Perioral dermatitis, rosacea and acne are the most common causes of rashes around the mouth. They can all present with redness, bumps, swelling and inflamed spots on the lower face. As such they are often confused with one another. This is a problem. Because although they may look similar, they don’t behave the same way and don’t respond to the same treatments. In fact, getting the diagnosis wrong can easily make things worse. In this article we review how to tell the difference between perioral dermatitis, rosacea and acne around the mouth. We also explore what usually triggers each condition and the best treatments to clear a rash around the mouth.
What Causes Rashes Around the Mouth?
There are quite a few things that can trigger or worsen rashes around the mouth and the cause often depends on which condition is actually responsible. Although there are many triggers, the most common causes of a rash around the mouth include:
- Topical steroids: Using steroid creams like hydrocortisone on the face is one of the most well-established causes of perioral dermatitis. Inhaled and nasal corticosteroids can also trigger it if the medication makes contact the surrounding skin. The classic pattern is that the rash improves temporarily with each application but rebounds worse when you stop.
- Skincare & cosmetics: Heavy moisturisers, occlusive foundations, fragranced products and overuse of active ingredients like exfoliating acids or retinoids can all damage the skin barrier around the mouth. This is because the skin in this area is thinner and more sensitive than the rest of the face.
- Hormonal changes: Many women notice lower-face breakouts around their period, after stopping oral contraception or during perimenopause. These hormonal changes can trigger acne which produces deeper spots and redness along the jawline and chin.
- Environmental triggers: Sun exposure, heat, cold wind, spicy food, alcohol and sudden temperature changes can trigger rosacea. This can present as redness and spots around the mouth, nose and cheek area.
- Toothpaste: Fluoride and sodium lauryl sulfate in toothpaste may also trigger or worsen perioral dermatitis. This usually presents as a stubborn rash around the mouth.
- Stress: Chronic stress can trigger or worsen both acne and rosacea.
Why Do Perioral Dermatitis, Acne & Rosacea Get Confused?
Perioral dermatitis, rosacea and acne can all cause small red bumps and patches of inflammation on the face. Although they may look similar at first glance, they are different conditions with different drivers. Acne is a chronic disorder of the hair follicles and oil glands in the skin. It typically produces non-inflammatory lesions like blackheads and whiteheads but can also progress to inflammatory lesions like pustules and cysts. Rosacea is also a chronic skin condition. It causes persistent redness, flushing and in some people acne-like papules and pustules. Perioral dermatitis usually presents as clusters of small inflamed papules around the mouth. There is often also dryness and scales.
How Can You Tell the Difference Between Perioral Dermatitis, Rosacea & Acne Rashes Around the Mouth?
The fastest way to separate these three conditions is to look at the combination of site, background skin and the type of spots you’re seeing. Each has a recognisable pattern even though they can look similar at first glance:
- Perioral dermatitis: This usually appears as clusters of small red or skin-coloured bumps around the mouth, often extending to the nose. It can also sometimes extend to the eyes. Perioral dermatitis however classically spares the skin immediately next to the lip border. The background skin tends to look dry, flaky or slightly rough. There is also often stinging, tightness or burning feeling. Unlike acne, perioral dermatitis doesn’t produce blackheads, whiteheads, nodules or cysts. There is a strong association between developing perioral dermatitis and using topical steroids. Heavy occlusive products and over-use of active skincare ingredients can also trigger perioral dermatitis.
- Rosacea: Although rosacea can extend onto the chin and lower face, the cheeks and nose are its classic sites. it’s not usually confined neatly to the area around the mouth like perioral dermatitis. There is also often a background redness, flushing and visible thread veins. This is often triggered by heat, alcohol, exercise or spicy food. Papulopustular rosacea can look very similar to inflammatory acne around the mouth. However, whilst acne can occur at any age, rosacea tends to occur in adults after the age of 30. It also usually comes and goes in cycles over the years.
