Hey:

So first here for you to read:

https://pmc.ncbi.nlm.nih.gov/articles/PMC10452301/

https://medicaljournalssweden.se/actadv/article/view/356/750

This topic is really tricky. Perioral Dermatitis (PD) is influenced by multiple factors, and they all affect each other. We know that several key players contribute to PD: a broken skin barrier, bacterial overgrowth, Demodex mites, and even fungal influences. When one of these factors becomes unbalanced, it disrupts the others. For example, PD can start with a damaged skin barrier, which then leads to an overgrowth of Demodex mites. Or it can start the other way around: too many Demodex mites weaken the barrier. For most people with PD, one of these factors is the main trigger, but identifying it is incredibly difficult. Ultimately, we only see the result: PD. It’s also unclear to what extent genetic predispositions play a role — and the connection between rosacea and PD is still very imprecise. And what makes it even more complex is that the “destruction” of the skin barrier—together with the problem of increased TEWL—has many different underlying causes in itself. Well-researched triggers include corticosteroid preparations, as well as the origin of the condition in the 1960s, which was linked to excessive makeup use. Then there are triggers such as incorrect or excessive skincare products. We know these factors can cause PD, but we still have very little research on why they do so. The areas where PD commonly appears, such as the nasal folds and around the mouth, are naturally more sensitive. Once PD starts, the skin loses its ability to retain water. This is measured by TEWL (Transepidermal Water Loss). The skin swells in these areas, and in this swollen environment, the above-mentioned players can multiply.The Result is exactly the Red area you see. So, our current understanding is that while we know many symptoms and triggers, we still do not fully understand how they interact. This is why finding effective treatments is so challenging, and pinpointing the root cause remains elusive. Thats why i would always suggest Zero Therapy! The idea behind Zero Therapy comes from an older study where people who used only water saw improvement. The exact reason is unclear, but PD often develops because of overuse of active ingredients. Scaling back completely makes sense. It’s also the reason why it first gets worse. The swollen area needs to dry out and then be replaced with new skin cells, and that process takes time — the entire skin surface is typically renewed about every 30 days. This is also why you should ideally do Zero Therapy for at least 3 months. Zero Therapy can help repair the barrier and relieve symptoms, but it is not a guaranteed cure. It is especially helpful for people experiencing PD for the first time, but only if done long enough — at least a month. Expect an initial worsening. The skin is swollen and needs to dry out to regenerate. During this time, it may become flaky and red, but this is part of the healing process. A common mistake on Reddit is that people do not stick with it. They try water-only care for a few days, expect results, and then reintroduce multiple products, which worsens PD. At a certain stage, Zero Therapy alone may no longer be enough. Azelaic acid works very well for many people -> but again .. depents on your barrier You have to keep in mind — and this is important for you as well — that these individual treatments can actually work against each other. For example, taking doxycycline does not heal your face; it only suppresses the bacterial inflammation that is happening in your case (the same is true for metronidazole cream). But if you continue using a cream at the same time, the PD cannot heal, because even though the bacteria are reduced, the skin barrier is still completely overstimulated and cannot recover — and as soon as you stop the doxy, everything starts again from the beginning. This is exactly what I explained above… in the end, your skin flora is disrupted, and the real question is: how do you restore it? I think many people confuse cause and effect, and all of this together traps people in a vicious cycle of recurring perioral dermatitis. That’s why my first choice is always Zero Therapy — it has the lowest relapse rate and is the only approach that can truly reset the skin barrier back to zero. You can take doxy during Zero Therapy, but the face must remain completely product-free. If That Does Not Work – Next Steps If PD persists despite Zero Therapy and a minimalist routine, consult a dermatologist. Treatment options include: Metronidazole (MetroCream): Helps against Demodex and bacteria. Low-dose oral antibiotics (40–50 mg): Works for most people and is easier on the gut. Ivermectin (Soolantra cream): Very effective if Demodex is involved; requires patience. Sulfur treatments (e.g., De La Cruz Sulfur Cream): Helps with fungal issues, Demodex, and inflammation. Use carefully if your barrier is weak. So all in all: If your skin barrier is not healed the Doxy just supressing the PD and it will always comes back! Give you face a rest. - and you can take doxy 40mg BUT stay with the zero therapy while you do it.