Perioral dermatitis, often called periorificial dermatitis as it can be around the nose or eyes as well, is an inflammatory rash 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 red bumpy rash around the mouth. There may be a clear fluid discharge. Redness and slight itching and burning can also occur.
Perioral dermatitis is more common in women between the ages of 16 to 45 years, but can be seen in all ages, races, and ethnicities. It also occurs in children of any age. Without the right treatment, cases of perioral dermatitis go away, but may reappear later. Episodes of perioral dermatitis can last weeks and even months.
The cause of perioral dermatitis is unknown. However, research suggests that it can occur after the use of strong topical steroids on the skin, which may be prescribed to treat another condition. Nasal sprays containing corticosteroids may cause 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
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.
Your doctor or dermatologist can often diagnose perioral dermatitis with just a visual examination of your skin, along with your medical history.
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. He or she will send the sample to a laboratory to test the skin cells for bacteria or fungi. Your doctor may perform a skin biopsy, especially if the rash doesn’t respond to standard treatments.
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. However, it’s important to speak with your doctor before discontinuing any medications.
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.
Medications your doctor may prescribe to treat your condition include:
- topical antibiotic medications, such as metronidazole (Metro gel) and erythromycin
- immunosuppressive creams, such as pimecrolimus or tacrolimus cream
- topical acne medications, such as adapalene or azelaic acid
- oral antibiotics, such as doxycycline, tetracycline, minocycline, or isotretinoin, for more severe cases
Diet and lifestyle
Part of treating perioral dermatitis is lifestyle changes that can help prevent it. Some possible actions include:
- 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 at the skin.
- Avoid steroid creams, even nonprescription hydrocortisone.
- Stop using or reduce use of makeup, cosmetics, and sunscreen.
- Frequently wash your pillow cases and towels in hot water.
- Limit overly salty or spicy foods, which can irritate skin around the mouth.
Some people will be more prone to or at risk of developing perioral dermatitis than others. Risk factors include:
- gender (women are more likely to develop this condition than men)
- use of steroid creams or ointments on the face
- age (teenagers, young adults, and middle-aged adults are most likely to be affected)
- a history of allergies
- hormonal imbalances
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
- makeup and cleansers that are applied to the affected or irritated area, which can make flare-ups worse
- birth control pills
- fluorinated toothpaste
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.
Since the causes of perioral dermatitis vary and the cause is not completely understood, 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. In general, it is more likely to occur with stronger topical steroids than weaker ones, so use the weakest possible one to treat the disease.
- 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.