Perioral dermatitis that keeps coming back despite daily tetracycline can be very discouraging and in your case it is understandably more complex because you are a kidney transplant recipient and are on long term immunosuppressant medicines This background changes how the skin behaves and also limits how aggressively we can treat it so everything has to be gentle kidney safe and non interfering
When immunity is medically suppressed the skin barrier becomes fragile reactive and slow to repair Antibiotics often push the rash down temporarily but once the dose is reduced or stopped the skin flares again because the underlying sensitivity inflammation and barrier weakness have not corrected Over time the skin can also become dependent on antibiotics which explains the repeated relapses
From an ayurvedic way of looking at it this is not just an infection but a state of chronic low grade inflammation and heat in the skin tissues with reduced local resistance However in transplant patients strong detox therapies or powerful herbs are not advisable
The safest approach is to calm the skin reduce triggers and support healing steadily without putting load on the kidneys or disturbing immune balance
It is very important to completely avoid steroid creams on the face even mild ones as they are a common reason for persistence and rebound Avoid heavy moisturisers petroleum based products fluoride toothpaste and frequent washing of the face Use only a very mild non foaming cleanser once daily and do not scrub exfoliate steam or do any facial treatments
Internal ayurvedic medicines should be kept minimal and only after clearance from your treating doctor If permitted the safest option is manjistha churna in a very small dose about one quarter teaspoon once daily after food with warm water and only if kidney parameters are stable Triphala should not be started unless it is specifically approved for you
External care is usually safer Apply a thin layer of pure aloe vera gel twice daily to soothe and repair the skin barrier If your skin tolerates it coconut oil infused with a very small amount of neem can be applied once daily but it should be stopped immediately if irritation increases
Diet has a strong influence Avoid spicy foods fermented foods excess sugar bakery items cheese and very hot beverages Reduce caffeine and prefer cooling simple freshly cooked meals
Stress poor sleep and over cleansing can keep perioral dermatitis active so regular sleep routines gentle skin care and restraint are essential
Because you are a kidney recipient it is important that any approach is coordinated with your dermatologist and nephrologist as even natural remedies can interact in immunosuppressed states
In transplant patients the aim is not aggressive cure but safe long term control calming the skin strengthening the barrier and reducing the frequency and intensity of flares over time
Start with Neem ghanvati 1-0-1 Sookshma Triphala guggul 1-0-1 After food with water Sarivasav 15 ml twice daily after food with water. Apply Aloe vera gel on face and skin area twice. Avipattikar tablet 1-0-1 after food with water. Do pranayam lom -vilom bhastrika bhamri 5-10mins twice daily.
Consulting the AYURVEDIC PHYSICIAN
PERIORAL DERMATITIS THAT KEEPS COMING BACK AFTER TETRACYCLINE IS VERY FRUSTRATING AND IN YOUR CASE IT NEEDS TO BE HANDLED WITH EXTRA CARE BECAUSE YOU ARE A KIDNEY TRANSPLANT RECIPIENT ON IMMUNOSUPPRESSANT MEDICATION
FIRST IT IS IMPORTANT TO BE VERY CLEAR AND HONEST TETRACYCLINE CONTROLS THE SYMPTOMS BUT IT DOES NOT CORRECT THE UNDERLYING SKIN BARRIER AND IMMUNE DYSREGULATION WHICH IS WHY THE RASH OFTEN RETURNS AS SOON AS THE ANTIBIOTIC IS REDUCED OR STOPPED THIS IS VERY COMMON IN CHRONIC PERIORAL DERMATITIS
IN TRANSPLANT PATIENTS THE SKIN IS MORE SENSITIVE AND REACTIVE BECAUSE IMMUNOSUPPRESSANTS ALTER NORMAL SKIN DEFENCE MECHANISMS THIS MAKES THE SKIN PRONE TO RECURRENT INFLAMMATORY CONDITIONS EVEN WITHOUT OBVIOUS TRIGGERS
