Navigating Perioral and Seborrheic Dermatitis: A Case Study

By Dr. Ashley Baldree, Village Dermatology, Katy and Memorial Houston

At Village Dermatology, we often encounter patients dealing with challenging skin conditions that affect their confidence and comfort. Recently, a 35-year-old female visited our clinic with a two-month history of a painful, dry, and flaking rash on her face. After trying and failing treatments, including doxycycline, ketoconazole, and hydrocortisone, she sought a solution to regain control over her skin health.

Understanding the Diagnosis

Upon examination, the patient displayed signs of two conditions: perioral dermatitis and seborrheic dermatitis.

• Perioral Dermatitis: This chronic rash, characterized by inflamed areas around the mouth and nose, was identified on her chin, cheek, and upper lip. Common triggers for this condition include cosmetics, topical steroids, fluorinated toothpaste, and environmental factors like wind or sun exposure.

• Seborrheic Dermatitis: Additionally, the patient exhibited pink/orange scaly plaques on the glabella, consistent with seborrheic dermatitis—a chronic condition prone to flares triggered by stress.

Seborrheic Dermatitis

Tailored Treatment Plan

To address these concerns, we devised a comprehensive treatment strategy:

• Perioral Dermatitis:

  • Prescribed Soolantra 1% cream (or Metrocream as an alternative) for daily application.

  • Provided Rhofade sample for temporary redness management before events.

  • Recommended gentle cleansing with La Roche-Posay Toleriane and daily use of Tizo tinted sunscreen to prevent UV-induced flares.

  • Counseling on minimizing cosmetic use and avoiding triggers.

• Seborrheic Dermatitis:

  • Suggested moisturizers like Cetaphil, CeraVe, and La Roche-Posay Toleriane for gentle care.

  • Emphasized using shampoos with tar, selenium, or zinc pyrithione to improve scalp health.

Patient Education and Follow-Up

Patients with chronic skin conditions like these require education on long-term management. We counseled her on expectations, including the potential for periodic flares and the importance of regular sunscreen application. A follow-up was scheduled within 2-4 weeks to evaluate progress and fine-tune the regimen.

Empowering Skin Health

At Village Dermatology, we prioritize individualized care to help patients feel confident in their skin. If you're managing perioral or seborrheic dermatitis, visit our dedicated page on seborrheic dermatitis or contact us for an appointment. Let us guide you toward healthier skin today!

Expert Care for Basal Cell Carcinoma on the Nasal Dorsum: A Patient’s Story

By Dr. David Wang

At Village Dermatology, we are dedicated to providing compassionate, expert care for patients managing skin cancer, including basal cell carcinoma (BCC). Today, we share the story of an 80-year-old male patient who came to our Katy and Memorial Houston offices for Mohs surgery to treat nodular basal cell carcinoma on the nasal dorsum.

Basal Cell Carcinoma: Understanding the Diagnosis

Basal cell carcinoma is the most common type of skin cancer. It typically appears as a small, flesh-colored bump or a pearly nodule and often develops on sun-exposed areas, such as the face and neck. Nodular basal cell carcinoma, a subtype, is characterized by its rounded growth and potential for local tissue invasion. While BCC rarely spreads to other parts of the body, timely treatment is crucial to prevent deeper tissue damage.

For more about basal cell carcinoma, visit our Basal Cell Carcinoma page.

The Patient’s Case: A Personalized Approach to Care

The patient initially presented with a 0.4 cm x 0.4 cm lesion on the nasal dorsum, which was confirmed as nodular basal cell carcinoma through a biopsy. Due to the tumor’s location on the nasal dorsum, an area where tissue conservation is critical, Mohs micrographic surgery was determined to be the most appropriate treatment.

Why Mohs Surgery?

Mohs surgery is a precise, tissue-sparing technique that removes the cancerous tissue layer by layer while preserving as much healthy tissue as possible. This method is especially beneficial for high-risk areas like the nose, where maintaining functionality and appearance is essential.

Mohs Surgery: Procedure Overview

The procedure began with a detailed discussion about the risks, benefits, and alternatives of Mohs surgery. After obtaining the patient’s informed consent, Dr. Wang performed the surgery in one stage, removing the tumor completely.

• Preoperative Size: 0.4 cm x 0.4 cm

• Final Defect Size: 0.7 cm x 0.7 cm

• Depth of Defect: Muscle

Frozen section analysis confirmed that all cancerous cells were removed, and the surgical site was carefully repaired using a complex repair technique to minimize scarring and optimize healing.

Postoperative Care and Patient Education

Following the procedure, the patient received detailed postoperative instructions to promote healing and reduce complications:

• Keep the area clean and dry.

• Apply petrolatum and pressure dressing as directed.

• Avoid sun exposure and use broad-spectrum sunscreen to protect the healing skin.

For tips on protecting your skin from sun damage, visit our Sun Protection page.

Why Early Detection Matters

Basal cell carcinoma is largely preventable with consistent sun protection and regular dermatologic check-ups. Early detection allows for less invasive treatments and better outcomes.

Expert Skin Cancer Care at Village Dermatology

At Village Dermatology, we specialize in advanced skin cancer treatments, including Mohs surgery, and prioritize patient-centered care. Whether you’re concerned about a new lesion or managing a confirmed diagnosis, our team is here to guide you every step of the way.

For more information or to schedule an appointment, visit our Basal Cell Carcinoma page or contact us directly.