Understanding Perioral Dermatitis

What is perioral dermatitis?

Perioral dermatitis usually appears as a scaly or red bumpy rash. There may be a clear fluid discharge. Slight itching and burning can also occur.

The condition is most common in women between 20 and 45 years old, but it can be seen in all ages, races, and ethnicities. It can occur in children of any age.

Perioral dermatitis goes away, even without proper treatment, but it may reappear later. Episodes of perioral dermatitis can last weeks and even months.

What causes perioral dermatitis?

The cause of perioral dermatitis is unknown. However, experts suggest it can occur after the use of strong topical steroids, which may be prescribed to treat another condition.

Nasal sprays containing corticosteroids may also cause perioral dermatitis, as can inhaled steroids.

Certain ingredients in cosmetics or personal care products may cause perioral dermatitis, too. Heavy skin creams that contain petroleum jelly or a paraffin base may cause or worsen this condition.

Other common culprits include fluoride and sodium lauryl sulfate (SLS).

What are the risk factors for perioral dermatitis?

Some people will be more prone to or at risk for developing perioral dermatitis.

Risk factors include:

• sex assigned at birth, as women are more likely to develop this condition than men
• age, with young and middle-aged adults most likely to be affected
• using steroid creams or ointments on the face
• having a history of allergies
• having hormonal imbalances

What are the symptoms of perioral dermatitis?

Perioral dermatitis usually appears as a rash of red bumps around the mouth and in the folds around the nose.

The bumps may be scaly in appearance. They can also appear in the area under the eyes, on the forehead, or on the chin.

These small bumps can contain pus or fluids. They may resemble acne.

You may also experience symptoms, such as burning or itching, especially as the rash worsens.

Some experts believe that perioral dermatitis is a type of rosacea, another condition that’s associated with skin redness. Other experts believe that they’re two distinct conditions.

How is perioral dermatitis diagnosed?

A doctor or dermatologist will often diagnose perioral dermatitis with just a visual examination of your skin, along with your medical history.

The doctor or dermatologist may also perform a skin culture test to rule out a possible infection. During this test, they’ll swab a small patch of skin in the affected area. They’ll send the sample to a laboratory to test the skin cells for bacteria or fungi.

They may also perform a skin biopsy, especially if the rash doesn’t respond to standard treatments.

What are the treatment options for perioral dermatitis?

The American Osteopathic College of Dermatology (AOCD) recommends stopping the use of topical steroid creams or nasal sprays containing steroids, if possible. These products can make symptoms worse and are likely responsible for the symptoms in the first place.

However, it’s important to speak with a doctor before discontinuing any medications. If you’re concerned about your condition and don’t already have a dermatologist, you can view dermatologists in your area through the ishonest FindCare tool.

A doctor or dermatologist will determine your treatment based on the severity of your condition. In some cases, using mild soaps and discontinuing the use of heavy skin creams and fluorinated toothpaste may ease symptoms. Medications may also speed healing.

Prescription medications

• doxycycline (Monodox, Vibramycin)
• tetracycline (Achromycin V)
• minocycline (Minocin, Dynacin)
• isotretinoin (Amnesteen, Claravis, Myorisan)

Oral antibiotics are prescribed for more severe cases.

Diet and lifestyle changes

Part of treating perioral dermatitis is incorporating lifestyle changes that can help prevent it from returning. Consider the following:

• Get rid of harsh face scrubs or perfumed cleansers. Instead, use only warm water during flare-ups. Once healed, only use mild soap and don’t scrub your skin.
• Avoid steroid creams, even nonprescription hydrocortisone.
• Stop using or reduce your use of makeup, cosmetics, and chemical sunscreen.
• Frequently wash your pillowcases and towels in hot water.
• Limit overly salty or spicy foods. They can irritate skin around the mouth.

What triggers perioral dermatitis?

There are several common triggers that can result in a perioral dermatitis outbreak. These should be avoided as much as possible.

These triggers include:

• using a steroid cream on the face
• applying certain makeup and cleansers to the affected or irritated area, which can make flare-ups worse
• having bacterial or fungal infections
• constant drooling
• using fluorinated toothpaste
• using birth control pills
• using sunscreen

What’s the long-term outlook?

Perioral dermatitis is difficult to treat and can last for months. According to the AOCD, even after a few weeks of treatment, the condition can get worse before it improves.

In some people, perioral dermatitis may become chronic.

How can I prevent perioral dermatitis?

Since the risk factors for perioral dermatitis vary and the cause isn’t completely understood, there isn’t a foolproof way to avoid getting it.

There are some things you can do to help alleviate it or to keep it from getting worse.

Avoid topical steroids

Avoid using steroid creams and ointments unless specifically directed by your dermatologist. If another medical practitioner prescribes a topical steroid, make sure to let them know you have perioral dermatitis.

In general, perioral dermatitis is more likely to occur with stronger topical steroids than weaker ones. Use the weakest possible one to treat the condition.

Use cosmetics with caution

Avoid using heavy cosmetics or skin creams. Ask the doctor or dermatologist which moisturizers are acceptable to use. Try switching brands if you decide to continue using cosmetics.

Switch to gentle cleansers and moisturizers. Ask your doctor or dermatologist for recommendations that would best suit your skin.

Protect your skin

Limit the amount of time your skin comes into contact with the elements. The sun’s ultraviolet (UV) rays, heat, and wind can aggravate perioral dermatitis. Some medications used to treat perioral dermatitis can also make your skin sensitive to the sun.

Be sure to protect your skin if you’ll be in the sun for prolonged periods.

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