ice water and ocicats

It appears that my adventures* with peri-nubblification (aka peri-orificial dermatitis) are over. I finished out my half-dose course of doxycycline a week ago, and stopped taking it with no particular drama.

Today I had my follow-up dermatology appointment, which I went to with the primary intent of giving feedback to the dermatologist for not telling me what to expect. The wind was taken out of my sails by my lateness (three busses in a row went past without taking passengers); the receptionist was dismissive, and I wondered if the whole thing was a petty waste of time. But when I actually saw the derm, she seemed delighted that my face was better, and I was kind of glad to be delivering good news to someone.

We talked about what to do if the nubbles come back (which they are unlikely to do with much ferocity if I avoid using cortisone on my face). She was sympathetic when I told her my skin had peeled a lot. "I wish I had known what to expect," I said, more gently than I'd expected to, and she said the peeling was unusual and also that it's really hard to predict, that some people actually do take two months to start responding to the medication. She also told me that mine was the worst case she'd seen ("I bet you don't hear that a lot." "No, I don't, do I get a prize?"). So maybe she wasn't so unsympathetic; maybe she was a bit out of her depth and doing the best she could.

Some non-dairy probiotic foods I should probably be trying to ingest at this point: kombucha tea (hmmm), lacto-fermented pickles, miso soup, unpasteurized sauerkraut, tempeh (yick), kimchi (yick), sourdough bread, olives, non-dairy yogurts.

* Adventures, should I want this later: diagnosis, eight days, four weeks, eight weeks.

As you might remember, eight days ago I was pretty upset with the horrible rash on my face... and with the vague-sounding diagnosis of peri-orificial dermatitis... and with the doxycycline (oral antibiotics) that the derm recommended I take twice a day for eight weeks to fix it. I don't blame myself a bit, by the way. It was all pretty bad, between redness and bumpiness and lots of blister-like vesicles that were not associated with pores and not remotely satisfying to pop.

It is not, however, on track to be bad for as long as a broken bone. The antibiotics kicked in with surprising power after about 48 hours. On Friday I wrote in an email:

Think pink instead of red, and a whole lot of skin peeling off, bad-sunburn style, from various quadrants around my mouth yesterday. Still bubbly under eyes. It's funny... peeling skin is harder to cover with makeup, and maybe it's nastier than the initial rash in terms of "ew, person's face is falling apart, don't want a piece of their face to LAND ON ME and give me cooties", but I totally welcome it because it's so obviously part of the healing process.

Since then I've had several more peelings, including scaling and sloughing of all the skin under and beside both eyes (acceptable, made me feel like a dragon). My skin is still producing a few tiny vesicles, but smaller and fewer; most of what's happening is peeling. And I think that at this point, when I wear makeup on the pink areas that remain, it doesn't really show at all to someone at normal conversational distance. If it were to stay like this at a low level for a few weeks, it would be livable.

The only side effect of the antibiotics so far is a small hemorrhoid that a doctor mentioned to me once but that never bothered me before; it got inflamed, probably a result of lowered poop pH, and the doctor had to tell me how one takes care of such a thing. I find it strangely congruous, having this affect the areas around both ends of the alimentary canal.

Back in March I complained about "Deep, biggish [papules] that are very prone to drying out on top and turning scabby even if I never squeeze them".

These are mostly a thing of the past now, thank goodness... but I do have one little mystery scab, low on my cheek, to be curious about. And I happened to remember that once, in high school, I was diagnosed with impetigo; a one-time thing as far as I knew, and at the time they asked me if I lived on a farm... I looked it up anyway, because hey, skin problem I once had -- and on medicinenet it says:

Non-bullous impetigo: This form initially presents as small red papules similar to insect bites. These lesions rapidly evolve to small blisters and then to pustules that finally scab over with a characteristic honey-colored crust. This entire process usually takes several days.

Slow-developing, blistery, crust-forming? Sounds familiar (would require a test by a dermatologist to be sure). If so, then they're caused by staph or strep bacteria rather than by p. acnes. Similar thing though, bacterial infection. Scarring is rare and Bacitracin is recommended as a treatment; no real way to prevent, except to wash hands and, presumably, by making skin a worse environment for bacteria to grow on.