometimes cause rebounds several hours after supplementation), vitamin B12, vitamin D (sunlight!), and calcium. Of these, B12, sunlight, and calcium have the most dramatic effects. Sunlight/vitamin D does not have an immediate effect, but usually kicks in around  a week after getting a day of sunbathing in (regardless of its continuation in the mean time). I can usually see the effects of B12 and calcium the day after they are taken.

Drinking a significant amount of goat’s milk (1.5 x my RDA of calcium) over the last few months has got rid of that last “one small spot” I could never get rid of on failsafe. However, the eczema is still there and I can still feel bumps and impurities in the skin that do flare up after two or three days of misbehaving, especially with stimulants like coffee, and amines in tomato and cheese dishes.

So the eczema came on when the thyroid problem came on. I believe there are several reasons for this. Firstly, calcium is hugely important for skin barrier protection, and when you don’t have enough thyroid hormone, you don’t have enough calcium, because thyroid hormone regulates the intake of calcium into your cells.

Secondly, when the thyroid problem came on, my adrenals went wild in an effort to compensate. High levels of cortisol and adrenaline tend to depress the immune system and thereby allow the infection to take hold. I enabled my adrenals with many supplements, such as large doses of B vitamins, pantothenic acid, and vitamin C. I believe this probably made the eczema worse, though it made me feel better in myself because I needed the stress hormones. For quite some time I was highly dependent on pantothenic acid, one could say addicted. I have also noticed that during the first few days of starting a low carb diet my eczema is worse, due to the increase in cortisol and adrenaline that it produces. I wonder how much the additional stress hormones have to do with a low carbohydrate diet making me feel better.

So I’m in the situation where I need thyroid hormone and don’t have it, my skin calcium level is too low, my adrenals are outputting lots of stress hormones and depressing my immune system, and therefore I’m an easy target for an opportunistic skin infection.

Unfortunately right now I have to manipulate this catch 22 situation, because it’s possible I need hydrocortisone in order to deal with the thyroid hormones I’m on, so that the thyroid hormones can get into the cells and start working. Therefore I may have to suck it up and allow my eczema to come back until I can get myself on a level. So I’ll be asking for some more clindamycin as well when I go to see the doctor again!

Hopefully in a few months time when I’m feeling better, I’ll be able to take a course of erythromycin to kill it off once and for all, assuming that enough thyroid hormone fixes my erythromycin intolerance, unless just getting enough thyroid hormone in itself will fix it for me. Who knows? Hopefully it will fix my otis externa too.


Written by alienrobotgirl

8 June, 2009 at 1:37 am

Posted in Thyroid

7 Responses

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  1. I’m curious, how are you using the hydrocortisone cream? How much (amount and dose %), how often, where applied? I’ve not known anyone who tried this.


    8 June, 2009 at 4:21 am

  2. I would hate to deviate from the topic of your entry, but I was wondering, do you think your carnitine levels are contributing to any of your symptoms? What about your homocysteine levels? With a high fat diet, there is always a chance that the methylation cycle might become inhibited, or that carnitine levels might be adversely affected.

    Oh, by the way, there hasn’t been a recurrence of the seizure/tic event. So, I’m assuming that the reaction was precipitated by the either the DHEA, the arginine, or maybe a combination of the two.


    8 June, 2009 at 5:16 am

  3. Of course, I mean the cognitive dysfunction symptoms, not the adrenal fatigue or the eczema.


    8 June, 2009 at 5:19 am

  4. Hi gatg

    I have some old out of date 5% cream and some newer 1% cream. I used the 5% twice on Saturday – a pea sized amount. On Sunday I used a pea sized amount of the 1% cream three times, in the morning, afternoon, and at bed time, the latter being a mistake because I couldn’t sleep! I’ve just been randomly using it on my legs, feet, thighs, wherever, but avoiding my face because of the eczema. I’ve also been taking salt, vitamin C, and selenium.

    I’ve actually been alarmed by the result today – I woke up with a temperature bang on NORMAL, though it has since dropped again but is still higher than it is usually. I was quite worried for a while as my pulse was over 95, (from being stuck at 60 permanently), though it has dropped back down to 75 now, though I can still feel it and it’s uncomfortable because I’m not used to it being so high. (Though, ironically, a “normal” pulse for me used to be 90bpm). It’s given me nausea and an upset stomach, which isn’t making me feel great. I was quite alarmed that this sudden rise is an indication that I might become thyrotoxic, so I haven’t taken my pill.


    8 June, 2009 at 8:55 am

  5. To be honest I don’t think carnitine is particularly relevant. I sometimes get carnitine deficiency symptoms at the start of a low carb diet, and I can guarantee to take off a diet induced headache with half a carnitine pill, but other than that, I don’t really see cognitive effects (though too much certainly gives me physical effects like an upset stomach). After the last couple of days, I’m pretty sure that the brain fog has something to do with low adrenal function. I have adverse reactions to most methylation cycle vitamins, with the exception of B12.

    I would be careful about playing around with free amino acids. With me, it almost always leads to trouble. I don’t know enough about DHEA to say.


    8 June, 2009 at 9:01 am

  6. Hi, lots of interesting stuff again in your latest blog entries, thanks.

    Finding out the reactions caused by hormonal fluctuations is awfully hard. Even though I had my stress hormones “coming back” almost one by one it was still very hard to pickpoint the reactions.

