Perioral dermatitis generally presents as a persistent red rash around the mouth but can also extend to the skin around the nose and even eyes. This common skin condition is often misunderstood and can be very difficult to treat. In this article, we’ll explore what perioral dermatitis is, its causes and how it appears. We’ll also review treatment options (both over the counter and prescription medication) for perioral dermatitis and what to expect during the healing stages.
What is Perioral Dermatitis?
Simply put, perioral dermatitis is a facial rash that typically affects the areas around the mouth and nose. It may occasionally even extend to the eyes in which case its called periocular dermatitis. The condition usually manifests as clusters of red and inflamed papules (small bumps). These sometimes have a scaly or flaky texture. Due to its appearance it is often misdiagnosed and confused with other common skin diseases including:
- Acne Vulgaris: Often features blackheads, whiteheads and cysts which are not normally present in perioral dermatitis. Also acne can appear anywhere on the face or body whereas perioral dermatitis typically is limited to main the mouth area and tends to spares the skin immediately bordering the lips. If it extends its usually to the skin around the nose and eyes.
- Rosacea: This presents with facial redness, visible blood vessels and sometimes acne-like bumps. However, rosacea primarily affects the central face and lacks the clear perioral pattern.
- Seborrhoeic Dermatitis: This condition manifests as greasy, yellowish scales and redness around the nose, eyebrows and scalp. On the other hand, perioral dermatitis tends to present with dry scaly bumps around the mouth.
- Contact Dermatitis: This results from skin irritation or allergy and often has a clear link to a specific product or material. The skin may be red, hot, swollen, itchy and with diffuse hives. It may resolve quickly after removing the trigger or with anti-histamines/steroids.
- Systemic Lupus Erythematosus (SLE): SLE is an autoimmune condition that causes a butterfly-shaped rash over the cheeks and nose. The rash is often scaly and red but may sometimes have sores or pus-like lesions. SLE also usually comes with other systemic symptoms like fatigue, joint pain and photosensitivity.
Perioral dermatitis is more common in women aged 20 to 45 which may suggest a genetic or hormonal predisposition. Although less common, men and children can also get it. It can also be chronic and recurring. That’s why early accurate diagnosis and appropriate treatment are key to managing symptoms and preventing flare-ups.
How Perioral Dermatitis Looks
To nake diagnosis even more difficult, the symptoms of perioral dermatitis can vary from person to person. However, there are some typical features which include:
- Red inflamed bumps around the mouth and nostrils
- Mild itching or burning
- Dry, flaky or peeling skin
- A clear zone of unaffected skin around the lip border
In some cases, the rash can spread to the cheeks, eyes and forehead. There may also be pustules or watery discharge. These are less common symptoms but especially likely if the perioral dermatitis is left untreated or if topical steroids are overused.
Causes of Perioral Dermatitis
Whilst the exact cause of perioral dermatitis is not fully understood, there are several factors which can trigger or worsen it The key contributing causes of perioral dermatitis are likely to include:
- Topical Steroids: Excessive prolonged use of topical corticosteroids on the face is one of the most common triggers of perioral dermatitis.
- Skincare: Heavy moisturisers, creams and balms such as those containing paraffin or petrolatum may irritate the skin in some people. This can trigger outbreaks of perioral dermatitis.
- Fluoridated Toothpaste: There are studies linking fluoride toothpaste to perioral dermatitis. This is most likely to affect people with sensitive skin who may have a fluoride intolerance.
- Hormonal Fluctuations: Women may notice perioral dermatitis flare-ups around their menstrual cycles, pregnancy, menopause or due to hormone contraceptives.
- Environmental Factors: In people with sensitive skin, UV exposure, wind, heat and stress can trigger or worsen the condition.
In addition to the above, there is also some emerging research that also links stress, diet and microbiome imbalance as possible causes for perioral dermatitis.
Perioral Dermatitis Treatments
Successful perioral dermatitis treatment usually involves a combination of removing triggers and starting targeted therapy. Depending on the cause and severity, the below are some of the most common treatment options for perioral dermatitis:
- Stop Steroids: If you’ve been using steroid creams, you may need to discontinue them depending on the reason you were on them in the first place. Please only do so under the guidance of a medical professional as there is a risk of steroid withdrawal which may make your skin initially worse.
- Simplify Your Skincare Routine: Its a good idea to use gentle, fragrance-free cleansers and moisturisers if you have perioral dermatitis. Avoid scrubs, exfoliants and occlusive creams at least during flareups.
- Over-The-Counter Treatments: Some skincare products may help manage milder cases of perioral dermatitis. Sulphur-based cleansers or creams can help reduce inflammation and support skin healing. Zinc oxide creams are also helpful for calming irritation and protecting the skin barrier as can niacinamide.
- Prescription Medications: If perioral dermatitis doesn’t respond to stopping triggers and using supportive skincare or in moderate to severe cases, your doctor may prescribe medication. Topical antimicrobials like metronidazole or clindamycin or even ivermectin as well as anti-inflammatory agents such as pimecrolimus or azelaic acid may help to reduce inflammation. In more persistent cases, oral antibiotics such as tetracycline, doxycycline or erythromycin may be useful.
The key to optimal perioral dermatitis treatment is to seek medical help early to ensure you get the appropriate medication if necessary. If you can’t do this then you should definitely do so if your rash is spreading, not improving or causing discomfort.
What are the Healing Stages of Perioral Dermatitis?
It’s really important to keep in mind that healing from perioral dermatitis can take weeks or even months and usually occurs in stages. This largely depends on the severity and effectiveness (as well as diligent use) of treatment. In general, here’s what to expect in terms of timeline for stages of healing in perioral dermatitis:
- Initial Flare (Days 1–7): At this stage, the rasjh might even get worse temporarily after stopping steroids or irritating products. If it does, seek guidance from your doctor right away.
- Stabilisation Phase (Weeks 2–4): With consistent perioral dermatitis treatment, inflammation should start to settle. The bumps often reduce quickly but redness may linger on.
- Repair Phase (Weeks 4–8): By this point, skin texture improves, flaking decreases and any hyperpigmentation fades.
- Long-Term Maintenance (Beyond Week 8): At this stage, treatment is usually stopped or wound down and the skin will have fully recovered. You should try to avoid known triggers and stick to a supportive skincare routine to prevent recurrence.
Remember that for many people, perioral dermatitis may come and go. There are however a few practical lifestyle measures that can help prevent recurrence. It’s best to avoid using topical steroids on the face unless medically necessary so let your doctor know if you have a history of this condition. Try to also to also choose gentle skincare products with cautious use of active ingredients. If you’re prone to skin sensitivities, consider switching a to fluoride-free toothpaste. lastly, managing stress, sleeping better and eating a balanced diet may also help minimise flare-ups and improve overall skin health
Perioral dermatitis is a stubborn but treatable skin condition. You can usually manage perioral dermatitis with the right combination of avoiding triggers, gentle skincare and appropriate medication. Early detection, treatment and lifestyle interventions can help achieve long-term control. Always seek medical help if you’re experiencing new skin changes or recurring symptoms.
At City Skin clinic, we are passionate about personalised skincare. Our virtual skin clinic offers safe and effective custom skin treatments containing ingredients like Tretinoin and Azelaic acid where appropriate. We treat skin conditions like acne, melasma, rosacea, hyperpigmentation and skin ageing. Start a virtual consultation with one of our doctors today. The journey towards great skin starts here.