- Acne: This tends to produce blackheads, whiteheads, inflamed papules, pustules and sometimes deeper nodules. Often people will have a combination of different types of acne lesions at anyone time. Oiliness, congestion and post-inflammatory dark marks and scars are also common. Acne can affect the skin around the mouth but is rarely limited to that area alone for long. Many people also have lesions on the chin, jawline, cheeks, forehead, chest or back. In women, lower-face acne can be a sign of a hormonal driver particularly if it is along the jawline. Acne is chronic condition which rarely improves without treatment.
One really important note is that in darker skin tones, redness may be less visually obvious and post-inflammatory hyperpigmentation can become a major part of the presentation. That can make diagnosis harder from appearance alone and is another reason a proper assessment is useful. It is also worth noting that overlap can also happen between these conditions. For example, some people may have both acne and rosacea. Similarly someone with acne or rosacea may also develop perioral dermatitis.
Why is it Important to Tell them Apart?
Distinguishing between these different conditions matters because a product that helps acne can aggravate perioral dermatitis and treatments that suppress redness in rosacea may not address true acne. The below mistakes can occur if you get the wrong diagnosis:
- Steroid misuse: Topical steroids such as hydrocortisone can temporarily reduce redness and irritation in inflammatory acne. However, they can trigger perioral dermatitis and can worsen rosacea.
- Irritants: Strong acne products can cause irritation which can worsen perioral dermatitis and rosacea. This is because actives like exfoliating acids, benzoyl peroxide and retinoids can push already-inflamed skin into a worse cycle of barrier damage and irritation.
- Missing triggers: Rosacea is often made worse by repeated exposure to personal triggers such as heat, alcohol, spicy food, sunlight and harsh skincare. Without the correct diagnosis, the rash around your mouth might persist because of ongoing rosacea tiggers.
How Treatment Differs for Perioral Dermatitis, Rosacea & Acne Around the Mouth
Before considering any treatment, it’s worth getting a medical assessment to ensure correct diagnosis of any rash around the mouth. This is particularly important if the rash is spreading, painful or there is warmth. As a general rule, the main principals for each of these conditions are:
- Perioral dermatitis: This often improves when triggers are removed, especially topical steroids and heavily occlusive facial products. Prescription options commonly include anti-inflammatory topical treatments and in more stubborn cases oral antibiotics such as doxycycline. Otherwise, you’ll need to follow a gentle and supportive skincare routine.
- Rosacea treatment: The best rosacea treatment depends on the subtype. For persistent redness and flushing, trigger management and gentle skincare are key. For papules and pustules, common prescription treatments like topical metronidazole, azelaic acid or ivermectin can help. In severe cases, oral doxycycline maybe helpful for inflammatory flare-ups.
- Acne treatment: Optimal acne treatment also depends on the type, location and severity. Depending on the pattern, treatment may involve over the counter products like benzoyl peroxide and salicylic acid. Prescription medicines like tretinoin, roaccutane, azelaic acid, spironolactone or clindamycin may also be necessary.
Perioral dermatitis, rosacea and acne around the mouth can look similar at first glance but there are usually useful clues to tell these rashes apart. Perioral dermatitis tends to cause dry, inflamed bumps around the mouth with relative sparing of the lip border and no true comedones. Rosacea is more strongly linked to flushing, persistent redness, visible blood vessels and central facial sensitivity. Acne is more likely when you can see blackheads, whiteheads, deeper spots or a broader pattern of breakouts. As always, getting the diagnosis right matters to ensure you properly restore your skin back to health. Also, the wrong treatment can easily make things worse.
At City Skin Clinic, we provide personalised prescription treatments for acne, rosacea, hyperpigmentation, melasma and skin ageing through our online skin clinic. Our doctors create custom treatments using actives such as Tretinoin, Azelaic Acid, Niacinamide, Ivermectin, Metronidazole and Clindamycin where appropriate for each individual patient. Start your virtual consultation and begin your journey to great skin today.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.