    There are just too many hormones taking part in the action, with different combinations:
    – All the hormones that have possibility to raise blood sugar: glucagon, adrenaline, noradrenaline, growth hormone, cortisol
    – All the hormones created in adrenals, including e.g the abovementioned DHEA

    Even though cortisol suppresses the immune system, it does it by suppressing inflammation also. So, you might get sick (e.g. flu or infection), but get no inflammation, pain or fever. Happened to me several times. But you should not be having much problems with autoimmune problems and allergies while on high cortisol. (but as I understood from above, your excema is not autoimmune, but some bacterial thing, so it probably explains the opposite reaction?)

    Totally different with adrenaline and GH, though. Adrenaline normally boosts the immune system, and if you are prone to it, makes it attack you. Probably at some point the shift may turn, but normally the adrenaline does not respond in long time bursts. Adrenaline works in short shifts and if the stress continues, cortisol takes its place as the main stress related hormone. At least my adrenaline response (in those very rare cases lately) is still very inflammatory even though I have had these problems for years.

    Cortisol inhibits the GH, and low cortisol thus may “cause” higher GH. GH is the one that most easily makes one throw up, and is usually at its highest in the nighttime. So if by accident your medicine was able to put down high nighttime cortisol, the resulting GH rise may have caused you to throw up. Same problem (low cortisol not being able to inhibit GH) may also cause one throw up or feel nausea when exercising.

    One thing that I often find useful when evaluating the fluctuations in hormones is the speed. Adrenaline/noradrenaline are fast hormones, ready to use immediately when needed. Cortisol is slower, it takes about 20 minutes to get it going.

    One other thing to note is that at least with cortisol, the symptoms from too low levels are similar to those from too high levels. You might wake up in the middle of the night from both cortisol too low or too high. If I recall correctly, the receptor binding thing causing that was explained in this article:

    Overall, endotext has a lot of good information about the problem:

    When I woke up in the night and ate some fruit (in my case, quaranteed to raise my cortisol), it took about 20 minutes to get back to sleep… So for some time I was eating night-snack every night. But eventually the cortisol response got back, and being too big, woke me up. Then I ate the same fruit just to get myself a headache.

    The same goes for cortisol and thyroid. Low cortisol, thyroid problems, high cortisol, thyroid problem.

    When evaluating the responses, the graphs of daily normal cycles of the hormones may provoke some thoughts also.

    What makes me puzzle is your blood sugar reaction to protein. Protein causes both glucagon and insulin rise. If there are problems (=low output) of stress hormones and one is prone to hypoglycemia, then the protein eaten alone should result the blood sugar to go swiftly down as glucagon is often incfluenced by the problem. Well… you did not mention when you measured and one measurement does not really tell anything. When I measure, I usually take one before eating and one every half hour for 3-4 hours. But checking the changes and stress reactions caused by different foods may help in evaluating the situation. Or may not 😉

    I have been thinking the corticoid-supplementation also, but I find a similar problem as with the thyroid. The levels are fluctuating and there is a myriad of hormones that would need to be *balanced* and the cortisol supplementation is instead keeping up the high (or low, but flat) levels that just continue to keep up the problem. Of course, when the situation is bad, one just desperately needs something to get feeling well…

    When I feel really bad (usually afternoons) I have been using anything that triggers or enhances my cortisol response, mainly fructose or liquorice (you can get liquorice root here, but that stuff is too strong for me), and I am not sure if that is any better. The amounts you have been using are so small I am amazed that they even have effect. Thus that may be better than my way. I probably have to try that too.

    The best thing would be to get all the relevant hormones back and working in right (daily) cycles, and that’s a tough one. Probably, at least if the fatigue is intolerance/bloodsugar-related, adrenaline is the first to go down. Even though you are having palpitations e.g, the proper adrenaline response if probably the last one to get back. I have had couple of odd days that I have had mine back and nothing beats the feeling. Its like being a kid again and being happy just because you are alive.

    But I have lost that again. Do not really know what I did wrong, or maybe this is just progression, since as I am sleeping better than before. Time will tell. But what has helped me most is acupuncture. It would have probably taken me months to wake up all the hormonal responses myself. If I would not had my blood sugar meter and found out I got my stress responses back, I probably would not have returned under needles. It felt awful, and continued to do that for about 2 days after each successful treatment (I had about 10 times, 2 of them failed to rise any response). That makes me think if it woke up the responses too early and the glands are burning out again. Hopefully not. But I feel it made a great difference in balancing things. I originally went to get physiotherapy for my back pain, since I realized I would never get my stress hormones under control if I had pain all the time. Fortunately the treatment he selected for me did more than expected. I was highly sceptical on that. The back pain seems to be related to this too, now the pain comes and goes along with the hormone fluctuations. Lately it have been gone, that is also a good sign. But now I feel I am polluting your blog… better stop…

    Your blog is one of the few places that offers me some new thoughts on the problem, even though your viewpoint is different from mine. Thanks. I hope you’ll get feeling better soon!


    8 June, 2009 at 5:32 pm

  7. I forgot to mention that the carpal tunnel syndrome symptoms may also be related to high nighttime GH.

    “Typical side effects of growth hormone medication include headache, nausea, vomiting, fatigue, muscle pain or weakness, swelling of the extremities, hypoglycemia (low blood sugar), blurred vision, burning/tingling sensations, dizziness, nervousness, numbness, carpal tunnel syndrome, or serious allergic reaction”


    8 June, 2009 at 5:36 pm

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