Perioral Dermatitis

Perioral Dermatitis

What Is Perioral Dermatitis?

Perioral dermatitis is an inflammatory rash eruption involving the skin around the mouth. The rash may spread up to the nose or even the eyes. It usually appears as a scaly or bumpy rash around the lips. It can also sometimes weep clear fluid. Redness and slight itching and burning can also occur.

Perioral dermatitis is more common in women, but also tends to affect young children and infants. Without the right treatment, cases of perioral dermatitis go away, but 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, research suggests that it can occur after the use of topical steroids on the skin, which may be prescribed to treat another condition. According to American Osteopathic College of Dermatology, nasal sprays containing corticosteroids can cause an outbreak of perioral dermatitis as well.

There is also evidence that certain ingredients in cosmetics can cause perioral dermatitis. Heavy skin creams that contain petrolatum or a paraffin base may cause or worsen this condition.

Other factors that may trigger this condition include:

  • bacterial or fungal infections
  • constant drooling
  • fluorinated toothpaste
  • oral contraceptives
  • sunscreen
  • rosacea

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. The bumps can also appear in the area under the eyes, on the forehead, and on the chin. These small bumps can contain pus or fluids and may resemble acne.

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

How Is Perioral Dermatitis Diagnosed?


Your doctor or dermatologist can often diagnose perioral dermatitis with just a visual examination of your skin.

Your doctor may also perform a skin culture test to rule out a possible infection. During this test, your doctor will 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. Finally, your doctor may perform a skin biopsy, especially if the rash doesn’t respond to standard treatments.

What Are the Treatment Options for Perioral Dermatitis?


Your doctor 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.

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. However, it’s important to speak with your doctor before discontinuing any medications.

Medications your doctor may prescribe to treat your condition include:

  • topical antibiotic medications, such as metronidazole (Metrogel) and erythromycin
  • immunosuppressive creams, such as pimecrolimus cream
  • topical anti-acne medications, such as adapalene or azelaic acid
  • oral antibiotics, such as doxycycline, tetracycline, minocycline, or isotretinoin, for more severe cases

What Is 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 becomes chronic.

How Can I Prevent Perioral Dermatitis?


Since the causes of perioral dermatitis vary, there isn’t a foolproof way to avoid getting it. However, there are some things you can do to help alleviate it or to keep it from getting worse:

  • Avoid steroid creams and ointments unless specifically directed by your doctor. If another medical practitioner prescribes a topical steroid, make sure to let them know that you have perioral dermatitis.
  • Avoid using heavy cosmetics or skin creams. Ask your doctor about which moisturizers are acceptable to use. Try switching brands if you decide to continue to use cosmetics.
  • Switch to gentle cleansers and moisturizers. Ask your dermatologist for recommendations that would best suit your skin.
  • Limit the amount of time your skin comes into contact with the elements. UV rays, heat, and wind can aggravate perioral dermatitis. Some medications used to treat perioral dermatitis will also make your skin sensitive to the sun. Be sure to protect your skin if you’ll be in the sun for prolonged periods.

You Asked, We Answered

  • What are some over-the-counter products that can alleviate the symptoms of perioral dermatitis?
  • There are numerous over-the-counter and homeopathic products that have been found to be helpful in controlling or treating perioral dermatitis (PD). Among those, aloe vera is widely used in the treatment of inflammatory skin conditions like perioral dermatitis. Aloe will help to restore the pH balance of your skin and relieve the itching sensation as well as skin irritation. Vitamin E oil is a natural product that promotes quicker skin healing and also provides significant relief from itching and inflammation. This product can be rub-massaged directly onto the PD rash, once or twice per day. Other useful natural remedies include oatmeal (found in products like Aveeno oil) and apple cider vinegar.

    - Dr. Steve Kim

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