Perioral dermatitis and hypothyroidism
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.