THE MOST IMPORTANT NON MEDICATION STEP IS TO SIMPLIFY EVERYTHING THAT TOUCHES YOUR FACE PERIORAL DERMATITIS WORSENS WITH OVERCARE STOP ALL STEROID CREAMS IF YOU ARE USING ANY EVEN OCCASIONALLY AVOID FLUORIDE TOOTHPASTE SWITCH TO A VERY BASIC NON FOAMING OPTION AVOID HEAVY MOISTURISERS OILS ESSENTIAL OILS SUNSCREENS AND COSMETICS AROUND THE MOUTH AREA LESS IS MORE WITH THIS CONDITION
DAILY CLEANSING SHOULD BE EXTREMELY GENTLE LUKEWARM WATER OR A VERY MILD NON SOAP CLEANSER ONCE DAILY ONLY DO NOT SCRUB DO NOT EXFOLIATE AND DO NOT OVERWASH EVEN IF THE AREA FEELS DRY
DIETARY FACTORS MATTER EVEN WHEN TRIGGERS ARE NOT OBVIOUS SPICY FOODS FERMENTED FOODS ALCOHOL EXCESS SUGAR AND VERY HOT BEVERAGES CAN MAINTAIN LOW GRADE INFLAMMATION A SIMPLE BLAND DIET FOR A FEW WEEKS OFTEN HELPS SETTLE FLARES
FROM AN AYURVEDIC PERSPECTIVE THIS CONDITION IS SEEN AS A LOCAL INFLAMMATORY SKIN DISORDER WITH SYSTEMIC IMMUNE AND DIGESTIVE INVOLVEMENT HOWEVER IN TRANSPLANT PATIENTS GREAT CAUTION IS REQUIRED STRONG HERBS DETOX MEDICINES AND BLOOD PURIFIERS ARE NOT ADVISED WITHOUT DIRECT SUPERVISION BECAUSE THEY CAN INTERACT WITH IMMUNOSUPPRESSANTS OR STRESS THE KIDNEYS
SAFE SUPPORTIVE OPTIONS THAT ARE GENERALLY CONSIDERED LOW RISK BUT STILL MUST BE CLEARED WITH YOUR TRANSPLANT TEAM INCLUDE VERY MILD INTERNAL SUPPORT SUCH AS GUDUCHI IN SMALL DOSES OR TRIPHALA IN TINY AMOUNTS HOWEVER EVEN THESE SHOULD NOT BE STARTED WITHOUT MEDICAL APPROVAL IN YOUR CASE DO NOT SELF START ANY HERBAL MEDICINE
EXTERNALLY SOMETIMES A SIMPLE COOLING GEL BASED APPLICATION OR ZINC BASED BARRIER CAN HELP CALM THE SKIN BUT AGAIN ANY NEW TOPICAL SHOULD BE PATCH TESTED AND DISCUSSED WITH YOUR DERMATOLOGIST
IT IS ALSO IMPORTANT TO RULE OUT THAT THE CURRENT FLARES ARE NOT BEING MAINTAINED BY LONG TERM ANTIBIOTIC USE ITSELF IN SOME PEOPLE PROLONGED TETRACYCLINE CAN ALTER SKIN MICROBIOME AND CAUSE RELAPSES WHEN STOPPED A DERMATOLOGIST MAY CONSIDER NON ANTIBIOTIC OPTIONS OR A VERY GRADUAL TAPER
THE GOAL IN YOUR CASE IS NOT AGGRESSIVE TREATMENT BUT STABILITY PROTECTING THE SKIN BARRIER REDUCING INFLAMMATION AND AVOIDING ANYTHING THAT COULD INTERFERE WITH YOUR TRANSPLANT MEDICATIONS
THIS CONDITION CAN BE CONTROLLED BUT IT OFTEN REQUIRES PATIENCE AND A CONSERVATIVE LONG TERM STRATEGY RATHER THAN QUICK FIXES ESPECIALLY IN IMMUNOSUPPRESSED INDIVIDUALS
Yes, there are gentle Ayurvedic and integrative approaches that may help manage perioral dermatitis, especially in your case where recurrence happens despite tetracycline and you’re on immunosuppressants.
Rx 1.Guduchi satva 250 mg once daily with lukewarm water empty stomach in the morning 2.Amalaki capsules 1 cap twice daily with lukewarm water 3.Avipattikar churna 1 tsp at bedtime with warm water
🧘♀️ Lifestyle & Diet Tips - Avoid triggers: Fluoride toothpaste, heavy cosmetics, steroid creams, spicy/sour foods, and stress. - Use mild, non-foaming cleansers: Prefer herbal ones with neem, tulsi, or rose. - Hydration: Sip warm water throughout the day. - Probiotics: Consider gut-friendly foods like rice kanji, buttermilk (if tolerated), or probiotic capsules (kidney-safe). - Stress management: Practice Anulom Vilom or Bhramari pranayama gently.
Topical (most important – low risk) Stop all steroid creams & heavy creams on face immediately (they worsen it long-term).
Use only plain petroleum jelly or ceramide-based moisturizer (e.g., CeraVe PM or Cetaphil Restoraderm) – twice daily. Pimecrolimus 1% cream (Elidel) – apply thin layer twice daily on affected area
Internal (only if doctor approves) 1 Zinc gluconate 30–50 mg once daily (anti-inflammatory, supports skin barrier – safe in transplant patients). 2 Probiotic (Lactobacillus rhamnosus GG or Saccharomyces boulardii) – daily (helps gut-skin axis & immunity).
Lifestyle Avoid: Fluoridated toothpaste (switch to SLS-free, fluoride-free), heavy makeup, topical steroids, harsh face washes.
Use: Gentle cleanser (Cetaphil or plain water), lukewarm water only, pat dry gently. Strict sun protection (SPF 30+ mineral, zinc-based).
Do NOT start/stop any new treatment without your transplant nephrologist’s approval (immunosuppressants + new drugs can interact).
Regards Dr Gursimran Jeet Singh MD Panchakarma
Hello,
Perioral dermatitis is a long-lasting inflammatory skin condition that causes: • Redness • Small bumps or pimples • Burning or mild itching around the mouth, nose, and sometimes eyes. Even though it looks like acne, it is not acne.
Why it keeps coming back in your case Because you are: • A kidney transplant recipient • On long-term immunosuppressant medicines • Using antibiotics (tetracycline) for a long time Your skin becomes: • More sensitive • Slower to heal • Easily disturbed by minor triggers Antibiotics control symptoms temporarily, but they do not correct the root cause, so the condition returns once medicine is
According to Ayurveda: This condition mainly involves: • Pitta Dosha (heat, inflammation, redness) • Kapha Dosha (small bumps, chronicity) • Rakta Dhatu (blood and skin tissues) • Agni imbalance (digestive/metabolic disturbance) In transplant patients • Immunosuppressants weaken natural tissue balance • Digestive fire becomes irregular • Skin loses its natural protective barrier So Ayurveda sees this as: Pitta-Kapha dominant Rakta Dushti with Agnimandya
Treatment goals: 1. Reduce inflammation (Pitta shaman) 2. Strengthen skin barrier gently 3. Improve digestion and gut health 4. Prevent recurrence 5. Avoid stress on kidneys and immunity
. Internal Ayurvedic Medicines
A. Guduchi = 250 mg capsule once daily after food for 6–8 weeks • Reduces skin inflammation • Supports immune balance (not immune stimulation) • Safe for kidneys in low dose
B. Manjistha capsule = 250 mg once daily after lunch for 6–8 weeks • Purifies Rakta (blood) • Improves chronic skin conditions • Helps reduce redness and recurrence
C. Triphala =½ teaspoon powder with warm water at night, 2–3 times per week only • Improves gut health • Reduces toxin buildup affecting
External Treatment A. Aloe Vera Gel • Use pure / preservative-free • Apply thin layer once or twice daily
• Cooling • Reduces redness and burning • Repairs skin barrier
B. Coconut Oil (if dryness only) • Very small amount • Apply at night only
• Restores moisture • Prevents cracking
C. Neem Water Wash • Boil 5–6 neem leaves in water • Cool and use once daily
• Mild antibacterial • Prevents secondary infection Avoid steroid creams, harsh herbal pastes, turmeric, lemon, essential oils.
Diet • Rice, oats, wheat • Moong dal • Bottle gourd, pumpkin, ridge gourd • Cooked vegetables • Coconut water (only if potassium is normal) • Foods to Avoid • Spicy, oily, fried foods • Fermented foods • Tomatoes, citrus fruits • Cheese, excess curd • Processed & junk food • Alcohol Diet alone can reduce recurrence significantly.
Lifestyle • Do not wash face more than 2 times/day • Avoid fluoridated toothpaste touching skin • Avoid cosmetic creams around mouth • Use mild soap only • Avoid sun exposure on affected area • Manage stress (very important)
Yoga • Anulom Vilom – 10 minutes daily • Sheetali / Sheetkari – cooling pranayama • Bhramari – reduces stress Gentle Yoga Asanas: • Vajrasana • Sukhasana • Shavasana Avoid hot yoga, excessive sweating practices.
Home Remedies • Cold compress (plain water) • Cucumber pulp application (10 minutes) • Rose water dab (pure) Avoid kitchen experiments.
Investigations Recommended To support treatment: • CBC • ESR / CRP • Vitamin B12 • Vitamin D • Thyroid profile • Review kidney function tests (already routine)
Duration & Expectations • Initial improvement: 3–4 weeks • Stable control: 6–8 weeks • Prevention depends on diet + skin care + stress control This is a chronic but controllable condition, not dangerous.
You are dealing with a sensitive skin condition influenced by necessary life-saving medicines. Ayurveda here works best as a supportive, balancing system, not as a replacement for transplant care. With: • Gentle Ayurvedic support • Correct diet • Proper skin care • Coordination with your doctors Long-term control is achievable without harming the kidney or immunity.
Do follow
Hope this might be helpful
Thank you
Dr. Maitri Acharya
